providing maternity care to women with fgm

Description

Critically discuss the role of the midwife in the provision of care and support for a woman who is experiencing female genital mutilation as a sensitive issue during their maternity care.
Section of Midwifery, DkIT
Course: BSc (Hons) in Midwifery
Module Level (8): Level 8; Semester 2
Module Title: Sensitive Midwifery Practice
Assignment Title:Learning outcomes will be assessed by means of a continuous assessment (100%).
Submission Date(s):
Written assignments are due on Friday 12th April 2023 by 16.00 
Guidelines for continuous assessment:
Academic assignment guidelines must be followed as per DkIT student handbook:
https://www.dkit.ie/nursing-midwifery-health-studi…
Students are required to submit a 2,500-word paper on the following:
Critically discuss the role of the midwife in the provision of care and support for a woman who is experiencing female genital mutilation as a sensitive issue during their maternity care.
Topic chosen: Female genital mutilation. Discuss:
The role of the midwife 
Assessing, screening for fgm at booking visits
Individualised care
Language barriers and communication
Continuity of care throughout pregnancy, childbirth and postpartum
Approach to the woman regarding fgm 
Importance of staff’s knowledge of fgm
Child safeguarding and law regarding fgm

Literature around the topic

Guidelines
Undertake a critical review of current literature on the sensitive issue from a midwifery perspective. Cognisance should be taken of any ethical and /or legal issues in relation to this.
Based on the evidence identify and discuss the midwife’s role in supporting and empowering women and their families with this issue.UNDERSTANDING
FEMALE GENITAL MUTILATION
(FGM)
AN ISSUE FOR HEALTHCARE PROFESSIONALS?
AkiDwA
Hope Turner
Migrant Women’s Health Officer
Introduction to AkiDwA

Established in 2001 to address social isolation, racism, and gender-based
violence migrant women were experiencing at the time.

AkiDwA (Swahili for sisterhood) is a national network of migrant women living
in Ireland.

Registered as a limited company with guarantee and no capital share and as a
charity CHY 17227

Vision: A just society where there is equal opportunity and equal access to
resources in all aspects of society, social, cultural, economic, civic and political.

Mission: To promote equality and justice for migrant women living in Ireland.

Funded by HSE, DOJ, EU, etc.

Membership: AkiDwA has over 6,000 members from over 50 countries of origin,
the organization is overseen by a board of management and currently has 12 staff
members.
Focus of AkiDwA

DSGBV: domestic violence, FGM, early and forced
marriages, human trafficking

Health: Sexual and reproductive health, mental health

Integration: racism, sexism, intersectionality, asylum,
employment, entrepreneurship & development

Activities: information provision, training, advocacy,
research and policy.
AkiDwA: FGM

The 5P’s

Prevention, protection, provision of service, prosecution
and promotion efforts to end FGM

Awareness raising

Training, professionals & frontline services

Engaging the community: CHA, men & youth

Research

Publications

Advocacy
What is FGM?
“Female genital mutilation (FGM/C)
comprises of 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”
WHO, 2013
Classification of FGM

Type I — Partial or total removal of the clitoris and/or the prepuce


Type II — Partial or total removal of the clitoris and the labia minora,
with or without excision of the labia majora


Excision
Type III — Narrowing of the vaginal orifice with creation of a
covering seal by cutting and positioning the labia minora and/or the
labia majora, with or without excision of the clitoris


Clitoridectomy
Infibulation
Type IV — All other harmful procedures to the female genitalia for
non-medical purposes, for example: pricking, stretching, piercing,
incising, scraping and cauterization
Where is FGM practiced?
FGM documented in 28 African countries, Asia and the Middle East. This includes
Iraq, Yemen, and Kurdish populations.
Demographic data on FGM/C is typically collected every five years through
Demographic and Health Surveys and Multiple Indicator Cluster Surveys- nationally
representative samples of households interviewed




6,000 girls per day undergo FGM.
3 million girls are at risk annually in Africa.
Peak age for FGM 4-12, although varies with tribe/culture/region.
Most girls are subjected to FGM before age 5.
Prevalence: FGM Globally
Ireland: 5795
Europe: 500,000
Globally: 200 Million
Over 6,000 girls, aged 0–18 and originating from countries where FGM is
practiced, are at risk in Ireland.
EIGE2015
Global Prevalence
Global Prevalence
Who performs FGM?

Who performs FGM?
• Traditional cutters (elderly women) and
health professionals
• Where is it performed?
• Home, private clinics and public hospitals.
• Materials used to perform:
• Blade/razor, sharp metal, scalpel, scissors.
• Age at cutting:
• Mainly between 4 and 10, but it can happen
before or after this period.
FGM: Social & Cultural

FGM is a complex multifaceted practice deeply rooted in a
strong cultural and social framework.

FGM is believed by practicing cultures to safeguard the
morality of women, preserve virginity, prevent sexual freedom,
and save them from temptation and/or disgrace.

