Involving the health sector in the prevention and care of female genital mutilation: results from formative research in Guinea

Abstract

Background Despite efforts to reduce the burden of female genital mutilation (FGM) in Guinea, the practice remains prevalent, and health care providers are increasingly being implicated in its medicalization. This formative study was conducted to understand the factors that facilitate or impede the health sector in providing FGM prevention and care services to inform the development of health sector-based interventions. Methods Between April and May 2018, a mixed methods formative study was carried out using a rapid assessment methodology in three regions of Guinea—Faranah, Labe and Conakry. A structured questionnaire was completed by one hundred and fifty health care providers of different cadres and 37 semi-structured interviews were conducted with health care providers, women seeking services at public health clinics and key stakeholders, including health systems managers, heads of professional associations and schools of nursing, midwifery, and medicine as well as representatives of the Ministry of Health. Eleven focus group discussions were conducted with female and male community members. Results This study revealed health systems factors, attitudinal factors held by health care providers, and other factors, that may not only promote FGM medicalization but also impede a comprehensive health sector response. Our findings confirm that there is currently no standardized pre-service training on how to assess, document and manage complications of FGM nor are there interventions to promote the prevention of the practice within the health sector. This research also demonstrates the deeply held beliefs of health care providers and community members that perpetuate this practice, and which need to be addressed as part of a health sector approach to FGM prevention. Conclusion As integral members of FGM practicing communities, health care providers understand community beliefs and norms, making them potential change agents. The health sector can support them by incorporating FGM content into their clinical training, ensuring accountability to legal and policy standards, and promoting FGM abandonment as part of a multi-sectoral approach. The findings from this formative research have informed the development of a health sector intervention that is being field tested as part of a multi-country implementation research study in Guinea, Kenya, and Somalia.

National and international programmatic perspective on facilitators and barriers for Sudan’s health sector response on female genital mutilation (2016–2018): a qualitative study

“…Interestingly, our findings on factors which influenced FGM service provision at primary healthcare settings was similar to other qualitative studies7 12 13 which showed limited knowledge and skills and supportive FGM attitudes among healthcare providers, together with the absence of clinic protocols, recording systems and referral systems as factors that negatively affected services. Our sampling respondents at the national level as opposed to state level, was justified because these first years of programmatic implementation focused on establishing national foundational activities that were mostly conducted by FMoH.…”

“…In contrast to FMoH leadership, midwives’ low knowledge of and supportive attitudes seemed to drive FGM medicalisation and explains their reluctance to provide FGM prevention services. These findings are similar to findings in Guinea and a systematic review that included eight African countries 12 30. Furthermore, 34% of midwives are employed in Sudan and their monthly governmental salary—between US$75 and US$12831—pales to the incentives they receive for performing FGM 32 33…”

“…Between 2016 and 2018, Sudan had significant achievements in the health component of SFFGC programme,5 prompting further in-depth study to understand how and why this occurred. The present study contributes to a much-needed programmatic evidence base on complex health interventions in low-income FGM prevalent settings, in contrast to the current body of evidence, which has addressed singular health interventions or factors affecting FGM-related health interventions in high-income settings 7–15…”

Lessons learnt in scaling up evidence-based comprehensive health sector responses addressing female genital mutilation in highly prevalent settings

“…[10][11][12] The health sector in countries with high FGM prevalence has made some progress in developing and implementing a comprehensive health sector approach informed by evidence-based resources. [13][14][15][16] However, there is a need to scale up this approach especially in FGM prevalent settings. The aim of this practice paper is to describe a multicountry participatory approach that was initiated by WHO in 2018 to facilitate the uptake and scale up of comprehensive health sector programmes in countries with high FGM prevalence.…”

“…The health sector in countries with high FGM prevalence has made some progress in developing and implementing a comprehensive health sector approach informed by evidence-based resources 13–16. However, there is a need to scale up this approach especially in FGM prevalent settings.…”