What women want: A reflexive thematic analysis of the healthcare experiences of women with female genital mutilation/cutting in South Australia.

BACKGROUND: Global migration has seen an increase in female genital mutilation/cutting (FGM/C) cases observed in countries where it is not part of the cultural norm. This shift has led to many healthcare professionals (HCPs) reporting a lack of knowledge and skills necessary to support the needs of women with FGM/C. AIM: To explore the experiences and needs of women with FGM/C accessing women's health services in South Australia. METHODS: Women with FGM/C were recruited through purposive and snowball sampling to participate in one-to-one semi-structured interviews. The voice recorded interviews were transcribed verbatim, coded, and analysed using Braun and Clarke's reflexive thematic analysis to determine themes. FINDINGS: Ten migrant and refugee women living in South Australia, were interviewed. Four themes and 13-subthemes were identified. The main themes were, 1) the healthcare experience, 2) cultural values shape the healthcare experience, 3) speaking up about female genital cutting and 4) working together to improve healthcare experiences. DISCUSSION: Women's cultural needs, not their health needs, play a fundamental role on how women experienced healthcare services. When women's cultural values and traditions are acknowledged by HCPs, they are more likely to trust and feel confident to engage with services and seek medical support. Areas identified for improvement included access to the right interpreters, having more time during appointments, opportunities for continuity of care and the inclusion of family in care and treatment decisions. CONCLUSION: Women with FGM/C have specific health and cultural needs that can be met through education and provision of woman-centred care.

Knowledge, attitudes, and practice of female genital mutilation and cutting: an observational cross-sectional study in English primary care (FGM/C Study).

BACKGROUND: Female genital mutilation and cutting (FGM/C) describes procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. Increasing migration means many communities living in the UK originate from countries where FGM/C is practised. Consequently, clinicians in the UK are increasingly exposed to women and children who have experienced FGM/C. AIM: To explore the knowledge, attitudes, and practice of primary care GPs and practice nurses (PNs) regarding FGM/C. DESIGN & SETTING: An observational cross-sectional study with GPs and PNs working in primary care in the West Midlands, UK. METHOD: An online survey was circulated to GPs and PNs between September 2019 and December 2019. RESULTS: A total of 137 survey responses were received. Study participants were predominantly female (81.8%) and GPs (59.9%), with a mean age of 47.3 years (standard deviation [SD] 9.1). The survey found 19.7% of responders reported seeing >1 patient with FGM/C in the past 12 months. It also found 91.3% of responders had received some form of FGM/C training; however, the format and frequency of training varied and 34.3% felt they had received inadequate training to manage treatment of FGM/C. CONCLUSION: The results have suggested varying degrees of competence and confidence associated with recognising and managing patients with FGM/C in primary care in the West Midlands. Given that patients with FGM/C typically present in primary care, it is important that clinicians can provide appropriate support underpinned by up-to-date training.

Factors associated with female genital mutilation: a systematic review and synthesis of national, regional and community-based studies.

BACKGROUND: This systematic review aimed to identify and describe the factors that influence female genital mutilation/cutting (FGM/C). METHODS: Searches were conducted in Medline, PsycInfo, Web of Science, Embase and the grey literature from 2009 to March 2020 with no language restrictions, using related MESH terms and keywords. Studies were included if they were quantitative and examined factors associated with FGM/C. Two researchers independently screened studies for inclusion, extracted data and assessed study quality. The direction, strength and consistency of the association were evaluated for determinants, presented as a descriptive summary, and were disaggregated by age and region. RESULTS: Of 2230 studies identified, 54 published articles were included. The majority of studies were from the African Region (n=29) followed by the Eastern Mediterranean Region (n=18). A lower level of maternal education, family history of FGM/C, or belonging to the Muslim religion (in certain contexts) increased the likelihood of FGM/C. The majority of studies that examined higher paternal education (for girls only) and living in an urban region showed a reduced likelihood of FGM/C, while conflicting evidence remained for wealth. Several studies reported that FGM/C literacy, and low community FGM/C prevalence were associated with a reduced likelihood of FGM/C. CONCLUSIONS: There were several characteristics that appear to be associated with FGM/C, and these will better enable the targeting of policies and interventions. Importantly, parental education may be instrumental in enabling communities and countries to meet the Sustainable Development Goals.

