Table 2.

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

Domain	Category/level	Theme	Sub-theme
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