scholarly journals The Acton Model: support for women with female genital mutilation

2020 ◽  
Vol 28 (10) ◽  
pp. 697-708
Author(s):  
Juliet Albert ◽  
Mary Wells
Keyword(s):  
Pregnant Women ◽  
Female Genital Mutilation ◽  
Psychological Symptom ◽  
Case Series ◽  
World Health ◽  
Specialist Service ◽  
Genital Mutilation ◽  
Wide Range ◽  
Type 3 ◽  
Female Genital

Objectives To identify the presenting characteristics, needs and clinical management of non-pregnant women with female genital mutilation who attended the Sunflower clinic, a midwife-led specialist service. Methods This was a retrospective case series review examining referral patterns, clinical findings and subsequent management between 1 April 2018 and 31 March 2019.The review was conducted at a multi-disciplinary female genital mutilation clinic for non-pregnant women aged 18 years and over in West London. Results There were 182 attendances at the clinic (88 new patients; 94 follow-up appointments). Almost half (52%) had type 3 mutilation, 32% had type 2; 9% had a history of type 3; 5% had type 1; one had type 4 and one declined assessment. A total of 35 women (40%) disclosed at least one psychological symptom (such as depression, anxiety, flashbacks, nightmares) during initial consultation. Conclusions Non-pregnant women attending female genital mutilation services present with a wide range of psychological and physical problems. Holistic woman-centred models of care appear to facilitate access to deinfibulation and counselling, which in turn may reduce long-term costs to the NHS. Safeguarding is an intrinsic part of midwives' work and is sometimes complex. The authors recommend a revision of the World Health Organization classifications to specify partial or total removal of the clitoral glans (rather than the clitoris as a whole) as this is inaccurate and may have a negative psychological impact for women.

scholarly journals Improving care for women and girls who have undergone female genital mutilation/cutting: qualitative systematic reviews

2019 ◽  
Vol 7 (31) ◽  
pp. 1-216 ◽  
Author(s):  
Catrin Evans ◽  
Ritah Tweheyo ◽  
Julie McGarry ◽  
Jeanette Eldridge ◽  
Juliet Albert ◽  
...  
Keyword(s):  
Health Care ◽  
Service Delivery ◽  
Pregnant Women ◽  
Systematic Reviews ◽  
Female Genital Mutilation ◽  
Genital Mutilation ◽  
Women And Girls ◽  
The Uk ◽  
Experienced Female ◽  
Female Genital

Background In a context of high migration, there are growing numbers of women living in the UK who have experienced female genital mutilation/cutting. Evidence is needed to understand how best to meet their health-care needs and to shape culturally appropriate service delivery. Objectives To undertake two systematic reviews of qualitative evidence to illuminate the experiences, needs, barriers and facilitators around seeking and providing female genital mutilation-/cutting-related health care from the perspectives of (1) women and girls who have experienced female genital mutilation/cutting (review 1) and (2) health professionals (review 2). Review methods The reviews were undertaken separately using a thematic synthesis approach and then combined into an overarching synthesis. Sixteen electronic databases (including grey literature sources) were searched from inception to 31 December 2017 and supplemented by reference list searching. Papers from any Organisation for Economic Co-operation and Development country with any date and in any language were included (Organisation for Economic Co-operation and Development membership was considered a proxy for comparable high-income migrant destination countries). Standardised tools were used for quality appraisal and data extraction. Findings were coded and thematically analysed using NVivo 11 (QSR International, Warrington, UK) software. Confidence in the review findings was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation – Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. All review steps involved two or more reviewers and a team that included community-based and clinical experts. Results Seventy-eight papers (74 distinct studies) met the inclusion criteria for both reviews: 57 papers in review 1 (n = 18 from the UK), 30 papers in review 2 (n = 5 from the UK) and nine papers common to both. Review 1 comprised 17 descriptive themes synthesised into five analytical themes. Women’s health-care experiences related to female genital mutilation/cutting were shaped by silence and stigma, which hindered care-seeking and access to care, especially for non-pregnant women. Across all countries, women reported emotionally distressing and disempowering care experiences. There was limited awareness of specialist service provision. Good care depended on having a trusting relationship with a culturally sensitive and knowledgeable provider. Review 2 comprised 20 descriptive themes synthesised into six analytical themes. Providers from many settings reported feeling uncomfortable talking about female genital mutilation/cutting, lacking sufficient knowledge and struggling with language barriers. This led to missed opportunities for, and suboptimal management of, female genital mutilation-/cutting-related care. More positive experiences/practices were reported in contexts where there was input from specialists and where there were clear processes to address language barriers and to support timely identification, referral and follow-up. Limitations Most studies had an implicit focus on type III female genital mutilation/cutting and on maternity settings, but many studies combined groups or female genital mutilation/cutting types, making it hard to draw conclusions specific to different communities, conditions or contexts. There were no evaluations of service models, there was no research specifically on girls and there was limited evidence on psychological needs. Conclusions The evidence suggests that care and communication around female genital mutilation/cutting can pose significant challenges for women and health-care providers. Appropriate models of service delivery include language support, continuity models, clear care pathways (including for mental health and non-pregnant women), specialist provision and community engagement. Routinisation of female genital mutilation/cutting discussions within different health-care settings may be an important strategy to ensure timely entry into, and appropriate receipt of, female genital mutilation-/cutting-related care. Staff training is an ongoing need. Future work Future research should evaluate the most-effective models of training and of service delivery. Study registration This study is registered as PROSPERO CRD420150300012015 (review 1) and PROSPERO CRD420150300042015 (review 2). Funding The National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Rethinking the Anti-FGM Zero-Tolerance Policy: from Intellectual Concerns to Empirical Challenges

