Factors associated with marital status of women with genital fistula after childbirth: a retrospective review in nine African countries

OBJECTIVE: To examine characteristics associated with remaining married with fistula. DESIGN: Retrospective record review and logistic regression. SETTING: Tanzania, Uganda, Kenya, Malawi, Zambia, Rwanda, Ethiopia, Somalia and South Sudan. PARTICIPANTS: Women who developed fistula during childbirth (1975–2017) and sought treatment (1994–2017). OUTCOME MEASURE: Self-reported status of living with original husband at time of presentation for fistula repair. RESULTS: Over half of the women lived with their husbands at the time of fistula treatment (57.2%, 3375/5903). The strongest predictor of remaining married with fistula was either parity at fistula development (adjusted odds ratio [AOR] 1.4–4.4) or living kids at fistula repair (among women who had not given birth between fistula development and repair) (AOR 1.7–4.9). Predicted probability of remaining married declined sharply over the first 2 years of incontinence, levelling out thereafter. Predicted probability of remaining married was lower for women with both urinary and faecal incontinence (AOR 0.68) as compared with women with urinary incontinence alone. Probability of remaining married with fistula declined over time (AOR 1.03–0.57). The woman’s education was not a statistically significant predictor, but the odds of remaining married were 26% higher if the husband had any formal schooling. CONCLUSION: Most husbands do not abandon wives with fistula following childbirth. Treatment, counselling, social support and rehabilitation must consider the circumstances of each woman, engaging men as partners where appropriate. Communities and facilities offering fistula repair services should stress the importance of early intervention.