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Eshraghi B, Marions L, Berger C, Berggren V. "A part of my life". A qualitative study about perceptions of female genital mutilation and experiences of healthcare among affected women residing in Sweden. BMC Womens Health 2024; 24:304. [PMID: 38778359 PMCID: PMC11110410 DOI: 10.1186/s12905-024-03149-1] [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: 11/07/2023] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Female genital mutilation (FGM) is defined as all procedures involving partial or total removal of the external female genitalia, or other injuries to them for non-medical reasons. Due to migration, healthcare providers in high-income countries need to better understand the consequences of FGM. The aim of this study was to elucidate women's experiences of FGM, with particular focus on perceived health consequences and experiences of healthcare received in Sweden. METHODS A qualitative study was performed through face-to-face, semi-structured interviews with eight women who had experienced FGM in childhood, prior to immigration to Sweden. The transcribed narratives were analyzed using content analysis. RESULTS Three main categories were identified : "Living with FGM", "Living with lifelong health consequences" and "Encounters with healthcare providers". The participants highlighted the motives behind FGM and their mothers' ambivalence in the decision process. Although the majority of participants had undergone FGM type 3, the most severe type of FGM, the lifelong health consequences were diverse. Poor knowledge about FGM, insulting attitude, and lack of sensitive care were experienced when seeking healthcare in Sweden. CONCLUSIONS Our findings indicate that FGM is a complex matter causing a diversity in perceived health consequences in women affected. Increased knowledge and awareness about FGM among healthcare providers in Sweden is of utmost importance. Further, this subject needs to be addressed in the healthcare encounter in a professional way.
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Affiliation(s)
- Bita Eshraghi
- Dept of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.
| | - Lena Marions
- Dept of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - Cecilia Berger
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - Vanja Berggren
- Dept of Neurobiology, Caring Science and Society (NVS), Karolinska Institutet, Stockholm, Sweden
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Harrison R, Iqbal MP, Chitkara U, Adams C, Chauhan A, Mitchell R, Manias E, Alston M, Hadley AM. Approaches for enhancing patient-reported experience measurement with ethnically diverse communities: a rapid evidence synthesis. Int J Equity Health 2024; 23:26. [PMID: 38342909 PMCID: PMC10860321 DOI: 10.1186/s12939-024-02107-5] [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: 03/06/2023] [Accepted: 01/13/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Patient-reported experience measures (PREMs) are used to drive and evaluate unit and organisational-level healthcare improvement, but also at a population level, these measures can be key indicators of healthcare quality. Current evidence indicates that ethnically diverse communities frequently experience poorer care quality and outcomes, with PREMs data required from this population to direct service improvement efforts. This review synthesises evidence of the methods and approaches used to promote participation in PREMs among ethnically diverse populations. METHODS A rapid evidence appraisal (REA) methodology was utilised to identify the disparate literature on this topic. A search strategy was developed and applied to three major electronic databases in July 2022 (Medline; PsycINFO and CINAHL), in addition to websites of health agencies in Organisation for Economic Co-operation and Development countries via grey literature searches. A narrative evidence synthesis was undertaken to address the review question. RESULTS The review resulted in 97 included studies, comprised 86 articles from electronic database searches and 11 articles from the grey literature. Data extraction and synthesis identified five strategies used in PREM instruments and processes to enhance participation among ethnically diverse communities. Strategies applied sought to better inform communities about PREMs, to create accessible PREMs instruments, to support PREMs completion and to include culturally relevant topics. Several methods were used, predominantly drawing upon bicultural workers, translation, and community outreach to access and support communities at one or more stages of design or administration of PREMs. Limited evidence was available of the effectiveness of the identified methods and strategies. PREMs topics of trust, cultural responsiveness, care navigation and coordination were identified as pertinent to and frequently explored with this population. CONCLUSIONS The findings provide a basis for a maturity model that may guide change to increase participation of ethnically diverse communities in PREMs. In the short-medium term, health systems and services must be able to recognise and respond to cultural and linguistic diversity in the population when applying existing PREMs. In the longer-term, by working in collaboration with ethnically diverse communities, systems and services may co-create adapted or novel PREMs that tackle the factors that currently inhibit uptake and completion among ethnically diverse communities.
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Affiliation(s)
- Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences- Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Maha Pervaz Iqbal
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences- Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Upma Chitkara
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences- Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Corey Adams
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences- Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Ashfaq Chauhan
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences- Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Rebecca Mitchell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Monash University, Melbourne, VIC, 3800, Australia
| | - Megan Alston
- Elevating the Human Experience Program, NSW Ministry of Health, Sydney, NSW, 2065, Australia
| | - Anne Marie Hadley
- Elevating the Human Experience Program, NSW Ministry of Health, Sydney, NSW, 2065, Australia
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Obionu IM, Onyedinma CA, Mielewczyk F, Boyle E. UK maternity care experiences of ethnic minority and migrant women: Systematic review. Public Health Nurs 2023; 40:846-856. [PMID: 37548036 DOI: 10.1111/phn.13240] [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: 03/22/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The increasing population of immigrant and migrant women in the United Kingdom has implications to the provision of healthcare and for healthcare experiences. Eliciting women's experiences and perceptions of maternity care received is an important way of monitoring and evaluating the quality of maternity services. This study was designed to explore the maternity care experiences of ethnic minority and migrant women in the United Kingdom. METHODS A literature search for relevant studies was carried across seven databases. We included nine studies carried out between 2015 and February 2022 that met the inclusion criteria. Data were analyzed using a thematic analysis approach. RESULTS Findings showed that ethnic minority women and migrant women have had mixed experiences while utilizing maternity services in the United Kingdom. However, most of the experiences were negative and included issues related to communication, discrimination, culture, access to care, physical comfort, and continuity of care. Only one of the studies reported that the respondents had a wholly positive communication experience, one found that a few women felt the staff were respectful and one reported that the midwives gave the women treatment options that would respect their cultural and religious beliefs. CONCLUSION This study has highlighted some important gaps in the maternity care experiences specific to ethnic minority and migrant women in the United Kingdom which provides useful insights to future policy and clinical practice.
