Woman and girl-centred care for those affected by female genital mutilation: a scoping review of provider tools and guidelines

Abstract

Background A woman and girl centred, rights-based approach to health care is critical to achieving sexual and reproductive health. However, women with female genital mutilation in high-income countries have been found to receive sub-optimal care. This study examined documents guiding clinicians in health and community service settings in English-speaking high-income countries to identify approaches to ensure quality women and girl-centred care for those with or at risk of female genital mutilation. Method We undertook a scoping review using the integrative model of patient-centredness to identify principles, enablers, and activities to facilitate woman and girl-centred care interactions. We developed an inclusion criterion to identify documents such as guidance statements and tools and technical guidelines, procedural documents and clinical practice guidelines. We searched the databases and websites of health professional associations, ministries of health, hospitals, national, state and local government and non-government organisations working in female genital mutilation in the United Kingdom, Ireland, Canada, The United States, New Zealand, and Australia. The Appraisal of Guidelines for Research and Evaluation tool was used to appraise screened documents. Findings One-hundred and twenty-four documents were included in this scoping review; 88 were developed in the United Kingdom, 20 in Australia, nine in the United States, three in Canada, two in New Zealand and two in Ireland. The focus of documents from the United Kingdom on multi-professional safeguarding (62), while those retrieved from Australia, Canada, Ireland, New Zealand and the US focused on clinical practice. Twelve percent of the included documents contained references to all principles of patient-centred care, and only one document spoke to all principles, enablers and activities. Conclusion This study demonstrates the need to improve the female genital mutilation-related guidance provided to professionals to care for and protect women and girls. Professionals need to involve women and girls with or at risk of female genital mutilation in the co-design of guidelines and tools and evaluation of them and the co-production of health care.

Strengthening woman-centred care for pregnant women with female genital mutilation in Australia: a qualitative muti-method study

“…A scoping review of providing tools and guidelines for the care of women affected by FGM ( 16 ) found one guideline that integrated all the dimensions of patient-centred care from the Scholl model ( 36 ). However, this guidance is not focused on maternity care.…”

“…A scoping review by Dawson et al ( 16 ) reviewed 124 FGM-related tools and guidelines from six high-income countries and found that only 10% of those guidelines addressed the principles of woman-centred care. A lack of clear guidelines defining how woman-centred care can be achieved may negatively affect health care provision.…”

“…Involving women in the development of guidelines can ensure that they are tailored to meet their individual needs and preferences, leading to better outcomes and higher care satisfaction rates ( 24 ). While there are general efforts to increase women's participation in guideline development through initiatives such as patient and public involvement (PPI) ( 25 ), there is little evidence of the direct involvement of women who have experienced FGM in developing or co-designing guidelines or tools ( 16 ). This study sought to address this gap by exploring the quality point of care experiences (refers to the direct interactions between women and healthcare providers at various stages of their care) and needs of pregnant women with FGM in the Australian health system to identify what elements of woman-centred care were important to women and how woman-centred care can be strengthened during consultations with health professionals.…”

Language and Cultural Barriers and Facilitators of Sexual and Reproductive Health Care for Migrant Women in High‐Income European Countries: An Integrative Review

“…[9][10][11][12][13]61,62 Sometimes, discrepancies between the predominant culture of the host country and the minority culture of the immigrant women led to racist behaviors, especially when dealing with issues that are strongly criticized, rejected, and even punished in the host country, such as FGM. Women with FGM in high-income countries receive suboptimal care and report poor experiences of care, 63 whereas American and European gynecologists and midwives find it challenging to care for them. 43,64 These findings indicate that much is needed to improve interactions between these women and their health care providers.…”

Examining the key features of specialist health service provision for women with Female Genital Mutilation/Cutting (FGM/C) in the Global North: a scoping review

“…They recommended that services be co-designed using a culturally competent lens and highlighted the importance of community engagement and safeguarding ( 27 ). A scoping review published by Dawson et al in 2022 ( 33 ) examined guidance and tools available to healthcare workers across six English speaking high income countries (UK, Ireland, Canada, Australia, US, New Zealand). The UK had produced the majority of publications, mostly focused upon multi-professional safeguarding.…”