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Altunkurek ŞZ, Yeşilyurt E, Hassan Mohamed S. Comparison of Menstrual Symptoms in University Students with and without Female Genital Mutilation/Cutting. Int J Womens Health 2024; 16:1451-1462. [PMID: 39247612 PMCID: PMC11380493 DOI: 10.2147/ijwh.s469902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 08/29/2024] [Indexed: 09/10/2024] Open
Abstract
Purpose The aim of this study was to compare the menstrual symptoms and dysmenorrhea in university students who underwent Female genital mutilation/cutting (FGM/C), in Mogadishu, Somalia, and students who did not undergo FGM/C in Ankara, Türkiye. Methods A comparative cross-sectional study design was used. Results Among the participants with FGM/C, 88.5% were Type 1 and the age at FGM/C was 8 years. The pain severity was 6.20±2.54 in women with FGM/C and was higher than that of those without FGM/C (5.97±2.32), but no significant difference was found. Among those who had FGM/C, 66% had a menstrual duration of 3-5 days, while 52.0.% of those who did not have FGM/C had a menstrual duration of 6-8 days (p<0.05). While 85.1% of those without FGM/C had a menstrual cycle of 21-35 days, 35% of those with FGM/C had a menstrual cycle of less than 20 days (p<0.05). It was found that 95% of those who have undergone female circumcision and 90.2% of those who have not had dysmenorrhea (p<0.05). Painkillers were always used by 28% of women with FGM/C and 26.3% of women without FGM/C (p<0.05). The total MSS score of those who have not had FGM/C was 3.34±0.72 and the score of those who have had FGM/C was 2.91±0.74 (p<0.05). The negative effects sub-dimension score was found to be higher in the non-FGM/C group with 3.20±0.75, while the coping methods sub-dimension score was higher in the FGM/C group with 2.91±1.13 (p<0.05). Conclusion FGM/C is still common in Somalia. Our study results showed that having FGM/C may cause differences in dysmenorrhea and menstrual symptoms. Efforts to increase students' effective coping with menstrual symptoms and dysmenorrhea are thought to be useful.
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Affiliation(s)
- Şeyma Zehra Altunkurek
- Department of Public Health Nursing, University of Health Sciences, Gulhane Faculty of Nursing, Ankara, Türkiye
| | - Eylül Yeşilyurt
- Department of Public Health Nursing, Ufuk University School of Nursing, Ankara, Türkiye
| | - Samira Hassan Mohamed
- Department of Nursing, University of Health Sciences, Somalia Mogadishu Recep Tayyip Erdoğan Faculty of Health Sciences, Mogadishu, Somalia
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Apini-Welcland L, Daniele MAS, Rocca-Ihenacho L, McCourt C. Pre-service education and continuous professional development on female genital mutilation/cutting for maternal health professionals in OECD countries: A scoping review. Midwifery 2024; 135:104027. [PMID: 38810417 DOI: 10.1016/j.midw.2024.104027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/30/2024] [Accepted: 05/09/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Female Genital Mutilation/Cutting can cause sequalae throughout pregnancy, childbirth, and the postpartum period. Due to changing patterns in migration flows, the practice evolved into a global phenomenon. Health professionals should ensure high quality of care during maternity service provision. OBJECTIVE This scoping review aimed to map available evidence on pre-service and continuous professional development education about Female Genital Mutilation/Cutting for maternal health professionals and identify developmental needs for topic inclusion into teaching. METHODOLOGY The review was conducted in accordance with the PRISMA-ScR guidelines. A protocol was developed and is publicly available (medRxiv 2022.08.16.22278598). Three databases (CINAHL, Embase, Medline) and other educational sources were searched. During the final stages of the review an ethical application was submitted and approved. Expert interviews were added to gain insights from practice. RESULTS The search identified 224 records. After title and abstract screening, 33 studies were selected for full-text review, resulting into the inclusion of 4 studies and 12 non-research educational sources. Scoping the topic revealed that Female Genital Mutilation/Cutting is often included ad-hoc or stand-alone during trainings and it remains unclear, who owes the responsibility. There is lack of knowledge about which competencies are needed for the different levels of health cadres, how competencies are achieved and outcomes measured. CONCLUSION More transparency into training on Female Genital Mutilation/Cutting and about how competency levels are achieved, maintained and evaluated is required. Further research and interdisciplinary collaboration could focus on the development of specific modules and lead to service improvement.