2020 ◽  
Vol 12 (4) ◽  
pp. 266-275
Author(s):  
Sarah O’Neill ◽  
Dina Bader ◽  
Cynthia Kraus ◽  
Isabelle Godin ◽  
Jasmine Abdulcadir ◽  
...  
Keyword(s):  
Female Genital Mutilation ◽  
Zero Tolerance ◽  
World Health ◽  
Genital Mutilation ◽  
Tolerance Strategy ◽  
Zero Tolerance Policy ◽  
Genital Cutting ◽  
Definition Of ◽  
Health Organization ◽  
Female Genital

Abstract Purpose of Review Based on the discussions of a symposium co-organized by the Université Libre de Bruxelles (ULB) and the University of Lausanne (UNIL) in Brussels in 2019, this paper critically reflects upon the zero-tolerance strategy on “Female Genital Mutilation” (FGM) and its socio-political, legal and moral repercussions. We ask whether the strategy is effective given the empirical challenges highlighted during the symposium, and also whether it is credible. Recent Findings The anti-FGM zero-tolerance policy, first launched in 2003, aims to eliminate all types of “female genital mutilation” worldwide. The FGM definition of the World Health Organization condemns all forms of genital cutting (FGC) on the basis that they are harmful and degrading to women and infringe upon their rights to physical integrity. Yet, the zero-tolerance policy only applies to traditional and customary forms of genital cutting and not to cosmetic alterations of the female genitalia. Recent publications have shown that various popular forms of cosmetic genital surgery remove the same tissue as some forms of “FGM”. In response to the zero-tolerance policy, national laws banning traditional forms of FGC are enforced and increasingly scrutinize the performance of FGC as well as non-invasive rituals that are culturally meaningful to migrants. At the same time, cosmetic procedures such as labiaplasty have become more popular than ever before and are increasingly performed on adolescents. Summary This review shows that the socio-legal and ethical inconsistencies between “FGM” and cosmetic genital modification pose concrete dilemmas for professionals in the field that need to be addressed and researched.

Legal Impact of Female Genital Mutilation: Special Reference to Penal Laws and Human Rights Perspective in the Criminal Justice System of Sri Lanka

2019 ◽  
Vol 4 (2) ◽  
pp. 222-237
Author(s):  
Aruni Wijayath
Keyword(s):  
Human Rights ◽  
Sri Lanka ◽  
Female Genital Mutilation ◽  
Cultural Practice ◽  
World Health ◽  
African Region ◽  
Genital Mutilation ◽  
Female Community ◽  
Health Organization ◽  
Female Genital

