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Albert J, Wells M, Spiby H, Evans C. Examining the key features of specialist health service provision for women with Female Genital Mutilation/Cutting (FGM/C) in the Global North: a scoping review. Front Glob Womens Health 2024; 5:1329819. [PMID: 38840583 PMCID: PMC11150566 DOI: 10.3389/fgwh.2024.1329819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 05/07/2024] [Indexed: 06/07/2024] Open
Abstract
Background Health care for women with Female Genital Mutilation/Cutting (FGM/C) in the Global North is often described as sub-optimal and focused on maternity care. Specialist FGM/C services have emerged with little empirical evidence informing service provision. The objective of this scoping review is to identify the key features of FGM/C specialist care. Methods The review was conducted in accordance with JBI methodology. Participants: organisations that provide specialist FGM/C care. Concept: components of specialist services. Context: high-income OECD countries. Eligibility criteria included primary research studies of any design from 2012 to 2022, providing a comprehensive description of specialist services. Seven bibliographic databases were searched (MEDLINE, EMBASE, CINAHL, Web of Science, SCOPUS, Cochrane Library and MIC). The components of "specialist" (as opposed to "generalist") services were defined and then applied to an analysis of FGM/C specialist care. FGM/C specialist provision was categorised into primary (essential) and secondary features. Data were extracted and analysed descriptively through charting in tables and narrative summary. Results Twenty-five papers described 20 unique specialist services across eleven high income countries. Primary features used to identify FGM/C specialist care were:-(i) Named as a Specialist service/clinic: 11/20 (55%); (ii) Identified expert lead: 13/20, (65%), either Midwives, Gynaecologists, Urologist, or Plastic Surgeons; (iii) Offering Specialist Interventions: surgical (i.e., reconstruction and/or deinfibulation) and/or psychological (i.e., trauma and/or sexual counselling); and (iv) Providing multidisciplinary care: 14/20 (70%). Eleven services (in Spain, Sweden, Switzerland, Germany, Italy, Netherlands, France, Belgium, and USA) provided reconstruction surgery, often integrated with psychosexual support. No services in UK, Norway, and Australia offered this. Six services (30%) provided trauma therapy only; 25% sexual and trauma therapy; 15% sexual therapy only; 30% did not provide counselling. Secondary features of specialist care were subdivided into (a) context of care and (b) the content of care. The context related to concepts such as provision of interpreters, cost of care, community engagement and whether theoretical underpinnings were described. Content referred to the model of care, whether safeguarding assessments were undertaken, and health education/information is provided. Conclusion Overall, the features and composition of FGM/C specialist services varied considerably between, and sometimes within, countries. Global guidelines advocate that specialist care should include access to deinfibulation, mental health support, sexual counselling, and education and information. The review found that these were rarely all available. In some high-income countries women cannot access reconstruction surgery and notably, few services for non-pregnant women mentioned safeguarding. Furthermore, services for pregnant women rarely integrated trauma therapy or psychosexual support. The review highlights a need for counselling (both trauma and psychosexual) and culturally-appropriate sensitive safeguarding assessments to be embedded into care provision for non-pregnant as well as pregnant women. Further research is needed to extract the features of specialist services into a comprehensive framework which can be used to examine, compare, and evaluate FGM/C clinical specialist care to determine which clinical features deliver the best outcomes. Currently a geographical lottery appears to exist, not only within the UK, but also across the Global North.
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Affiliation(s)
- Juliet Albert
- University of Nottingham and Division of Womens, Children and Clinical Support, Imperial College Healthcare NHS Trust (ICHNT), London, United Kingdom
| | - Mary Wells
- Nursing Directorate, Department of Surgery and Cancer, Imperial College Healthcare NHS Trust (ICHNT), Imperial College London, London, United Kingdom
| | - Helen Spiby
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Catrin Evans
- The Nottingham Centre for Evidence Based Healthcare, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
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Ugarte-Gurrutxaga MI, Mazoteras-Pardo V, de Corral GM, Molina-Gallego B, Mordillo-Mateos L, Gómez-Cantarino S. "Nurses and health professionals facing female genital mutilation: a qualitative study ". BMC Nurs 2023; 22:408. [PMID: 37904211 PMCID: PMC10614387 DOI: 10.1186/s12912-023-01549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/03/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Transnational migratory movements make Spain a country with a very diverse population, including women and girls from countries where Female Genital Mutilation (FGM) is practiced. Given this reality, we set out to carry out a qualitative study to identify the knowledge, attitudes and skills of health professionals regarding FGM. METHOD Qualitative study with a content analysis approach. Forty-seven health professionals with the profiles of Nursing, Family Medicine, Pediatrics, Midwifery and Gynecology and Obstetrics were purposively selected. Data were collected through semi-structured in-depth interviews and focus groups. The qualitative content analysis approach was used for data analysis. The study was conducted in the years 2019 and 2022. RESULTS Although most professionals are aware of the current legislation on FGM in Spain, only a few of them are aware of the existence of the FGM prevention protocol in Castilla-La Mancha. This lack of knowledge together with the perception that FGM belongs to the private sphere of women, contributes to the loss of opportunities to identify and prevent FGM. CONCLUSION Health professionals' training, especially midwives and pediatricians, is essential to the identification and action against Female Genital Mutilation.