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Affiliation(s)
- Lisa Apini-Welcland
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, 1 Myddelton Street, London EC1R 1UW, UK.
| | - Marina A S Daniele
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, 1 Myddelton Street, London EC1R 1UW, UK
| | - Lucia Rocca-Ihenacho
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, 1 Myddelton Street, London EC1R 1UW, UK
| | - Christine McCourt
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, 1 Myddelton Street, London EC1R 1UW, UK
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Genital Modifications in Prepubescent Minors: When May Clinicians Ethically Proceed? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024:1-50. [PMID: 39018160 DOI: 10.1080/15265161.2024.2353823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
When is it ethically permissible for clinicians to surgically intervene into the genitals of a legal minor? We distinguish between voluntary and nonvoluntary procedures and focus on nonvoluntary procedures, specifically in prepubescent minors ("children"). We do not address procedures in adolescence or adulthood. With respect to children categorized as female at birth who have no apparent differences of sex development (i.e., non-intersex or "endosex" females) there is a near-universal ethical consensus in the Global North. This consensus holds that clinicians may not perform any nonvoluntary genital cutting or surgery, from "cosmetic" labiaplasty to medicalized ritual "pricking" of the vulva, insofar as the procedure is not strictly necessary to protect the child's physical health. All other motivations, including possible psychosocial, cultural, subjective-aesthetic, or prophylactic benefits as judged by doctors or parents, are seen as categorically inappropriate grounds for a clinician to proceed with a nonvoluntary genital procedure in this population. We argue that the main ethical reasons capable of supporting this consensus turn not on empirically contestable benefit-risk calculations, but on a fundamental concern to respect the child's privacy, bodily integrity, developing sexual boundaries, and (future) genital autonomy. We show that these ethical reasons are sound. However, as we argue, they do not only apply to endosex female children, but rather to all children regardless of sex characteristics, including those with intersex traits and endosex males. We conclude, therefore, that as a matter of justice, inclusivity, and gender equality in medical-ethical policy (we do not take a position as to criminal law), clinicians should not be permitted to perform any nonvoluntary genital cutting or surgery in prepubescent minors, irrespective of the latter's sex traits or gender assignment, unless urgently necessary to protect their physical health. By contrast, we suggest that voluntary surgeries in older individuals might, under certain conditions, permissibly be performed for a wider range of reasons, including reasons of self-identity or psychosocial well-being, in keeping with the circumstances, values, and explicit needs and preferences of the persons so concerned. Note: Because our position is tied to clinicians' widely accepted role-specific duties as medical practitioners within regulated healthcare systems, we do not consider genital procedures performed outside of a healthcare context (e.g., for religious reasons) or by persons other than licensed healthcare providers working in their professional capacity.
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Pipes G, Dunleavy S, Brown J. Female genital mutilation and cutting: a survey of child abuse pediatricians. BMC Womens Health 2024; 24:348. [PMID: 38886697 PMCID: PMC11181596 DOI: 10.1186/s12905-024-03119-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/29/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND As global immigration from countries with a high prevalence of female genital mutilation and cutting (FGM/C) has grown in the United States (US), there is need for pediatricians to have adequate training to care for these patients. The objective of this study is to determine the level of knowledge and attitudes of child abuse pediatricians (CAPs) towards FGM/C in the US. METHODS This cross-sectional study distributed a peer-reviewed survey to US CAPs-members of the Helfer Society-to assess their attitudes, knowledge, clinical practice, and education about FGM/C. Data was analyzed using descriptive statistics, Kruskal-Wallis tests, and Fisher's exact test. RESULTS Most of the 65 respondents were aware that FGM/C is illegal (92%) and agreed that it violated human rights (99%). Individuals reporting previous training related to FGM/C were significantly more likely to correctly identify World Health Organization types of FGM/C (p < 0.05) and report confidence in doing so (p < 0.05). Only 21% of respondents felt comfortable discussing FGM/C with parents from countries with a high prevalence of FGM/C. Sixty-three percent were not aware of the federal law, and 74% were not aware of their own state's laws about FGM/C. CONCLUSIONS US CAPs have high rates of training related to FGM/C; however, they need additional training to increase confidence and ability to identify FGM/C. FGM/C remains a topic that CAPs find difficult to discuss with families. With culturally sensitive training, CAPs have the opportunity to help manage and prevent the practice by serving as educators and experts for general pediatricians.
