Quality of obstetric and midwifery care for pregnant women who have undergone female genital mutilation

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.

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Perception and attitude of pregnant women in a rural community north-west Nigeria to female genital mutilation

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-014-3478-z ◽

2014 ◽

Vol 291 (3) ◽

pp. 695-700 ◽

Cited By ~ 4

Author(s):

Adewale O. Ashimi ◽

Taiwo G. Amole

Keyword(s):

Pregnant Women ◽

Rural Community ◽

Female Genital Mutilation ◽

North West ◽

Genital Mutilation ◽

Female Genital

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The Acton Model: support for women with female genital mutilation

British Journal of Midwifery ◽

10.12968/bjom.2020.28.10.697 ◽

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.

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Quality of services offered to women with female genital Mutilation across health facilities in a Kenyan County

10.21203/rs.3.rs-1048045/v1 ◽

2021 ◽

Author(s):

Samuel Kimani ◽

Chantalle Okondo ◽

Jacinta Muteshi ◽

Jaldesa Guyo

Keyword(s):

Health System ◽

Female Genital Mutilation ◽

Health Facilities ◽

Health System Strengthening ◽

Quality Of Services ◽

Negative Consequences ◽

Genital Mutilation ◽

Management Interventions ◽

Female Genital

Abstract Background Female genital mutilation (FGM) is a challenge to women’s health, human rights and development. Health as a critical pillar for social justice is key in addressing FGM while executing its core mandate of disease prevention and management. By leveraging opportune moments, events and experiences involving client-provider interactions, relevant FGM-related communications, behavior change and management interventions can be implemented at health facility or community level. It is unclear whether health system is maximizing this strategic position to address FGM in Kenya. Objective Determine the quality of services offered to women with FGM across health facilities in West Pokot county. Methods A mixed quantitative data collection strategies were used. These included: client-provider interactions observations (61) with health care workers (HCWs) and women with FGM seeking services on content and quality of FGM-related care; client-exit interviews (360) with women with FGM seeking services to determine content and services received during consultation with HCWs; and service data abstractions (10) from facility records on services sought/offered. Results A large (76%) proportion of women visiting health facilities experienced FGM at 11-15 years, were married aged 15-19 years (39%), had primary (47.5%) or no education (33%) and income of ˂30 USD/month (43%). Only 14.8% HCWs identified FGM and its related complications (11.5%) during consultations. Few FGM-related prevention interventions were implemented but IEC materials (4.9%) for reinforcing preventive messages were lacking. Adequate (88.5%) infrastructure supporting reproductive health services albeit limited human resources (14.8%) and capacity (42.6%) for FGM prevention and management existed; few health facilities and workers explained the negative consequences of FGM (16%) and need to stop it (15.3%); and data on clients who sought ANC, PNC and FP services were available but no information on women with FGM or those with FGM complications. Conclusion Health systems in high prevalent settings are actively interfacing with women with FGM, despite the primary reason for seeking services not being FGM. Despite high number of women with FGM, diagnosis, prevention and care services, documentation of FGM and its related complications are suboptimal. This underscores the need for health system strengthening in response to FGM with consideration on development of training kits for HCWs, training of HCWs, anchoring of FGM indicators in the HMIS, documentation and IEC material to support FGM prevention at service delivery points, and overall integration of FGM into ongoing health programs.

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