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Affiliation(s)
- Ifeoma Maureen Obionu
- College of Public Health and Social Justice, Saint Louis University, St Louis, Missouri
| | - Chioma Amarachi Onyedinma
- Department of Community Medicine University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Frances Mielewczyk
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Elaine Boyle
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
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Jones L, Danks E, Costello B, Jolly K, Cross-Sudworth F, Latthe P, Fassam-Wright M, Clarke J, Byrne A, Taylor J. Views of female genital mutilation survivors, men and health-care professionals on timing of deinfibulation surgery and NHS service provision: qualitative FGM Sister Study. Health Technol Assess 2023; 27:1-113. [PMID: 36946235 PMCID: PMC10041342 DOI: 10.3310/jhwe4771] [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: 03/17/2023] Open
Abstract
Background Female genital mutilation is an important UK health-care challenge. There are no health benefits of female genital mutilation, and it is associated with lifelong physical, psychological and sexual impacts. The annual cost to the NHS to care for survivors is £100M. Deinfibulation may improve the health and well-being of some women, but there is no consensus on the optimal timing of surgery for type 3 survivors. UK care provision is reportedly suboptimal. Objectives We aimed to explore the views of survivors, men and health-care professionals on the timing of deinfibulation surgery and NHS service provision. Methods This was a qualitative study informed by the Sound of Silence framework. This framework is useful for researching sensitive issues and the health-care needs of marginalised populations. A total of 101 interviews with 44 survivors, 13 men and 44 health-care professionals were conducted, supplemented by two workshops with affected communities (participants, n = 10) and one workshop with stakeholders (participants, n = 30). Data were analysed using a hybrid framework method. Results There was no clear consensus between groups on the optimal timing of deinfibulation. However, within groups, survivors expressed a preference for deinfibulation pre pregnancy; health-care professionals preferred antenatal deinfibulation, with the caveat that it should be the survivor's choice. There was no consensus among men. There was agreement that deinfibulation should take place in a hospital setting and be undertaken by a suitable health-care professional. Decision-making around deinfibulation was complex. Deficiencies in professionals' awareness, knowledge and understanding resulted in impacts on the provision of appropriate care. Although there were examples of good practice and positive care interactions, in general, service provision was opaque and remains suboptimal, with deficiencies most notable in mental health. Deinfibulation reportedly helps to mitigate some of the impacts of female genital mutilation. Interactions between survivors and health-care professionals were disproportionately framed around the law. The way in which services are planned and provided often silences the perspectives and preferences of survivors and their families. Limitations Only a minority of the interviews were conducted in a language other than English, and the recruitment of survivors was predominantly through maternity settings, which meant that some voices may not have been heard. The sample of men was relatively small, limiting interpretation. Conclusions In general, service provision remains suboptimal and can silence the perspectives and preferences of survivors. Deinfibulation services need to be widely advertised and information should highlight that the procedure will be carried out in hospital by suitable health-care professionals and that a range of time points will be offered to facilitate choice. Future services should be developed with survivors to ensure that they are clinically and culturally appropriate. Guidelines should be updated to better reflect the needs of survivors and to ensure consistency in service provision. Future work Research is needed to (1) map female genital mutilation service provision; (2) develop and test effective education to address deficits in awareness and knowledge for affected communities and health-care professionals; and (3) develop, monitor and evaluate clinically and culturally competent female genital mutilation services. Trial registration Current Controlled Trials ISRCTN14710507. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment Programme and will be published in full in Health Technology Assessment; Vol. 27, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Laura Jones
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Emma Danks
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Benjamin Costello
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Fiona Cross-Sudworth
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Pallavi Latthe
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Joanne Clarke
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alison Byrne
- University Hospitals Birmingham NHS Foundation Trust, Heartlands Hospital, Birmingham, UK
| | - Julie Taylor
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Familusi OO, Amutah C, Levin P, Andy U, James A. U.S.-Based Obstetrician/Gynecologists' Experiences with Delivering Care to Women with Female Genital Cutting. J Womens Health (Larchmt) 2023; 32:486-493. [PMID: 36857710 DOI: 10.1089/jwh.2022.0294] [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: 03/03/2023] Open
Abstract
Background: There has been an increase of women living in the United States who have experienced female genital cutting (FGC). However, limited research exists evaluating the experiences of obstetrician/gynecologists delivering care to this patient population. This study aimed to assess the overall experiences, including barriers and facilitators, of U.S.-based obstetrician/gynecologists (OBGYNs) with delivering care to patients with female genital cutting at a single academic health center in the United States. Materials and Methods: This is a qualitative study of OBGYNs at a large, U.S., urban, academic health center. OBGYNs participated in a one-on-one semistructured interview. Thematic analysis using a grounded theory approach was conducted to identify predominating themes regarding the overall experiences, barriers, and facilitators to delivering care to patients with FGC. Results: Analysis of 15 study interviews revealed 4 main themes impacting the ability of OBGYNs to deliver care to patients with FGC: (1) limited educational training on FGC, (2) challenges with identifying that a patient had FGC and with using the World Health Organization classification system, (3) questions regarding "normative" anatomy and reinfibulation after vaginal procedures, and (4) navigating affective responses of patient and self when FGC is encountered. Conclusion: The above findings have practical implications, showing that the limited educational experience and lack of a clear policy on how to manage the care of women with FGC lead to variation and even limitations in how care is delivered to these women. We encourage OBGYN professional societies to consider creating education and policy to aid clinicians in caring for patients with FGC.
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Affiliation(s)
- Olivia O Familusi
- Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina Amutah
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pamela Levin
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania. USA
| | - Uduak Andy
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania. USA
| | - Abike James
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania. USA
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Jacobson D, Grace D, Boddy J, Einstein G. Reproductive health care appointments: How the institutional organization of obstetric/gynecological work shapes the experiences of women with female genital cutting in Toronto, Canada. PLoS One 2023; 18:e0279867. [PMID: 36656810 PMCID: PMC9851502 DOI: 10.1371/journal.pone.0279867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/15/2022] [Indexed: 01/20/2023] Open
Abstract
We investigated the social relations shaping the reproductive health care experiences of women with female genital cutting (FGC) in Toronto, Canada. Using Institutional Ethnography, we interviewed eight women with FGC and seven obstetrician/gynecologists (OB/GYN). We found a disjuncture between women's needs during appointments that extended beyond the reproductive body and range of care that doctors were able to provide. Women engaged in emotional healthwork during appointments by explaining FGC to doctors, reading doctors' body language, and getting through vulvar/vaginal examinations. Women reported that if they had emotional reactions during appointments, they were often referred to a mental health specialist, a referral on which they did not act. OB/GYNs described their specialty as "surgical"-training centered around treating reproductive abnormalities and not mental health issues. Therefore, the disjuncture between women's needs and OB/GYNs' institutional training highlights the difficulties inherent when bodies of "difference" encounter the reproductive health care system.
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Affiliation(s)
- Danielle Jacobson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- * E-mail:
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Janice Boddy
- Department of Anthropology, University of Toronto, Toronto, Canada
| | - Gillian Einstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Psychology, University of Toronto, Toronto, Canada
- Department of Gender Studies, Linköping University, Linköping, Sweden
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González-Timoneda A, Sánchez AC, González-Timoneda M, Ros VR. Cultural Beliefs, Perceptions, and Experiences on Female Genital Mutilation Among Women and Men: A Qualitative Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP15504-NP15531. [PMID: 34011175 DOI: 10.1177/08862605211015257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The practice of female genital mutilation (FGM) is a deeply-rooted tradition that affects predominantly regions of Africa and Asia. Because of migration flows, FGM is an issue of increasing concern worldwide. FGM is now carried out in Europe, North America, Australia and New Zealand, and more specifically among immigrant communities from countries where it is common. This study aims to assess the experience, knowledge, attitudes, and beliefs related to FGM of migrant women and men from FGM-affected countries residing in Spain and the United Kingdom. A phenomenological qualitative approach was used. Participants (n=23) were recruited by using the snowball sampling technique until data saturation was reached. Data were collected through 18 open-ended interviews and a focus group. Of the 23 participants, 20 women had undergone FGM. The following five themes were generated from interviews: (a) FGM practice development, (b) knowledge about the practice, (c) reasons for performing FGM, (d) attitudes toward continuing or abandoning the practice, and (e) criminalization of FGM. The study here presented identifies a lack of information, memory, and knowledge about the practice of FGM and typology among women with FGM. The justification of the practice seems to be based on a multifactorial model, where sociocultural and economic factors, sexual factors, hygienic-esthetic factors, and religious-spiritual factors take on a greater role in the analysis of the interviews carried out. The participants practically unanimously agree to advocate the abandonment and eradication of this harmful traditional practice. The knowledge displayed in this study may provide a basis for improving awareness and healthcare in such collectives, aiming the eradication of this harmful traditional practice.
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MacLellan J, Collins S, Myatt M, Pope C, Knighton W, Rai T. Black, Asian and minority ethnic women's experiences of maternity services in the UK: A qualitative evidence synthesis. J Adv Nurs 2022; 78:2175-2190. [PMID: 35332568 PMCID: PMC9314829 DOI: 10.1111/jan.15233] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/24/2022] [Accepted: 02/21/2022] [Indexed: 01/13/2023]
Abstract
AIMS Black, Asian and minority ethnic women are at higher risk of dying during pregnancy, childbirth and postnatally and of experiencing premature birth, stillbirth or neonatal death compared with their White counterparts. Discrimination against women from ethnic minorities is known to negatively impact women's ability to speak up, be heard and their experiences of care. This evidence synthesis analysed Black, Asian and minority ethnic women's experiences of UK maternity services in light of these outcomes. DESIGN We conducted a systematic review and qualitative evidence synthesis using the method of Thomas and Harden. DATA SOURCES A comprehensive search in AMED, Cinahl, Embase, Medline, PubMed and PsycINFO, alongside research reports from UK maternity charities, was undertaken from 2000 until May 2021. Eligible studies included qualitative research about antenatal, intrapartum and postnatal care, with ethnic minority women in maternity settings of the UK NHS. REVIEW METHODS Study quality was graded using the Critical Appraisal Skills Programme tool. RESULTS Twenty-four studies met the inclusion criteria. Our synthesis highlights how discriminatory practices and communication failures in UK NHS maternity services are failing ethnic minority women. CONCLUSION This synthesis finds evidence of mistreatment and poor care for ethnic minority women in the UK maternity system that may contribute to the poor outcomes reported by MBRRACE. Woman-centred midwifery care is reported as positive for all women but is often experienced as an exception by ethnic minority women in the technocratic birthing system. IMPACT Ethnic minority women report positive experiences when in receipt of woman-centred midwifery care. Woman-centred midwifery care is often the exception in the overstretched technocratic UK birthing system. Mistreatment and poor care reported by many ethnic minority women in the UK could inform the inequalities of outcomes identified in the MBRRACE report.
