Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation: A review of global experience
Section snippets
Background/introduction
Female genital mutilation (FGM), also known as female cutting or female circumcision, is a practice that is carried out on young girls and women in 29 countries in Africa and the Middle East, as well as some Asian countries (WHO, 2008). Although the practice is more prevalent in African countries, changing patterns of migration have led to health professionals encountering women with FGM in high income countries (HIC) including Sweden (Lundberg and Gerezgiher, 2008), Norway (Johansen, 2006),
Method
A narrative synthesis methodology was employed to analyse selected literature. This method was chosen due to the varied methodologies of the studies identified for the review, which did not allow for the synthesis of findings.
A Population, Interventions, Comparators, Outcomes, Study design (PICOS) question was developed to guide this review according to guidelines (CRD, 2009). The review objective was to identify midwives׳ perspective in LMIC and HIC with respect to FGM. Outcomes of interest
Findings
Of the 10 papers included in the review, there were four that employed qualitative methods (Berggren et al., 2004, Isman et al., 2013, Lazar et al., 2013, Leval et al., 2004), five used a quantitative survey design (Jacoby and Smith, 2013, Korfker et al., 2012, Tamaddon et al., 2006, Widmark et al., 2002, Zaidi et al., 2007) and one used a survey design that also collected qualitative data. Eight papers were from HIC and two provided data about midwives in LMIC (Berggren et al., 2004, Isman et
Discussion
This integrative literature review of the experiences and needs of midwives with respect to FGM in LMIC and HIC has identified a lack of technical knowledge, limited cultural competency and socio-cultural challenges to abandonment of the practice. Midwives called for professional education and training, a working environment supported by guidelines, responsive policy and community education.
Midwives are frontline service providers to many women with FGM and this study indicates a paucity of
Conflict of interest
None of the authors have any financial, personal, political, intellectual or religious interests that would compete with this work.
References (96)
- et al.
Male complications of female genital mutilation
Soc. Sci. Med.
(2001) - et al.
An explorative study of Sudanese midwives׳ motives, perceptions and experiences of re-infibulation after birth
Midwifery
(2004) - et al.
Knowledge of female genital cutting and experience with women who are circumcised: a survey of nurse-midwives in the United States
J. Midwifery Women׳s Health
(2010) - et al.
Experiences from pregnancy and childbirth related to female genital mutilation among Eritrean immigrant women in Sweden
Midwifery
(2008) - et al.
Cultural safety and its importance for Australian midwifery practice
Coll. (R. Coll. Nurs. Austr.)
(2010) - et al.
Female genital mutilation in Upper Egypt in the new millennium
Int. J. Gynecol. Obstet.
(2011) The medicalization of female ‘circumcision’: harm reduction or promotion of a dangerous practice?
Soc. Sci. Med.
(2001)- et al.
A study of Swedish midwives׳ encounters with infibulated African women in Sweden
Midwifery
(2002) - et al.
Providing culturally appropriate care: a literature review
Int. J. Nurs. Stud.
(2010) - et al.
Care of women with female genital mutilation/cutting
Swiss Med. Wkly.
(2011)
Strengthening intersectoral collaboration for primary health care in developing countries: can the health sector play broader roles?
Journal of environmental and public health
Knowledge and attitudes of female genital mutilation among midwives in Eastern Sudan
Reproduct. Health
Decision on the Support of a Draft Resolution at the Sixty Sixth Ordinary Session of the General Assembly of the United Nations to Ban Female Genital Mutilation in the World
Female genital mutilation. [Article]
Nurs. Stand.
Midwifery training and female circumcision in the inter-war Anglo-Egyptian Sudan
J. Afr. History
Effectiveness of interventions designed to prevent female genital mutilation/cutting: a systematic review
Stud. Fam. Plann.
A realist synthesis of controlled studies to determine the effectiveness of interventions to prevent genital cutting of girls
Paediatr. Int. Child Health
Female genital mutilation: FGM patients treated at the ‘Umberto I’ polyclinic of Rome: 1985–1996
Clin. Ter.
The applicability of behaviour change in intervention programmes targeted at ending female genital mutilation in the EU: integrating social cognitive and community level approaches
Obstet. Gynecol. Int.
Female Genital Mutilation Multi-agency Guidance
What has the literature taught us about culturally competent care of women and children
MCN Am. J. Matern./Child Nurs.
