Percent of women who have been treated for obstetric fistula who receive reintegration services

Percent of women who have been treated for obstetric fistula who receive reintegration services

Percent of women who have been treated for obstetric fistula who receive reintegration services

The percent of patients treated for obstetric fistula (OF) who received reintegration services either onsite or elsewhere (e.g. non-governmental organization or other program).  Treatment of OF can either be through catheter management or surgical intervention.

To date, there is no defined set of reintegration services. According to the WHO, at a minimum, reintegration services should include counseling on what fistula is, how the injury was sustained, future risk factors and how to prevent fistula from occurring again, including the use of family planning and good obstetric care (2006). Other example of reintegration services that are currently being provided or have been recommended include:

  • other psychosocial support services (e.g. peer groups, peer counseling)
  • literacy training
  • income generation activities (e.g. micro-credit, vocational training, small business promotion)
  • provision of new clothes
  • funds for transport home
  • accompanied return to community/family

This indicator is calculated as:

(Number of women treated for OF who received one or more reintegration services / Total number of women treated for OF) x 100

Data Requirement(s):

Number of women treated for OF; number of women served by reintegration services. Data can be disaggregated by the types of reintegration services provided (and if they were provided directly or through referral) as well as the woman’s personal characteristics (e.g. age, marital status).

Facility-based survey; program reports

OF affects some of the most marginalized members of the population—poor, young, often illiterate girls and women in remote regions of the developing world.  After the initial medical intervention to treat the fistula, they require emotional, psychological and economic support to address their long-term needs, help them reintegrate into their families and communities, and continue life with dignity.  This outcome indicator measures what percent of treated women are receiving these essential services.

At a minimum, postoperative care should include counseling on family planning and birth spacing.  It may be useful to compare findings from this indicator with the indicator, “Percent of women who have been treated for obstetric fistula who receive family planning or birth spacing counseling,” to
more fully understand whether this specific reintegration service is actually available and offered to women after treatment.

Because the essential components of reintegration services have not been universally agreed upon, there is no minimum standard that can be used as a benchmark to measure provision of reintegration services against.

Therefore, the type and extent of reintegration services received by the women included in the numerator can vary greatly.  Also, the quality of  reintegration services cannot be determined by this indicator.

While facility data can be useful, it generally only gives information on girls and women before their repair and not their experiences on returning home afterwards. Exceptions may be in cases where women come for follow-up examinations or where explicit measures are taken to find women post-repair. Some facilities, such as the Addis Ababa Fistula Hospital in Ethiopia, provide a comprehensive package of OF treatment, rehabilitation, and prevention.  However most facilities providing OF treatment have minimal resources to follow up with patients or provide reintegration services onsite.

An additional constraint to collecting data is the significant time and expense required in gathering information on women once they have left the facility. Women may travel up to 1,000 kilometers to seek repair. As such, once healed, they return to far-off villages in remote regions making follow-up difficult.  Many girls and women do not even return home, healed or not healed, because of taboos surrounding fistula.  They may have been forced to flee their villages when they got the fistula or were not welcomed back upon returning, which makes client follow-up extremely challenging (WHO, 2006).

access, obstetric fistula (OF), family planning, community, safe motherhood (SM)

WHO: Department of Making Pregnancy Safer.  2006.  Obstetric Fistula: Guiding principles for clinical management and programme development.