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Affiliation(s)
- Grace Pipes
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
- Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, USA.
| | - Spencer Dunleavy
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Jocelyn Brown
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Rodríguez-Sánchez V, Ventura-Miranda MI, Berthe-Kone O, Hernández-Padilla JM, Fernández-Sola C, Molina JG, Morante-García W, García-González J. Understanding the consequences of Female Genital Mutilation: a phenomenological study in sub-Saharan women living in Spain. Midwifery 2023; 123:103711. [PMID: 37172409 DOI: 10.1016/j.midw.2023.103711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 03/20/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Female Genital Mutilation (FGM), which is culturally accepted in some African communities, has serious consequences on the physical, psychological, urogynecological, obstetrical and sexual health of girls and women. It is therefore important to understand women's experiences of the consequences of FGM. OBJECTIVE to understand the experiences of the consequences of female genital mutilation in sub-Saharan female survivors living in Spain. DESIGN a qualitative study based on Merleau-Ponty's hermeneutic phenomenology. PARTICIPANTS AND SETTING 13 sub-Saharan female survivors of female genital mutilation participated. The study was carried out in two south-eastern Spanish provinces where many jobs in the agricultural and service industry are done by African immigrants originating from ethnic groups in which FGM is still prevalent. FINDINGS In-depth interviews were carried out for data collection. ATLAS.ti was used for inductive analysis, from which two main themes were developed that represent the experiences of the consequences of FGM: (a) The impact of FGM: Hijacked sexual health and (b) The difficult process of genital reconstruction: overcoming the aftereffects and regaining integrity. CONCLUSION AND IMPLICATIONS FOR PRACTICE The mutilated women experienced serious consequences in their sexual, psychological and obstetrical health. Genital reconstruction was a difficult decision but contributed to regaining their sexual health and identity. The professionals involved play an important role in the care provided for the associated consequences of FGM, in identifying risk groups and in providing advice that allows the women to regain their sexual and reproductive health.
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Affiliation(s)
| | | | | | | | - Cayetano Fernández-Sola
- Department of Nursing Science, Physiotherapy and Medicine. University of Almeria. Spain; Associated Reseacher, Facultad de Ciencias de la Salud. Universidad Autónoma de Chile. Santiago, Chile.
| | - José Granero Molina
- Department of Nursing Science, Physiotherapy and Medicine. University of Almeria. Spain; Associated Reseacher, Facultad de Ciencias de la Salud. Universidad Autónoma de Chile. Santiago, Chile.
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Akinsulure-Smith AM, Min M. What African immigrant service providers can teach us about the needs of African immigrant survivors of FGM/C. Health Care Women Int 2023; 45:463-474. [PMID: 37010566 PMCID: PMC11062593 DOI: 10.1080/07399332.2023.2196247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
Health and social service providers who immigrated from regions with high Female Genital Mutilation/Cutting (FGM/C) prevalence rates can provide unique insights on serving women with FGM/C experience. Specifically, we investigated African immigrant service providers' knowledge, experience, attitudes about FGM/C, and their recommendations on how to provide services to immigrants from sub-Saharan Africa who have experienced FGM/C. Derived from a larger study, interviews of 10 African service providers were selectively analyzed with a particular attention to cultural insights that could inform the framework in Western destination countries on how to serve women and girls with FGM/C experience.