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Affiliation(s)
- Jennifer MacLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Sarah Collins
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Level 3, Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - Margaret Myatt
- University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | | | - Tanvi Rai
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
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Jacobson D, Grace D, Boddy J, Einstein G. Emotional Health Work of Women With Female Genital Cutting Prior to Reproductive Health Care Encounters. QUALITATIVE HEALTH RESEARCH 2022; 32:108-120. [PMID: 34865565 PMCID: PMC8739574 DOI: 10.1177/10497323211049225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We used institutional ethnography to explore the social relations that shaped the reproductive health care experiences of women with female genital cutting. Interviews with eight women revealed that they engaged in discourse that opposed the practices of cutting female genitals as a human-rights violation. This discourse worked to protect those affected by the practices, but also stigmatized female genital cutting, making participants anticipate experiencing stigmatization during health care. Women's engagement in this discourse shaped their emotional health work to prepare for such encounters. This work included navigating feelings of worry, shame, and courage to understand what to expect during their own appointment; learning from family/friends' experiences; and seeking a clinic with the reputation of best care for women with female genital cutting. It is important to strive for more inclusive health care in which women do not have to engage in emotional health work to prepare for their clinical encounters.
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Affiliation(s)
- Danielle Jacobson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Janice Boddy
- Department of Anthropology, University of Toronto, Toronto, ON, Canada
| | - Gillian Einstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Department of Gender Studies, Linköping University, Linköping, Sweden
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Lived Experiences and Perceptions of Childbirth among Pastoralist Women in North-Eastern Ethiopia: A Multimethod Qualitative Analysis to the WHO Health Systems Responsiveness Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312518. [PMID: 34886246 PMCID: PMC8656568 DOI: 10.3390/ijerph182312518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/20/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022]
Abstract
Maternity should be a time of hope and joy. However, for women in pastoralist communities in Ethiopia, the reality of motherhood is often grim. This problem is creating striking disparities of skilled birth uptake among the agrarian and pastoral communities in Ethiopia. So far, the depth and effects of the problem are not well understood. This study is intended to fill this research gap by exploring mothers’ lived experiences and perceptions during skilled birthing care in hard-to-reach communities of Ethiopia. An Interpretive Phenomenological approach was employed to analyse the exploratory data. Four key informant interviews, six in-depth interviews, six focus group discussions, and twelve focused observations were held. WHO responsiveness domains formed the basis for coding and analysis: dignity, autonomy, choice of provider, prompt attention, communication, social support, confidentiality, and quality of basic amenities. The skilled birthing experience of nomadic mothers is permeated by a deep-rooted and hidden perceived neglect, which constitutes serious challenges to the health system. Mothers’ experiences reflect not only the poor skilled delivery uptake, but also how health system practitioners are ignorant of Afar women’s way of life, their living contexts, and their values and beliefs regarding giving birth. Three major themes emerged from data analysis: bad staff attitude, lack of culturally acceptable care, and absence of social support. Nomadic mothers require health systems that are responsive and adaptable to their needs, beliefs, and values. The abuse and disrespect they experience from providers deter nomadic women from seeking skilled birthing care. Women’s right to dignified, respectful, skilled delivery care requires the promotion of woman-centred care in a culturally appropriate manner. Skilled birthing care providers should be cognizant of the WHO responsiveness domains to ensure the provision of culturally sensitive birthing care.
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Agbemenu K, Banke-Thomas A, Ely G, Johnson-Agbakwu C. Avoiding obstetrical interventions among US-based Somali migrant women: a qualitative study. ETHNICITY & HEALTH 2021; 26:1082-1097. [PMID: 31072134 DOI: 10.1080/13557858.2019.1613519] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/20/2019] [Indexed: 06/09/2023]
Abstract
Objective: Somali refugee women are known to have poor health-seeking behavior with a higher proportion of adverse pregnancy outcomes compared to US-born women. Yet unknown is how they avoid obstetrical interventions. This study sought to identify perceived protective mechanisms used to avoid obstetric interventions as well as the underpinning factors that influence aversion to obstetrical interventions by Somali refugee women.Design: A descriptive, exploratory qualitative study purposively sampled Somali refugee women recruited via snowball technique in Franklin County, Ohio, United States. Data were collected through audio-recordings of individual interviews and focus groups conducted in English and Somali languages. The collected data were transcribed and analyzed using thematic analyses.Results: Forty Somali refugee women aged 18-42 years were recruited. Participants reported engaging in four perceived protective mechanisms to avoid obstetrical interventions during pregnancy and childbirth: (1) intentionally not seeking or misleading prenatal care, (2) changing hospitals and/or providers, (3) delayed hospital arrival during labor, and (4) refusal of care. Underpinning all four avoidance mechanisms were their significant fear of obstetrical interventions, and perceived lack of choice in their care processes as influenced by cultural and/or religious beliefs, feeling judged or undervalued by service providers, and a lack of privacy provided to them while receiving care.Conclusion: Like every woman, Somali women also have a right to choose or refuse care. If the intention is to improve access to and experiences with care for this population, building trust, addressing their fears and concerns, and respecting their culture is a critical first step. This should be well established prior to the need for critical decisions surrounding pregnancy and childbirth wherein Somali women may feel compelled to refuse necessary obstetrical care. Bridging gaps between Somali women and their providers is key to advance health equity for this vulnerable population.
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Affiliation(s)
- Kafuli Agbemenu
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY, USA
| | - Aduragbemi Banke-Thomas
- Department of Health Policy, London School of Economics and Political Science, London, UK
- Refugee Women's Health Clinic, Women's Care Center, Maricopa Integrated Health System, Phoenix, AZ, USA
| | - Gretchen Ely
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY, USA
| | - Crista Johnson-Agbakwu
- Refugee Women's Health Clinic, Women's Care Center, Maricopa Integrated Health System, Phoenix, AZ, USA
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ, USA
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Female Genital Mutilation Consequences and Healthcare Received among Migrant Women: A Phenomenological Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137195. [PMID: 34281134 PMCID: PMC8296853 DOI: 10.3390/ijerph18137195] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 11/17/2022]
Abstract
European healthcare systems are increasingly being challenged to respond to female genital mutilation (FGM). This study explores the FGM experiences of migrant women coming from FGM-practicing countries residing in a European host country. A qualitative phenomenological study was carried out and 23 participants were included. Data were collected through 18 face-to-face open-ended interviews and a focus group and were analysed using Giorgi’s four-step phenomenological approach. Three main themes were derived: “FGM consequences”, “healthcare received” and “tackling FGM”. Participants highlighted obstetric, gynaecological and genitourinary consequences such as haemorrhages, perineal tears, caesarean delivery, risk of infection, dysmenorrhea, urinary tract infections and dysuria; consequences for sexuality, mainly, dyspareunia, loss of sexual interest and decreased quality of sexual intercourse; and psychological consequences such as loss of self-esteem, feelings of humiliation and fear of social and familial rejection. Women perceived a profound lack of knowledge about FGM from health providers and a lack of sensitive and empathetic care. Some women perceived threatening and disproportionate attitudes and reported negative experiences. Participants highlighted the importance of educating, raising awareness and improving prevention and detection strategies. The findings disclose the need to improve training and institutional plans to address structural and attitudinal barriers to health equity across migrant families in their host countries.