Some People are Different from You: A Case Study of a Cultural and Ethical Problem in Global Health.

Pharmacists, student pharmacists, and other healthcare providers are frequent participants on short-term medical service trips (MSTs) to medically underserved areas. Many such MSTs take place in areas like sub-Saharan Africa where cultural beliefs about healthcare and society may be very different from what volunteers from the Global North believe. These cultural divergences may then give rise to ethical problems MST volunteers need to navigate. This case study provides an example of such an ethical problem developing from a difference in cultures - the case of female genital cutting. Often, the ethical training that most MST volunteers receive during their clinical education is inadequate to help them address these kinds of cultural differences and the problems that result. A six-step process to provide MST volunteers with the tools to address such cultural-ethical problems is included. Medical, Public Health, and Microfinance Teams with local interpreters in Nana Kenieba, Cercle of Kati, Koulikoro Region, Southwest Mali.

Clitoral reconstructive surgery after female genital mutilation: A systematic review.

OBJECTIVE: To summarize available evidence on clitoral reconstruction after Female genital mutilations/cut (FGM/C). STUDY DESIGN: Systematic review of the literature to identify studies on clitoral reconstruction after previous FGM/C with at least 6 months of follow-up. The literature search was performed in the following databases: PubMed, EMBASE, Web of Science, and the Cochrane Library. The period considered was from the database inception to June 30th, 2020. MAIN OUTCOME MEASURES: Post-operative vulvar pain or dyspareunia, changes in sexual activity or orgasm, and the impact on self-image. RESULTS: We identified 8 studies; four used the same "Foldès technique", and four adopted similar techniques based on the downward mobilization of the clitoral stump, with different reconstructions of glans and prepuce. The postoperative complication rate was reported at 5.3%. Sexual function is the only outcome investigated by all studies, which consistently suggest that clitoral reconstruction appear effective to improve clitoral pleasure/orgasm. Almost all studies assessed self-image, which appears improved. Only 2 studies provided data about pain and/or dyspareunia, which were improved by clitoral reconstruction. However, the risk of bias is high. Most patients were lost at follow-up, and validated instruments to assess outcomes were used only in a minority of studies. CONCLUSIONS: Although clitoral reconstructive surgery for FGM/C appears safe and effective, caution is required to interpret available evidence due to significant limitations. Further studies are required to compare the proposed techniques and to confirm the effectiveness in terms of vulvar pain and/or dyspareunia, sexual activity and/or orgasm, and self-image improvement.

Guideline No. 395-Female Genital Cutting.

OBJECTIVES: To decrease the likelihood that the practice of female genital cutting (FGC) be continued in the future and to improve the care of girls and women who have been subjected to FGC or who are at risk by providing (1) information intended to strengthen knowledge and understanding of the practice, (2) information regarding the legal issues related to the practice, (3) guidance for the management of its obstetrical and gynaecological complications, and (4) guidance on the provision of culturally competent care to girls and women affected by FGC. OPTIONS: Strategies for the primary, secondary, and tertiary prevention of FGC and its complications. OUTCOMES: The short- and long-term consequences of FGC. INTENDED USERS: Health care providers delivering obstetrical and gynaecological care. TARGET POPULATION: Women from countries where FGC is commonly practised and Canadian girls and women from groups who may practise FGC for cultural or religious reasons. EVIDENCE: Published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library in September 2010 using appropriate controlled vocabulary (e.g., Circumcision, Female) and key words (e.g., female genital mutilation, clitoridectomy, infibulation). Searches were updated and incorporated in the guideline revision December 2018. VALIDATION METHODS: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS: There are no anticipated harms or costs to health care facilities with implementation of this guideline. Benefits may include a greater willingness of women living with FGC to seek timely care. SUMMARY STATEMENTS: RECOMMENDATIONS.