Female genital mutilation (FGM) is a ritual and religious and cultural practice among the Moor, Malay and Dawoodi Bohra ethnic communities in Sri Lanka. The process of FGM is ensconced from the general public in Sri Lanka; therefore, few pieces of research pertaining to the practice of FGM are available. A considerable number of international organizations profess that the percentage of FGM/cutting is zero in Sri Lanka through their reports, although newspaper articles and country reports disclose that FGM actually exists among the Muslim community in Sri Lanka. The knowledge regarding the process of FGM is in the backwater in Sri Lanka, even though a considerable number of feminism activists have created a platform to discuss the bad consequences emerging from this harmful practice. According to the World Health Organization (WHO), 30 countries of African Region, selected countries in the Middle East, and countries of Asian Region practice this custom among the female community in some ethnic and religious groups. Through this practice, the female community has not gained any advantage or benefit. The purpose of this research is to explore the municipal laws and human rights regarding FGM in the Sri Lankan context. Furthermore, international conventions which are ratified by Sri Lanka will be analysed in this manner. This research is mainly based on the normative method and retrieved Internet documentary analysis in a qualitative manner.

scholarly journals The Applicability of Behaviour Change in Intervention Programmes Targeted at Ending Female Genital Mutilation in the EU: Integrating Social Cognitive and Community Level Approaches

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Katherine Brown ◽  
David Beecham ◽  
Hazel Barrett
Keyword(s):  
Behaviour Change ◽  
Female Genital Mutilation ◽  
Female Circumcision ◽  
Behavioural Change ◽  
Community Change ◽  
World Health ◽  
Female Genital Cutting ◽  
Genital Mutilation ◽  
Female Genital ◽  
The Eu

With increased migration, female genital mutilation (FGM) also referred to as female circumcision or female genital cutting is no longer restricted to Africa, the Middle East, and Asia. The European Parliament estimates that up to half a million women living in the EU have been subjected to FGM, with a further 180,000 at risk. Aware of the limited success of campaigns addressing FGM, the World Health Organization recommended a behavioural change approach be implemented in order to end FGM. To date, however, little progress has been made in adopting a behaviour change approach in strategies aimed at ending FGM. Based on research undertaken as part of the EU’s Daphne III programme, which researched FGM intervention programmes linked to African communities in the EU (REPLACE), this paper argues that behaviour change has not been implemented due to a lack of understanding relating to the application of the two broad categories of behaviour change approach: individualistic decision-theoretic and community-change game-theoretic approaches, and how they may be integrated to aid our understanding and the development of future intervention strategies. We therefore discuss how these can be integrated and implemented using community-based participatory action research methods with affected communities.

Health Consequences of the Female Genital Mutilation: A Systematic Review Running title: Health Consequences of Female Genital Mutilation

2019 ◽  
Vol 8 ◽  
pp. 1336
Author(s):  
Khadijeh Sarayloo ◽  
Robab Latifnejad Roudsari ◽  
Amy Elhadi
Keyword(s):  
Systematic Review ◽  
Women’S Health ◽  
Women's Health ◽  
Female Genital Mutilation ◽  
World Health ◽  
Health Concern ◽  
Current Evidence ◽  
Health Consequences ◽  
Genital Mutilation ◽  
Female Genital

Female genital mutilation (FGM) is a general health concern. The World Health Organization has recognized it as a condition that endangers women’s health. This review study aimed to identify the types of health outcomes of FGM. Therefore, a systematic review was conducted to create a critical view of the current evidence on the effect of circumcision on girls and women's health. In this study, we focused on the health risks of female circumcision. Academic databases such as PubMed, Science Direct, Scopus, Google Scholar, Cochrane Database of Systematic Reviews, SID, IranMedex, Irandoc, and Magiran were searched with regard to the health consequences of FGM from January 1990 until 2018. Eleven review studies met the criteria and contained 288 relevant studies on the risks of FGM. It was suggested that FGM had various physical, obstetric, sexual, and psychological consequences. Women with FGM experienced mental disturbances (e.g., psychiatric diagnoses, anxiety, somatization, phobia, and low self-esteem) than other women. Our study can provide evidence on improving, changing behaviors, and making decisions on the quality of services offered to women suffering from FGM. [GMJ.2019;inpress:e1336]

scholarly journals Fornah v Secretary of State for the Home Department, House of Lords [2006] UKHL 46, [2006] 3 FCR 381, [2007] 1 All ER 671

