Abstract:
Obstetric fistula is an indicator of failure of proper management of obstructed labour. It mirrors the failure of healthcare systems in provision of accessible, timely and appropriate emergency obstetric care. Although often neglected, obstetric fistula (OF) is a significant health problem with a devastating physical, emotional and social consequences among women worldwide. Obstetric Fistula can be corrected through surgical repair. Unfortunately, it can recur in a woman whose fistula has been successfully repaired surgically but received little or no follow-up. Due to lack of family planning support, the woman can become pregnant again before proper healing takes place. The study aimed at assessing the determinants of utilization of family planning services among women post obstetric fistula repair in KNH. This study adopted a cross-sectional study design. Study participants who met the inclusion criteria were recruited as they came to seek routine clinical care services in the hospital (clinic 66). Pre-testing was done in ward 1B where all OF patients going for surgery are admitted and nursed. Permission to undertake this study was obtained from Kenyatta National Hospital/ University of Nairobi Ethics and Review Committee and Hospital Administration upon approval granted by graduate school, JKUAT. A structured questionnaire was used to collect data from the OF clients while an interview schedule was used to collect data from key informants who were nurses. Analysis of data was done by verification and coding into an electronic system and use of Statistical Package for Social Sciences (SPSS) done. Descriptive statistics were used to summarize the characteristics of the participants by presenting categorical variables as percentages and continuous data as means or medians. Utilization of family planning was then presented as a proportion. Factors associated with FP use were determined using chi-square test. A p-value of < 0.05 was used to assess statistical significance. The study found that utilization of family planning services was very low in women after repair of obstetric fistula with only a quarter (25%) using contraceptive methods. The study further found a significant relationship between previous use of FP methods and utilization of FP services after repair of obstetric fistula. The chi-square test results revealed that the outcome of the last delivery had significant influence on the time of commencement of family planning (χ²=5.429, p=0.020) and that there was significant influence of time plan to get pregnant in the future and commencement of family planning (χ²=8.722, p=0.033). The results also revealed a significant relationship between affordability and accessibility of the FP methods with utilization post repair of OF (χ²=4.000, p=0.046). Following the themes from the qualitative arm of the study, the study further revealed that there was need for integrating family planning services with OF services to ensure reduction of turn around time. The study concluded that though there are a high level of awareness of family planning methods there seems to be several barriers that hinder women from taking up the methods.The study recommended that there is need to give all relevant family planning information to the clients before discharge to allow them to have an informed decision regarding delaying pregnancy to allow enough time for complete healing. The government should avail all methods of FP to all government facilities to improve on accessibility. There’s further need for NHIF to include Family Planning methods in their schedule to improve affordability.