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Johnson-Agbakwu CE, Manin E. Sculptors of African Women's Bodies: Forces Reshaping the Embodiment of Female Genital Cutting in the West. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1949-1957. [PMID: 32328914 PMCID: PMC8275492 DOI: 10.1007/s10508-020-01710-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 05/05/2023]
Affiliation(s)
- Crista E Johnson-Agbakwu
- Southwest Interdisciplinary Research Center, Watts College of Public Service and Community Solutions, Arizona State University, MC 5120, 201 North Central Avenue, 33rd Floor, Phoenix, AZ, 85004, USA.
- Refugee Women's Health Clinic, Obstetrics and Gynecology, Valleywise Health, Phoenix, AZ, USA.
| | - Emily Manin
- Southwest Interdisciplinary Research Center, Watts College of Public Service and Community Solutions, Arizona State University, MC 5120, 201 North Central Avenue, 33rd Floor, Phoenix, AZ, 85004, USA
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The experiences and psychological outcomes for pregnant women who have had FGM: A systematic review. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100639. [PMID: 34051456 DOI: 10.1016/j.srhc.2021.100639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/10/2021] [Accepted: 05/04/2021] [Indexed: 12/15/2022]
Abstract
Female genital mutilation (FGM) is a global issue, with 200 million women and girls thought to be affected. FGM is defined as removal of female external genitalia, either partial or total, for non-medical purposes. FGM is embedded in tradition, including cultural beliefs about sexual behaviour. Associated risks include haemorrhage, infection, death, dyspareunia, childbirth complications and psychological issues. Although FGM negatively impacts on women's psychological wellbeing, little is known about the impact on pregnancy experiences. Psychological consequences of FGM are likely to be intensified during pregnancy when women have concerns about their own and their baby's wellbeing. This mixed-method systematic review aimed to provide insight into the psychological impact of FGM on women who subsequently become pregnant. Nine electronic databases were searched, using a search strategy to identify relevant studies. Studies were considered for inclusion if they were primary studies (qualitative, quantitative or mixed-method) involving pregnant women of any age who have previously undergone FGM. Relevant studies were evaluated using the MMAT appraisal tool. Analysis was guided by the review questions and the evidence identified. One quantitative and 9 qualitative papers were included. Qualitative data were analysed using meta-ethnography. Narrative analysis of the quantitative study was conducted. Findings relate to power of choice linked to reinfibulation, deinfibulation, birth procedures and pain management; importance of knowledgeable and sensitive health care professionals; and relived trauma experienced during childbirth. These findings could inform the development of supportive interventions for women with FGM within maternity services.
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Dixon S, Duddy C, Harrison G, Papoutsi C, Ziebland S, Griffiths F. Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations. BMJ Open 2021; 11:e039809. [PMID: 33753429 PMCID: PMC7986780 DOI: 10.1136/bmjopen-2020-039809] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/11/2020] [Accepted: 11/09/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Little is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients. SETTING Primary care in England. DATA SOURCES Realist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients. PRIMARY OUTCOME MEASURE This realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated. RESULTS 124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations. CONCLUSIONS There is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities' health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation. PROSPERO REGISTRATION NUMBER CRD42018091996.
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Affiliation(s)
- Sharon Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Frances Griffiths
- Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
- Warwick Medical School, University of Warwick, Coventry, UK
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16
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Effects of clitoral reconstruction for female genital mutilation on perinatal outcomes: A retrospective case-control study. J Gynecol Obstet Hum Reprod 2020; 50:101954. [PMID: 33080401 DOI: 10.1016/j.jogoh.2020.101954] [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: 08/08/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To investigate the perinatal outcomes of women with a history of female genital mutilation (FGM) who underwent clitoral reconstruction (CR) compared with women with FGM who did not undergo CR. MATERIAL AND METHODS Retrospective case-control study at Angers University Hospital, between 2005 and 2017. INCLUSION CRITERIA pregnant women >18 years who underwent CR after FGM. Only the first subsequent delivery after CR was included. Each woman with CR was matched for age, ethnicity, FGM type, parity, and gestational age at the time of delivery with two women with FGM who did not undergo CR during the same period of time. At birth, the main outcomes were the need for episiotomy and having an intact perineum after delivery. RESULTS 84 women were included (28 in the CR group; 56 in the control group). In the CR group, patients required significantly fewer episiotomies (5/17[29.4 %]) compared to the control group (28/44[63.6 %], p = 0.02), even after excluding operative vaginal deliveries (2/13[15.4 %] vs 21/36[58.3], p < 0.01). CR reduces the risk of episiotomy (aOR = 0.15, 95 %CI [0.04-0.56]; p < 0.01) after adjusting on the infant weight and the need for instrumental delivery. In the CR group, 47 % of the patients had an intact perineum after delivery, compared to 20.4 % in the control group (p = 0.04). CR increases the odds of having an intact perineum at birth by 3.46 times (CI95 %[1.04-11.49]; p = 0.04). CONCLUSION CR after FGM increases the chances of having an intact perineum after delivery by 3.46 times and reduces the risk of episiotomy by 0.15 times compared to women with FGM who did not underwent CR.
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Ziyada MM, Lien IL, Johansen REB. Sexual norms and the intention to use healthcare services related to female genital cutting: A qualitative study among Somali and Sudanese women in Norway. PLoS One 2020; 15:e0233440. [PMID: 32421757 PMCID: PMC7233551 DOI: 10.1371/journal.pone.0233440] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/05/2020] [Indexed: 11/30/2022] Open
Abstract
Background Female Genital Cutting (FGC) is a traditionally meaningful practice in Africa, the Middle East, and Asia. It is associated with a high risk of long-term physical and psychosexual health problems. Girls and women with FGC-related health problems need specialized healthcare services such as psychosexual counseling, deinfibulation, and clitoral reconstruction. Moreover, the need for psychosexual counseling increases in countries of immigration where FGC is not accepted and possibly stigmatized. In these countries, the practice loses its cultural meaning and girls and women with FGC are more likely to report psychosexual problems. In Norway, a country of immigration, psychosexual counseling is lacking. To decide whether to provide this and/or other services, it is important to explore the intention of the target population to use FGC-related healthcare services. That is as deinfibulation, an already available service, is underutilized. In this article, we explore whether girls and women with FGC intend to use FGC-related healthcare services, regardless of their availability in Norway. Methods We conducted 61 in-depth interviews with 26 Somali and Sudanese participants with FGC in Norway. We then validated our findings in three focus group discussions with additional 17 participants. Findings We found that most of our participants were positive towards psychosexual counseling and would use it if available. We also identified four cultural scenarios with different sets of sexual norms that centered on getting and/or staying married, and which largely influenced the participants’ intention to use FGC-related services. These cultural scenarios are the virgin, the passive-, the conditioned active-, and the equal- sexual partner scenarios. Participants with negative attitudes towards the use of almost all of the FGC-related healthcare services were influenced by a set of norms pertaining to virginity and passive sexual behavior. In contrast, participants with positive attitudes towards the use of all of these same services were influenced by another set of norms pertaining to sexual and gender equality. On the other hand, participants with positive attitudes towards the use of services that can help to improve their marital sexual lives, yet negative towards the use of premarital services were influenced by a third set of norms that combined norms from the two aforementioned sets of norms. Conclusion The intention to use FGC-related healthcare services varies between and within the different ethnic groups. Moreover, the same girl or woman can have different attitudes towards the use of the different FGC-related healthcare services or even towards the same services at the different stages of her life. These insights could prove valuable for Norwegian and other policy-makers and healthcare professionals during the planning and/or delivery of FGC-related healthcare services.
