Female genital mutilation in the UK- where are we, where do we go next? Involving communities in setting the research agenda.

BACKGROUND: Female Genital Mutilation (FGM) is all practices involving cutting, alteration or injury to the female genitalia for non-medical reasons. It is a form of violence against women and children, with no benefits and many harms. In 2014, the UK Government committed to working to eliminate FGM. Steps taken towards this aim included creation of educational and safeguarding resources for professionals, and legislative changes including a mandatory reporting duty for professionals in England and Wales (where if a girl under 18 discloses or is found on examination to have FGM then the professional is mandated to report this to the police), and an FGM Enhanced Dataset applicable to NHS organisations in England requiring the submission of personal data about women and girls who have had FGM to NHS Digital. To date, compliance with dataset returns from primary care services have been low. This report describes using patient and public involvement (PPI) to identify research and service priorities to support communities affected by FGM. METHODS: We held a series of PPI events (4 focus groups, and a multi-agency seminar) in 2015-2016, following the introduction of these legislative changes, speaking to community members, and professionals involved in their care. We asked participants to consider what they identified as research, knowledge and service priorities to support communities affected by FGM. RESULTS: The impact of these legislative and reporting requirements on the trust needed for community members to seek to consult health services was identified as important for further research. Priorities for service development were holistic services, that met a woman's needs throughout her lifecourse. Participants emphasised the importance of understanding how to listen, involve and utilise community voices in developing education for professionals, designing services, and developing policy. CONCLUSIONS: There was a desire for change to develop from within affected communities; any learning and resources need to be co-created and constructed in such a way that they can be effectively shared between women, communities, and professionals. Questions remain about how to define community consultation, how to recognise when it was adequate, and how to hear beyond community activists to hear a wider range of voices.

Access to sexual and reproductive health care: adolescents and young people.

Obstetricians and gynecologists at the FIGO pre-congress workshop on adolescents deliberated on their role as clinicians, educators and advocates in upholding young peoples' sexual and reproductive health rights. Comprehensive services to adolescents should include emergency contraception, safe abortion and also provide care for survivors of sexual violence. Key to successful access to youth friendly services consist of providers' attitudes and addressing consent, confidentiality, evolving capacities of young people and youth participation.

A battered woman needs more than biological help.

PIP: Violence against women can take many forms and is widespread, but incidences are difficult to quantify because women suffer in silence or fail to realize that the violence they experience is unacceptable. In India, a survey of 1842 rural women of reproductive age revealed that both men and women consider wife beating acceptable and that 40% of all wives have been beaten by their husbands. Indian women who have a good education, are married at later ages, and have control over economic resources are less likely to experience domestic violence. Females can suffer from violence throughout their life cycle. Fetuses may be aborted just because they are female; infants may be killed because they are female; girls may be neglected or subject to various other types of abuse; adolescents may be raped; married women may be beaten, raped, or killed by their husbands; and widows may be neglected and abused. The health effects of this violence, thus, range from death to psychological trauma. In response to this situation, women's organizations have focused worldwide attention on violence against women as a human rights violation and are beginning to hold accountable governments that were party to the Convention on the Elimination of All Forms of Discrimination Against Women. Training medical personnel on how to deal with women who are obvious victims of domestic violence will be an important strategy.^ieng