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Affiliation(s)
- Adeyinka M Akinsulure-Smith
- Department of Psychology, The City College of New York, New York, New York, USA
- The Graduate Center, City University of New York, New York, New York, USA
| | - Moonkyung Min
- Werklund School of Education, University of Calgary, Calgary, Canada
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Hess RF, Ross R, Wyss L, Donnenwirth JA. Nursing students' knowledge gained about female genital cutting/mutilation through dramatization simulation with a standardized patient: A quasi-experimental study. NURSE EDUCATION TODAY 2022; 116:105443. [PMID: 35717812 DOI: 10.1016/j.nedt.2022.105443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 05/26/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Female genital cutting is a culture bound ritual involving excision of the female genitalia. Little is known about nursing students' knowledge and perceptions of female genital cutting and no studies using simulation to teach this topic exist. OBJECTIVE The aim of this study was to examine the impact of a dramatization simulation on nursing students' knowledge about and perceptions of female genital cutting. DESIGN A quasi-experimental pretest posttest study with a convenience sample. SETTING Two Bachelor of Nursing schools in Northeast Ohio, United States. PARTICIPANTS 35 third year undergraduate students. METHODS Students were divided into an intervention group (n = 14) and a wait list control group (n = 21). The intervention group took a pre-test, did a reading assignment and then attended a virtual, dramatization simulation session with a standardized patient; a Muslim woman with a personal history of female genital cutting. They took the posttest within the next week. The control group took the pretest, did the reading assignment, and then took the posttest, followed by the simulation. The survey instrument used for pretest and posttest was the Knowledge, Perceptions, and Practice Questionnaire on Female Genital Cutting for Healthcare Professionals in the United States. Debriefing was a critical part of the simulation. RESULTS The knowledge of female genital cutting of the nursing students in the intervention group increased more than that of the students in the control group (change score 3.57 and 2.05 respectively). Students' perceptions of female genital cutting were not significantly changed by intervention type. CONCLUSION This study was the first of its kind to measure nursing students' knowledge and perceptions about female genital cutting before and after a dramatization simulation. A standardized patient dramatization simulation including focused debriefing may be an effective education strategy to teach nursing students about female genital cutting.
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Affiliation(s)
| | - Ratchneewan Ross
- University of Louisville School of Nursing Health Sciences, Louisville, KY, USA.
| | - Lora Wyss
- Malone University School of Nursing, Canton, OH, USA.
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Wyss L, Donnenwirth JA, Ross R, Hess RF. Educating Nursing Students About Female Genital Cutting/Mutilation Using a Standardized Patient in a Virtual Dramatization Simulation. J Transcult Nurs 2022; 33:652-658. [PMID: 35808892 DOI: 10.1177/10436596221107599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Female genital cutting/mutilation (FGC/M) is a ritual to remove any or all of the external female genitalia. Educational strategies regarding the teaching of FGC/M for nursing students are scarce. The focus of this article is to describe the development, implementation, and evaluation of a virtual, FGC/M-related dramatization simulation with a standardized patient (SP). METHODS This educational intervention used an East African immigrant woman as the SP with 35 undergraduate nursing students in two nursing schools in the Midwest United States. RESULTS Participants appraised the simulation as an effective way to teach and learn about FGC/M. Debriefing was a key part of the simulation. DISCUSSION Students felt the simulation was novel and engaging for a highly sensitive topic. The SP thought the virtual setting made it more comfortable for her to reveal sensitive facts. The researchers confirmed that the simulation required extensive time commitment to develop, critique, and implement.
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Berthe-Kone O, Ventura-Miranda MI, López-Saro SM, García-González J, Granero-Molina J, Jiménez-Lasserrotte MDM, Fernández-Sola C. The Perception of African Immigrant Women Living in Spain Regarding the Persistence of FGM. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13341. [PMID: 34948950 PMCID: PMC8704587 DOI: 10.3390/ijerph182413341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/27/2022]
Abstract
Approximately 200 million women and girls have undergone female genital mutilation (FGM) worldwide. Migration has spread the practice of FGM around the world, thus making it a global public health issue. The objective of this descriptive qualitative study was to explore the perceptions of Sub-Saharan immigrant women in Spain in relation to the causes of the persistence of FGM. In-depth interviews were carried out with 13 female FGM survivors of African origin, followed by inductive data analysis using ATLAS.ti software. Two main themes emerged from the analysis: (1) A family ritual symbolic of purification and (2) a system of false beliefs and deception in favour of FGM. The FGM survivors living in Europe are aware that FGM is a practice that violates human rights yet persists due to a system of false beliefs rooted in family traditions and deception that hides the reality of FGM from young girls or forces them to undergo the practice. The ritualistic nature of FGM and the threat of social exclusion faced by women who have not had it performed on them contributes to its persistence nowadays.
