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Exploring barriers to seeking health care among Kenyan Somali women with female genital mutilation: a qualitative study.

ABSTRACT: BACKGROUND:Female genital mutilation/cutting (FGM/C) is a cultural practice associated with health consequences, women rights and deprivation of dignity. Despite FGM/C-related health consequences, circumcised women may encounter additional challenges while seeking interventions for reproductive health problems. Experiences of women/girls while accessing health services for reproductive health problems including FGM/C-related complications in poor, remote and hard to reach areas is poorly understood. We sought to explore barriers to care seeking among Somali women with complications related to FGM/C in public health facilities in Kenya. METHODS:We drew on qualitative data collected from purposively selected women aged 15-49?years living with FGM/C, their partners, community leaders, and health providers in Nairobi and Garissa Counties. Data were collected using in-depth interviews (n?=?10), key informant interviews (n?=?23) and 20 focus group discussions. Data were transcribed and analyzed thematically using NVivo version 12. RESULTS:Barriers were grouped into four thematic categories. Structural barriers to care-seeking, notably high cost of care, distance from health facilities, and lack of a referral system. Concerns regarding perceived quality of care also presented a barrier. Women questioned health professionals' and health facilities' capacity to offer culturally-sensitive FGM/C-specific care, plus ensuring confidentiality and privacy. Women faced socio-cultural barriers while seeking care particularly cultural taboos against discussing matters related to sexual health with male clinicians. Additionally, fear of legal sanctions given the anti-FGM/C law deterred women with FGM/C-related complications from seeking healthcare. CONCLUSION:Structural, socio-cultural, quality of service, and legal factors limit health seeking for reproductive health problems including FGM/C-related complications. Strengthening health system should consider integration of FGM/C-related interventions with existing maternal child health services for cost effectiveness, efficiency and quality care. The interventions should address health-related financial, physical and communication barriers, while ensuring culturally-sensitive and confidential care.

SUBMITTER: Kimani S

PROVIDER: S-EPMC6986153 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Exploring barriers to seeking health care among Kenyan Somali women with female genital mutilation: a qualitative study.

Kimani Samuel S Kabiru Caroline W CW Muteshi Jacinta J Guyo Jaldesa J

BMC international health and human rights 20200128 1

<h4>Background</h4>Female genital mutilation/cutting (FGM/C) is a cultural practice associated with health consequences, women rights and deprivation of dignity. Despite FGM/C-related health consequences, circumcised women may encounter additional challenges while seeking interventions for reproductive health problems. Experiences of women/girls while accessing health services for reproductive health problems including FGM/C-related complications in poor, remote and hard to reach areas is poorly ...[more]

PMID: 31992317

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Project description:ObjectiveTo explore the experiences of accessing and receiving healthcare related to female genital mutilation/cutting (FGM/C) across the life course from the perspective of women and girls who have undergone FGM/C.DesignA systematic review of qualitative research studies using a thematic synthesis approach.MethodsInclusion criteria were qualitative studies (including grey literature) of any design, from Organisation for Economic Co-operation and Development (OECD) countries, of any date and any language. Sixteen electronic databases were searched from inception to December 2017, supplemented by reference list searching. Papers were screened, selected and quality-appraised by two reviewers using established tools from the Joanna Briggs Institute. NVivo software was used to extract study characteristics and code study findings. An inductive thematic synthesis approach was undertaken to identify descriptive themes and interpret these into higher order analytical constructs. Confidence in the review findings was assessed using Grading of Recommendations, Assessment, Development and Evaluations-Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual).ResultsFifty-seven papers (from 55 distinct studies) from 14 different OECD countries were included (50% published within the last 8?years). One-third of studies focused exclusively on maternity care experiences, whereas others covered a range of foci. No studies reported explicitly on girls' experiences or on experiences of health service-led safeguarding interventions. Only three studies addressed psychological care. The synthesis developed 17 descriptive themes, organised into 5 analytical constructs. These related to communication, access to care, experiences of cultural dissonance/integrity, disempowering care experiences and positive care encounters. The themes illuminate significant challenges to obtaining timely and holistic care (especially for deinfibulation), and highlight different ways in which women may experience care as disrespectful, unsafe and disempowering. Key elements of 'culturally safe care' are identified.ConclusionsThis review has highlighted key knowledge gaps, especially around (1) girls'/unmarried women's experiences and (2) the impact of recent safeguarding interventions. There is an ongoing need for community engagement, service development and staff training.Prospero registration numberCRD420150300012015.