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Affiliation(s)
- Mai Mahgoub Ziyada
- Section for Trauma, Catastrophes and Forced Migration—Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- * E-mail:
| | - Inger-Lise Lien
- Section for Trauma, Catastrophes and Forced Migration—Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - R. Elise B. Johansen
- Section for Trauma, Catastrophes and Forced Migration—Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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18
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Wallmo S, Allgurin K, Berterö C. The lived experience among Somali women of giving birth in Sweden: an interpretive phenomenological study. BMC Pregnancy Childbirth 2020; 20:262. [PMID: 32357845 PMCID: PMC7193409 DOI: 10.1186/s12884-020-02933-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 04/12/2020] [Indexed: 11/10/2022] Open
Abstract
Background The health care-seeking behaviour among Somali women is different from Swedish women’s behaviour, and this may have consequences for birth giving. The aim of the study was to identify and describe Somali women’s lived experience of birth giving in Sweden. Methods Qualitative individual interviews were conducted in Swedish with seven Somali women. The sample was purposeful, and the snowball sampling method was used. The interviews were digitally recorded and transcribed verbatim. Data were analysed using interpretative phenomenological analysis. Results Four themes emerged during the analysis which revealed the Somali women’s lived experiences of giving birth in Sweden. a) Being recognised and confirmed as a woman. Somali women consider it important to be confirmed as a woman by the surrounding and professionals during pregnancy and birth giving. b) Communication is important for the women’s independence. There is a need to provide a structure for how this information is given and adaptation regarding content and format .c) Something naturally becomes unknown and complicated. Somali women come from a different culture, which affects their lived experiences of pregnancy and birth giving. There is a need for improved and clearer information for these Somali women regarding pregnancy and birth giving in another culture- the Swedish context d) Professional and competent taking care of. The women appreciate if they are treated with competency and professionalism; they do not want to be discriminated. The women feel confidence in health care when they meet competent and professional health care professionals. Conclusions The findings in the study indicate that reproductive health care for Somali women should be improved with regard to cultural differences and lived experiences, as this affects their experience of pregnancy and childbirth in Sweden. There is a need for both knowledge and understanding in order to provide good quality care for these Somali women, especially those who have been genitally mutilated.
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Affiliation(s)
- Susanne Wallmo
- Women's Health Care, Gynaecological Clinic Ryhov Region County Hospital, SE- 551 85, Jönköping, Sweden
| | - Karin Allgurin
- Maternity Ward, Gynaecological Clinic Ryhov County Region Hospital, SE- 551 85, Jönköping, Sweden
| | - Carina Berterö
- Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, SE- 581 83, Linköping, Sweden.
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Mbanya VN, Terragni L, Gele AA, Diaz E, Kumar BN. Barriers to access to the Norwegian healthcare system among sub-Saharan African immigrant women exposed to female genital cutting. PLoS One 2020; 15:e0229770. [PMID: 32187198 PMCID: PMC7080260 DOI: 10.1371/journal.pone.0229770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 02/14/2020] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Millions of women and girls have been exposed to female genital cutting (FGC). The practice of FGC extends beyond countries in Africa and Asia in which it is traditionally practiced. Women living with FGC in Norway have been reported to be in need of healthcare, but there is evidence of suboptimal use of healthcare services among this group, and we lack the women's perspective about this problem. This study aims to explore the experiences and perceptions hindering access and use of the Norwegian healthcare system among sub- Saharan African (SSA) immigrant women exposed to FGC. METHOD This qualitative research was conducted using purposive and snowball sampling to recruit thirteen SSA immigrant women in Norway previously exposed to FGC. Interviews were conducted from October 2017 to July 2018. The Interpretative Phenomenological Analysis method was used. RESULTS The findings indicate that women experience barriers both in reaching out to the healthcare system and within the healthcare system. Barriers prior to contact with the healthcare system include lack of information, husband and family influence on healthcare, and avoiding disclosing health problems. Barriers within the healthcare system include care providers with insufficient knowledge and poor attitudes of care providers. CONCLUSION This study reveals multiple barriers to healthcare access that co-exist and overlap. This indicates that SSA immigrant women are 'left behind' in being able to access and use the Norwegian healthcare system. Therefore, appropriate interventions to improve access to healthcare should be considered in order to reach Universal Health Coverage, thus having a positive impact on the health of these women. Equitable healthcare should be reflected in policy and practice.
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Affiliation(s)
- Vivian N. Mbanya
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Laura Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Abdi A. Gele
- Unit for Migration and Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
| | - Esperanza Diaz
- Unit for Migration and Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bernadette N. Kumar
- Unit for Migration and Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
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20
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Akpak YK, Yilmaz I. The impact of female genital mutilation/cutting on obstetric outcomes and its management. J Matern Fetal Neonatal Med 2020; 35:927-932. [PMID: 32131659 DOI: 10.1080/14767058.2020.1734925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Female genital mutilation/cutting (FGM/C) is a surgical intervention that is still widely performed around the world with serious obstetric and neonatal outcomes. We aimed to determine the obstetric and neonatal effects of FGM/C in pregnant women in a hospital with high standards of care in Sudan, where this is a common case, using a homogenous patient group.Methods: This is a retrospective cohort study in pregnant women with FGM/C, conducted at Nyala, Sudan-Turkey Training and Research Hospital. The inclusion criteria were: >18 years of age, history of FGM/C, vertex presentation, full-term birth, and single pregnancy. FGM/C group was compared with women without FGM/C (control group) who were monitored for the same period of 8 months in terms of age, parity, gestational age, and obstetric and neonatal outcomes.Results: A total of 220 eligible pregnant women were included in the study. Each group consisted of 110 pregnant women (FGM/C and control groups). We noticed that in the FGM/C group more emergency C-sections occurred, the second stage of the delivery was prolonged significantly, and episiotomy and periclitoral injuries were higher. Also, it was seen that postpartum blood loss and hospitalization of the mother lasted longer in the FGM/C group. No significant differences were found between the two groups with regard to newborns.Conclusions: FGM/C is definitely associated with poor obstetric outcomes. These patients should be diagnosed during the antenatal period, and the delivery processes should be managed by experienced healthcare professionals according to the type of FGM/C.
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Affiliation(s)
- Yaşam Kemal Akpak
- Department of Obstetrics and Gynaecology, Tepecik Training and Research Hospital, University of Health Science, Izmir, Turkey.,Department Obstetrics and Gynaecology, Nyala Sudan-Turkey Training and Research Hospital, University of Health Science, Nyala, Sudan
| | - Ismayil Yilmaz
- Department Obstetrics and Gynaecology, Nyala Sudan-Turkey Training and Research Hospital, University of Health Science, Nyala, Sudan.,Department of General Surgery, Okmeydanı Training and Research Hospital, University of Health Science, Istanbul, Turkey
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Higginbottom GMA, Evans C, Morgan M, Bharj KK, Eldridge J, Hussain B, Salt K. Access to and interventions to improve maternity care services for immigrant women: a narrative synthesis systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In 2016, over one-quarter of births in the UK (28.2%) were to foreign-born women. Maternal and perinatal mortality are disproportionately higher among some immigrants depending on country of origin, indicating the presence of deficits in their care pathways and birth outcomes.
Objectives
Our objective was to undertake a systematic review and narrative synthesis of empirical research that focused on access and interventions to improve maternity care for immigrant women, including qualitative, quantitative and mixed-methods studies.
Review methods
An information scientist designed the literature database search strategies (limited to retrieve literature published from 1990 to 2018). All retrieved citations (45,954) were independently screened by two or more team members using a screening tool. We searched grey literature reported in related databases and websites. We contacted stakeholders with subject expertise. In this review we define an immigrant as a person who relocates to the destination country for a minimum of 1 year, with the goal of permanent residence.
Results
We identified 40 studies for inclusion. Immigrant women tended to book and access antenatal care later than the recommended first 10 weeks of pregnancy. Primary factors included limited English-language skills, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Immigrant women had mixed perceptions regarding how health-care professionals (HCPs) had delivered maternity care services. Those with positive perceptions felt that HCPs were caring, confidential and openly communicative. Those with negative views perceived HCPs as rude, discriminatory or insensitive to their cultural and social needs; these women therefore avoided accessing maternity care. We found very few interventions that had focused on improving maternity care for these women and the effectiveness of these interventions has not been rigorously evaluated.
Limitations
Our review findings are limited by the available research evidence related to our review questions. There may be many aspects of immigrant women’s experiences that we have not addressed. For example, few studies exist for perinatal mental health in immigrant women from Eastern European countries (in the review period). Many studies included both immigrant and non-immigrant women.
Conclusions
Available evidence suggests that the experiences of immigrant women in accessing and using maternity care services in the UK are mixed; however, women largely had poor experiences. Contributing factors included a lack of language support, cultural insensitivity, discrimination and poor relationships between immigrant women and HCPs. Furthermore, a lack of knowledge of legal entitlements and guidelines on the provision of welfare support and maternity care to immigrants compounds this.
