Strategies and Recommendations
Introduction
Research indicates that female genital mutilation (FGM) is a global issue that is becoming increasingly recognized in the thread of Canadian society due to immigration. Despite this, there is limited knowledge of FGM and how to manage it. Due to the scope of the issue and its effects on children and women, there is an increasing awareness that it needs to be addressed.
Reorientation of Health Services
To date, our health services are limited in the knowledge and care given to children and women with FGM. With that in mind, we believe it is necessary to raise awareness and educate health care providers in all spectrums to accommodate the physical, psychological and emotional needs of children, women and families affected by FGM. As defined by the Ottawa Charter, “the responsibility for health promotion in health services is shared among individuals, community groups, health professionals, health services institutions and government. “They must work together toward a health care system that contributes to the pursuit of health” (Fownes & Vollman, 2012, p. 140). In Canada, “this includes a call to action by provincial governments that are charged with delivering health services, the federal government that governs national health policies, social economic sectors, non-governmental and voluntary organizations, local authorities, industry, and the media.” (Fownes & Vollman, 2012, p. 141)
One way in which we can achieve this goal is to promote awareness about FGM through education programs to health care providers. Leye et al (2006) states that:
The training needs of health care professionals must be assessed. Training should take into account various levels: clinical care, the prevention of FGM; counselling, communication, attitudes, and ethical issues. In addition, FGM should be included in the curricula of medical students, nurses, and midwives. (p. 374)
Furthermore, Leye et al (2006, p. 372) observed three interventions practiced in some European countries that address FGM:
1. Technical guidelines for the clinical management of women with FGM;
2. Codes of conduct for health care professionals, published by professional associations, on quality care issues (e.g., culturally appropriate care);
3. Specialised health services that provide medical care, psychological care, and counselling.
Another way to promote the health of women with FGM is through cultural competency. “The provision of culturally competent care to women with FGM is of particular importance to ensuring accessibility of immigrant women to available health resources in their countries” (Ogunsiji, Wilkes & Jackson, 2007, p. 27). Reasons for practising FGM may not be understood in Western society. This can lead to assumptions and prejudice against women with FGM. Therefore, as nurses, it is our responsibility to not pass judgment and to assist patients in the best way possible. This can only be done with knowledge and understanding. “Whatever one’s personal beliefs or prejudices may be the priority should be the care of the patient which requires knowledge of FGM practice and its implications, reporting practices, and protocols for how to care for the patient.” (McGargill, 2009, p. 5). With that in mind, “cultural competence is considered an ongoing process with a goal of achieving ability to work effectively with culturally diverse groups and communities” (as cited by Dvorak 2000; Gonser 2000; Herrick & Brown 1998).
Creating Supportive Environments
Children and Women of FGM may have difficulty discussing intimate matters; therefore, health care providers should create an atmosphere that is open and non-judgmental. McGargill (2009) suggests that:
To approach the practice with an arrogant, ignorant, superior or condemning attitude would risk alienating the individuals we are intending to help. Understanding the immense pressure women are put under by their culture and their families to have their daughters undergo this abuse can help health care practitioners appreciate the difficulty these women have protecting their daughters and themselves. This can open the door to communication and education about stopping the practice. (p. 1)
It is important that health care providers establish an effective and collaborative partnership with children, women and their families in a dignified and respectful manner. Ball, Bindler, & Cowen (2010) suggest that:
Implementing Family Centered Care establishes a mutually beneficial partnership between the family and the nurse, and other health professionals. In this way, the priorities and needs of the family are addressed when the family seeks health care for the child. (pg.32)
It should also be recognized that Health Care Workers also need support when exposed to children and women with FGM. “Clinicians experienced shock, disbelief, psychological and even physical distress when first exposed to caring for women with FGM” (Ogunsiji, Wilkes & Jackson, 2007, p. 27). This statement by Ogunsiji, Wilkes & Jackson (2007) highlights:
A need for health workers to be able to discuss their feelings about FGM in a supportive environment, and to be able to seek information about FGM so that they can best meet the needs of these women clients. (p27)
Changing the face of health care services to accommodate children and women of FGM will include awareness, education and cultural competency. These factors will aid a nursing professional to create an environment that will support women of FGM. “The nursing community is on the front line for seeing this population and providing the care they need, as well as organizing to stop the practice through outreach and education” (McGargill, 2009, p. 5).
Development of Personal Skills
Through developing personal skills each individual has the ability to learn and become informed about health, as well as take actions toward lifestyle choices they make. As health care providers become more aware of FGM, they can empower children, women and families to increase their level of education about this practice, and thereby increasing control over their life. Studies show that the more educated women and children are about the practice of FGM, the less likely they are to have the procedure done. Olarinmoye & Amusan (2008, p. 294) state that “the proportion of respondents who had their daughters excised was higher among those with no formal education.” Furthermore, Olarinmoye & Amusan (2008, p. 294) suggest that “literacy and empowerment leading to gender equality and equal opportunity is clearly an essential way forward” in eradicating this practice. Through the “development of individual capacities and the mobilization of these toward health promoting behaviours and increased control over health” (Fownes & Vollman, 2012, p. 88) women are more likely to stop this practice within their own families and empower others to do so.
