Analysis of a specialist service for non-pregnant women with female genital mutilation: 2008–2019
Female genital mutilation affects an estimated 200 million women and girls worldwide. This article examines a midwife-led service that integrates health advocates and counsellors into a model of holistic woman-centred care and was the blueprint for new national clinics opened in 2019.
This retrospective case note review examined referral patterns, clinical findings and interventions over 11 years at a UK specialist clinic for non-pregnant women with female genital mutilation.
More than 2000 consultations were conducted. Two thirds of women had type 3 mutilation. Most were Somali (73.4%) with 18 other ethnic backgrounds represented. Women presented with dysuria, dyspareunia/apareunia, dysmenorrhea, recurrent infections, post-traumatic stress disorder, nightmares, flashbacks and psychosexual issues. Interventions included deinfibulation under local anaesthetic (many as same day walk-in cases), clinical reports for asylum applications and trauma counselling. One in 10 attendees were healthcare professionals/carers. Nearly 5% were refugees/asylum seekers. There were 12 safeguarding referrals, three cases of mandatory reporting duty and two protection orders. Intersectional violence was frequently reported among women of West African origin.
Significant numbers of non-pregnant women require specialist help. Innovative means to publicise clinics and routine enquiry during gynaecological consultations and GP registration, could ensure earlier signposting to services. Deinfibulation can be safely performed by an expert midwife in a community or outpatient setting.
Female genital mutilation is defined as ‘all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons’ (World Health Organization (WHO), 2021). An estimated 200 million women and girls worldwide (UNICEF, 2016) have experienced the physical, psychological, and social sequelae of female genital mutilation, with associated healthcare costs of 1.4 billion US dollars per year (WHO, 2021). In 2011, it was calculated that 137000 women and girls with female genital mutilation resided in England and Wales, (MacFarlane and Dorkenoo, 2015) costing the NHS approximately £100 million annually (Hex et al, 2016).
Female genital mutilation is recognised as a form of gender-based violence and human rights violation rooted in gender inequality (WHO, 2021). It is a global public health concern, presenting an increasing challenge to countries with large diaspora. Despite prevention efforts, the pace of decline is uneven and UNICEF (2022) estimate that an additional 2 million girls could be at risk of female genital mutilation by 2030 as a result of social disruption caused by COVID-19. The practice, which has been illegal in the UK since 1985, is often justified by cultural or religious reasons underpinned by the desire to control female sexuality (Berg and Denison, 2012).
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