Abstract
BackgroundObstetric fistula (OF) is a birth complication that largely affects women in developing countries. These women suffer constant incontinence, shame, social segregation, and health problems. Reconstructive surgery can usually repair OF, enabling the women to reintegrate back into their communities. However, pro repair does not necessarily equate with emotional recovery. Our objective was to explore women’s experiences of social support after first time OF repair. MethodsAn evidence synthesis was performed based on a systematic search of literature done between January and March 2020 in PubMed, CINAHL, ProQuest, and EMBASE databases using keywords including “obstetric fistula”, “vesicovaginal fistula”, “vesicovaginal”, “fistula”, and “social support”. Inclusion criteria were primary peer reviewed articles addressing one or more study objectives, in English, on OF support, regardless of location. Two reviewers independently assessed eligibility of the studies and extracted the data. Disagreement between the reviewers were resolved by a third reviewer. The scoping review was based on a framework proposed by Arksey and O’Malley (2015). ResultsThe search resulted in 246 articles, of which 14 met inclusion/exclusion criteria. The synthesis of the studies was theoretically guided by Berkman’s Model which emphasizes a link between social resources, social support, and disease. We found that support was either internal or external. Internal support constituted self-efficacy resulting in strengthened internal locus of control. Externally, women were supported by friends and family with material and financial resources. In some cases, the women were supported with educational opportunities and/or business start-up capital. Our review identified the need to support women with information about OF. Most post-OF repair women who were successfully re-integrated into their communities choose to support other women suffering from OF. ConclusionsSocial networks make a significant contribution to emotional and psychological recovery of women after a successful OF surgical repair. Lack of social networks were also found to be detrimental to emotional and psychological recovery of women. Most women were abandoned and not supported by their husbands. Restorative surgery is not sufficient making supportive and well organised social networks an integral component of full recovery post-OF repair.
Highlights
Obstetric fistula (OF) is a birth complication that largely affects women in developing countries
An evidence synthesis was performed based on a systematic search of literature published between 2008 and October 2019 in PubMed, Medline and CINAHL databases using keywords “Obstetric Fistula”, "vesicovaginal fistula", "vesicovaginal", “Fistula”, and “Social Support”
The search resulted in 212 articles, of which 15 were included in this review
Summary
1. To holistically assess women’s experiences of social support (i.e., psychological, social, sexual) 2. To describe the women’s social networks pre- and post-fistula repair 3. To examine the nature and effectiveness of social support networks including but not limited to spousal/partner relationships Review questions. The scoping review was guided by the following questions: 1. What are the women’s social support experiences during the twelve months following a first time OF repair?. 2. What are the existing social support networks available for women pre and post-OF repair? (What social support networks exist or would be desired for women pre- and post-OF repair?). 3. How effective are the women’s existing social support networks post-OF repair? How effective are the women’s existing social support networks post-OF repair? At the spousal/partner level? At the family level? At the community level?
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