Female Genital Mutilation/Cutting Education for Midwives and Nurses as Informed by Women’s Experiences: Protocol for an Exploratory Sequential Mixed Methods Study

Abstract

Background Female genital mutilation/cutting (FGM/C) is a complex and deeply rooted sociocultural custom that is innately entrenched in the lives of those who continue its practice despite the physical and psychological dangers it perpetrates. FGM/C is considered a significant independent risk factor for adverse maternal and fetal outcomes in pregnancy and childbirth. Several studies in high-income countries have explored the experiences and needs of women with FGM/C as well as the knowledge of the health professionals, particularly midwives and nurses, who care for them. However, to date, no studies have evaluated the implementation of education for health professionals in high-income countries to meet the specific needs of women with FGM/C. Objective This study aims to explore the impact of an FGM/C education program for midwives and nurses as informed by the experiences of women with FGM/C accessing maternity, gynecological, and sexual health services in South Australia. Methods This study will adopt a three-phase, exploratory sequential mixed methods design. Phase 1 will involve the exploration of women with FGM/C views and experiences accessing maternity and gynecological (including sexual health) services in South Australia. The findings from phase 1 will inform phase 2: the development of an educational program for midwives and nurses on the health and cultural needs of women with FGM/C. Phase 3 will involve the evaluation of the program by measuring midwives’ and nurses’ changes in knowledge, attitude, and practice immediately before and after the education as well as 4 months after completing the program. Phase 1 of this study has been approved by the Women’s and Children’s Health Network human research ethics committee (ID number 2021/HRE00156) and the University of South Australia human research ethics committee (ID number 204096). Results Phase 1 will commence in August 2021, with the interpretation of findings being undertaken by November 2021. Phase 2 will be developed and facilitated by February 2022, and the final phase of this study will begin in March 2022. This study is expected to be completed by February 2023. Conclusions The findings of this research will provide insight into the development and evaluation of education programs for midwives and nurses that includes collaboration with women from culturally and linguistically diverse backgrounds to address the specific cultural and health needs of communities. International Registered Report Identifier (IRRID) PRR1-10.2196/32911

Turning the tide on female genital mutilation in a high prevalence country: a programmatic data analysis for Sudan’s comprehensive health sector response, 2016–2018

“…There is a growing body of evidence on health sector interventions determining their effectiveness [7][8][9][10][11][12][13][14][15][16][17] in changing healthcare providers' knowledge, attitudes and skills to provide FGM prevention or care of its complications. However, there is limited literature examining country-level health sector interventions 18 especially in high FGM prevalence, low-income countries 19 with no granular data detailing type of activities implemented, their costs or results.…”

Healthcare professionals attitudes on “Female Genital Mutilation”: an observational study

“…Therefore, it was necessary to ensure and evaluate adequate skills among healthcare professionals, also through training both on-line or in-person, too. Several studies adopted post-training evaluation strategies, as well as the study of Diaz et al [51] which assessed the knowledge among USA nurses and midwives before and after training in FGM women's, by adopting an educational program that included instructional information, case studies, a laboratory of practical deinfibulation and repair skills, and advice from an intermediary. Knowledge in several types of mutilation and the ability to provide safe assistance were greatly improved after training [50].…”

“…Each of us could play an active role in abandoning this practice, which violated the right of choice and health of every child, girl, woman who was still undergoing any kind of genital cut dictated by social norms, as well as providing adequate health care so as to reduce any complications from FGM. "We need training, awareness and empowerment processes, which concerned not only local communities, but also all sectors involved in the phenomenon" [51,53].…”

National and international programmatic perspective on facilitators and barriers for Sudan’s health sector response on female genital mutilation (2016–2018): a qualitative study

“…The present study contributes to a much-needed programmatic evidence base on complex health interventions in low-income FGM prevalent settings, in contrast to the current body of evidence, which has addressed singular health interventions or factors affecting FGM-related health interventions in high-income settings. [7][8][9][10][11][12][13][14][15] We conducted in-depth interviews with programme managers to identify the factors and their mechanisms of influence on the health sector component of the SFFGC programme during the first 3 years (2016-2018).…”

“…Between 2016 and 2018, Sudan had significant achievements in the health component of SFFGC programme,5 prompting further in-depth study to understand how and why this occurred. The present study contributes to a much-needed programmatic evidence base on complex health interventions in low-income FGM prevalent settings, in contrast to the current body of evidence, which has addressed singular health interventions or factors affecting FGM-related health interventions in high-income settings 7–15…”