Evidence map›Paper›PMID 37598146›Full record

ArticleReproductive health2023

Contraceptive preferences and adoption following female genital fistula surgery in Uganda: a mixed-methods study.

Alison M El Ayadi, Hadija Nalubwama, Caitlyn Painter, Othman Kakaire, Suellen Miller, Justus Barageine, Josaphat Byamugisha, Susan Obore, Abner Korn, Cynthia C Harper

Open access · goldAbstract read
In one paragraph

Article in Reproductive health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.6field-weighted citation impact, top 29% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 2 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 3 institutions in 2 countries.

Alison M El AyadiDepartment of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94518, USA. alison.elayadi@ucsf.edu.
Hadija NalubwamaDepartment of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda.
Caitlyn PainterDepartment of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94518, USA.
Othman KakaireDepartment of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda.
Suellen MillerDepartment of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94518, USA.
Justus BarageineDepartment of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda.
Josaphat ByamugishaDepartment of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda.
Susan OboreUrogynaecology Division, Mulago National Teaching and Referral Hospital, Kampala, Uganda.
Abner KornDepartment of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94518, USA.
Cynthia C HarperDepartment of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94518, USA.
University of California, San Francisco · USMakerere University · UGMulago Hospital · UG

Funding

Comprehensive Reintegration Assistance for Women with Obstetric FistulaR00HD086232 · NICHD · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI EL AYADI, ALISON M · 2018 to 2020
$713k
Beyond Repair: Family and Community Reintegration after Obstetric Fistula SurgeryR21HD075008 · NICHD · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI MILLER, SUELLEN · 2013 to 2014
$331k
NICHD NIH HHS R00 HD086232NICHD NIH HHS R21 HD075008
6 · The paper itself

Abstract

backgroundFemale genital fistula, largely caused by prolonged obstructed labour, is treated by surgical repair. Preventing pregnancy for a minimum period post-repair is recommended to ensure adequate healing and optimize post-repair outcomes.

methodsWe examined contraceptive preferences and use among Ugandan fistula patients (n = 60) in the year following genital fistula surgery using mixed-methods. Sexual activity, contraceptive use and pregnancy status were recorded quarterly for 12 months after surgery. In-depth interviews among purposively selected participants (n = 30) explored intimate relationships, sexual experiences, reproductive intentions, and contraceptive use.

resultsMedian participant age was 28 years and almost half (48%) were married or living with partners. Counselling was provided to 97% of participants on delaying sexual intercourse, but only 59% received counselling on contraception. Sexual activity was reported by 32% after 6 months and 50% after 12 months. Eighty-three percent reported not trying for pregnancy. Among sexually active participants, contraceptive use was low at baseline (36%) but increased to 73% at 12 months. Six (10%) women became pregnant including two within 3 months post-repair. Interview participants who desired children immediately were young, had fewer children, experienced stillbirth at fistula development, and felt pressure from partners. Women adopted contraception to fully recover from fistula surgery and avoid adverse outcomes. Others simply preferred to delay childbearing. Reasons cited for not adopting contraception included misconceptions related to their fertility and to contraceptive methods and insufficient or unclear healthcare provider advice on their preferred methods.

conclusionsA high proportion of patients were not counselled by healthcare providers on contraception. Provision of comprehensive patient-centred contraceptive counselling at the time of fistula surgery and beyond is important for patients to optimize healing from fistula and minimize recurrence, as well as to meet their own reproductive preferences.

Indexed as

Contraceptive AgentsFistulaAdultChildContraceptive DevicesFemaleGenitalia, FemaleHumansPregnancyUgandaContraceptive AgentsContraceptionFamily planningFemale genital fistulaFertility intentionSurgery

Identifiers

PMID37598146
PMCPMC10439586
OpenAlexW4386001260

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.