Future work
Studies are required on the development of interventions and rigorous scientific evaluation of these interventions. Development and evaluation of online antenatal education resources in multiple languages. Development and appraisal of education packages for HCPs focused on the provision of culturally safe practice for the UK’s diverse population. The NHS in the UK has a hugely diverse workforce with a vast untapped linguistic resource; strategies could be developed to harness this resource.
Study registration
This study is registered as PROSPERO CRD42015023605.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gina MA Higginbottom
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Catrin Evans
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | | | - Jeanette Eldridge
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Basharat Hussain
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Karen Salt
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
- Centre for Research into Race and Rights, University of Nottingham, Nottingham, UK
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Kimani S, Kabiru CW, Muteshi J, Guyo J. Exploring barriers to seeking health care among Kenyan Somali women with female genital mutilation: a qualitative study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2020; 20:3. [PMID: 31992317 PMCID: PMC6986153 DOI: 10.1186/s12914-020-0222-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 01/20/2020] [Indexed: 01/29/2023]
Abstract
Background Female genital mutilation/cutting (FGM/C) is a cultural practice associated with health consequences, women rights and deprivation of dignity. Despite FGM/C-related health consequences, circumcised women may encounter additional challenges while seeking interventions for reproductive health problems. Experiences of women/girls while accessing health services for reproductive health problems including FGM/C-related complications in poor, remote and hard to reach areas is poorly understood. We sought to explore barriers to care seeking among Somali women with complications related to FGM/C in public health facilities in Kenya. Methods We drew on qualitative data collected from purposively selected women aged 15–49 years living with FGM/C, their partners, community leaders, and health providers in Nairobi and Garissa Counties. Data were collected using in-depth interviews (n = 10), key informant interviews (n = 23) and 20 focus group discussions. Data were transcribed and analyzed thematically using NVivo version 12. Results Barriers were grouped into four thematic categories. Structural barriers to care-seeking, notably high cost of care, distance from health facilities, and lack of a referral system. Concerns regarding perceived quality of care also presented a barrier. Women questioned health professionals’ and health facilities’ capacity to offer culturally-sensitive FGM/C-specific care, plus ensuring confidentiality and privacy. Women faced socio-cultural barriers while seeking care particularly cultural taboos against discussing matters related to sexual health with male clinicians. Additionally, fear of legal sanctions given the anti-FGM/C law deterred women with FGM/C-related complications from seeking healthcare. Conclusion Structural, socio-cultural, quality of service, and legal factors limit health seeking for reproductive health problems including FGM/C-related complications. Strengthening health system should consider integration of FGM/C-related interventions with existing maternal child health services for cost effectiveness, efficiency and quality care. The interventions should address health-related financial, physical and communication barriers, while ensuring culturally-sensitive and confidential care.
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Affiliation(s)
- Samuel Kimani
- Africa Coordinating Centre for the Abandonment of FGM/C (ACCAF), University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya. .,School of Nursing Sciences, University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya.
| | | | - Jacinta Muteshi
- Population Council-Kenya, PO Box 17643-00500, Nairobi, Kenya
| | - Jaldesa Guyo
- Africa Coordinating Centre for the Abandonment of FGM/C (ACCAF), University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya.,School of Nursing Sciences, University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya
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Higginbottom GMA, Evans C, Morgan M, Bharj KK, Eldridge J, Hussain B. Experience of and access to maternity care in the UK by immigrant women: a narrative synthesis systematic review. BMJ Open 2019; 9:e029478. [PMID: 31892643 PMCID: PMC6955508 DOI: 10.1136/bmjopen-2019-029478] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED One in four births in the UK is to foreign-born women. In 2016, the figure was 28.2%, the highest figure on record, with maternal and perinatal mortality also disproportionately higher for some immigrant women. Our objective was to examine issues of access and experience of maternity care by immigrant women based on a systematic review and narrative synthesis of empirical research. REVIEW METHODS A research librarian designed the search strategies (retrieving literature published from 1990 to end June 2017). We retrieved 45 954 citations and used a screening tool to identify relevance. We searched for grey literature reported in databases/websites. We contacted stakeholders with expertise to identify additional research. RESULTS We identified 40 studies for inclusion: 22 qualitative, 8 quantitative and 10 mixed methods. Immigrant women, particularly asylum-seekers, often booked and accessed antenatal care later than the recommended first 10 weeks. Primary factors included limited English language proficiency, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Maternity care experiences were both positive and negative. Women with positive perceptions described healthcare professionals as caring, confidential and openly communicative in meeting their medical, emotional, psychological and social needs. Those with negative views perceived health professionals as rude, discriminatory and insensitive to their cultural and social needs. These women therefore avoided continuously utilising maternity care.We found few interventions focused on improving maternity care, and the effectiveness of existing interventions have not been scientifically evaluated. CONCLUSIONS The experiences of immigrant women in accessing and using maternity care services were both positive and negative. Further education and training of health professionals in meeting the challenges of a super-diverse population may enhance quality of care, and the perceptions and experiences of maternity care by immigrant women.
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Affiliation(s)
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Sciences, King's College London, London, UK
| | | | - Jeanette Eldridge
- Research and Learning Services, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Basharat Hussain
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Rayment‐Jones H, Harris J, Harden A, Khan Z, Sandall J. How do women with social risk factors experience United Kingdom maternity care? A realist synthesis. Birth 2019; 46:461-474. [PMID: 31385354 PMCID: PMC6771833 DOI: 10.1111/birt.12446] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Echoing international trends, the most recent United Kingdom reports of infant and maternal mortality found that pregnancies to women with social risk factors are over 50% more likely to end in stillbirth or neonatal death and carry an increased risk of premature birth and maternal death. The aim of this realist synthesis was to uncover the mechanisms that affect women's experiences of maternity care. METHODS Using realist methodology, 22 papers exploring how women with a wide range of social risk factors experience maternity care in the United Kingdom were included. The data extraction process identified contexts (C), mechanisms (M), and outcomes (0). RESULTS Three themes, Resources, Relationships, and Candidacy, overarched eight CMO configurations. Access to services, appropriate education, interpreters, practical support, and continuity of care were particularly relevant for women who are unfamiliar with the United Kingdom system and those living chaotic lives. For women with experience of trauma, or those who lack a sense of control, a trusting relationship with a health care professional was key to regaining trust. Many women who have social care involvement during their pregnancy perceive health care services as a system of surveillance rather than support, impacting on their engagement. This, as well as experiences of paternalistic care and discrimination, could be mitigated through the ability to develop trusting relationships. CONCLUSIONS The findings provide underlying theory and practical guidance on how to develop safe services that aim to reduce inequalities in women's experiences and birth outcomes.
