The role of the health sector in contributing to the abandonment of female genital mutilation

Tordrup, David; Ahmed, Wisal

doi:10.1016/j.medj.2021.04.023

Cited by 8 publications

(6 citation statements)

References 10 publications

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“…It may be possible to integrate similar questions into other data collection efforts, such as routine health assessments or community-based surveys. This is consistent with global literature that calls for a more engaged health care sector using a public health and human rights approach, and a multi sectored approach (including community health workers) for FGM prevention efforts [32,33]. The WHNS design could be adapted to investigate other sensitive topics among populations where a sampling frame is limited or does not exist.…”

Section: Discussionsupporting

confidence: 70%

The women’s health needs study among women from countries with high prevalence of female genital mutilation living in the United States: Design, methods, and participant characteristics

Besera,

Snead,

Goodwin

et al. 2024

PLoS ONE

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Background The Women’s Health Needs Study (WHNS) collected information on the health characteristics, needs, and experiences, including female genital mutilation (FGM) experiences, attitudes, and beliefs, of women aged 18 to 49 years who were born, or whose mothers were born, in a country where FGM is prevalent living in the US. The purpose of this paper is to describe the WHNS design, methods, strengths and limitations, as well as select demographic and health-related characteristics of participants. Methods We conducted a cross-sectional survey from November 2020 –June 2021 in four US metropolitan areas, using a hybrid venue-based sampling (VBS) and respondent-driven sampling (RDS) approach to identify women for recruitment. Results Of 1,132 participants, 395 were recruited via VBS and 737 RDS. Most were born, or their mothers were born, in either a West African country (Burkina Faso, Guinea, Mali, Mauritania, Sierra Leone, The Gambia) (39.0%) or Ethiopia (30.7%). More than a third were aged 30–39 years (37.5%) with a majority who immigrated at ages ≥13 years (86.6%) and had lived in the United States for ≥5 years (68.9%). Medicaid was the top health insurer (52.5%), followed by private health insurance (30.5%); 17% of participants had no insurance. Nearly half of women reported 1–2 healthcare visits within the past 12 months (47.7%). One in seven did not get needed health care due to cost (14.8%). Over half have ever used contraception (52.1%) to delay or avoid pregnancy and 76.9% had their last pelvic and/or Papanicolaou (pap) exam within the past 3 years. More than half experienced FGM (55.0%). Nearly all women believed that FGM should be stopped (92.0%). Conclusion The VBS/RDS approach enabled recruitment of a diverse study population. WHNS advances research related to the health characteristics, needs, and experiences of women living in the US from countries where FGM is prevalent.

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Section: Discussionsupporting

confidence: 70%

The women’s health needs study among women from countries with high prevalence of female genital mutilation living in the United States: Design, methods, and participant characteristics

Besera,

Snead,

Goodwin

et al. 2024

PLoS ONE

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“…Understanding the community and health sector perspectives on FGM medicalization is an important step in developing health sector approaches to address it. With adequate support and training, health care providers, as respected and influential community members, could play an important role in national efforts towards FGM abandonment in addition to providing appropriate care for FGM-related health complications [ 7 ]. There is, however, a dearth of evidence on what works to effectively involve them in FGM prevention and care efforts.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Introductionmentioning

confidence: 99%

“…The health interventions funded by the SFFGC programme were guided by WHO’s four pillars of action: strengthen governance and funding (pillar 1); increase health workers’ knowledge and skills (pillar 2); improve monitoring and evaluation (M&E) and accountability (pillar 3); and create a supportive environment (pillar 4). 6 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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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ObjectivesTo explore the facilitators and barriers that affected the design and implementation of the first 3 years of Sudan’s largest health programme on female genital mutilation (FGM).DesignWe used a qualitative case study guided by the Consolidated Framework for Implementation Research to conduct in-depth interviews with programme managers and for thematic data analysis.SettingAbout 14 million girls and women in Sudan are affected by FGM, which is mainly performed by midwives (77%). Since 2016, Sudan has received substantial donor funding to develop and implement the largest global health programme to stop midwives’ involvement and improve the quality of FGM prevention and care services.ParticipantsEight Sudanese and two international programme managers representing governmental, international and national organisations and donor agencies participated in interviews. Their job positions required detailed involvement in planning, implementing and evaluating diverse health interventions in the areas of governance, building knowledge and skills of health workers, strengthening accountability, monitoring and evaluation and creating an enabling environment.ResultsRespondents identified funding availability and comprehensive plans, integration of FGM-related interventions within existing priority health intervention packages and presence of an evaluation and feedback culture within international organisations as implementation facilitators. The barriers were low health system functionality, low inter-organisational coordination culture, power asymmetries in decision-making during planning and implementation of nationally-funded and internationally-funded interventions, and non-supportive attitudes among health workers.ConclusionUnderstanding the factors affecting planning and implementation of Sudan’s health programme addressing FGM may potentially mitigate barriers and improve results. Interventions which change midwives’ supportive values and attitudes towards FGM, strengthen health system function and increase intersectoral and multisectoral coordination including equitable decision-making among relevant actors, may be needed to address the reported barriers. The impact of these interventions on the scale, effectiveness and sustainability of the health sector response merits further study.

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The role of the health sector in contributing to the abandonment of female genital mutilation

Abstract: N.J. (2021). Risk of cardiovascular outcomes among women with endometriosis in the United Kingdom: a retrospective matched cohort study. BJOG.

Cited by 8 publications

References 10 publications

The women’s health needs study among women from countries with high prevalence of female genital mutilation living in the United States: Design, methods, and participant characteristics

The women’s health needs study among women from countries with high prevalence of female genital mutilation living in the United States: Design, methods, and participant characteristics

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

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

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