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Affiliation(s)
- Ousmane Berthe-Kone
- Surgical Critical Resuscitation, Torrecárdenas University Hospital, 04009 Almeria, Spain;
| | - María Isabel Ventura-Miranda
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; (J.G.-G.); (J.G.-M.); (M.d.M.J.-L.); (C.F.-S.)
| | | | - Jessica García-González
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; (J.G.-G.); (J.G.-M.); (M.d.M.J.-L.); (C.F.-S.)
| | - José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; (J.G.-G.); (J.G.-M.); (M.d.M.J.-L.); (C.F.-S.)
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 7500000, Chile
| | - María del Mar Jiménez-Lasserrotte
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; (J.G.-G.); (J.G.-M.); (M.d.M.J.-L.); (C.F.-S.)
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, 04120 Almeria, Spain; (J.G.-G.); (J.G.-M.); (M.d.M.J.-L.); (C.F.-S.)
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 7500000, Chile
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Akinsulure-Smith AM, Wong T, Min M. Addressing Female Genital Cutting among service providers in New York. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2021; 52:202-212. [PMID: 34556896 DOI: 10.1037/pro0000381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Tracy Wong
- Brooklyn College. City University of New York
| | - Moonkyung Min
- The City College of New York, City University of New York
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Fay KE, Snead CM, Huennekens K, O'Brian CA, Tom L, Simon MA. United States' Obstetrician/Gynecologists' Readiness to Care for Women Affected by Female Genital Cutting. J Womens Health (Larchmt) 2021; 31:431-438. [PMID: 33926232 DOI: 10.1089/jwh.2020.8622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Female genital cutting (FGC) is a form of gender-based violence with obstetrical and gynecological complications that require recognition and care. Data suggest that United States' physicians are not prepared to care for those who have been affected by this practice. This study evaluated the knowledge and practices of United States' obstetricians and gynecologists to care for patients who have undergone FGC. Materials and Methods: This was a cross-sectional confidential survey distributed electronically to a sample of clinically active members of the American College of Obstetricians and Gynecologists. The survey consisted of questions characterizing care of patients who had undergone FGC and barriers to optimal support. Results: Five hundred forty-eight participants representing a wide range of years in practice, geographical locations, subspecializations, and patient demographics participated. Sixty-six percent of participants had cared for patients who had undergone FGC. Participants' description of their patient population racial/ethnic composition did not correlate with likelihood of treating this patient population. Forty percent of participants reported some form of education about FGC, more often among women, younger physicians, and those in practice for fewer years. Thirty-one percent of participants were comfortable counseling about and 20% were comfortable performing deinfibulation; these percentages were higher among those who had received education or had recently cared for an affected patient. Participants reported insufficient training as the largest barrier to providing care to women. Conclusions: While most physicians in this national cohort had cared for women who had undergone cutting, a minority had any form of education. However, prior education correlated with indicators of improved care. Physicians require additional guidance in treating this important and growing patient population.
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Affiliation(s)
- Kathryn E Fay
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Carrie M Snead
- Department of Research, American College of Obstetrics and Gynecology Research, Washington, District of Columbia, USA
| | - Kaitlin Huennekens
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Catherine A O'Brian
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Laura Tom
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Young J, Rodrigues KK, Imam B, Johnson-Agbakwu C. Female Genital Mutilation/Cutting-Pediatric Physician Knowledge, Training, and General Practice Approach. J Immigr Minor Health 2021; 22:668-674. [PMID: 31602532 DOI: 10.1007/s10903-019-00938-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Female genital mutilation/cutting (FGM/C) is outlawed in much of the world but still mainly occurs from infancy-age 15. Many at-risk and FGM/C-affected girls live in the US. No standard pediatric training exists. A questionnaire assessing FGM/C education, knowledge, diagnostic confidence and external genital examination (EGE) approach was sent to pediatric listservs at 3 hospitals and a child abuse pediatrician (CAP) network. Analysis used χ2 and Fisher's exact tests. Compared to general pediatricians, CAP reported more FGM/C education (RR 2.0 [95% CI 1.3-3.2]), awareness of ICD-9/10 codes (RR 3.2 [95% CI 1.4-7.3]), confidence in identifying sub-types (RR 4.5 [95% CI 2.3-8.7]) and discussing FGM/C (RR 4.2 [95% CI 2.3-7.6]). For 6-12 month olds, 10% of general pediatricians reported never performing EGE at female well child visits (WCV), increasing to > 50% for 17-18 year olds. Pediatric physicians are not trained to diagnose or manage FGM/C. EGE are not done at WCVs and FGM/C diagnoses are missed.