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Affiliation(s)
- Hannah Rayment‐Jones
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and MedicineNorth Wing St. Thomas' Hospital, King's College LondonLondonUK
| | - James Harris
- Elizabeth Garrett Anderson Wing, University College HospitalLondonUK
| | - Angela Harden
- Institute for Health and Human Development, University of East LondonLondonUK
| | - Zahra Khan
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative CareKing's College LondonLondonUK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and MedicineNorth Wing St. Thomas' Hospital, King's College LondonLondonUK
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Evans C, Tweheyo R, McGarry J, Eldridge J, Albert J, Nkoyo V, Higginbottom G. Improving care for women and girls who have undergone female genital mutilation/cutting: qualitative systematic reviews. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07310] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
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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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Ritah Tweheyo
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Julie McGarry
- School of Health Sciences, University of Nottingham, Nottingham, UK
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26
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Evans C, Tweheyo R, McGarry J, Eldridge J, Albert J, Nkoyo V, Higginbottom GMA. Seeking culturally safe care: a qualitative systematic review of the healthcare experiences of women and girls who have undergone female genital mutilation/cutting. BMJ Open 2019; 9:e027452. [PMID: 31147364 PMCID: PMC6549627 DOI: 10.1136/bmjopen-2018-027452] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/15/2019] [Accepted: 04/15/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To explore the experiences of accessing and receiving healthcare related to female genital mutilation/cutting (FGM/C) across the life course from the perspective of women and girls who have undergone FGM/C. DESIGN A systematic review of qualitative research studies using a thematic synthesis approach. METHODS Inclusion criteria were qualitative studies (including grey literature) of any design, from Organisation for Economic Co-operation and Development (OECD) countries, of any date and any language. Sixteen electronic databases were searched from inception to December 2017, supplemented by reference list searching. Papers were screened, selected and quality-appraised by two reviewers using established tools from the Joanna Briggs Institute. NVivo software was used to extract study characteristics and code study findings. An inductive thematic synthesis approach was undertaken to identify descriptive themes and interpret these into higher order analytical constructs. Confidence in the review findings was assessed using Grading of Recommendations, Assessment, Development and Evaluations-Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual). RESULTS Fifty-seven papers (from 55 distinct studies) from 14 different OECD countries were included (50% published within the last 8 years). One-third of studies focused exclusively on maternity care experiences, whereas others covered a range of foci. No studies reported explicitly on girls' experiences or on experiences of health service-led safeguarding interventions. Only three studies addressed psychological care. The synthesis developed 17 descriptive themes, organised into 5 analytical constructs. These related to communication, access to care, experiences of cultural dissonance/integrity, disempowering care experiences and positive care encounters. The themes illuminate significant challenges to obtaining timely and holistic care (especially for deinfibulation), and highlight different ways in which women may experience care as disrespectful, unsafe and disempowering. Key elements of 'culturally safe care' are identified. CONCLUSIONS This review has highlighted key knowledge gaps, especially around (1) girls'/unmarried women's experiences and (2) the impact of recent safeguarding interventions. There is an ongoing need for community engagement, service development and staff training. PROSPERO REGISTRATION NUMBER CRD420150300012015.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Ritah Tweheyo
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Julie McGarry
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Jeanette Eldridge
- Research and Learning Services, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Juliet Albert
- Department of Midwifery, Imperial College Healthcare NHS Trust, London, UK
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27
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Abstract
This qualitative study aims to explore and analyse the experiences of women living with female genital mutilation (FGM) who have sought help from healthcare providers within the NHS. Nine women aged 20-46 years were recruited from support organisations in the north-west of England and interviewed about their experiences of NHS care and if any screening had taken place in relation to the consequences of living with FGM. The interviews were undertaken in English, audiotaped, transcribed and analysed using a framework analysis method. Eight of the women had given birth and the main contact with the NHS had been with midwifery, gynaecology and paediatric services. Three key themes emerged from the qualitative data: involvement with healthcare professionals; silent suffering; and compassionate communication. Findings highlight the importance of sensitive and culturally competent communication nurses require to support women and refer them to appropriate services.
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Affiliation(s)
- Judith Ormrod
- Lecturer, Faculty of Biology Medicine and Health, University of Manchester
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28
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Turkmani S, Homer CSE, Dawson A. Maternity care experiences and health needs of migrant women from female genital mutilation-practicing countries in high-income contexts: A systematic review and meta-synthesis. Birth 2019; 46:3-14. [PMID: 29954045 DOI: 10.1111/birt.12367] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Female genital mutilation (FGM) is a cultural practice defined as the partial or total removal of the external female genitalia for nontherapeutic indications. Due to changing patterns of migration, clinicians in high-income countries are seeing more women from countries where the practice is prevalent. This review aims to understand the sociocultural and health needs of these women and identify opportunities to improve the quality of maternity care for women with FGM. METHODS We undertook a systematic review and meta-synthesis of peer-reviewed primary qualitative research to explore the experience and needs of migrant women with FGM receiving maternity care. A structured search of nine databases was undertaken, screened papers appraised, and a thematic analysis undertaken on data extracted from the findings and discussion sections of included papers. RESULTS Sixteen peer-reviewed studies were included in the systematic review. Four major themes were revealed: Living with fear, stigma, and anxiety; Feelings of vulnerability, distrust, and discrimination; Dealing with past and present ways of life after resettlement; and Seeking support and involvement in health care. CONCLUSIONS The findings suggest that future actions for improving maternity care quality should be focused on woman-centered practice, demonstrating cultural safety and developing mutual trust between a woman and her care providers. Meaningful consultation with women affected by FGM in high-income settings requires cultural sensitivity and acknowledgment of their specific circumstances. This can be achieved by engaging women affected by FGM in service design to provide quality care and ensure woman-focused policy is developed and implemented.
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Affiliation(s)
- Sabera Turkmani
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Angela Dawson
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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29
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Scamell M, Ghumman A. The experience of maternity care for migrant women living with female genital mutilation: A qualitative synthesis. Birth 2019; 46:15-23. [PMID: 30294872 DOI: 10.1111/birt.12390] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/16/2018] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Increasing numbers of childbearing women with a history of female genital mutilation (FGM) are accessing maternity services in high-income countries across the world. For many of these women, their first contact with the health services in their host country is when they are pregnant. While the clinical consequences of certain categories of FGM are well documented, how high-risk maternity services - designed to mitigate the obstetric consequences of FGM - impact upon women's experience of childbearing is less clear. METHODS Using a meta-synthesis approach, this paper synthesizes 12 qualitative research papers, conducted in 5 high-income countries, to explore how migrant women with a history of FGM experience maternity care in their host countries. RESULTS One over-arching theme and four discrete subthemes of migrant women's experience of the maternity services in their host country were identified: feelings of alienation; fatalism and divine providence, positive and negative feelings about maternity care, different understandings of the birthing process, and feelings about FGM. CONCLUSIONS The findings illustrate that migrant women with a history of FGM frequently encounter negative attitudes when accessing the maternity services in their host countries. Women's experiences suggest a concerning absence of sensitive and empathetic care; a more woman-centered approach is recommended.
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Affiliation(s)
- Mandie Scamell
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Aliyha Ghumman
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
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30
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Mbanya VN, Gele AA, Diaz E, Kumar B. Health care-seeking patterns for female genital mutilation/cutting among young Somalis in Norway. BMC Public Health 2018; 18:517. [PMID: 29669570 PMCID: PMC5907307 DOI: 10.1186/s12889-018-5440-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 04/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background Female genital mutilation/cutting (FGM/C) is a great concern, considering all the potential health implications. Use of health care services related to FGM/C by women who have been subjected to FGM/C in Norway remains to be understood. This study aims to explore the health care-seeking patterns for FGM/C-related health care problems, among young Somalis in Norway. Methods A cross-sectional study involving 325 young Somalis in Oslo was conducted in 2014 using respondent-driven sampling (RDS) technique. The RDS was initiated by a small number of recruited seeds, who were given coded coupons to recruit their peers to participate in the study. Eligible recruiters who participated in the study and redeemed their coupons created the first wave of respondents. The first wave further recruited their peers, the second wave. The cycle continued to attain the needed samples. Using interviews and structured questionnaires, data on socio-demographic, FGM/C status and FGM/C-related use of health care were obtained. Logistic regressions were used to compute the odds ratio (OR) and the confidence interval (CI) for the associations between demographic variables, to circumcision status and health care-seeking for FGM/C. This study will focus on the 159 female participants of the total 325. Results While 51.6% of the 159 women were subjected to FGM/C, only 20.3% of them used health care services for FGM/C-related problems. Women’s FGM/C status was associated with age ≥ 12 years at migration, experience of stigma regarding FGM/C practice (p < 0.05), support of FGM/C practice, and place of birth of women (p < 0.05). Conclusion Only one-fifth of the women with FGM/C sought care for FGM/C-related health problems. Our study does not provide the answers to why only a few of them sought care for FGM/C. However, as a large proportion of women did not seek care, it is important to investigate the reasons for this. For, we propose to conduct further research targeting girls and women who have undergone FGM/C to assess challenges in accessing health care services for proper intervention.
