부산대학교 도서관

Background: Female genital fistula, largely caused by prolonged obstructed labour, is treated by surgical repair. Preventing pregnancy for a minimum period post-repair is recommended to ensure adequate healing and optimize post-repair outcomes. Methods: We examined contraceptive preferences and use among Ugandan fistula patients (n = 60) in the year following genital fistula surgery using mixed-methods. Sexual activity, contraceptive use and pregnancy status were recorded quarterly for 12 months after surgery. In-depth interviews among purposively selected participants (n = 30) explored intimate relationships, sexual experiences, reproductive intentions, and contraceptive use. Results: Median participant age was 28 years and almost half (48%) were married or living with partners. Counselling was provided to 97% of participants on delaying sexual intercourse, but only 59% received counselling on contraception. Sexual activity was reported by 32% after 6 months and 50% after 12 months. Eighty-three percent reported not trying for pregnancy. Among sexually active participants, contraceptive use was low at baseline (36%) but increased to 73% at 12 months. Six (10%) women became pregnant including two within 3 months post-repair. Interview participants who desired children immediately were young, had fewer children, experienced stillbirth at fistula development, and felt pressure from partners. Women adopted contraception to fully recover from fistula surgery and avoid adverse outcomes. Others simply preferred to delay childbearing. Reasons cited for not adopting contraception included misconceptions related to their fertility and to contraceptive methods and insufficient or unclear healthcare provider advice on their preferred methods. Conclusions: A high proportion of patients were not counselled by healthcare providers on contraception. Provision of comprehensive patient-centred contraceptive counselling at the time of fistula surgery and beyond is important for patients to optimize healing from fistula and minimize recurrence, as well as to meet their own reproductive preferences. Plain English Summary: Female genital fistula is an injury that can happen during childbirth if women do not get high-quality care. It can be treated by surgery. After fistula surgery, women should not get pregnant right away so they can heal. To help women heal, we need to know how women with fistula think and feel about birth control. We collected data from 60 Ugandan women for one year after fistula surgery to learn about sex after surgery, contraceptive use, and pregnancy. We talked with 30 of them to learn more about their relationships, experiences with sex, plans for children, and birth control use. Most women were told to not have sex right away (97%) and many were told about birth control (59%). Some women had sex by 6-months after surgery (32%) and half by 12-months (50%). Most did not want to get pregnant (83%). Contraceptive use rose to 73% among those having sex by 12-months. Women who wanted to get pregnant soon were young, had fewer children, had lost their baby at fistula, and their partners wanted a child. Women told us they used contraception so they could recover from surgery or because they did not want a child right away. Some women told us they did not use contraception because they were worried it would hurt them. Others did not know enough about contraception. Patient education on contraception is needed at fistula surgery to help patients heal and meet their plans for children. [ABSTRACT FROM AUTHOR]