‘Birds of the same feathers fly together’: midwives’ experiences with pregnant women and FGM/C complications - a grounded theory study in Liberia

Abstract

Background In Liberia, approximately 70% of the women of the North-Central and North-Western regions could have undergone female genital mutilation/cutting (FGM/C) in their childhood during a traditional ceremony marking their entrance into Sande, a secret female society. Little is known about FGM/C from Liberian women’s perspective. This study aimed to understand the health implications of FGM/C as perceived by qualified female midwives. Methods This qualitative study was conducted in 2017 in Monrovia, Liberia’s capital. Twenty midwives were approached. Of these, seventeen consented to participate in in-depth interviews. A thematic guide was used to gain insights about their knowledge on FGM/C and their experiences attending women victims of FGM/C. A feminist interpretation of constructivist grounded theory guided data generation and analysis. Results The midwives participants described how clitoridectomy was the most common FGM/C type done to the girls during the Sande initiation ceremonies. Sexual impairment and intrapartum vulvo-perineal laceration with subsequent hemorrhage were described as frequent FGM/C-attributable complications that some midwives could be unable to address due to lack of knowledge and skills. The majority of midwives would advocate for the abandonment of FGM/C, and for the preservation of the traditional instructions that the girls in FGM/C-practicing regions receive when joining Sande. The midwives described how migration to urban areas, and improved access to information and communication technologies might be fuelling abandonment of FGM/C. Conclusion Liberian midwives need tailored training to provide psychosexual counseling, and to attend the obstetric needs of pregnant women that have undergone FGM/C. In spite of FGM/C being seemingly in the decline, surveillance at clinic-level is warranted to prevent its medicalization. Any clinic- or community-based training, research, prevention and awareness intervention targeting FGM/C-practicing populations should be designed in collaboration with Sande members, and acknowledging that the Liberian population may place a high value in Sande’s traditional values.

Exploring Perceptions of Female Genital Mutilation/Cutting Abandonment (FGM/C) in Kenyan Health Care Professionals

“…A GT approach was used for this study, given that GT has been used in other qualitative studies researching FGM/C and the sparse literature pertaining to HCPs’ views on abandonment of the practice ( Glover et al, 2017 ; Johnson & Waterfield, 2004 ; Tarr-Attia et al, 2019 ). GT aims to develop new theory “grounded” in data that are systematically collected and analyzed ( Connelly, 2013 ; Strauss & Corbin, 1990 ).…”

Consideration of Cultural Practices When Characterizing the Vaginal Microbiota Among African and African American Women

“…Cultural beliefs about the benefits of FGM in countries around the world where it is practiced include, but are not limited to, social acceptance, increased pleasure for male partners, preservation of fertility, and ensuring virginity (Klein et al, 2018; Odukogbe et al, 2017). In some cultures, girls who are uncut may be considered unfeminine, unclean, or sexually promiscuous, and therefore not suitable for marriage (Gebremicheal et al, 2018; Olijra et al, 2016; Tarr-Attia et al, 2019). In Liberia, West Africa, as many as 70% of women in the North-Central and North-Western regions may have undergone FGM during their childhood (Liberia Institute of Statistics, 2013).…”

Management of Female Genital Mutilation/Cutting-Related Obstetric Complications: A Training Evaluation

“…In Guinea, Liberia or Sierra Leone, FGM/C is a requisite for girls to join a secret society, making FGM/C a practice that nobody dares to unveil. The secrecy around FGM/C hampers advocacy activities and education on its health effects [ 9 ]. Further, there is a lack of legal, social, and institutional support to tackle training needs and to ensure the translation of knowledge into clinical practice [ 10 ].…”

“…To improve healthcare provision to survivors of FGM/C in Liberia, training tailored to the expectations, needs, capacities, and social and cultural values of the Liberian health workforce must be implemented [ 1 , 18 ]. In ensuring the effectiveness of FGM/C training provision in Liberia, a study of acronym PerTradFGMo was carried out in 2017, which assessed healthcare workers’ experiences with obstetric care provision to FGM/C survivors in Liberia [ 9 ]. PerTradFGMo findings informed the design of a training programme titled “Integrated FGM/C Antenatal and Psychosocial Care Workshop” (hereafter workshop) that was conducted in 2019.…”