IndexSocioeconomic Challenges Faced by Fistula Survivors After Obstetric Fistula SurgerySocial ChallengesUnsuccessful RepairEconomic ChallengesPost-Repair InterventionsSocioeconomic Challenges Faced by Fistula Survivors After Surgery surgery for obstetric fistulaA condition such as OF has an impact on the woman, the community and the family unit and can have devastating effects. (Jarvis, 2017; Mselle, et al., 2011). Only a few studies have examined the adverse social, economic, and psychological consequences of fistula; However, these studies provide some empirical evidence that treatment, counseling, social support and rehabilitation can significantly improve the physical and mental health of affected women and provide these women with a second chance to participate in family life, then simply repair a fistula is not enough. the end of their challenges. The problems faced by women mainly fall into three categories; emotional and psychological trauma, social and economic difficulties, however this literature review will mainly focus on social and economic challenges. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an Original Essay Social Challenges Erving Goffman (1963), defines stigma as "a deeply discrediting attribute." His definition of stigma focuses on the public's attitude toward a person who possesses an attribute that does not meet society's expectations. The person with the attribute is “reduced in our minds from a whole and usual person to a contaminated and taken for granted person”. From a public health perspective, stigma or discrimination is associated with worsened health outcomes and is thought to be linked to reduced self-esteem and quality of life (Mselle, 2011). Among fistula patients, stigma manifests differently, from subtle to overt discrimination and isolation, before and continues even after corrective surgery. It is even worse for those whose corrective surgery was unsuccessful. Midwifery survivors are labeled as having an illness that has left them imperfect and therefore are not fully accepted by their communities. Stigma is directed at women by both their families and the community, who isolate them, subject them to negative comments about their previous status, and in some cases do not allow them to participate in domestic, social, and even economic activities (Khisa, 2016). . For example, in a study conducted by Khisa (2010), women reported that even though they were invited to social events such as weddings and community gatherings, they could not help with cooking or serve guests despite having recovered. . Ultimately, it seemed to survivors that the disease had left a permanent stigmatizing label. Even though they no longer leaked urine and feces, their view of the rest of the world had not changed. This treatment by the community or family members not only reduces the survivor to an inferior human being, preventing him from improving his life (Goffman (1963), but also leaves him with feelings of reduced social value. According to (Khisa, 2010 ; Mselle, 2011), after surgery, most survivors believe that the previous illness has reduced their chances of leading a normal social life. Survivors are often shy in relating to other people, probably due to internalized stigma before surgery. For the most part, this is due to the insecurity that comes from the perception that whether a person has beenoperated on, it's not normal. This type of feeling often leads survivors to isolate themselves from other community members after surgery. Since they shy away from social events, their reintegration is very difficult as they have little or no activities to do with other community members. Unsuccessful repair The biggest challenge for obstetric fistula survivors is unsuccessful repairs. Even with successful closure fistulataxy of 65-95%, there are cases where continence cannot be achieved with successful closure of the fistula if the urethra is nonfunctional or the continence mechanism has been destroyed. Approximately one-third of women experience persistent incontinence after surgery (Byamugisha, et al., 2015). Continued urinary and/or fecal incontinence results in continued social isolation and stigma for survivors as their situation has not changed. This leaves the survivor suffering as before the surgery, causing attractive thoughts of being cursed or being blamed by the community and family members for not being healed. (Khisa, 2010). Both parties expect the woman to recover after surgery, but as with failed repairs, it is usually the latter. Economic Challenges After OF repair, women are asked not to do strenuous work. This threatens their ability to earn money because work in rural areas where most survivors live requires manual labor. (Jarvis et al., 2017). Most feel challenged to resume economic activity after restructuring because they have been removed from the workforce for so long. In studies conducted in Ethiopia and Kenya on the challenges women face after fistula repair (Donnelly, et al., 2015; Khisa, 2010), women reported no longer having the strength or stamina to do the work of which they were responsible for before the fistula. Many, particularly unmarried ones, complained of being unable to do more physically demanding jobs that might make potential employers reluctant to hire them. This loss of income exacerbates survivors' economic hardship and threatens their already precarious livelihoods. Similarly, Women's Dignity and Engender Health, (2008) and Ojanuga, (1994) highlighted the economic challenges that survivors faced after surgery. They examined the economic pressure that obstetric fistula places on a patient's family. They noted that income was lost through several mechanisms, ranging from the direct cost of fistula-related care, time taken away from the farm, survivors' inability to work due to stigma, the health effects of fistula, and the need to wash or bathe constantly. change clothes for those with unsuccessful surgery. All these families were affected because as a result one less person was not working either in the home or on the farm. This doubled the work for the rest of the family members as they took over all the work the survivor was previously doing, meaning they had to forgo income that the women might previously have contributed, thus reducing the family income. Due to widespread poverty, there is a strong and shared desire for women to become self-sufficient and improve their lives by contributing to the family income. Although men work to provide for major cash expenses, women's work provides for the family's basic needs. (Donnelly, 2015). Therefore, a woman's economic livelihood has implications not only for herself but also for thelivelihood of his family because it is positively associated with well-being through greater spending on household food and child support. (Jarvis, et al., 2017) However, although women are highly motivated to expand their income by engaging in income-generating activities, they are severely limited by the lack of start-up capital or credit to start business ventures. Furthermore, some survivors felt that the lack of economic empowerment was a potential barrier to full integration after surgery as they found themselves dependent on their spouses and other relatives. Being able to work and provide for your family is a source of pride and intrinsic self-esteem. When women were interviewed in two studies conducted by Khisa (2010; 2016) in Kenya, most noted that when they returned home after surgery, they needed capital to purchase food and provide for their children. The biggest concern for most is back home they were finding the capital to take care of their children and family. Most said they did not expect their husbands to take care of every detail of their personal or family needs, so it was imperative to find work or capital to start a business immediately upon returning home. With any successful fistula surgery, it is assumed that the patient will have a smooth reintegration into daily life; Unfortunately these patients still face multiple challenges when they return home, so simply repairing a fistula is not the end of their challenges. Understanding these challenges faced by women before and after fistula repair will help base the required intervention on clearly understood problems. Post-Remedial Interventions (Engen, et al., 2016), defines rehabilitative interventions as planned, multidisciplinary measures or treatments designed to help users improve or maintain their level of functioning. Rehabilitation interventions are often complex and multidimensional and their effects can be influenced by individual processes and interactions between different elements of the interventions. (Why, et al., 2014). From the context of obstetric fistula, an intervention program should be able to take care of the physical, mental, social and economic harm that has been commonly inflicted on girls and women with obstetric fistula. (Mohammad, 2007). However, there is no clear definition of the term Post-Remediation Interventions as this term is defined within a program contextual basis. Therefore, when talking about post-repair interventions in the context of obstetric fistula, two words: “rehabilitation” and “reintegration” are synonymous with the term post-repair intervention and are used interchangeably. Lombard (2015) defines rehabilitation and reintegration as any experience that helps improve women's lives after obstetric fistula surgery, while Mselle (2012) defines reintegration as the process of helping women with obstetric fistula to return to the life they lived before developing a fistula. . This includes how women adapt and reconnect to work, families, communities and social life in order to restore lost dignity and respect and increase their self-esteem. Furthermore, the term Post-restorative interventions in the context of obstetric fistula includes all intervention support provided to fistula survivors after surgery in terms of professional training, personal hygiene products, food, transportation, start-up capital, support educational to conduct awareness raising activities or.