General Recommendation No. 19 – Eleventh Session, Violence Against Women
Nurses׳ experiences of caring for culturally diverse patients in an acute care setting Contemporary Nurse
J. Austr. Nurs. Prof.
Cultural competence in nursing: new meanings
J. Transcult. Nurs.
Systematic Reviews CRD׳s Guidance for Undertaking Reviews in Health Care
A statistical study to estimate the prevalence of female genital mutilation in England and Wales. Summary report
Clin. Obstet. Gynecol.
Multi-Agency Practice Guidelines: Female Genital Mutilation
A discussion of the legal aspects of female genital mutilation
J. Adv. Nurs.
Definition of the Midwife
Midwives׳ experiences in providing care and counselling to women with female genital mutilation (FGM) related problems
Obstet. Gynecol. Int.
Challenges to reaching MDG5: a qualitative analysis of the working environment of skilled birth attendants in Cambodia
Int. J. Childbirth
Increasing certified nurse-midwives׳ confidence in managing the obstetric care of women with female genital mutilation/cutting
J. Midwifery Womens Health
Care for infibulated women giving birth in Norway: an anthropological analysis of health workers׳ management of a medically and culturally unfamiliar issue
Med. Anthropol. Q
What works and what does not: a discussion of popular approaches for the abandonment of female genital mutilation
Obstet. Gynecol. Int.
Perceptions of obstetrical interventions and female genital cutting: insights of men in a Somali refugee community
Ethn. Health
Improving the Health Care of Women and Girls Affected by Female Genital Mutilation/Cutting: A National Approach to Service Coordination
Female Genital Mutilation: perceptions of healthcare professionals and the perspective of the migrant families
BMC Public Health
Perception of primary health professionals about Female Genital Mutilation: from healthcare to intercultural competence
BMC Health Services Res.
Knowledge, attitudes and practices of female genital mutilation/cutting among health care professionals in The Gambia: a multiethnic study
BMC Public Health
Female genital mutilation – experience of the Royal Women׳s Hospital, Melbourne
Austr. New Zealand J. Obstet. Gynaecol.
Cited by (37)
Effectiveness of female genital mutilation/cutting education for health professionals: An integrative review
2023, Nurse Education in PracticeNursing students' knowledge gained about female genital cutting/mutilation through dramatization simulation with a standardized patient: A quasi-experimental study
2022, Nurse Education TodayCitation Excerpt :Health care professionals unfamiliar with the procedure and its health-related consequences are more and more likely to encounter women who were cut prior to immigration to countries where FGC is rarely done. Extensive reviews of the literature by Evans et al. (2019), Abdulcadir et al. (2017), and Dawson et al. (2015) revealed that healthcare professionals (HCPs) were not comfortable dealing with FGC, particularly because they were unsure of culturally appropriate ways to care for women who had been cut (Levy et al., 2021). One reason may be because FGC has been a rare topic in nursing education.Donnenwirth et al. (2021) found that <30 % of nursing schools in the United States include any information in their curriculum related to FGC.
Maternity care of women affected by female genital mutilation/cutting: An audit of two Australian hospitals
2020, Women and BirthCitation Excerpt :Health providers caring for a woman with FGM/C throughout pregnancy can play a key role in beginning a dialogue about FGM/C provided they are adequately trained to discuss the issue in a culturally respectful and sensitive manner. Many studies have shown that healthcare providers feel they lack the requisite knowledge and skills to appropriately discuss this issue with women.7,8,10–13,16,22–24 We can postulate that this lack of confidence on the health providers’ part is the reason there were so few documented conversations regarding the maternal consequences of FGM/C – none at one site and only 18% at the other site.
Living with mutilation: A qualitative study on the consequences of female genital mutilation in women's health and the healthcare system in Spain
2018, MidwiferyCitation Excerpt :The study participants’ perception is that none of the healthcare professionals who attended to them detected their genital mutilation since they did not broach the subject with them. This failure to address the issue may be produced due to a lack of knowledge or awareness by healthcare professionals which in turn prevents the detection, care and prevention of FGM in immigrant women, as described in studies on an international (Isman et al., 2013; Dawson et al., 2014; Abdulcadir et al., 2017), national (García Aguado & Sánchez López, 2013) and regional (Vázquez Moya & Almansa Martínez, 2012) level, indicating a need for education and training for healthcare professionals which should be supported by international and community level guidelines and policies. A number of possible biases which could affect results were taken into account.
Strengthening woman-centred care for pregnant women with female genital mutilation in Australia: a qualitative muti-method study
2024, Frontiers in Global Women's Health