This article presents data from 1354 women from five countries who participated in a prospective cohort study conducted between 2007 and 2010. Women undergoing surgery for fistula repair were interviewed at the time of admission, discharge, and at a 3-month follow-up visit. While women's experiences differed across countries, a similar picture emerges across countries: women married young, most were married at the time of admission, had little education, and for many, the fistula occurred after the first pregnancy. Median age at the time of fistula occurrence was 20.0 years (interquartile range 17.3–26.8). Half of the women attended some antenatal care (ANC); among those who attended ANC, less than 50% recalled being told about signs of pregnancy complications. At follow-up, most women (even those who were not dry) reported improvements in many aspects of social life, however, reported improvements varied by repair outcome. Prevention and treatment programmes need to recognise the supportive role that husbands, partners, and families play as women prepare for safe delivery. Effective treatment and support programmes are needed for women who remain incontinent after surgery.

We seek to assist decision makers in maximizing provision of essential services without compromising access to quality family planning care and while minimizing the risk of COVID-19 transmission among clients, and between clients and health care workers. n Managers should help facility teams to integrate counseling and provide a range of contraceptive methods as is feasible within existing contacts with pregnant, postabortion, birthing, and postpartum women, even as services migrate to new models with a mixture of in-person and virtual/tele-health consultations. n Policy makers should prioritize devoting resources to meet the family planning needs of pregnant, postabortion, birthing, and postpartum women, and the health care workers serving them as an investment against higher health systems burdens in later months and during subsequent waves of the pandemic.

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This article describes how a mission hospital in East Africa expanded its quality improvement (QI) process by promoting partnership with the community in order to better meet the community's needs. The partnership evolved from the hospital's existing COPE (client-oriented, provider-efficient) self-assessment approach. In addition to seeking the views of clients, the hospital embarked on a process to engage community members in a dialogue, implement improvements suggested by the community, and gradually ensure community representation on its QI committee. The importance of considering the cultural diversity of the community was reinforced by the outcome of the COPE initiative.