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Affiliation(s)
- Janine Young
- Department of General Pediatrics, Denver Health and Hospital Authority, University of Colorado School of Medicine, 1001 Yosemite St., Denver, CO, 80230, USA.
| | - Kristine Knuti Rodrigues
- Department of General Pediatrics, Denver Health and Hospital Authority, University of Colorado School of Medicine, 1001 Yosemite St., Denver, CO, 80230, USA
| | - Basel Imam
- Department of Pediatric and Adolescent Gynecology, Phoenix Children's Hospital, Phoenix, AZ, USA
- Department of Obstetrics and Gynecology, Edward Hospital, Naperville, IL, USA
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Ugarte-Gurrutxaga MI, Molina-Gallego B, Mordillo-Mateos L, Gómez-Cantarino S, Solano-Ruiz MC, Melgar de Corral G. Facilitating Factors of Professional Health Practice Regarding Female Genital Mutilation: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8244. [PMID: 33171622 PMCID: PMC7664698 DOI: 10.3390/ijerph17218244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 01/26/2023]
Abstract
Introduction: According to figures released by UNICEF (United Nations Children's Fund), more than 200 million girls and women have suffered female genital mutilation (FGM) in 30 African and Middle East countries. An increasing number of African women who come from ethnic groups where FGM is practised are arriving in Western countries. Healthcare professionals play a fundamental role in its prevention. Goals: To learn about the factors that healthcare professionals consider as facilitators for prevention and action when faced with female genital mutilation. Methods: A cross-sectional descriptive study developed on the basis of the qualitative methodological perspective, where 43 healthcare professionals participated. A series of analysis dimensions were established, based on which, the interview and discussion group scripts were designed. Results: Addressing FGM requires a series of structural adaptations of the healthcare system that facilitate the recording and monitoring of cases, both for treatment and for prevention. In addition, it is necessary to establish coordination between the healthcare, social services and education sectors. Conclusions: The existence of a protocol of action and training in its use is one of the key tools to take into account.
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Affiliation(s)
- M Idoia Ugarte-Gurrutxaga
- Department of Nursing, Physical and Occupational Therapy University of Castilla-La Mancha, Campus Toledo, 13001 Ciudad Real, Spain; (M.I.U.-G.); (B.M.-G.); (S.G.-C.); (G.M.d.C.)
| | - Brígida Molina-Gallego
- Department of Nursing, Physical and Occupational Therapy University of Castilla-La Mancha, Campus Toledo, 13001 Ciudad Real, Spain; (M.I.U.-G.); (B.M.-G.); (S.G.-C.); (G.M.d.C.)
| | - Laura Mordillo-Mateos
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina (Toledo), Spain
| | - Sagrario Gómez-Cantarino
- Department of Nursing, Physical and Occupational Therapy University of Castilla-La Mancha, Campus Toledo, 13001 Ciudad Real, Spain; (M.I.U.-G.); (B.M.-G.); (S.G.-C.); (G.M.d.C.)
| | | | - Gonzalo Melgar de Corral
- Department of Nursing, Physical and Occupational Therapy University of Castilla-La Mancha, Campus Toledo, 13001 Ciudad Real, Spain; (M.I.U.-G.); (B.M.-G.); (S.G.-C.); (G.M.d.C.)