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Affiliation(s)
- Vivian N Mbanya
- Department of Community Medicine and Global health, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O Box 1130, Blindern, 0318, Oslo, Norway.
| | - Abdi A Gele
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.,Norwegian Centre for Minority Health Research, Oslo, Norway
| | - Esperanza Diaz
- Norwegian Centre for Minority Health Research, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bernadette Kumar
- Department of Community Medicine and Global health, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O Box 1130, Blindern, 0318, Oslo, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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31
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Hamid A, Grace KT, Warren N. A Meta-Synthesis of the Birth Experiences of African Immigrant Women Affected by Female Genital Cutting. J Midwifery Womens Health 2018; 63:185-195. [PMID: 29569363 DOI: 10.1111/jmwh.12708] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 08/14/2017] [Accepted: 08/24/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this qualitative meta-synthesis was to understand the labor and birth experiences of immigrant women in countries of resettlement who have a history of female genital cutting (FGC), also known as female genital mutilation or female circumcision. METHODS We used a meta-ethnography approach to synthesize the literature on this topic. We searched PubMed, Embase, Web of Science, CINAHL, PsycINFO, and Sociological Abstracts databases from inception to May 2016 using the search terms female genital cutting, female circumcision, clitorectomy, clitoridectomy, pharaonic circumcision, genital circumcision, female genital mutilation, infibulation, and deinfibulation. Our inclusion criteria were 1) peer-reviewed, original qualitative research; 2) focused on populations affected by FGC or their health care providers; 3) conducted in a country where FGC is not documented as an indigenous practice; 4) English language; and 5) included a description of postmigratory labor and birth experiences of women affected by FGC. Fourteen articles were included. RESULTS Two new syntheses emerged from our sample of studies including African immigrant women primarily resettled in Europe and the United States. First, birth after FGC in the context of resettlement included pain and anxiety, and has the potential to retraumatize. Second, while women experienced nostalgia for familiar traditions and perceived disrespect in their new setting, they questioned traditions, including the role of FGC, in their and their daughters' lives. DISCUSSION The negative birth experiences of women affected by FGC highlight the need to improve care for this population. Health care professionals can serve as a source of support for women affected by FGC by acknowledging and addressing FGC in their care and actively listening to their perspectives and concerns.
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Evans C, Tweheyo R, McGarry J, Eldridge J, McCormick C, Nkoyo V, Higginbottom GMA. What are the experiences of seeking, receiving and providing FGM-related healthcare? Perspectives of health professionals and women/girls who have undergone FGM: protocol for a systematic review of qualitative evidence. BMJ Open 2017; 7:e018170. [PMID: 29247096 PMCID: PMC5736050 DOI: 10.1136/bmjopen-2017-018170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Female genital mutilation (FGM) is an issue of global concern. High levels of migration mean that healthcare systems in higher-income western countries are increasingly being challenged to respond to the care needs of affected communities. Research has identified significant challenges in the provision of, and access to, FGM-related healthcare. There is a lack of confidence and competence among health professionals in providing appropriate care, suggesting an urgent need for evidence-based service development in this area. This study will involve two systematic reviews of qualitative evidence to explore the experiences, needs, barriers and facilitators to seeking and providing FGM-related healthcare in high-income (Organisation for Economic Cooperation and Development) countries, from the perspectives of: (1) women and girls who have undergone FGM and (2) health professionals. REVIEW METHODS Twelve databases including MEDLINE, EMBASE, PsycINFO, ASSIA, Web of Science, ERIC, CINAHL, and POPLINE will be searched with no limits on publication year. Relevant grey literature will be identified from digital sources and professional networks.Two reviewers will independently screen, select and critically appraise the studies. Study quality will be assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument appraisal tool. Findings will be extracted into NVivo software. Synthesis will involve inductive thematic analysis, including in-depth reading, line by line coding of the findings, development of descriptive themes and re-coding to higher level analytical themes. Confidence in the review findings will be assessed using the CERQual approach. Findings will be integrated into a comprehensive set of recommendations for research, policy and practice. DISSEMINATION The syntheses will be reported as per the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. Two reviews will be published in peer-reviewed journals and an integrated report disseminated at stakeholder engagement events. PROSPEROREGISTRATION NUMBER CRD42015030001: 2015 and CRD42015030004: 2015.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Ritah Tweheyo
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Julie McGarry
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Jeanette Eldridge
- Research and Learning Services, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Carol McCormick
- Consultant Midwife, Nottingham University Hospital Trust, Nottingham, UK
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33
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Are obstetric outcomes affected by female genital mutilation? Int Urogynecol J 2017; 29:339-344. [DOI: 10.1007/s00192-017-3466-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/18/2017] [Indexed: 12/24/2022]
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Berg RC, Taraldsen S, Said MA, Sørbye IK, Vangen S. Reasons for and Experiences With Surgical Interventions for Female Genital Mutilation/Cutting (FGM/C): A Systematic Review. J Sex Med 2017; 14:977-990. [PMID: 28666656 DOI: 10.1016/j.jsxm.2017.05.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 05/19/2017] [Accepted: 05/31/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Because female genital mutilation/cutting (FGM/C) leads to changes in normal genital anatomy and functionality, women are increasingly seeking surgical interventions for their FGM/C-related concerns. AIM To conduct a systematic review of empirical quantitative and qualitative research on interventions for women with FGM/C-related complications. METHODS We conducted systematic searches up to May 2016 in 16 databases to obtain references from different disciplines. We accepted all study designs consisting of girls and women who had been subjected to FGM/C and that examined a reparative intervention for a FGM/C-related concern. We screened the titles, abstracts, and full texts of retrieved records for relevance. Then, we assessed the methodologic quality of the included studies and extracted and synthesized the study data. OUTCOMES All outcomes were included. RESULTS Of 3,726 retrieved references, 71 studies including 7,291 women were eligible for inclusion. We identified three different types of surgical intervention: defibulation or surgical separation of fused labia, excision of a cyst with or without some form of reconstruction, and clitoral or clitoral-labial reconstruction. Reasons for seeking surgical interventions consisted of functional complaints, sexual aspirations, esthetic aspirations, and identity recovery. The most common reasons for defibulation were a desire for improved sexual pleasure, vaginal appearance, and functioning. For cyst excision, cystic swelling was the main reason for seeking excision; for reconstruction, the main reason was to recover identity. Data on women's experiences with a surgical intervention are sparse, but we found that women reported easier births after defibulation. Our findings also suggested that most women were satisfied with defibulation (overall satisfaction = 50-100%), typically because of improvements in their sexual lives. Conversely, the results suggested that defibulation had low social acceptance and that the procedure created distress in some women who disliked the new appearance of their genitalia. Most women were satisfied with clitoral reconstruction, but approximately one third were dissatisfied with or perceived a worsening in the esthetic look. CLINICAL TRANSLATION The information health care professionals give to women who seek surgical interventions for FGM/C should detail the intervention options available and what women can realistically expect from such interventions. STRENGTHS AND LIMITATIONS The systematic review was conducted in accordance with guidelines, but there is a slight possibility that studies were missed. CONCLUSION There are some data on women's motivations for surgery for FGM/C-related concerns, but little is known about whether women are satisfied with the surgery, and experiences appear mixed. Berg RC, Taraldsen S, Said MA, et al. Reasons for and Experiences With Surgical Interventions for Female Genital Mutilation/Cutting (FGM/C): A Systematic Review. J Sex Med 2017;14:977-990.
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Affiliation(s)
- Rigmor C Berg
- Norwegian Institute of Public Health, Oslo, Norway; University of Tromso, Tromso, Norway.
| | - Sølvi Taraldsen
- Norwegian National Advisory Unit on Women's Health, Division of Gynecology and Obstetrics, Oslo University Hospital HF Rikshospitalet, Oslo, Norway
| | - Maryan A Said
- Norwegian National Advisory Unit on Women's Health, Division of Gynecology and Obstetrics, Oslo University Hospital HF Rikshospitalet, Oslo, Norway; Oslo University Hospital Ullevål Hospital, Oslo, Norway
| | - Ingvil Krarup Sørbye
- Norwegian National Advisory Unit on Women's Health, Division of Gynecology and Obstetrics, Oslo University Hospital HF Rikshospitalet, Oslo, Norway
| | - Siri Vangen
- Norwegian National Advisory Unit on Women's Health, Division of Gynecology and Obstetrics, Oslo University Hospital HF Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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