Seeking culturally safe care: a qualitative systematic review of the healthcare experiences of women and girls who have undergone female genital mutilation/cutting

Abstract

ObjectiveTo explore the experiences of accessing and receiving healthcare related to female genital mutilation/cutting (FGM/C) across the life course from the perspective of women and girls who have undergone FGM/C.DesignA systematic review of qualitative research studies using a thematic synthesis approach.MethodsInclusion criteria were qualitative studies (including grey literature) of any design, from Organisation for Economic Co-operation and Development (OECD) countries, of any date and any language. Sixteen electronic databases were searched from inception to December 2017, supplemented by reference list searching. Papers were screened, selected and quality-appraised by two reviewers using established tools from the Joanna Briggs Institute. NVivo software was used to extract study characteristics and code study findings. An inductive thematic synthesis approach was undertaken to identify descriptive themes and interpret these into higher order analytical constructs. Confidence in the review findings was assessed using Grading of Recommendations, Assessment, Development and Evaluations-Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual).ResultsFifty-seven papers (from 55 distinct studies) from 14 different OECD countries were included (50% published within the last 8 years). One-third of studies focused exclusively on maternity care experiences, whereas others covered a range of foci. No studies reported explicitly on girls’ experiences or on experiences of health service-led safeguarding interventions. Only three studies addressed psychological care. The synthesis developed 17 descriptive themes, organised into 5 analytical constructs. These related to communication, access to care, experiences of cultural dissonance/integrity, disempowering care experiences and positive care encounters. The themes illuminate significant challenges to obtaining timely and holistic care (especially for deinfibulation), and highlight different ways in which women may experience care as disrespectful, unsafe and disempowering. Key elements of ‘culturally safe care’ are identified.ConclusionsThis review has highlighted key knowledge gaps, especially around (1) girls’/unmarried women’s experiences and (2) the impact of recent safeguarding interventions. There is an ongoing need for community engagement, service development and staff training.PROSPERO registration numberCRD420150300012015.

Sexual norms and the intention to use healthcare services related to female genital cutting: A qualitative study among Somali and Sudanese women in Norway

“…In the last decade, migrant health and migrants' equitable access to healthcare has received increased attention in Europe [1][2][3][4]. This attention is reflected in the significant increase in the body of literature on the provision and utilization of healthcare services related to Female Genital Cutting (FGC) in the European context [5][6][7][8][9][10][11][12]. FGC is mostly prevalent in 30 countries in Africa, Asia and the Middle East [13], but over half a million immigrant women and girls living in Europe are estimated to have undergone FGC [14].…”

Medical Defibulation as a Possibility-the Experiences of Young Swedish- Somali Women

“…The limited number of articles signals a research gap on medical defibulation in general, and on the women's views especially. The need for research is obvious and, concerning the women's views, highlighted in two reviews (Abdulcadir et al, 2015;Evans et al, 2019).…”

“…As previous qualitative studies on the women's views on medical defibulation have interviewed mostly middle-aged women, most of them who were married, there is an urgent need to investigate how younger women perceive medical defibulation. Evans et al (Evans et al, 2019) also remark on a need to explore issues on FGC from a life coarse perspective, especially concerning younger and older women, as they have found no studies concerning these groups. Against this background, the purpose of this study was to investigate what it means to have the possibility to undergo medical defibulation in Sweden, from the perspective of young Swedish-Somali women.…”

Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations

“… 17 18 43–47 65 102 This review includes other syntheses, which included grey literature, 47 and evidence syntheses that included both provider and community perspectives. 45 46 In addition to their review of healthcare provider perspectives, Evans et al 145 have undertaken a comprehensive systematic qualitative synthesis of women affected by FGMs experiences of healthcare. This wide-ranging review included grey literature and considered experiences across all healthcare settings, including primary care.…”