What question did this study set out to answer?

The study aims to explore the experiences of young women who underwent obstetric fistula repair and their journey of reintegration into the community.

March 26, 2026Open Access

From stigma to strength: voices of women in Malawi after obstetric fistula repair

Key Points

The study aims to explore the experiences of young women who underwent obstetric fistula repair and their journey of reintegration into the community.
Qualitative study design with semi-structured interviews
Participants aged 13-29 who experienced obstetric fistula repair
Interviews analyzed thematically using Braun and Clarke’s framework
Eighteen women recruited from a single fistula care center in Malawi
Data coded and organized with NVivo software
Participants reported low awareness of obstetric fistula and significant access barriers to care
Stigma led to social isolation and a loss of independence for many women
Post-repair experiences showed restoration of autonomy and community integration
Emerging themes included the need for awareness campaigns and improved provider education for better support

Abstract

Obstetric 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. Eighteen 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. Participants 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. Findings 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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