Impacto de la mutilación genital femenina en los objetivos del milenio / Impacto da mutilação genital feminina nos objetivos do milênio / Impact of female genital mutilation on the millennium goals

RESUMEN Objetivo Relacionar la Mutilación Genital Femenina como factor negativo para la consecución de los Objetivos de Desarrollo del Milenio 1, 3, 4, 5 y 6. Métodos Se ha realizado la recogida de datos a través de una revisión integradora de la literatura en los años 2014 y 2015. Se consultaron las bases de datosMedline/PubMed, Web of Science , LILACS, SCIELO, Tesis Doctorales TESEO y en las webs de WOK, UNICEF, UNAF y WHO utilizando los descriptores: circuncisión femenina, objetivos de desarrollo del milenio y mutilación genital femenina. Se incluyeron artículos publicados entre los años de 2010 y 2015, y se seleccionaron finalmente 24 artículos. Resultados La Mutilación Genital Femenina es una práctica basada en discriminaciones de género que refuerza e incentiva el círculo de la pobreza. Provoca complicaciones físicas que pueden repercutir en la mortalidad y morbilidad infantil, así como en complicaciones en el embarazo y el parto y en la adquisición del virus de la inmunodeficiencia humana. Conclusión La lucha contra la Mutilación Genital Femenina contribuye a la consecución de cinco de los ocho Objetivos del Milenio.

RESUMO Objetivo Relacionar a MGF como um fator negativo para a realização dos Objetivos de Desenvolvimento do Milênio 1, 3, 4, 5 e 6. Método Foi realizada a coleta de dados por meio da revisão da literatura nos anos de 2014 e 2015, nas bases de dados Medline/PubMed, Web of Science, LILACS, SCIELO, Tesis Doctorales TESEO e nos sites da UNICEF, UNAF e WHO utilizando-se os descritores: circuncisão feminina, objetivos de desenvolvimento do milênio e mutilação genital feminina. Foram incluídos artigos publicados entre os anos de 2010 e 2015, e selecionados finalmente 24 artigos. Resultados A mutilação genital feminina é uma prática baseada na discriminação de género que reforça e estimula o ciclo da pobreza. Causa complicações físicas que podem afetar a mortalidade e morbidade infantil, bem como complicações na gravidez e no parto e na aquisição de HIV. Conclusão a luta contra a MGF contribui para a realização de cinco dos oito Objetivos de Desenvolvimento do Milênio.

ABSTRACT Objective To relate the Female Genital Mutilation as a negative factor for the achievement of the Millennium Development Goals 1, 3, 4, 5 and 6. Method Data collection was through review literature review between in the years 2014 and 2015 in the databases Medline/PubMed, Web of Science, LILACS, SCIELO, Tesis Doctorales TESEO and in the webs of WOK, UNICEF, UNAF and WHO using the descriptors: female circumcision, millennium development goals, rights of women. Articles published between years 2010 y 2015, were included and finally 24 articles were selected. Results The Female Genital Mutilation is based on gender discrimination, and reinforces and encourages the circle of poverty. This practice causes physical complications that may affect the infant mortality and morbidity, complications in pregnancy and childbirth and there is a relationship between the practice and the transmission of human immunodeficiency virus. Conclusion The fight against Female Genital Mutilation contributes to the achievement of five of the eight Millennium Goals.

[Mothers knowledges, attitudes and practices on female genital excision in Bamako]. / Connaisssances, attitudes et pratiques des meres relatives a l'excision a Bamako.

AIM: In Mali society, female excision is a cultural practice. Despite the awareness campaigns, it affects nearly 85% of the female population (EDSM IV). This study was initiated to assess the knowledges, attitudes and practices of mothers about female circumcision. METHOD: We conducted a prospective, cross-sectional study from June 1 to July 31, 2011, in the Department of Pediatrics of the teaching hospital of Gabriel Touré, Bamako, regarding the knowledge, attitudes and practices of mothers related to the female excision. RÉSULTS: We interviewed 224 mothers. The prevalence of female circumcision was 73%. In 72.7% of cases, the area affected by the mutilation was unknown to the mother. Nearly seventy percent (69.6%) of mothers thought that female circumcision had advantages only and should even be mandatory (74.6%). Female circumcision was associated with tradition, and it would be a religious obligation for 65%, and 21.4% of mothers, respectively. More than half of the girls were circumcised before their first year (76.3%) and 26.3% in the neonatal period. The majority of mothers were against a law banning the practice of female circumcision (54%). Ninety five percent of mothers reported that they would renew the experience of female circumcision. CONCLUSION: Female circumcision remains a well-established practice. Policies to fight against female circumcision are faced to very deep beliefs.