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Affiliation(s)
- MIdoia Ugarte-Gurrutxaga
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, Toledo, Spain
- Nursing, Pain and Care Research Group, University of Castilla-La Mancha, Toledo, Spain
| | - Victoria- Mazoteras-Pardo
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, Toledo, Spain.
- Nursing, Pain and Care Research Group, University of Castilla-La Mancha, Toledo, Spain.
| | - Gonzalo Melgar de Corral
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, Toledo, Spain
| | - Brígida Molina-Gallego
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, Toledo, Spain
- Nursing, Pain and Care Research Group, University of Castilla-La Mancha, Toledo, Spain
- National Hospital of Paraplegics. Health Service of Castilla-La Mancha, Toledo, Spain
| | - Laura Mordillo-Mateos
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, Toledo, Spain
| | - Sagrario Gómez-Cantarino
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La Mancha, Toledo, Spain
- Nursing, Pain and Care Research Group, University of Castilla-La Mancha, Toledo, Spain
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Holuszko OM, Abdulcadir J, Abbott D, Clancy J. Health Care Providers' Readiness to Adopt an Interactive 3D Web App in Consultations About Female Genital Mutilation/Cutting: Qualitative Evaluation of a Prototype. JMIR Form Res 2023; 7:e44696. [PMID: 37768712 PMCID: PMC10570893 DOI: 10.2196/44696] [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: 11/30/2022] [Revised: 07/05/2023] [Accepted: 08/07/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Comprehensive and appropriate health care provision to women and girls with female genital mutilation or cutting (FGM/C) is lacking. Use of visuals in health care provider (HCP) consultations facilitates the communication of health information and its comprehension by patients. A web app featuring a 3D visualization of the genitourinary anatomy was developed to support HCPs in conferring clinical information about FGM/C to patients. OBJECTIVE The aim of this study was to explore HCP perspectives on the use of visuals in discussion about FGM/C with their patients as well as to obtain their feedback on whether an interactive 3D web app showing the genitourinary anatomy would be helpful in patient consultations about FGM/C, identifying key features that are relevant to their clinical practice. METHODS We evaluated the web app through a semistructured interview protocol with seven HCPs from various disciplines experienced in care for women and girls with FGM/C in migration-destination settings. Interviews were audio- and video-recorded for transcription, and were then analyzed thematically for contextualized data regarding HCPs' willingness to use a 3D web app visualizing anatomy in FGM/C consultations with patients. RESULTS All but one of the seven participants expressed keen interest in using this web app and its 3D visuals of anatomy in FGM/C consultations with patients. Participants shared the common contexts for the use of visuals in health care for FGM/C and the concepts they are used to support, such as to help describe a patient's genitals after FGM/C and reinforce an understanding of clitoral anatomy, to illustrate the process of defibulation, or to explain the physiological effects of FGM/C. Participants also highlighted the benefit of using visuals that patients can relate to, expressing approval for the ability to customize the vulva by FGM/C subtype, skin tone, and complexity of the visual shown in the web app. Despite critiques that the visualization may serve to perpetuate idealistic standards for how a vulva should look, participants largely agreed on the web app's perceived usefulness to clinical practice and beyond. CONCLUSIONS Evaluation of the web app developed in this study identified that digital tools with 3D models of the genitourinary anatomy that are accessible, informative, and customizable to any specific patient are likely to aid HCPs in communicating clinical information about FGM/C in consultations. Universal access to the web app may be particularly useful for HCPs with less experience in FGM/C. The app also prompts options for applications such as for personal use, in medical education, in patient medical records, or in legal settings. Further qualitative research with patients is required to confirm that adoption of the web app by HCPs in a consultation setting will indeed benefit patient care for women and girls with FGM/C.