Research indicates that female genital mutilation (FGM) is a global issue that is becoming increasingly recognized in the thread of Canadian society due to immigration. Despite this, there is limited knowledge of FGM and how to manage it. Due to the scope of the issue and its effects on children and women, there is an increasing awareness that it needs to be addressed.
Reorientation of Health Services
To date, our health services are limited in the knowledge and care given to children and women with FGM. With that in mind, we believe it is necessary to raise awareness and educate health care providers in all spectrums to accommodate the physical, psychological and emotional needs of children, women and families affected by FGM. As defined by the Ottawa Charter, “the responsibility for health promotion in health services is shared among individuals, community groups, health professionals, health services institutions and government. “They must work together toward a health care system that contributes to the pursuit of health” (Fownes & Vollman, 2012, p. 140). In Canada, “this includes a call to action by provincial governments that are charged with delivering health services, the federal government that governs national health policies, social economic sectors, non-governmental and voluntary organizations, local authorities, industry, and the media.” (Fownes & Vollman, 2012, p. 141)
One way in which we can achieve this goal is to promote awareness about FGM through education programs to health care providers. Leye et al (2006) states that:
The training needs of health care professionals must be assessed. Training should take into account various levels: clinical care, the prevention of FGM; counselling, communication, attitudes, and ethical issues. In addition, FGM should be included in the curricula of medical students, nurses, and midwives. (p. 374)
Furthermore, Leye et al (2006, p. 372) observed three interventions practiced in some European countries that address FGM:
1. Technical guidelines for the clinical management of women with FGM;
2. Codes of conduct for health care professionals, published by professional associations, on quality care issues (e.g., culturally appropriate care);
3. Specialised health services that provide medical care, psychological care, and counselling.
Another way to promote the health of women with FGM is through cultural competency. “The provision of culturally competent care to women with FGM is of particular importance to ensuring accessibility of immigrant women to available health resources in their countries” (Ogunsiji, Wilkes & Jackson, 2007, p. 27). Reasons for practising FGM may not be understood in Western society. This can lead to assumptions and prejudice against women with FGM. Therefore, as nurses, it is our responsibility to not pass judgment and to assist patients in the best way possible. This can only be done with knowledge and understanding. “Whatever one’s personal beliefs or prejudices may be the priority should be the care of the patient which requires knowledge of FGM practice and its implications, reporting practices, and protocols for how to care for the patient.” (McGargill, 2009, p. 5). With that in mind, “cultural competence is considered an ongoing process with a goal of achieving ability to work effectively with culturally diverse groups and communities” (as cited by Dvorak 2000; Gonser 2000; Herrick & Brown 1998).
Creating Supportive Environments
Children and Women of FGM may have difficulty discussing intimate matters; therefore, health care providers should create an atmosphere that is open and non-judgmental. McGargill (2009) suggests that:
To approach the practice with an arrogant, ignorant, superior or condemning attitude would risk alienating the individuals we are intending to help. Understanding the immense pressure women are put under by their culture and their families to have their daughters undergo this abuse can help health care practitioners appreciate the difficulty these women have protecting their daughters and themselves. This can open the door to communication and education about stopping the practice. (p. 1)
It is important that health care providers establish an effective and collaborative partnership with children, women and their families in a dignified and respectful manner. Ball, Bindler, & Cowen (2010) suggest that:
Implementing Family Centered Care establishes a mutually beneficial partnership between the family and the nurse, and other health professionals. In this way, the priorities and needs of the family are addressed when the family seeks health care for the child. (pg.32)
It should also be recognized that Health Care Workers also need support when exposed to children and women with FGM. “Clinicians experienced shock, disbelief, psychological and even physical distress when first exposed to caring for women with FGM” (Ogunsiji, Wilkes & Jackson, 2007, p. 27). This statement by Ogunsiji, Wilkes & Jackson (2007) highlights:
A need for health workers to be able to discuss their feelings about FGM in a supportive environment, and to be able to seek information about FGM so that they can best meet the needs of these women clients. (p27)
Changing the face of health care services to accommodate children and women of FGM will include awareness, education and cultural competency. These factors will aid a nursing professional to create an environment that will support women of FGM. “The nursing community is on the front line for seeing this population and providing the care they need, as well as organizing to stop the practice through outreach and education” (McGargill, 2009, p. 5).
Development of Personal Skills
Through developing personal skills each individual has the ability to learn and become informed about health, as well as take actions toward lifestyle choices they make. As health care providers become more aware of FGM, they can empower children, women and families to increase their level of education about this practice, and thereby increasing control over their life. Studies show that the more educated women and children are about the practice of FGM, the less likely they are to have the procedure done. Olarinmoye & Amusan (2008, p. 294) state that “the proportion of respondents who had their daughters excised was higher among those with no formal education.” Furthermore, Olarinmoye & Amusan (2008, p. 294) suggest that “literacy and empowerment leading to gender equality and equal opportunity is clearly an essential way forward” in eradicating this practice. Through the “development of individual capacities and the mobilization of these toward health promoting behaviours and increased control over health” (Fownes & Vollman, 2012, p. 88) women are more likely to stop this practice within their own families and empower others to do so.