Exploring barriers to seeking health care among Kenyan Somali women with female genital mutilation: a qualitative study

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 culturallysensitive 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.

“When my mother called me to say that the time of cutting had arrived, I just escaped to Belgium with my daughter”: identifying turning points in the change of attitudes towards the practice of female genital mutilation among migrant women in Belgium

“…FGM is a harmful practice due to: (i) its consequences on women's health; (ii) the violation of women's bodily integrity, as a healthy organ is cut without a medical reason. Complications related to FGM vary from both immediate to long-term concerns and sometimes require interventions from health professionals [4]. Several studies have looked at the negative consequences of FGM on the lives and health of women who have undergone it [1,5,6].…”

Impact of introduction of the anti-female genital mutilation law on the practice of female genital mutilation in Garissa County, Kenya

“…11 To this date, the negative health and social effects FGM has on women who have participated in it still constitute the major push for the abandonment of the act. 9,12,13 The finding of this study of cultural reasons being the main reason for practice of FGM contravene opinions of UNICEF who reported religious reasons to be the main reason for Muslim persons of Somali origin to participate in the act. 4 Even so, grouping of the reasons by gender of respondent had religious reason as the main reason for supporting the act.…”

Trends and Determinants of Female Genital Mutilation in Ethiopia: Multilevel Analysis of 2000, 2005 and 2016 Ethiopian Demographic and Health Surveys

“…Though FGM is usually performed between infancy and 15 years of age, 11 victims suffer from complications throughout their lives, 4 and the procedure can be even fatal. 1 FGM is also associated with a reduced level of antenatal care 12 and other health-care service utilization 13,14 and increases the risk of Human papillomavirus infection. 15 Despite many physical, sexual, and psychological problems are associated with FGM, it is still practiced in greater than 30 countries mainly in the west and east Africa including Ethiopia.…”