Table 2 Domains, categories, themes, and sub-themes from interviews with Malawian women 1–2 years post fistula repair surgery

Overall Quality of Life (QOL)

Greatest concerns before surgery

Death during surgery

Irreparable Fistula

Marital discord

(1) Partner abandonment

(2) Polygamy

(3) Fistula affected sexual intercourse

Greatest concerns after surgery

Financial challenges

Additional surgery

Reproductive health and fertility

(1) Desire to have children

Relationship challenges

(1) Unsupportive relationships

(2) Fear of being unmarried

(3) Challenges with sexual intercourse

Individual Level

Compared to before surgery, QOL had improved

(1) QOL after surgery is similar to QOL before fistula developed

Interpersonal Level

Relationships with family and friends before fistula repair

(1) Stigma from family, friends, and community

Relationships with family and friends after fistula repair

(1) Few with ongoing stigma after repair

Participation in social activities before surgery

(1) Isolation because of urine leakage

(2) Inability to work or attend activities

Participation in social activities after surgery

(1) Reintegration back into social and work activities

(2) Holding positions within groups

Fertility and pregnancy after repair

Fertility desires and pregnancy outcomes

(1) Fear of fistula recurrence from future pregnancy

(2) Confusion about ability to bear children

(3) Consequences of not being able to have children

Family planning use

Understanding of fistula

Knowledge of fistula

(1) Delay seeking hospital care contributes to fistula development

(2) Understanding prolonged labor as a cause of fistula but poor understanding of cause of prolonged labor

(3) Cultural beliefs

Fistula advocacy to others

(1) Assisted women with fistula to seek repair

(2) Advocating for fistula prevention in communities

Suggestions for helping women/with fistula