Female Genital Mutilation/Cutting: Innovative Training Approach for Nurse-Midwives in High Prevalent Settings.

Background Female genital mutilation/cutting (FGM/C) has no medical benefits and is associated with serious health complications. FGM/C including medicalization is illegal in Kenya. Capacity building for nurse-midwives to manage and prevent FGM/C is therefore critical. Objective Determine the current FGM/C knowledge and effect of training among nurse-midwives using an electronic tool derived from a paper-based quiz on FGM/C among nurse-midwives. Methods Nurse-midwives (n=26) were assessed pre- and post-FGM/C training using a quiz comprising 12 questions. The quiz assessed the following factors: definition, classification, determining factors, epidemiology, medicalization, prevention, health consequences, and nurse-midwives' roles in FGM/C prevention themes. The scores for individuals and all the questions were computed and compared using SPSS V22. Results The mean scores for the quiz were 64.8%, improving to 96.2% p < 0.05 after training. Before the training, the following proportions of participants correctly answered questions demonstrating their knowledge of types of cutting (84.6%), link with health problems (96.2%), FGM/C-related complications (96.2%), communities that practice FGM/C (61.5%), medicalization (43.6%), reinfibulation (46.2%), dissociation from religion (46.2%), and the law as it relates to FGM/C (46.2%). The participants demonstrated knowledge of FGM/C-related complications with the proportion of nurse-midwives correctly answering questions relating to physical impact (69.2%), psychological impact (69.2%), sexual impact (57.7%), and social impact (38.5%). Additionally, participant awareness of NM roles in managing FGM/C included the following: knowledge of the nurse-midwife as counselor (69.2%), advocate (80.8%), leader (26.9%), role model (42.3%), and caregiver (34.6%). These scores improved significantly after training. Conclusion Substantial FGM/C-related knowledge was demonstrated by nurse-midwives. They, however, showed challenges in preventing/rejecting medicalization of FGM/C, and there were knowledge gaps concerning sexual and social complications, as well as the specific roles of NM. This underscores the need to implement innovative FGM/C training interventions to empower health professionals to better respond to its management and prevention.

[1]  M. Utzet,et al.  Female genital mutilation/cutting: changes and trends in knowledge, attitudes, and practices among health care professionals in The Gambia , 2016, International journal of women's health.

[2]  Adriana Kaplan Marcusan,et al.  Female genital mutilation/cutting: changes and trends in knowledge, attitudes, and practices among health care professionals in The Gambia. , 2016 .

[3]  Y. Zurynski,et al.  Female genital mutilation and cutting: a systematic literature review of health professionals’ knowledge, attitudes and clinical practice , 2015, BMC International Health and Human Rights.

[4]  N. Varol,et al.  Female genital mutilation/cutting – towards abandonment of a harmful cultural practice , 2014, The Australian & New Zealand journal of obstetrics & gynaecology.

[5]  A. Padela,et al.  Perceptions of obstetrical interventions and female genital cutting: insights of men in a Somali refugee community , 2014, Ethnicity & health.

[6]  R. Berg,et al.  A realist synthesis of controlled studies to determine the effectiveness of interventions to prevent genital cutting of girls , 2013, Paediatrics and international child health.

[7]  C. Johnson-Agbakwu,et al.  Providers' Perceptions of Challenges in Obstetrical Care for Somali Women , 2013, Obstetrics and gynecology international.

[8]  V. Berggren,et al.  Midwives' Experiences in Providing Care and Counselling to Women with Female Genital Mutilation (FGM) Related Problems , 2013, Obstetrics and gynecology international.

[9]  A. Kaplan,et al.  Knowledge, attitudes and practices of female genital mutilation/cutting among health care professionals in The Gambia: a multiethnic study , 2013, BMC Public Health.

[10]  G. Serour.  Medicalization of female genital mutilation/cutting , 2013 .

[11]  K. Brown,et al.  The Applicability of Behaviour Change in Intervention Programmes Targeted at Ending Female Genital Mutilation in the EU: Integrating Social Cognitive and Community Level Approaches , 2013, Obstetrics and gynecology international.

[12]  N. Craddock,et al.  Reproductive outcomes and risk of subsequent illness in women diagnosed with postpartum psychosis , 2013, Bipolar disorders.

