Providers' Perceptions of Challenges in Obstetrical Care for Somali Women

Abstract

Background. This pilot study explored health care providers' perceptions of barriers to providing health care services to Somali refugee women. The specific aim was to obtain information about providers' experiences, training, practices and attitudes surrounding the prenatal care, delivery, and management of women with Female Genital Cutting (FGC). Methods. Individual semi-structured interviews were conducted with 14 obstetricians/gynecologists and nurse midwives in Columbus, Ohio. Results. While providers did not perceive FGC as a significant barrier in itself, they noted considerable challenges in communicating with their Somali patients and the lack of formal training or protocols guiding the management of circumcised women. Providers expressed frustration with what they perceived as Somali patients' resistance to obstetrical interventions and disappointment with a perception of mistrust from patients and their families. Conclusion. Improving the clinical encounter for both patients and providers entails establishing effective dialogue, enhancing clinical and cultural training of providers, improving health literacy, and developing trust through community engagement.

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

“…A study of 243 American certified nurse midwives by Hess et al (2010) revealed that they had better technical knowledge on FGM types and complication than knowledge of cultural and legal issues. A lack of cultural knowledge was also reported by midwives in another US study by Lazar et al (2013).…”

“…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 & 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 al, 2013).…”

“…Table 2 indicates the themes by paper. (Berggren, et al, 2004) 3 3 3 (Hess, 2010) 3 3 (Isman, et al, 2013) 3 3 3 (Jacoby & Smith, 2013) 3 (Korfker, et al, 2012) 3 (Lazar, et al, 2013) 3 3 (Leval, et al, 2004) 3 (Tamaddon, et al, 2006) 3 3 3 (Widmark, et al, 2002) 3 3 3 (Zaidi, et al, 2007) 3…”

“…Nearly 13% of study participants indicated they were always asked to perform reͲinfibulation after birth, 15.4% often and 15.4% sometimes. An American midwife participant in one study (Lazar, et al, 2013) mentioned that they had considered adopting a protocol to address requests for reͲ infibulation but it was never taken forward. Midwives in this study reported communication issues and cultural differences that affected the provision of care and one said that they had encountered resistance from women who they believed to be afraid of caesarean sections.…”

“…A number of studies in the review from HIC noted that midwives had a poor understanding of the culture of the women they were caring for (Hess, 2010;Lazar, et al, 2013;Leval, et al, 2004;Widmark, et al, 2002). Culturally competent midwives and nurses are critical to the provision of quality maternal and child health care (Callister, 2005), which involves midwives working effectively within the cultural context of the women and their families.…”