2012 ◽  
Vol 19 (1) ◽  
pp. 271-278
Author(s):  
Susan Edwards
Keyword(s):  
Social Services ◽  
Female Genital Mutilation ◽  
Female Circumcision ◽  
Complete Removal ◽  
World Health ◽  
Small Aperture ◽  
Her Family ◽  
Genital Mutilation ◽  
Labia Minora ◽  
Female Genital

FEMALE GENITAL MUTILATION – VIOLENCE AGAINST GIRLS AND WOMEN  AS A  PARTICULAR SOCIAL GROUPZainab Esther Fornah was fifteen years old when on 15th March 2003, as an unaccompanied minor, she arrived at UK’s Gatwick airport claiming asylum. As she was a child she was taken into the care of West Sussex Social Services Child Asylum Team. She had fled Sierra Leone where she had been captured by rebels, who had killed her family, and was repeatedly raped.  She did not want to return to her uncle’s village fearing that she would be forcibly genitally mutilated, as was customary practice. Whilst her father was alive he was able to protect her from this practice. Female genital mutilation, has variously been described as female circumcision and as clitoridectomy, as if to render benign this very specific inhumane habituated practice against females. It involves cutting away the clitoris, labia minora, labia majora and vulva of a female. The area remaining is then sewn together leaving a small aperture to allow for menstruation and urination. This maiming is often perpetrated without anaesthetic and some children do not survive. The World Health Organisation defines this particular form of torture, somewhat blandly, as “the partial or complete removal of the external female genitalia or other injury to the female genital organs whether for cultural or any other non-therapeutic reason.

scholarly journals Female Genital Mutilation/Cutting in Sudan and Subsequent Pelvic Floor Dysfunction.

2021 ◽  
Author(s):  
Özer Birge ◽  
Aliye Nigar Serin ◽  
Mehmet Sait Bakır
Keyword(s):  
Female Genital Mutilation ◽  
Pelvic Floor Dysfunction ◽  
Reference Category ◽  
Genital Mutilation ◽  
Group 2 ◽  
Type 3 ◽  
Female Genital ◽  
Group 1

Abstract Background: We aimed to evaluate the socio-demographic characteristics of women with female genital mutilation/cutting (FGM/C) and the results of FGM/C due to pelvic floor dysfunction.Results: The prevalence of FGM/C was 87,2% in Sudan and Type 3 (50.4%) was the most prevalent. Type 3 (50.4%) was the most prevalent, followed by Type 2 (35%) and Type 1 (8.5%). In the multinominal logistic regression analysis performed for the effect of FGM/C alone on pelvic organ prolapse, it was observed that FGM/C in group 2 was not statistically different when the reference category was taken as group 1. In the evaluation for symptomatic POP (group 3), compared to type 3 FGM/C, there was a significantly less risk of developing POP in patients without FGM/C at a rate of 82.9% (OR(odds ratio): 0,171 (p:0,002), (Confidence Interval (CI) %95; 0,058-0,511), in patients with type 1 FGM/C at a rate of 75% (OR:0,250 (p:0,005), CI %95; 0,094-0,666) and in patients with type 2 FGM / C at a rate of 78.4% (OR:0,216 (p:0,0001), CI%95; 0,115-0,406). In the multinominal logistic regression analysis performed by including other variables affecting POP when group 1 was taken as the reference category, we found that the possibility of developing mild POP (group 2) decreased in FGM/C type 1 and 2 compared to FGM/C type 3 but it was not statistically significant. However, the evaluation for symptomatic POP showed up a significantly lower risk of developing POP in patients with type 2 FGM/C at a rate of 58.4%, compared to type 3 FGM/C (OR:0,416 (p:0,016), CI%95; 0,205-0,847). In addition, older age and being unemployed were found to be significant risk factors for increasing symptomatic POP (p:0,004, p:0,045; respectively).Conclusions: Female genital mutilation/cutting (FGM/C) defined by the World Health Organization and consists of all procedures that involving partial or total removal of the external female genitalia or another injury to the female genital organs whether for cultural or other non-medical reasons. Especially type 2 and 3 FGM/C continues to be an important health problem in terms of complications that may develop in advanced ages as well as many short-term complications as a result of mechanical or physiological deterioration of the female genital anatomy.

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