Obstetric fistula is a debilitating birth injury that affects an estimated 2 - 3 million women, most in sub-Saharan Africa. Obstetric fistula has broad physical and psychosocial ramifications, and women with obstetric fistula are severely stigmatized and marginalized. Over the past decade, fistula surgery has become more accessible; however, surgical success ranges from 60 - 90% and many women experience persistent fistula-related physical and mental health sequelae which impact their ability to reintegrate to their families and communities. Unfortunately no parallel development of evidence-based reintegration programming has occurred. This K99/R00 proposes training and research activities to develop expertise in obstetric fistula reintegration, followed by the development and pilot test of a multi-component reintegration intervention to improve women's psychosocial and physical recovery after fistula.

The research activities proposed include secondary data analysis to understand trajectories of women’s mental and physical health after fistula surgery and predictors of successful reintegration, leading to R00 specific aims:

1) conducting a systematic review of the published and grey literature on reintegration programming for OF and analogous conditions; 

2) designing a post-surgical reintegration intervention for women and their households to improve women's psychosocial and physical recovery through iterative work with key stakeholders; and 

3) piloting the intervention developed in Aim 2 using a cohort- controlled design and measure the feasibility, acceptability and preliminary impact on post-surgical reintegration success.