Female Genital Mutilation/Cutting among Somali Women in the U.S. State of Arizona: Evidence of Treatment Access, Health Service Use and Care Experiences

Abstract

Background. Female genital mutilation/cutting (FGM/C) is associated with adverse sexual, reproductive and psychological sequelae. The aim of this study was to quantitatively explore factors related to satisfaction with FGM/C-related care in the US focusing on access to care, health service utilization, and women’s experiences. Methods. A community-based survey of 879 Ethnic Somali and Somali Bantu women using snowball sampling was conducted in Arizona. Bivariate, multivariable and ordered logistics analyses assessed the relationship between the aforementioned factors measured along six dimensions: non-discrimination, physical, economic, informational, health system accessibility and individual-level health service use factors. Findings. Most participants possessed FGM/C (77.4%), namely Type III (40.2%). FGM/C related health service use was low (14.3%). Perceived discrimination was associated with reduced satisfaction in care (OR = 0.22; CI 0.13–0.37). For FGM/C-specific variables, only recollection of adverse physical or psychological events at the time of circumcision predicted service use (OR = 3.09; CI 1.67–5.68). Somali Bantu (OR = 0.10; CI 0.02–0.44) and highly acculturated women (OR = 0.39; CI 0.17–0.86) had lower odds of service use. Conclusions. Achieving respectful care and outreach to women affected by FGM/C has contextual complexity. However, the clinical implications and insights provided may have broader impacts on advancing health equity for FGM/C-affected women.

Attitudes and Experiences Surrounding Female Genital Mutilation/Cutting in the United States: A Scoping Review

“…Studies collected data from participants in a wide range of US locations, with New York-based samples most common [24, 29, 33–35, 37, 41, 45, 48–50]. Most study populations were adults aged 18 or older, with few including individuals under 18 [9, 43, 47, 48, 51]. Study participants largely came from African countries, with Somalia the most common [9, 23, 25–27, 30, 32, 33, 36, 38, 39, 42, 47–49, 52–58].…”

“…Twenty-eight studies examined attitudes about FGM/C [25-34, 36-38, 42, 44, 45, 47-49, 51-56, 58, 60, 61], including support for or opposition to FGM/C; opinions on FGM/C of daughters; FGM/C as a cultural or religious practice; potential harm caused by FGM/C; and FGM/C and attitudes about healthcare experiences and preferences (Table 2).…”

Adolescent Sexual and Reproductive Health Counselling in Relation to Female Genital Cutting: Swedish Professionals’ Approach to Menstrual Pain as an Empirical Example

“…In this study, professionals formulated their concerns in terms of finding their way to initiate a discussion in ways that would not alienate, offend or frighten the young woman. Professionals are welladvised in their caution not to use stigmatising language and attitudes, as this might contribute to distrust in service providers (Khaja et al, 2010) and influence willingness to seek care (Michlig et al, 2021), as well as contributing to women feeling 'abnormal' (Villani, 2020), 'traumatised' or 'stigmatised' (Karlsen et al, 2019). Starting conversations about health problems (experienced or not) that were believed to resonate with the real-life experience of living with FGC, was seen as a tool for building rapport and establishing a neutral, less intimidating environment.…”

“…This is relevant not least in the Swedish context where FGC type III used to be a common type of FGC among immigrants, but now is a practice in decline (Powell et al, 2020), which is also suggested by the observations made by professionals in this study. Moreover, recent studies suggest that it is not necessarily the extent of the procedure that determines how harmful it is perceived by the individual to be (if experiencing harm at all), but the experience of the procedure itself (Michlig et al, 2021;see also Sharif Mohamed et al, 2020).…”

“…Third, a downside of introducing FGC as a probable cause for discomfort is the risk of iatrogenic pathology (Michlig et al, 2021) in that it might prompt young women to interpret their bodies in terms of deficiencies related to FGC (and, as such, a chronic condition), when this does not correspond to their own experiences, or when menstrual pain might just be ordinary dysmenorrhoea (thus temporary). Ultimately, through expectancy effect, this could lead to maladaptive responses or internalisation of genital pain (see Earp, 2020 for a theoretical discussion).…”