People often assume that women who’ve undergone an obstetric fistula repair are not interested in using family planning (FP). After all, most lost a baby during the obstructed labor that led to their injury. However, recent studies (see here and here) indicate that fistula clients are often interested in using FP if they learn about available methods and services during their post-repair recovery period. When fistula surgeons and counselors make assumptions about women’s desires, they miss the opportunity to provide needed services and to offer reproductive choices to women who may have been disadvantaged and marginalized as a result of their injury.
Access to high-quality FP services and a wide range of methods supports a woman’s right to have the number of children she wants (if possible) and to space births to protect the health of the mother and her infant(s). FP is also uniquely important for women who have had a fistula. Access to contraception helps to protect a repaired fistula and prevent breakdown and recurrence by delaying pregnancy. FP counseling can also help women who want to achieve a successful pregnancy to increase their fertility awareness and to delay a future pregnancy until they are fully healed.
FP counseling can be particularly empowering for fistula clients. By providing FP information to women who’ve undergone a fistula repair (and whose fecundity remains), post-repair support becomes a process that respects and protects women’s rights to reproductive self-determination, access to services, and nondiscrimination. Women are empowered to make their own reproductive decisions.
Not all women will be able to conceive following fistula repair, however. Sometimes the injuries are severe enough to compromise a woman’s future fertility. FP counselors must therefore navigate carefully, explaining choices with the caveat that some women will be unlikely to become pregnant again. In addition, most women are advised to abstain from sex for three months or more to allow for healing. FP counseling and method provision must take this into account.
At the 2012 London Summit on Family Planning, rights advocates expressed concern that the goal to reach 120 million women with FP by 2020 could lead to a prioritization of services for urban groups who may already have access to services. Such a focus might come at the expense of marginalized women—including women who have had a fistula repair—who are costly to reach, and who may face financial, social, or other barriers preventing them from accessing such services. As implementers of FP programs work to achieve FP2020 goals, we must ensure that the principles of equity and non-discrimination outlined in the London Summit Business Plan align with the needs and rights of women with fistula.
The Fistula Care project conducted in 2012 a six-country evaluation of its rights-based approach to FP-fistula integration. The evaluation documented a correlation between the availability of FP information and counseling at fistula repair sites (thanks to job aids and client materials) and a strong uptake in method use. Integrated FP-fistula services have helped to ensure that FP is an integral part of fistula treatment, not an additive service.
Through such collaborations, we can together ensure that women with an obstetric fistula receive integrated services at the time of their repair—high-quality services in which the providers let the women decide and fulfill their FP needs, making no assumptions.