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14
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Donnenwirth JA, Hess RF, Wyss L. Searching for content on female genital cutting/mutilation in curriculums of U.S. Nursing Schools. J Prof Nurs 2020; 37:80-85. [PMID: 33674113 DOI: 10.1016/j.profnurs.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Over 500,000 women and girls in the U.S. are at risk for female genital cutting/mutilation, (FGC/M) because their cultural heritage is from countries where FGC/M is prevalent. Nurses lack knowledge about FGC/M, making them less likely to provide culturally congruent care. Little is known about FGC/M-related information in nursing school curriculums. METHODS A total of 403 schools of nursing (SONs) responded to an anonymous online survey to identify the extent, placement, and educational approaches regarding FGC/M found in curricular content in nursing schools in the U.S. RESULTS Fifty-seven percent of respondents did not know if nurses cared for FGC/M-affected women in the region where their nursing school was located. Only 27% of responding schools indicated FGC/M was taught in their curriculums, mostly in undergraduate programs, and primarily during classroom lectures, and rarely by simulation. SONs that were aware that nurses in their region provided care to women and girls at risk for FGC/M were more likely to have content on FGC/M in their curriculums. CONCLUSION Though respondents indicated that this topic is important to global nursing education, it appears that few U.S. nursing students are learning to provide culturally congruent care to women and girls at risk for FGC/M. It is vital that nurse educators include this topic in appropriate places in the curriculum, so that students learn the unique healthcare needs of this population.
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Affiliation(s)
| | - Rosanna F Hess
- Malone University School of Nursing, 2600 Cleveland Ave. NW, Canton, OH 44709, USA.
| | - Lora Wyss
- Malone University School of Nursing, 2600 Cleveland Ave. NW, Canton, OH 44709, USA
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15
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Young J, Nour NM, Macauley RC, Narang SK, Johnson-Agbakwu C. Diagnosis, Management, and Treatment of Female Genital Mutilation or Cutting in Girls. Pediatrics 2020; 146:peds.2020-1012. [PMID: 32719089 DOI: 10.1542/peds.2020-1012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Female genital mutilation or cutting (FGM/C) involves medically unnecessary cutting of parts or all of the external female genitalia. It is outlawed in the United States and much of the world but is still known to occur in more than 30 countries. FGM/C most often is performed on children, from infancy to adolescence, and has significant morbidity and mortality. In 2018, an estimated 200 million girls and women alive at that time had undergone FGM/C worldwide. Some estimate that more than 500 000 girls and women in the United States have had or are at risk for having FGM/C. However, pediatric prevalence of FGM/C is only estimated given that most pediatric cases remain undiagnosed both in countries of origin and in the Western world, including in the United States. It is a cultural practice not directly tied to any specific religion, ethnicity, or race and has occurred in the United States. Although it is mostly a pediatric practice, currently there is no standard FGM/C teaching required for health care providers who care for children, including pediatricians, family physicians, child abuse pediatricians, pediatric urologists, and pediatric urogynecologists. This clinical report is the first comprehensive summary of FGM/C in children and includes education regarding a standard-of-care approach for examination of external female genitalia at all health supervision examinations, diagnosis, complications, management, treatment, culturally sensitive discussion and counseling approaches, and legal and ethical considerations.
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Affiliation(s)
- Janine Young
- Department of General Pediatrics, Denver Health Refugee Clinic, and Human Rights Clinic, Denver Health and Hospitals and School of Medicine, University of Colorado Denver, Denver, Colorado;
| | - Nawal M Nour
- African Women's Health Center, Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Robert C Macauley
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Sandeep K Narang
- Division of Child Abuse Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and
| | - Crista Johnson-Agbakwu
- Refugee Women's Health Clinic, Department of Obstetrics and Gynecology, Valleywise Health Medical Center and Office of Refugee Health, Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, Arizona
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16
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National Survey of US Plastic Surgeon Experience with Female Genital Mutilation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2624. [PMID: 32537325 PMCID: PMC7253244 DOI: 10.1097/gox.0000000000002624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/04/2019] [Indexed: 01/25/2023]
Abstract
Female genital mutilation (FGM) is a growing problem in the United States, with the past few decades showing a dramatic increase in prevalence. This study aims to understand the plastic surgeon experience with FGM and inform preparedness for this rising problem.
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17
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Female Genital Cutting in Immigrant Children—Considerations in Treatment and Prevention in the United States. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00200-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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