ArticleTropical medicine and health2026
From stigma to strength: voices of women in Malawi after obstetric fistula repair.
Article in Tropical medicine and health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundObstetric fistula (OF) is a significant issue in sub-Saharan Africa, where healthcare barriers and stigma delay treatment. Women with OF often experience prolonged isolation and face challenges reintegrating into their communities following surgical repair. Exploring their experiences is essential for improving programming, education, research, and policy. Therefore, the purpose of this qualitative study was to explore the experiences of young women (ages 13-29) who underwent OF repair and participated in community reintegration programs at a Fistula Care Centre in Malawi.
methodsEighteen participants were recruited from one fistula care center and completed semi-structured interviews in English or Chichewa. Interviews were audio-recorded, transcribed, and analyzed thematically using Braun and Clarke's six-phase framework. NVivo software supported data coding and organization, and analysis was conducted collaboratively through regular meetings with four coding team members to discuss interpretations, resolve discrepancies, and refine themes. The full team reviewed and confirmed the data analysis.
resultsParticipants ranged in age from 19 to 28 years, with a mean age of 22 years. Most (94%) resided in rural areas. Over half (61%) developed an OF after their first pregnancy, and 78% experienced a stillbirth. The average duration living with OF before repair was 7 months, and the average time since repair was 12 months. Five themes emerged from the data analysis: (1) awareness, accessibility, and barriers to care; (2) stigma, segregation, and self-isolation; (3) loss and restoration of independence; (4) family and community support; and (5) building skills for community reintegration. Overall, participants reported low awareness and access barriers, stigma and social isolation, and loss of independence, with post-repair experiences marked by restored autonomy, community reintegration, and development of skills to support social and economic participation.
conclusionsFindings highlight the need for targeted awareness campaigns, expanded community ambassador programs, improved provider education, and sustained reintegration support. Ongoing evaluation is essential to ensuring responsive, inclusive care for women with OF.
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