Intersecting stigma, social exclusion and coping mechanisms among women living with obstetric fistula in rural northern Ghana: a qualitative study.

BACKGROUND

Obstetric fistula is a preventable childbirth injury that remains socially devastating for women in low-resource settings. Existing evidence on obstetric fistula stigma is largely derived from treatment centres and urban settings, leaving limited understanding of the lived experiences of women in underserved rural communities. This study addresses this knowledge gap by qualitatively examining stigma, coping strategies, and support needs among obstetric fistula survivors in Kpandai District, northern Ghana.

METHODS

A qualitative exploratory descriptive design was used. Fourteen women aged 30-70 years who were living with obstetric fistula were recruited through purposive and snowball sampling until data saturation was reached. Semi-structured face-to-face interviews were audio-recorded, transcribed verbatim, and analysed using Braun and Clarke's thematic analysis approach. Link and Phelan's stigma framework informed the analytic interpretation.

RESULTS

Five themes were generated: labelling and stereotypes, separation from community, status loss and discrimination, coping mechanisms, and recommendations and support needs. Participants described name-calling, association of fistula with sin or curses, abandonment by relatives, exclusion from social and religious gatherings, and loss of social respect. Coping strategies included faith and spirituality, concealment of leakage and odour, withdrawal from public spaces, and limited psychosocial support from relatives or friends. Participants prioritised accessible fistula treatment, community education, livelihood support, and social inclusion.

CONCLUSION

Obstetric fistula-related stigma extends beyond the physical injury, profoundly affecting women's social identity, dignity, and wellbeing. Comprehensive survivor-centred care that integrates surgical repair with psychosocial support, community stigma reduction, livelihood restoration, and strengthened referral systems is essential to promote successful reintegration and improve long-term health and social outcomes.