‘Putting salt on the wound’: a qualitative study of the impact of FGM-safeguarding in healthcare settings on people with a British Somali heritage living in Bristol, UK

Abstract

ObjectivesThis research documents the experiences of people with Somali heritage with female genital mutilation (FGM)-safeguarding services in healthcare and whether such services are considered appropriate by the people who encounter them.DesignSix focus groups conducted with ethnic Somalis living in Bristol, during the summer of 2018, divided by gender and whether people had experienced FGM-safeguarding as adults or children.SettingParticipants experienced FGM-safeguarding in primary and secondary care.Participants30 people (21 women and 9 men), identified through local organisations or snowball sampling. All participants were of Somali heritage and aged over 18.ResultsGovernment priorities to support those who have experienced female genital cutting/mutilation (FGC/M) are being undermined by their own approaches to protect those considered at risk. Participants argued that approaches to FGM-safeguarding were based on outdated stereotypes and inaccurate evidence which encouraged health and other service providers to see every Somali parent as a potential perpetrator of FGC/M. Female participants described providers in a range of healthcare settings, including Accident and Emergency Departments (A&E), antenatal care and general practice, as ‘fixated’ with FGC/M, who ignored both their health needs and their experience as victims. Participants felt stigmatised and traumatised by their experience. This undermined their trust in health services, producing a reticence to seek care, treatment delays and reliance on alternative sources of care. Associated recommendations include developing more accurate evidence of risk, more appropriate education for healthcare providers and more collaborative approaches to FGM-safeguarding.ConclusionAll the participants involved in this study are committed to the eradication of FGC/M. But the statutory approaches currently adopted to enable this are considered ill-conceived, unnecessarily heavy-handed and ultimately detrimental to this. Recognising these common aims can enable the development of services better able to protect and support those at risk of FGC/M in ways which are culturally competent and sensitive.

Deinfibulation Contextualized: Delicacies of Shared Decision-Making in the Clinic

“…As a result, they reported avoiding medical care and/or approaching appointments with hostility and fear. (Karlsen et al, 2019 , p. 7)…”

“…The situation in the UK is illustrative: It has perhaps the most advanced legal regulations toward professional groups when it comes to FGC, and among the measures is an absolute duty for healthcare providers to report any FGC found in a minor girl. These policies aim to identify illegal cases of FGC, but the “side effects” for the affected communities are severe (Creighton, Samuel, Otoo-Oyortey, & Hodes, 2019 ; Johnsdotter, 2019 ; Karlsen, Carver, Mogilnicka, & Pantazis, 2019 ; Lane, Johnson-Agbakwu, Warren, Budhathoki, & Cole, 2018 ). As reported by a research group in the UK after a study among Somalis in Bristol: Women in our focus groups experienced FGM-safeguarding repeatedly in routine health care settings with midwives, GPs and health visitors.…”

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

“… 12 13 84 86 120 121 Furthermore, if women perceive that the HCP is more interested in data management about their FGM than their needs, they may feel disrespected and may avoid healthcare settings. 84 …”

Supporting patients with female genital mutilation in primary care: a qualitative study exploring the perspectives of GPs’ working in England

“…8,9 Concerns about the potential impacts of these two policies have been raised by both professionals and community members. [10][11][12][13][14][15][16] In the most recent data report for the FGM Enhanced Dataset, only 59 GP practices submitted attendance data in the year 2019-2020. 17 There were approximately 6813 GP practices in England in February 2020.…”