About This Project

Women with obstetric fistula experience chronic leaking urine, leading to stigma, isolation, and loss of income. (Wall, 2006) Repair is possible, but only 2% of the two million affected women ever access surgery, and 50-100,000 new cases occur each year. (UN, 2014) Women and girls are in dire need of a new solution to manage their injury. For this project, we will interview Ghanaian women with fistula to study stigma, coping, and acceptability of a non-surgical method for fistula management.

Ask the Scientists

What is the context of this research?

Obstetric fistula results when a woman’s labor is prolonged and buildup of pressure leads to the formation of a hole between the bladder and vagina. This hole, or fistula, causes the woman to experience chronic urine leakage, which may lead to stigma and reduced opportunities for employment and community participation. Once common in the US, this problem dissipated as women received timely access to emergency care like c-section. (Wall, 2006) In developing countries, fistula persists but only 2% of the two million affected women and girls will access surgery in their lifetime. (Adler, 2013; UN, 2014) While waiting for repair, those affected need an accessible, acceptable, and low-cost solution to manage their leaking urine and improve their quality of life.

What is the significance of this project?

There are too few rigorous qualitative studies on fistula and no qualitative studies on acceptability to non-surgical management. This research will explore how women with fistula in Ghana are currently coping with their leaking and vulnerability to stigma and examine their acceptability of an insertable silicone cup to manage leaking urine and support coping. The knowledge generated from this project will inform future research, including modifications to the design of the cup itself and the accompanying counseling message. Ultimately, this coping innovation could improve the quality of women’s lives, allowing them to manage their chronic illness so they can return to the market, to school, to their families, and to other social groups

What are the goals of the project?

There are 3 goals for the research this summer in Ghana: to examine vulnerability to stigma, strategies for coping, and acceptability of a coping innovation. I will engage 32 women with current or repaired fistula in semi-structured interviews to talk about coping and stigma. Then I will invite those who are interested/eligible to briefly trial the cup and will interview them on their acceptability. This work uses a multi-phase mixed methods design to inform ongoing research of the effectiveness of the coping innovation: quantitative questions focus on measurement (ex: severity of stigma), qualitative questions focus on experience (ex: what was it like coping with stigma), and findings are integrated to gain a holistic understanding of the interview topics.