Project description:Although female genital mutilation/cutting (FGM/C) has declined, it is pervasive albeit changing form among communities in Kenya. Transformation of FGM/C include medicalization although poorly understood has increased undermining abandonment efforts for the practice. We sought to understand drivers of medicalization in FGM/C among selected Kenyan communities. A qualitative study involving participants from Abagusii, Somali and Kuria communities and key informants with health care providers from four Kenyan counties was conducted. Data were collected using in-depth interviews (n = 54), key informant interviews (n = 56) and 45 focus group discussions. Data were transcribed and analyzed thematically using NVivo version 12. We found families practiced FGM/C for reasons including conformity to culture/tradition, religion, marriageability, fear of negative sanctions, and rite of passage. Medicalized FGM/C was only reported by participants from the Abagusii and Somali communities. Few Kuria participants shared that medicalized FGM/C was against their culture and would attract sanctions. Medicalized FGM/C was perceived to have few health complications, shorter healing, and enables families to hide from law. To avoid arrest or sanctions, medicalized FGM/C was performed at home/private clinics. Desire to mitigate health complications and income were cited as reasons for health providers performing of FGM/C. Medicalization was believed to perpetuate the practice as it was perceived as modernized FGM/C. FGM/C remains pervasive in the studied Kenyan communities albeit changed form and context. Findings suggest medicalization sustain FGM/C by allowing families and health providers to conform to social norms underpinning FGM/C while addressing risks of FGM/C complications and legal prohibitions. This underscores the need for more nuanced approaches targeting health providers, families and communities to promote abandonment of FGM/C while addressing medicalization.

Project description:BackgroundIn Ethiopia, female genital mutilation (FGM) remains a serious concern and has affected 23.8 million women and girls, with the highest prevalence in Somali regional state. Even though FGM is reported to be associated with a range of obstetric complications, little is known about its effects on childbirth in the region. Therefore, the objective of this study was to test the hypothesis that FGM is a contributing factor to the increased risk of complication during childbirth.MethodsFacility based cohort study, involving 142 parturients with FGM and 139 parturients without FGM, was conducted in Jijiga town from October to December, 2014. The study participants were recruited by consecutive sampling technique. Data were collected using a structured interviewer administered questionnaire and observational checklists. Data were analyzed using SPSS version 16 and STATA version 11.ResultsThe existence of FGM was significantly associated with perinealtear [RR = 2.52 (95% CI 1.26-5.02)], postpartum blood loss [RR = 3.14 (95% CI 1.27-7.78)], outlet obstruction [RR = 1.83 (95% CI 1.19-2.79)] and emergency caesarean section [RR = 1.52 (95% CI 1.04-2.22)]. FGM type I and FGM type II did not demonstrate any association with prolonged 2nd stage of labour, emergency caesarean section, postpartum blood loss, and APGAR score < 7. FGM type III however was significantly associated with prolonged 2nd stage of labour [RR = 2.47 (95% CI 1.06-5.76)], emergency caesarean section [RR = 3.60 (95% CI 1.65-7.86)], postpartum blood loss [RR = 6.37 (95% CI 2.11-19.20] and APGAR score < 7 [RR = 4.41 (95% CI, 1.84-10.60)]. FGM type II and type III were significantly associated with perinealtear [RR = 2.45(95% CI 1.03-5.83)], [RR = 4.91(95% CI 2.46-9.77)] and outlet obstruction [RR = 2.38(95% CI 1.39-4.08)], [RR = 2.94(95% CI 1.84-4.71)] respectively.ConclusionWomen with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive form of FGM. Adverse obstetric outcomes can therefore be added to the known harmful immediate and long-term effects of FGM.