[13]  P. S. Yoder,et al.  Estimates of female genital mutilation/cutting in 27 African countries and Yemen. , 2013, Studies in family planning.

[14]  J. Knipscheer,et al.  Coping and chronic psychosocial consequences of female genital mutilation in the Netherlands , 2012, Ethnicity & health.

[15]  S. Grover,et al.  Female genital mutilation/cutting (FGM/C): Survey of RANZCOG Fellows, Diplomates & Trainees and FGM/C prevention and education program workers in Australia and New Zealand , 2012, The Australian & New Zealand journal of obstetrics & gynaecology.

[16]  A. Kaplan,et al.  Health consequences of female genital mutilation/cutting in the Gambia, evidence into action , 2011, Reproductive health.

[17]  P. Adongo,et al.  Trends in the prevalence of female genital mutilation and its effect on delivery outcomes in the kassena-nankana district of northern ghana. , 2010, Ghana medical journal.

[18]  A. Fretheim,et al.  Psychological, social and sexual consequences of female genital mutilation/cutting (FGM/C): a systematic review of quantitative studies , 2010 .

[19]  Rosanna F. Hess,et al.  Knowledge of female genital cutting and experience with women who are circumcised: a survey of nurse-midwives in the United States. , 2010, Journal of midwifery & women's health.

[20]  L. Almroth,et al.  Female genital mutilation among antenatal care and contraceptive advice attendees in Sweden , 2008, Acta obstetricia et gynecologica Scandinavica.

[21]  A. Khalil,et al.  Knowledge of female genital mutilation among healthcare professionals , 2007, Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology.

[22]  E. Banks,et al.  Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries , 2006, The Lancet.

[23]  S. Okogbenin,et al.  Female genital mutilation: knowledge, attitude and practice among nurses. , 2006, Journal of the National Medical Association.

[24]  P. Mårdh,et al.  Female genital mutilation – an exported medical hazard , 2005, The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception.

[25]  M. Tanner,et al.  Female genital mutilation in the context of migration: experience of African women with the Swiss health care system. , 2005, European journal of public health.

[26]  I. Askew,et al.  Female Genital Cutting among the Somali of Kenya and Management of its Complications , 2005 .

[27]  S. Bergström,et al.  An explorative study of Sudanese midwives' motives, perceptions and experiences of re-infibulation after birth. , 2004, Midwifery.

[28]  C. Tishelman,et al.  THE ENCOUNTERS THAT RUPTURE THE MYTH: CONTRADICTIONS IN MIDWIVES' DESCRIPTIONS AND EXPLANATIONS OF CIRCUMCISED WOMEN IMMIGRANTS' SEXUALITY , 2004, Health care for women international.

[29]  C. Tishelman,et al.  A study of Swedish midwives' encounters with infibulated African women in Sweden. , 2002, Midwifery.

[30]  L. Schwartz,et al.  Is there an advocate in the house? The role of health care professionals in patient advocacy , 2002, Journal of medical ethics.

[31]  S. Bergström,et al.  Male complications of female genital mutilation. , 2001, Social science & medicine.

[32]  E. Krug,et al.  Epidemiology of violent deaths in the world , 2001, Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention.

[33]  B. Shell-Duncan,et al.  The medicalization of female "circumcision": harm reduction or promotion of a dangerous practice? , 2001, Social science & medicine.

[34]  S. Hopkins,et al.  A discussion of the legal aspects of female genital mutilation. , 1999, Journal of advanced nursing.

[35]  T. Bishop,et al.  Female genital mutilation. , 1997, Journal of the National Medical Association.

[36]  M. Olfson,et al.  Depression in women: implications for health care research , 1995, Science.

[37]  A. Dawson,et al.  Challenges to Reaching MDG5:A Qualitative Analysis of the Working Environment of Skilled Birth Attendants in Cambodia , 2012, International Journal of Childbirth.

[38]  R. Berg,et al.  Interventions to reduce the prevalence of female genital mutilation/cutting in African countries , 2011 .

[39]  E. Leye,et al.  Responding to female genital mutilation in Europe. Striking the right balance between prosecution and prevention , 2009 .

[40]  M. Morrissey.  Suffer no more in silence: challenging the myths of women's mental health in childbearing. , 2007, The international journal of psychiatric nursing research.

[41]  Dugger Cw.  A refugees body is intact but her family is torn. , 1996 .