Original Research – QuantitativeA survey of Australian midwives’ knowledge, experience, and training needs in relation to female genital mutilation
Introduction
Female genital mutilation (FGM) involves partial or total removal of the external female genitalia or any other injury of the female genital organs for non-medical reasons.1 This practice is deeply rooted in culture, with social obligation and marriageability considered to be two of the most important reasons for its continuation.2 It has also been linked with a girl’s transition from childhood to womanhood,3, 4 perceived religious requirement, family honour through premarital virginity and marital fidelity, aesthetics, and fear of exclusion from resources and opportunities as a young woman.5 There are no health benefits associated with FGM and the practice has many short and long term consequences, which significantly impact on women’s lives.1 The World Health Organization (WHO) and other international and national agencies and governments have been advocating for the abandonment of FGM for many decades.1, 2 FGM is banned by law in 26 African and Middle Eastern countries plus 33 countries with migrant populations from high prevalent FGM practicing countries.6
Despite the serious and often long-term adverse consequences of FGM, the practice remains prevalent.1 It is estimated that 200 million women and girls have undergone FGM worldwide and another three million women and girls are at risk annually.1, 7 FGM is practised in 30 African and Middle Eastern countries, and in some parts of Asia.7 Recently it has been reported in Russia.8 However, in recent years there has been an increasing number of women with FGM residing across Europe, the United States, Australia, New Zealand and Canada as a result of demographic change due to widespread global migration.9, 10, 11, 12 Although, FGM prevalence data is not collected in Australia the number of women with FGM who have migrated from high FGM-prevalent countries is estimated to be 83,000 of which 44% are women of childbearing age.13 Given the international migration patterns, healthcare professionals in high income countries (HIC) are increasingly caring for women with FGM.11, 14, 15, 16, 17, 18 This highlights the need for up to date data on FGM to inform maternity health service planning.15
Studies of healthcare professionals, including midwives, providing care for women who have undergone FGM in HIC, have indicated major gaps in the technical knowledge and skills of providers.17, 19, 20, 21 A study in Sweden found a lack of hospital policy in relation to FGM that resulted in inconsistent care for women with FGM.22 The research found that doctors and midwives were unclear about their professional roles and responsibilities with regard to the clinical care and referral of women with FGM. This situation affected the monitoring of pregnant women and communication between women and clinical staff. There is evidence from some HIC that health care professionals are largely unaware of legal issues related to FGM. For example, in a survey of Belgium gynaecologists more than half did not know that FGM was illegal.23 In contrast, in the United Kingdom (UK)24 the majority of doctors in a survey knew that FGM was illegal but they were unable to provide details about the relevant Act.
Australia, like many other countries, has endorsed legislation against FGM.25 However, there have been reports of FGM offences in Australia.26, 27 A small number of health care professionals in Australia have also reported that they have been asked by their patients to perform FGM.17, 28
There are only two small qualitative studies in New South Wales, Australia that have explored the knowledge and experiences of a midwives.15, 29 These studies found that midwives lack knowledge, experience, and competency in providing care for women with FGM. Midwives expressed their lack of confidence about interacting with women from different cultures where FGM is practised and perceive this as a barrier to providing quality care to women.15
The aim of this study therefore was to explore the knowledge, experience and needs of a larger number of midwives working in a range of contexts in relation to the care of women in Australia with FGM. With the scarcity of data in this area, this paper provides further evidence to inform midwifery education and training in order to improve the quality of maternity care.
Section snippets
Method
A self-administrated online survey was designed to explore the knowledge and experience of midwives in caring for women with FGM across all states and territories of Australia. The survey comprised 19 multiple choice and open ended questions, containing demographic data (i.e. age, country of midwifery training, qualifications, experience and speciality areas including years of experience as midwife), knowledge of FGM types based on WHO classification (see Table 1), means for access to technical
Findings
Two hundred midwives responded to the survey (67 online and 133 paper based hardcopies). Two surveys were returned blank and were excluded. A total of 198 surveys were included in the study. However, not all midwives responded to every question so that the denominators were different for some questions.
The majority of the respondents were midwives from New South Wales (NSW) (74%, n = 147), followed by Queensland (10.1%, n = 20), Victoria (6.6%, n = 13), South Australia (3.6%, n = 7), Western Australia
Discussion
The findings of this survey suggest that despite Australian midwives being well informed about FGM as a public health issue, there are gaps in their knowledge. This is supported by the findings of earlier qualitative studies among midwives by Dawson et al.15 and Ogunsiji.29 The survey demonstrated gaps in the technical knowledge of midwives despite 43% of our respondents reporting clinical experience of caring for women with FGM.
There are other studies from high income countries which also
Conclusion
This study indicates that Australian midwives encountering women with FGM while there are gaps in technical and legal knowledge. The need for specialised training programs as a compulsory part of professional development and pre-service education is important particularly for midwives who are caring for women in hospitals, health centres and home who are from communities where FGM is a traditional practice.
Ethical statement
We confirm that any aspect of the work covered in this manuscript that has involved human has been conducted with the ethical approval of by University of Technology Sydney, Human Research Ethics Committee (Approval Number HERC2014/2/5.9(3916)) and that such approvals are acknowledged within the manuscript.
Acknowledgements
The authors would like to acknowledge funding by the Health System Capacity Development Flexible Fund of the Australian Commonwealth, Department of Health and Aging.
This work was completed as part of a PhD project with the Faculty of Health, University of Technology Sydney (UTS) through Australian Government Research Training Program (RTP) Scholarship.
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