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An Exploration of a Culture of Reintegration with Women Who Have Experienced Obstetrical Fistula Repair in Northern Ghana, West Africa Open Access


Other title
Obstetrical Fistula Repair
Type of item
Degree grantor
University of Alberta
Author or creator
Jarvis,Kimberly D
Supervisor and department
Richter,Magdalena (Nursing)
Examining committee member and department
O'Brien,Beverley (Nursing)
Vallianatos, Helen (Anthroplogy)
Salami, Bukola (Nursing)
Aniteye, Patience (Nursing University of Ghana)
Nolte, Anne ( Nusring University of Johannesburg)
Faculty of Nursing

Date accepted
Graduation date
2016-06:Fall 2016
Doctor of Philosophy
Degree level
More than two million women in Asia and sub-Saharan Africa live with untreated obstetric fistula (OF). Factors contributing to and affecting the care of OF are embedded in the social determinants of health. A three-pronged approach to OF care has been suggested, including awareness, treatment, and social reintegration; however, women’s health organizations have argued that social reintegration is the most important aspect of care next to the surgery itself. The aim of this study was to explore a culture of reintegration for women who experience an OF repair in northern Ghana. A critical ethnography was employed, using a health equity/social justice lens to discern the meaning and point of view of participants about a culture of reintegration post-OF. Ninety-nine participants were recruited from 24 rural communities in northern Ghana using convenience, purposive and snowball sampling. Study participants included: • Women who had experienced an OF repair a minimum of three months prior to being interviewed. • Family members of women who had experienced an OF repair and were involved in their care pre- and post-OF repair, or post-OF repair only. Only those identified as family members of women interviewed were considered. • Health-care providers (HCPs) who cared for women who experienced an OF repair (i.e. nurses, doctors, traditional birth attendants, traditional healers). • Community stakeholders, those in leadership positions, or who provided service to the community, and were involved in OF care at the community, regional or national level (i.e. government officials, nongovernmental organizations, religious leaders, women leaders). Observation, field notes, personal reflections, semi-structured interviews, and the assessment of relevant public policy documents were methods utilized. Data was analysed according to Hammersley and Atkinson’s (2007) approach to ethnographic analysis. Nvivo 10.0 software was used for data management. Ethics approval was received from the Human Research Ethics Review Board at the University of Alberta, Canada and at the Navrongo Health Research Center, Institutional Review Board, Ghana. Findings suggest that reintegration does not occur in isolation of the other two components of care; awareness and treatment. Although most families are excited to have their family member return home post-OF, women, families, and communities do express feelings of uncertainty. Women, their families, HCPs, and community stakeholders identify that OF health teaching, skills training, community follow-up, community awareness, family support, and existing health policies are important factors in the success of reintegration. Despite this fact, participants describe the economic, societal, systemic and cultural constraints to a woman’s ability to reintegrate, and offer solutions for change. Additionally, family members describe the impact OF had on them, drawing attention to the need for formal care-giving supports in light of the changing role of the family in Ghanaian society. Research findings provide support for policy development pertaining to improved maternal, reproductive and community health initiatives as it relates to reintegration post-OF repair.
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
Citation for previous publication
Jarvis, K. (2016). Dilemmas in international research and the value of practical wisdom. Developing World Bioethics. doi:10.1111/dewb.12121.

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