Fertility and pregnancy outcomes among women with obstetric fistula in rural Malawi

Objective: To assess the fertility and pregnancy experiences of rural Malawian women living with obstetric fistula and following surgical repair of fistula. Methods: Fertility histories were collected via in-depth interviews with women identified in 2007 as having obstetric fistula and with their family members. Results: Of the 32 affected women interviewed, 17 (53.1%) conceived after developing obstetric fistula: 13 before repair and 6 after repair (with 2 conceiving both pre- and post-repair). Complaints of infertility were more frequent and urgent among women who had undergone repair than among those who had not. Over half (53.8%) of the women who conceived while living with obstetric fistula and all of those who conceived post-repair experienced at least 1 spontaneous abortion or perinatal death. Nineteen (47.5%) of the 40 pregnancies among women living with obstetric fistula and 7 (70.0%) of the 10 pregnancies among women post-repair ended in spontaneous abortion or perinatal death. Conclusion: Even 2 years after undergoing surgical repair, women can continue to experience the effects of obstetric fistula, which include infertility, spontaneous abortion, and perinatal mortality. The factors responsible for extensive infertility and poor pregnancy outcome in women post-repair warrant further investigation. (C) 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All lights reserved.