Patient Counseling Strategies at Female Genital Fistula Repair: A Qualitative Study among Ugandan Fistula Care...

Ensuring high-quality provider counseling is needed to protect the health and well-being of women affected by genital fistula. We sought to understand Ugandan providers counseling practices and strategies.

We conducted in-depth interviews with 30 fistula providers to understand their counseling practices and recommendations regarding post-repair reproductive health and pregnancy. We analyzed the data thematically across counseling domains: sexual resumption, post-repair pregnancy timeline, and post-repair birth mode.

Providers universally advised delaying sexual intercourse for 3-6 months post-repair to ensure proper healing. While nearly all providers emphasized delaying pregnancy, recommended timelines varied (3 months to >2 years) and were often tailored to patient characteristics and fistula history. Adherence strategies included couples counseling and the provision of written guidance. Contraceptive counseling and provision varied by facility affiliation and fistula type/severity, with religiously affiliated facilities favoring natural family planning. Elective cesarean section for post-repair births was universally recommended and providers employed diverse strategies to overcome the absence of standard guidelines and strong care linkages. Systemic barriers, such as contraceptive stock-outs and fragmented follow-up care, undermined effective counseling. Cross-cutting strategies to improve post-repair outcomes included economic empowerment, male partner engagement, and peer counseling.

Counseling importance and broad messaging was consistent across reproductive health topics; however, key details varied by provider, facility, and patient characteristics. Standardizing key guidance and identifying optimal patient adherence messaging could improve post-repair pregnancy outcomes among this higher-risk population.