FGM is also closely associated with family honour, it is
believed that if a woman loses her honour, the entire family is
also dishonoured
Traditional myths and beliefs
Many myths about FGM, particularly those relating to hygiene and beauty have
been passed down from generation to generation without being questioned and are
subsequently held on to with tenacity. These include the following:

Some communities believe that the clitoris is dangerous during childbirth and
can cause death when in contact with the baby’s head

amongst some communities the clitoris is thought to produce an offensive
discharge and release a filthy smell

Some believe if the female genitals are not excised, they will grow and dangle
between the legs like a man

Others believe that an unexcised woman cannot conceive

in some countries, the external female genitals are considered dirty, ugly, and
disfiguring. Infibulation is believed to produce a clean smooth skin surface that
is desirable to touch

in some cultures, it is believed that the clitoris is a masculine feature which
must be removed to create true femininity in women. Women who have not
undergone FGM are believed to have characteristics thought to be only
appropriate for men, such as sexual desire and promiscuity.
Health Complications
IMMEDIATE HEALTH
CONSEQUENCES






Severe pain, shock and bleeding.
Difficulty passing urine.
Psychological trauma.
Infection.
Tetanus.
Transmission of HIV and other
viruses
• Death as a result of the above.
LONG-TERM COMPLICATIONS
• Chronic urinary and menstrual
problems.
• Chronic pain.
• Pelvic inflammatory disease.
• Cysts.
• Increased risk of HIV transmission.
• Infertility.
• Serious problems for mother and baby
during childbirth.
Sex, Pregnancy & Mental Health
Sex: FGM can make it difficult and
painful to have sex. It can also result in
reduced sexual desire and a lack of
pleasurable sensation.

In some cases, a surgical procedure
called a deinfibulation may be
recommended, which can alleviate
and improve some symptoms.
Pregnancy: Some women with FGM
may find it difficult to become
pregnant, and those who do conceive
can have complications with vaginal
labour and delivery.
Mental Health: FGM can be an
extremely traumatic experience that can
cause emotional difficulties throughout
life, including;

depression

anxiety

flashbacks to the time of the cutting

nightmares and insomnia
In some cases, women may not
remember having the FGM at all,
especially if it was performed when they
were an infant.
How do we talk about FGM?
• Non-stigmatising language – survivor, not a victim
• Survived, experienced, living with
• Female professional where possible
• Make no assumptions
• Give person time to talk and actively listen
• Create opportunity for child or woman to disclose
• Sensitivity
• Non-judgmental
• Gather information – Is risk of FGM imminent?
Obstetric Issues
• Risk factor for increased maternal and infant mortality
• National Maternity Booking Form & Healthcare
Record
• Type III FGM requires de-infibulation surgery as early
as possible in pregnancy term
• Refer to IFPA Specialised FGM Clinic
Deinfibulation

Deinfibulation surgery can be performed to open the vulva, if necessary

It’s sometimes known as a reversal, although this name is misleading as the
procedure does not replace any removed tissue and will not undo the damage
caused.

Surgery may be recommended for:


Women who are unable to have sex or have difficulty urinating as a result of
FGM

Pregnant women at risk of labour & delivery complications as a result of FGM
Deinfibulation should be carried out before pregnancy, if possible.

It can be performed in pregnancy or labour, if necessary, but ideally should be
done before the last 2 months of pregnancy.

The surgery involves making a cut (incision) to open the scar tissue over the
entrance to the vagina.

It’s usually performed under local anaesthetic in an outpatient clinic
FGM Law & Policy in Ireland

Criminal Justice (Female Genital Mutilation) Act 2012.
• Signed into law April 2012, came into effect Sept 2012.

The maximum penalty under all sections of this new law is a fine of up to
€10,000 or imprisonment for up to 14 years or both. Included as a form of Child
Abuse in Children First National Guidance for the Protection and Welfare of
Children, 2011

The Children and Family Relationships Act 2015 was passed in 2015, and a
number of its provisions came into force on 18 January 2016, FGM fall under
harm to the child.

A legal obligation to Report under the Criminal Justice (Withholding of
Information on Offenses Against children and Vulnerable Persons) Act 2012.”
Video and Films
• UK Profession-tailored videos
• http://www.fgmresource.com/
• UNICEF Introduction to FGM Clip
• https://www.youtube.com/watch?v=h8TxXOD9X7U&feature
=youtu.be
• Moolaadé (2004):
• The film addresses the subject of female genital mutilation, a
common practice in a number of African countries, especially
those immediately south of the Sahara Desert. The film argues
strongly against the practice, depicting a village woman,
Collé, who uses moolaadé (magical protection) to protect a
group of girls. She is opposed by the villagers who believe in
the necessity of female genital cutting, which they call
“purification”.
NHS: Speaking with Patients
UNFPA “True Story”
Discussion and Questions
• How do you feel about FGM in midwifery?
• Do you know the referral process?
• Do you feel comfortable raising the question to
patients?
• This is the time to ask questions!
THANK YOU

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