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

Dawson, Angela; Turkmani, Sabera; Fray, Shairon; Nanayakkara, Susie; Varol, Nesrin; Homer, Caroline

doi:10.1016/j.midw.2014.08.012

Cited by 47 publications

(43 citation statements)

References 46 publications

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“…The prevalence of FGM is consistent with other units in Australia, expanding the evidence for the relevance and importance of this issue. Education on the management of women affected by FGM is the focus of clinical guidelines and the RANZCOG online training modules due to demonstrated lack of knowledge, skills and cultural awareness surrounding this complex issue …”

Section: Discussionmentioning

confidence: 99%

Female genital mutilation: Obstetric outcomes in metropolitan Sydney

Davis

Jellins

2019

Aust NZ J Obst Gynaeco

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Background: Female genital mutilation (FGM) and its impact on women's health are becoming relevant in Australia due to increases in numbers of refugees and migrants from affected countries. Notwithstanding the psychological trauma from FGM, there is a broad range of sequelae relevant to obstetrics and gynaecology, particularly related to maternal morbidity from labour and delivery. Aims:To assess the prevalence of FGM in our unit and document its effect on maternal and neonatal outcomes. Methods:Retrospective cohort study of women affected by FGM who delivered at a metropolitan hospital in Sydney over a five-year period. The primary outcome was mode of delivery and secondary outcomes addressed maternal morbidity and neonatal nursery admission compared with women unaffected by FGM. Results:A full data set was available for 141/142 women affected by FGM. The overall prevalence of FGM was 1.64%. The majority of women affected by FGM were documented to have FGM 3 (41.1%). There was no difference in caesarean section rate. Women with FGM were less likely to be delivered by vacuum or forceps (11.1% vs 2.8%; P = 0.0009). There was no difference in perineal trauma, postpartum haemorrhage and neonatal nursery admission. Women with FGM 3 were more likely to have an episiotomy (4.8% vs 25.9%; P = 0.0007) without an increase in anal sphincter injury (P = 0.7). Documentation complying with local policy and guidelines was poor.Conclusions: FGM is increasingly common in Australia. This study adds to the Australian literature quantifying the effects on obstetric outcomes in these high-risk women.

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Section: Discussionmentioning

confidence: 99%

Female genital mutilation: Obstetric outcomes in metropolitan Sydney

Davis

Jellins

2019

Aust NZ J Obst Gynaeco

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“…Only 15% of these clinicians acknowledged they had some education and training in FGM/C and 65% requested educational materials on FGM/C [38]. Global experience on education and training for HCP involved in the care of women with FGM/C is in keeping with findings in Australia [34, 35, 39–42]. In response to this lack of knowledge, training courses and education modules on FGM/C for continuous professional development for HCPs have been developed by various organisations in different states in Australia [25, 26, 31, 43, 44].…”

Section: Introductionmentioning

confidence: 91%

“…Education and training on the sociocultural underpinnings of FGM/C, management of its complications, and obstetric management, are a prerequisite for accurate and consistent data collection, as well as for the provision of specialised healthcare services [18, 34, 35]. Midwives in Australia were cognisant of their lack of confidence and fear of caring for women with FGM/C due to cultural misunderstanding and difficulty in development of rapport, lack of knowledge about FGM/C and data collection, and ignorance of relevant clinical guidelines and policies [36].…”

Section: Introductionmentioning

confidence: 99%

Evidence-based policy responses to strengthen health, community and legislative systems that care for women in Australia with female genital mutilation / cutting

