Percent of women who have been treated for obstetric fistula who receive family planning or birth spacing counseling
The percent of women who have been treated for obstetric fistula (OF) (whether surgical or not) during a given timeframe (generally quarterly) who received counseling on their reproductive intentions, which includes discussion of birth spacing and family planning (FP) methods, as part of the package of reintegration services.
This indicator is calculated as:
(Number of women treated for OF who received FP or birth spacing counseling / Total number of women treated for OF) x 100
Total number of women who received treatment for OF either through catheter management or surgical intervention, regardless of outcome; number of women counseled on FP and birth spacing. Evaluators may wish to collect data on other types of reproductive health counseling received, such as prevention and treatment of sexually transmitted infections, antenatal care, and delivery with a skilled provider.
Data should be disaggregated by:
- Fistula treatment results: closed with continence (closed and dry), closed with urinary incontinence (closed and leaking), non-closure of fistula. It is often expected that women with continuing incontinence or a failed repair will likely need greater support for reintegration.
- Duration living with fistula: Sample categories: <1 year, 1-3 years, 4-7 years, 7-10 years, >10 years (EngenderHealth, 2006). This may be useful as it has been suggested that women who have lived with OF for a longer duration may need more support for reintegration.
- Marital status: Married/in-union, widowed, divorced, separated, or single. Some evidence suggests that women who were married and remained married/in union while living with OF may have experienced reduced psychosocial and socio-economic consequences and therefore potentially have less need for reintegration support.
- Fistula treatment facility (public, private, non-governmental, community-based; primary, secondary or tertiary)
If targeting and/or linking to inequity, classify outlets where
counseling is taking place by location (poor/not poor) and disaggregate
by area served. Exit interviews can be conducted with clients to
determine client’s poverty status.
Exit interviews; facility and program records at sites that are providing fistula treatment services. If services are provided through referral, then the records of the providing institution or organization can serve as the source.
The injury to a woman’s genital tract – either through childbirth or inflicted trauma – resulting in a fistula requires adequate time to fully heal. Thus, as part of comprehensive OF treatment, it is critical for health care providers to discuss with women who have had fistula repairs the woman’s reproductive intentions and how to avoid or postpone pregnancy for at least nine months following surgery. The Fistula Care project has developed a useful booklet, Family Planning for Women and Couples following Fistula Repair (EngenderHealth, 2010) to address this concern. This indicator can assess both access to counseling services as well as the quality of reintegration services with regard to the inclusion of FP and birth spacing counseling.
Understanding the reasons that women have not received these services may require further analysis. It may signify a lack of providers, non-existent or inadequate counseling on FP counseling, or logistical problems such as a poorly-executed referral system.
Because this data is currently not being gathered on a routine basis, it may be difficult to collect the information before the indicator is more widely used. Also, women treated outside of the recognized national treatment sites will likely not be captured. For referrals, it may not be possible to determine if the woman actually received the services and/or may require alignment of records from both treatment and referral sites, which in some cases could result in double reporting.
Without conducting provider observations, which have their own biases, one cannot assess from this indicator the quality of the FP and birth spacing counseling itself.
quality, obstetric fistula (OF), family planning, safe motherhood (SM)
Women’s Dignity Project, EngenderHealth, 2006.
Fistula Care project, 2010. Family Planning for Women and Couples following Fistula Repair. EngenderHealth and USAID. http://www.fistulacare.org/pages/pdf/FC_Tools/Family_Planning_booklet12.15.2010.pdf