Female Genital Mutilation/Cutting: Innovative Training Approach for Nurse-Midwives in High Prevalent Settings

Abstract

Background Female genital mutilation/cutting (FGM/C) has no medical benefits and is associated with serious health complications. FGM/C including medicalization is illegal in Kenya. Capacity building for nurse-midwives to manage and prevent FGM/C is therefore critical. Objective Determine the current FGM/C knowledge and effect of training among nurse-midwives using an electronic tool derived from a paper-based quiz on FGM/C among nurse-midwives. Methods Nurse-midwives (n=26) were assessed pre- and post-FGM/C training using a quiz comprising 12 questions. The quiz assessed the following factors: definition, classification, determining factors, epidemiology, medicalization, prevention, health consequences, and nurse-midwives' roles in FGM/C prevention themes. The scores for individuals and all the questions were computed and compared using SPSS V22. Results The mean scores for the quiz were 64.8%, improving to 96.2% p < 0.05 after training. Before the training, the following proportions of participants correctly answered questions demonstrating their knowledge of types of cutting (84.6%), link with health problems (96.2%), FGM/C-related complications (96.2%), communities that practice FGM/C (61.5%), medicalization (43.6%), reinfibulation (46.2%), dissociation from religion (46.2%), and the law as it relates to FGM/C (46.2%). The participants demonstrated knowledge of FGM/C-related complications with the proportion of nurse-midwives correctly answering questions relating to physical impact (69.2%), psychological impact (69.2%), sexual impact (57.7%), and social impact (38.5%). Additionally, participant awareness of NM roles in managing FGM/C included the following: knowledge of the nurse-midwife as counselor (69.2%), advocate (80.8%), leader (26.9%), role model (42.3%), and caregiver (34.6%). These scores improved significantly after training. Conclusion Substantial FGM/C-related knowledge was demonstrated by nurse-midwives. They, however, showed challenges in preventing/rejecting medicalization of FGM/C, and there were knowledge gaps concerning sexual and social complications, as well as the specific roles of NM. This underscores the need to implement innovative FGM/C training interventions to empower health professionals to better respond to its management and prevention.

Facilitating Factors of Professional Health Practice Regarding Female Genital Mutilation: A Qualitative Study

“…There is evidence that, despite the government's efforts to eradicate the practice of FGM, there is a lack of training among healthcare professionals to address its treatment. We found this lack of training in the scientific literature to which we have access [27], which shows that the training strategies implemented in many of the countries that have declared their commitment to the eradication of FGM are not adequate.…”

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

“…Kenyan health system experiences challenges in responding to the burden of FGM/C as evidenced by poor or lack of documentation, absence of an audit system on FGM/C cases, complications, and referrals [47]. Not surprisingly therefore, lack of an effective referral system for further care of FGM/C cases was highlighted as a challenge.…”

“…Strengthening the training of health care providers is a critical intervention because capacity deficits limit the uptake of health services [59,60]. Importantly, there are numerous support tools [46] for management of FGM/ C-related complications as well as prevention of new FGM/C cases [2,47,61,62]. These tools can be useful in addressing gaps in knowledge and skills among health care providers.…”

“…Healthcare providers have a responsibility to take the legislative framework into consideration and may be required to report FGM/C cases; thus, facing an ethical dilemma. As outlined in WHO guidelines for the management of FGM/C-related health complications, "states must set in place systems and structures to support 'women and children who are victims of harmful practices' by ensuring access to 'immediate support services, including medical, psychological and legal services'" (page 7) [47].…”

“…Related to aforementioned, stigmatization and ostracism on women with FGM/C by health care providers from non-cutting community affected health seeking [36,38]. Additionally, the health care providers were reported to lack capacity to implement FGM/ C-related management interventions as a result of poor or lack of training [46,47]. The women with FGM/C also faced barriers to health seeking associated with lack of a well-functioning referral system [38,43,48].…”