RÉSUMÉ: Au Mali, l'excision est une pratique culturelle dans la société. Malgré les campagnes de sensibilisation, elle toucherait 85% de la population féminine (EDSM IV). Ce travail a été initié pour évaluer les connaissances, les attitudes et les pratiques des mères sur l'excision de leurs filles. MÉTHODE: Nous avons effectué une étude prospective transversale du 1er juin au 31 juillet 2011, dans le département de pédiatrie du CHU Gabriel Touré portant les connaissances, les attitudes et les pratiques des mères relatives à l'excision. RÉSULTATS: Nous avons interrogé 224 mères. La prévalence de l'excision était de 73%. Dans 72,7% des cas, la zone concernée par la mutilation était méconnue de la mère. Les mères pensaient dans 69,6% des cas que l'excision n'avait que des avantages et qu'elle doit être obligatoire (74,6%). L'excision était associée à la tradition pour 65% des mères. Elle serait une obligation religieuse pour 21,4% des mères. Plus de la moitié des filles était excisée avant leur première année (76,3%) et 26,3% dans la période néonatale. La majorité des mères étaient contre une loi interdisant la pratique de l'excision (54%). Sur 100, 95 mères affirmaient qu'elles renouvelleraient l'expérience de l'excision. CONCLUSION: L'excision reste une pratique bien ancrée. Les politiques de lutte contre l'excision se heurtent ainsi à des croyances très profondes.

Os desafios éticos da mutilação genital feminina e da circuncisão masculina / Los desafíos éticos de la mutilación genital femenina y de la circuncisión masculina / Ethical challenges of female genital mutilation and of male circumcision

O trabalho aborda os desafios éticos concernentes à mutilação genital feminina e à circuncisão masculina, mostrando similitudes e diferenças. A circuncisão masculina é um procedimento médico para determinadas condições clínicas da saúde genital masculina. Os povos que praticam a mutilação genital feminina também praticam a circuncisão masculina ritualística, sendo que há povos e religiões que praticam a circuncisão masculina sem que haja mutilação genital feminina. A mutilação genital feminina se concentra em bolsões de pobreza, sendo atentatória aos direitos humanos, havendo diversos movimentos mundiais em prol de sua erradicação. A circuncisão masculina pode se associar a complicações bastante sérias, de modo que não é aceitável sua realização sem indicação clínica precisa.

Este artículo enfoca los desafíos éticos acerca de la mutilación genital femenina y la circuncisión masculina, demostrando las similitudes y diferencias. La circuncisión masculina es un procedimiento médico para determinadas condiciones clínicas de la salud genital masculina. Los pueblos que practican la mutilación genital femenina también practican la circuncisión masculina ritualista, habiendo pueblos y religiones que practican la circuncisión masculina sin que exista la mutilación genital femenina. La mutilación genital femenina se concentra en zonas de pobreza y ofende a los derechos humanos, habiendo muchos movimientos mundiales en favor de su erradicación. La circuncisión masculina puede estar asociada con complicaciones muy graves, por lo que no es aceptable su realización sin una indicación clínica precisa.

This article is about the ethical challenges related to female genital mutilation and male circumcision, by showing similarities and differences. Male circumcision is a medical procedure to some clinical conditions of male genital health. The peoples that carry out the female genital mutilation also carry out together the ritual of male circumcision, but there are peoples and religions that carry out male circumcision without female genital mutilation. Female genital mutilation occurs concentrated in very poor regions and it is against Human Rights, so there are several worldwide movements for its eradication. Male circumcision can be associated to seriously dangerous complications, so that it is not ethically acceptable to be carried out without a precise clinical indication.