et al. 2017

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BackgroundThe physical and psychological impact of female genital mutilation / cutting (FGM/C) can be substantial, long term, and irreversible. Parts of the health sector in Australia have developed guidelines in the management of FGM/C, but large gaps exist in community and professional knowledge of the consequences and treatment of FGM/C. The prevalence of FGM/C amongst Australian women is unknown. Our article reviews the literature on research on FGM/C in Australia, which focuses on health system response to women and girls with FGM/C. Recommendations are made for policy reform in health, legislation, and community programs to provide the best healthcare, protect children, and help communities abandon this harmful practice.Main bodyMidwives and doctors in Australia acknowledged a lack of knowledge on FGM/C, clinical guidelines and consequences for maternity care. In a metropolitan Australian hospital with specialised FGM/C care, women with FGM/C had similar obstetric outcomes as women without FGM/C, underlining the importance of holistic FGM/C clinics.Greater focus on integration of refugee and migrant populations into their new cultures may be an important way of facilitating the abandonment of this practice, as is education of communities that practise FGM/C, and experts involved in the care and protection of children. Men could be important advocates for protecting women and girls from violence and FGM/C through a man-to-man strategy with programs focussing on men’s health and other personal issues, education, and communication.The Australian Government has identified gender-based violence as an area of priority and has been implementing a National plan to reduce violence against women and their children 2010–2022. A multidisciplinary network of experts on FGM/C could be established within this taskforce to develop well-defined and rapid referral pathways to care for and protect these children, as well as coordinate education and prevention programs to help communities abandon this harmful practice.ConclusionCountries of migration can be part of the solution for abandonment of FGM/C through community interventions and implementation of national and coordinated training in FGM/C of experts involved in the care and protection of children and women. The global focus on collaboration on research, training and prevention programs should be fostered between countries of FGM/C prevalence and migration.

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“…Health professionals in HIC are often not aware of FGM or have knowledge and skills to adequately care for affected women or protect children at risk. FGM therefore presents a challenge to the health system in HIC [21, 22]. …”

Section: Introductionmentioning

confidence: 99%

Preventing female genital mutilation in high income countries: a systematic review of the evidence

et al. 2019

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Background Female genital mutilation (FGM) is prevalent in communities of migration. Given the harmful effects of the practice and its illegal status in many countries, there have been concerted primary, secondary and tertiary prevention efforts to protect girls from FGM. However, there is paucity of evidence concerning useful strategies and approaches to prevent FGM and improve the health and social outcomes of affected women and girls. Methods We analysed peer-reviewed and grey literature to extract the evidence for FGM prevention interventions from a public health perspective in high income countries by a systematic search of bibliographic databases and websites using appropriate keywords. Identified publications were screened against selection criteria, following the PRISMA guidelines. We examined the characteristics of prevention interventions, including their programmatic approaches and strategies, target audiences and evaluation findings using an apriori template. Findings Eleven documents included in this review described primary and secondary prevention activities. High income countries have given attention to legislative action, bureaucratic interventions to address social injustice and protect those at risk of FGM, alongside prevention activities that favour health persuasion, foster engagement with the local community through outreach and the involvement of community champions, healthcare professional training and capacity strengthening. Study types are largely process evaluations that include measures of short-term outcomes (pre- and post-changes in attitude, knowledge and confidence or audits of practices). There is a dearth of evaluative research focused on empowerment-oriented preventative activities that involve individual women and girls who are affected by FGM. Beattie’s framework provides a useful way of articulating negotiated and authoritative prevention actions required to address FGM at national and local levels. Conclusion FGM is a complex and deeply rooted sociocultural issue that requires a multifaceted response that encompasses socio-economic, physical and environmental factors, education and learning, health services and facilities, and community mobilisation activities. Investment in the rigorous longitudinal evaluation of FGM health prevention efforts are needed to provide strong evidence of impact to guide future decision making. A national evidence-based framework would bring logic, clarity, comprehension, evidence and economically more effective response for current and future prevention interventions addressing FGM in high income countries.

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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

Cited by 47 publications

References 46 publications

Female genital mutilation: Obstetric outcomes in metropolitan Sydney

Female genital mutilation: Obstetric outcomes in metropolitan Sydney

Evidence-based policy responses to strengthen health, community and legislative systems that care for women in Australia with female genital mutilation / cutting

Preventing female genital mutilation in high income countries: a systematic review of the evidence

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