Fertility desires and sexual behaviours among women recovering from genital fistula repair in Eldoret, Kenya.

OBJECTIVES: The reproductive desire of women following genital fistula repair surgery is complex, varied and often not addressed, although it carries significant consequences. The aim of this study was to better understand the fertility desires and sexual behaviours of women who recently underwent surgical repair of a genital fistula. METHODS: This is a secondary analysis of a retrospective cohort study designed to assess the effectiveness of Beyond Fistula, a reintegration programme for women recovering from genital fistula surgery in Eldoret, Kenya. One hundred women who participated in the Beyond Fistula programme between 2013 and 2019 were interviewed in person regarding future fertility desire, current sexual behaviour and contraceptive use. RESULTS: Among the 79 reproductive-aged women included in this study, 63.3% reported no future desire for pregnancy. Those that desired another pregnancy were significantly younger (48.3% were 18-29 years old vs. 66.0% were 35 years old or more, p = 0.004), had fewer living children (70% had 0-2 children vs. 56% had 3 or more children, p < 0.001), and a lower level of food insecurity (27.6% reported no to marginal insecurity vs. 14%, p = 0.014). Current sexual activity was marginally different between women who did and did not desire future pregnancy (82.8% vs. 66.0%, p = 0.053). Of the 50 women in our study who did not desire pregnancy, 62.0% were sexually active and of these, only 38.7% were preventing pregnancy. Lack of knowledge and access to methods were most commonly cited as barriers to use. CONCLUSIONS: Many women recovering from genital fistula surgery do not desire pregnancy and are sexually active but are not using a method to prevent pregnancy. The potential for post-surgical reintegration programmes to address education and access to contraception is a vital and unmet need to promote reproductive empowerment in this population of women as they reestablish their lives.

Impact of Beyond Fistula programming on economic, psychosocial and empowerment outcomes following female genital fistula repair: A retrospective study.

OBJECTIVE: To retrospectively assess changes in economic status, psychosocial status and empowerment among women who participated in Beyond Fistula reintegration programming following fistula repair. METHODS: We conducted a retrospective study among 100 Beyond Fistula program participants capturing sociodemographic characteristics, obstetric and fistula history, program participation, and our primary outcomes: economic status, psychosocial status, and empowerment via quantitative survey at two time points: before program participation and currently. Data were collected from November 2020 to July 2021 from 2013 to 2019 program participants. We compared outcomes across these two time points using paired t tests or McNemar's tests. RESULTS: The proportion of individuals owning property (28.0% vs. 38.0%, P = 0.006), having a current source of income (19.0% vs. 56.0%, P < 0.001), and saving or investing income (11.0% vs. 37.0%, P < 0.001) increased significantly from pre- to post-programming. We also identified statistically significant increases from pre- to post-programming in self-esteem (5.0 [IQR 4.0-5.0] vs. 5.0 [IQR 5.0-5.0], P < 0.001), reintegration (53.0 [IQR 43.0-69.0] vs. 65.0 [IQR 51.0-72.0], P < 0.001) and level of input into household economic decision making (2.0 [SD 1.0] vs. 2.3 [SD 1.0], P = 0.004). CONCLUSION: Beyond Fistula programming likely improved economic status, psychosocial status, and empowerment of participants. Post-surgical interventions incorporating a holistic approach can advance recovery through supporting psychosocial and economic wellbeing and should be offered to women undergoing genital fistula repair.

Histologic and colposcopic correlates of ASCUS pap smears in pregnancy.

OBJECTIVE: A historic cohort analysis was performed to assess the colposcopic and histologic correlates of atypical squamous cells of undetermined significance (ASCUS) Pap smears in pregnant and nonpregnant women. MATERIALS AND METHODS: A chart review of all gynecologic and obstetric patients seen in the outpatient clinic at the Maimonides Medical Center between January 1996 and December 1999 was undertaken. All of the charts of patients with ASCUS Pap smears were reviewed to confirm the diagnosis and to obtain medical and demographic information. To be eligible for inclusion, patients needed to have a documented colposcopic exam within 6 months of the ASCUS Pap smear and be between the ages of 14 and 45 years old. The records from the colposcopic examination including histologic data were subsequently reviewed. The generalized Fisher exact test was utilized to determine the exact probability. RESULTS: Over a 4-year period from January of 1996 to December of 1999, 198 women were diagnosed with ASCUS on their Pap smears. A total of 122 patients met the inclusion criteria. Of those included in the study, 58 were pregnant at the time of diagnosis and 64 were nonpregnant. The mean age of the obstetric and gynecologic patients was 26.9 (range = 18-37) and 31.0 (range = 18-44) years, respectively (p = NS). Thirty-two (50%) nonpregnant patients had histologic findings of cervical intraepithelial neoplasia (CIN) compared with 15 of the 45 (33.3%) (p = .019) obstetric patients who had biopsies within the first 6 months postpartum. CIN 1 was detected in 12 of the 45 (26.7%) biopsies of the postpartum patients and 26 of the 64 (40.6%) (p = .16) gynecologic patients. CIN 2,3 was found in 2 of the 45 (4.4%) postpartum patients versus 6 of the 64 (9.4%) (p = .12) gynecologic patients. One pregnant woman with ASCUS was found to have cervical cancer (2.2%). Overall, a biopsy proven neoplastic lesion was found in 15 of 45 (33.3%) postpartum women compared with 32 of the 64 (50%) (p = .019) nonpregnant women. CONCLUSION: A cytologic diagnosis of ASCUS in pregnancy is associated with a significantly lower rate of neoplasia than the rate of neoplasia found among nonpregnant women with an ASCUS smear. A risk of cervical cancer following an ASCUS Pap smear was 2.2% in our pregnant population. Therefore, ASCUS diagnosed on the Pap smear in both pregnant and nonpregnant women warrants colposcopy and close follow-up.