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

Abstract

ObjectivesLittle is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients.SettingPrimary care in England.Data sourcesRealist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients.Primary outcome measureThis realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated.Results124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations.ConclusionsThere is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities’ health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation.PROSPERO registration numberCRD42018091996.

Barriers and facilitators to the access to specialized female genital cutting healthcare services: Experiences of Somali and Sudanese women in Norway

“…When the GPs did not ask them about-or link their health problems to-FGC, participants mostly concluded that the GPs lacked knowledge of FGC or that their health problems were not FGC-related. We do not know the GPs' exact reasons for not asking about FGC, but former findings [60][61][62] suggest that perceiving FGC as a taboo and having insufficient knowledge may play a key role. In several Western countries, GPs score low on both the clinical and cultural aspects of FGC [63][64][65].…”

Identifying evidence for five realist reviews in primary health care: A comparison of search methods

“…The lead reviewers on each project agreed to contribute their data to this study. The detailed methods employed in each review are reported in their own study protocols and published reports (where applicable) 39–48 . For this study, we collected data from each review team relating to the final list of documents included in each review.…”

Women’s health and primary care: time to get it right for the life course

“…In our work on endometriosis 12 and female genital mutilation (FGM), 13 – 14 we found that the majority of evidence deployed in primary care is derived from specialist settings and then extrapolated back to the primary care setting, where the populations and needs may significantly differ.…”

“…Another example is the predominance of FGM research in obstetric and midwifery settings resulting in a lack of evidence or resources for how GPs might support women with FGM beyond their reproductive years and through the menopause. 14 Where potential gaps in care are identified, all too often the conclusion is that GPs lack knowledge and awareness, and that increasing these would improve care. 12 However, our work on endometriosis demonstrates GPs are rarely working with a lack of knowledge, but rather engage with complex and nuanced considerations.…”