Project description:Female genital mutilation and cutting (FGM/C, herein FGM) is a widespread and harmful practice. The Government developed a national campaign in Sudan, called Saleema, to change social norms discouraging FGM. Saleema translates to being "whole", healthy in body and mind, unharmed, intact, pristine, and untouched, in a God-given condition. An interim evaluation was conducted using focus groups among Sudanese adults. The primary aim was to explore perceptions of the Saleema poster exemplars and to assess if the desired themes were being communicated. Secondary aims were to understand more about participants' information sources, values, and suggestions for the campaign broadly.The Saleema campaign evaluation included four focus groups from each of the 18 states in Sudan (72 total). Participants were presented with three poster stimuli from the Saleema campaign and asked about the content and their reactions. Themes were coded inductively by concepts that arose through content in the transcripts. Codes were also reviewed in conjunction with themes from the broader Saleema evaluation framework.Participants reported the most common source of information or admiration was from local leaders who are responsive to a community, media-based outlets, and discussions among community members. Participants held high value for education, community solidarity, and/or religious devotion. Participants had positive opinions of Saleema and responded positively to the branding elements in the posters and the campaign as a whole. The most common suggestion was continued awareness. Advocacy, training, and posters were suggested to highlight the harms of FGM through leaders or in community settings. Individuals suggested that these activities target older women and individuals in rural villages. There was also a burgeoning theme of targeting youth for support of the campaign.The results of this focus group analysis demonstrate support for future Saleema campaign efforts promoting awareness and community engagement. The campaign could capitalize on partnerships with young people and those who are respected in the community (e.g., religious leaders) or continue promoting common values aligning with the support of education and community solidarity. Continuing campaign efforts have promise to decrease the harms of FGM in Sudan.

Project description:BackgroundFemale genital mutilation (FGM) is prevalent in Iraqi Kurdistan Region, but there is a lack of adequate knowledge about how the practice is perceived by the women population who are the direct victims of the practice. This study aimed to assess the knowledge, beliefs, and attitude of a sample of Kurdish women of FGM and identify the main enabling factors for performing this practice and the barriers to ending it.MethodsThis qualitative study was based on six focus groups involving a sample of 51 women. We used a topic guide to lead discussions, which included questions on women's perspectives of different aspects of FGM such as the reasons for practicing it, the positive and negative consequences, the continuation of the practice and tackling this problem in the community. Content analysis was used for the qualitative analysis of the data.ResultsThe women had poor knowledge about different aspects of FGM particularly concerning the procedure and the consequences. The mutilated participants revealed the devastating experience of the pain and the psychological effects they have experienced. Reducing sexual desire, having halal (permissible by Allah) hands, and religious requirement were the main reasons for practicing FGM. Reduction in women's sexual desire and the related social problems with the husband were the main problems identified to be associated with FGM. Most women did not support the continuation of FGM practice, but some women still think that FGM should be left to the people's preference. The participants identified raising people's awareness, active involvement of religious leaders in prevention efforts and the issuance and enforcement of legislation against FGM as the primary measures to reduce FGM practice.ConclusionPassing through FGM at childhood is an overwhelming experience with long-term effects for women. There is still a significant segment among the women population that do not oppose the continuations of FGM and need religious and scientific evidence against FGM. Some reasons for practicing FGM are deeply embedded in the culture and traditions, and there is a need for extensive efforts to raise the awareness of the population and change their thoughts and behavior about FGM.

Dataset Information

Exploring barriers to seeking health care among Kenyan Somali women with female genital mutilation: a qualitative study.

Publications

Exploring barriers to seeking health care among Kenyan Somali women with female genital mutilation: a qualitative study.

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