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Affiliation(s)
- Olivia May Holuszko
- School of Simulation & Visualisation, Glasgow School of Art, Glasgow, United Kingdom
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jasmine Abdulcadir
- Department of Women, Child and Adolescent, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Daisy Abbott
- School of Simulation & Visualisation, Glasgow School of Art, Glasgow, United Kingdom
| | - Jennifer Clancy
- School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Ugarte-Gurrutxaga MI, Molina-Gallego B, Mordillo-Mateos L, Gómez-Cantarino S, Solano-Ruiz MC, Melgar de Corral G. Facilitating Factors of Professional Health Practice Regarding Female Genital Mutilation: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8244. [PMID: 33171622 PMCID: PMC7664698 DOI: 10.3390/ijerph17218244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 01/26/2023]
Abstract
Introduction: According to figures released by UNICEF (United Nations Children's Fund), more than 200 million girls and women have suffered female genital mutilation (FGM) in 30 African and Middle East countries. An increasing number of African women who come from ethnic groups where FGM is practised are arriving in Western countries. Healthcare professionals play a fundamental role in its prevention. Goals: To learn about the factors that healthcare professionals consider as facilitators for prevention and action when faced with female genital mutilation. Methods: A cross-sectional descriptive study developed on the basis of the qualitative methodological perspective, where 43 healthcare professionals participated. A series of analysis dimensions were established, based on which, the interview and discussion group scripts were designed. Results: Addressing FGM requires a series of structural adaptations of the healthcare system that facilitate the recording and monitoring of cases, both for treatment and for prevention. In addition, it is necessary to establish coordination between the healthcare, social services and education sectors. Conclusions: The existence of a protocol of action and training in its use is one of the key tools to take into account.
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Affiliation(s)
- M Idoia Ugarte-Gurrutxaga
- Department of Nursing, Physical and Occupational Therapy University of Castilla-La Mancha, Campus Toledo, 13001 Ciudad Real, Spain; (M.I.U.-G.); (B.M.-G.); (S.G.-C.); (G.M.d.C.)
| | - Brígida Molina-Gallego
- Department of Nursing, Physical and Occupational Therapy University of Castilla-La Mancha, Campus Toledo, 13001 Ciudad Real, Spain; (M.I.U.-G.); (B.M.-G.); (S.G.-C.); (G.M.d.C.)
| | - Laura Mordillo-Mateos
- Faculty of Health Sciences, Universidad de Castilla la Mancha, 45600 Talavera de la Reina (Toledo), Spain
| | - Sagrario Gómez-Cantarino
- Department of Nursing, Physical and Occupational Therapy University of Castilla-La Mancha, Campus Toledo, 13001 Ciudad Real, Spain; (M.I.U.-G.); (B.M.-G.); (S.G.-C.); (G.M.d.C.)
| | | | - Gonzalo Melgar de Corral
- Department of Nursing, Physical and Occupational Therapy University of Castilla-La Mancha, Campus Toledo, 13001 Ciudad Real, Spain; (M.I.U.-G.); (B.M.-G.); (S.G.-C.); (G.M.d.C.)
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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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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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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: 28] [Impact Index Per Article: 5.6] [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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Evans C, Tweheyo R, McGarry J, Eldridge J, Albert J, Nkoyo V, Higginbottom G. Crossing cultural divides: A qualitative systematic review of factors influencing the provision of healthcare related to female genital mutilation from the perspective of health professionals. PLoS One 2019; 14:e0211829. [PMID: 30830904 PMCID: PMC6398829 DOI: 10.1371/journal.pone.0211829] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 01/22/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION As a result of global migration, health professionals in destination countries are increasingly being called upon to provide care for women and girls who have experienced female genital mutilation/cutting (FGM/C). There is considerable evidence to suggest that their care experiences are sub-optimal. This systematic review sought to illuminate possible reasons for this by exploring the views, experiences, barriers and facilitators to providing FGM-related healthcare in high income countries, from health professionals' perspectives. METHODS Sixteen electronic databases/resources were searched from inception to December 2017, supplemented by reference list searching and suggestions from experts. Inclusion criteria were: qualitative studies (including grey literature) of any design, any cadre of health worker, from OECD countries, of any date and any language. Two reviewers undertook screening, selection, quality appraisal and data extraction using tools from the Joanna Briggs Institute (JBI). Synthesis involved an inductive thematic approach to identify descriptive themes and interpret these into higher order analytical constructs. Confidence in the review findings was assessed using GRADE-CERQual. The review protocol was registered with PROSPERO (CRD420150300042015). RESULTS Thirty papers (representing 28 distinct studies) from nine different countries were included. The majority of studies focused on maternity contexts. No studies specifically examined health professionals' role in FGM/C prevention/safeguarding. There were 20 descriptive themes summarised into six analytical themes that highlighted factors perceived to influence care: knowledge and training, communication, cultural (mis)understandings, identification of FGM/C, clinical management practices and service configuration. Together, these inter-linked themes illuminate the ways in which confidence, communication and competence at provider level and the existence and enactment of pathways, protocols and specialist support at service/system level facilitate or hinder care. CONCLUSIONS FGM/C is a complex and culturally shaped phenomenon. In order to work effectively across cultural divides, there is a need for provider training, clear guidelines, care pathways and specialist FGM/C centres to support mainstream services.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- * E-mail:
| | - Ritah Tweheyo
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Julie McGarry
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Jeanette Eldridge
- Libraries Research and Learning Resources, University of Nottingham, Nottingham, United Kingdom
| | - Juliet Albert
- Department of Maternity and Obstetrics, Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Gina Higginbottom
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
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