Evaluating a Community-Led Intervention to Reduce Stigma and Improve Care-Seeking for Obstetric Fistula in Niger: A Mixed-Methods Study

Obstetric fistula remains a severe maternal morbidity in Niger, with associated stigma a documented barrier to timely surgical care. Evidence for the effectiveness of community-led strategies within Niger from 2021 onwards is limited. This study evaluated a community-led intervention programme implemented in the Maradi region from 2023 to 2025. The objectives were to assess changes in community-level stigma and to measure the programme's impact on care-seeking intentions and behaviours. A concurrent mixed-methods design was employed. A pre- and post-intervention survey was administered to a cohort of 450 community members (2023 and 2025). Qualitatively, 24 in-depth interviews and six focus group discussions were conducted with women affected by fistula, community health workers, and local leaders in 2025. Survey data indicated a 40% reduction in respondents endorsing stigmatising statements post-intervention. Qualitative analysis revealed a key theme of 'reclaimed social participation', where women reported increased involvement in community events. Referrals to the regional fistula centre from intervention communities increased by 60% between 2023 and 2025. The intervention was associated with a measurable decrease in stigma and a substantial increase in care-seeking referrals. Empowering communities to address social norms can be an effective component of fistula care programmes in this setting. Integrate sustained community-led anti-stigma components into national fistula prevention and repair programmes. Policy should support training and funding for community health workers to lead ongoing dialogue and maintain referral pathways. Obstetric fistula, stigma, community health workers, Niger, mixed-methods, maternal health This study provides evidence from 2023–2025 on the role of community-led action in reducing fistula-related stigma and improving care-seeking in Niger, informing national programme strategy.