Category Archives: Review

Female genital mutilation: implications for clinical practice

Br J Nurs. 2017 Oct 12;26(18):S22-S27. doi: 10.12968/bjon.2017.26.18.S22.

Female genital mutilation: implications for clinical practice

von Rège I, Campion D

ABSTRACT

Female genital mutilation (FGM) is an established cultural practice in over 30 countries. It has no health benefits, carries a high risk of physical and psychological harm, and is illegal in many countries including the UK. A sensitive approach is required, both in the management of complications and prevention of this practice. This article discusses the prevalence and classification of FGM, and offers practical advice to nurses and midwives involved in general and obstetric care. Legal aspects, including safeguarding responsibilities and the mandatory duty to report FGM in England and Wales, are outlined.

This article can be accessed in this LINK

Health information interventions for female genital mutilation.

FREEInt J Gynaecol Obstet. 2017 Feb;136 Suppl 1:79-82. doi:10.1002/ijgo.12052.

Health information interventions for female genital mutilation.

Smith H, Stein K.

ABSTRACT

Providing information and education to women and girls living with female genital mutilation (FGM) could be an important influence on their healthcare-seeking behavior. Healthcare providers also need adequate knowledge and skills to provide good quality care to this population. Recent WHO guidelines on managing health complications from FGM contain best practice statements for health education and information interventions for women and providers. This qualitative evidence synthesis summarizes the values and preferences of girls and women living with FGM, and healthcare providers, together with other evidence on the context and conditions of these interventions. The synthesis highlights that healthcare providers lack skills and training to manage women, and women are concerned about the lack of discussion about FGM with providers. There is a need for more training for providers, and further research to understand how health information interventions may be perceived or experienced by women living with FGM in different contexts.

This article can be accessed in this LINK

Deinfibulation for treating urologic complications of type III female genital mutilation: A systematic review.

FREEInt J Gynaecol Obstet. 2017 Feb;136 Suppl 1:30-33. doi:10.1002/ijgo.12045.

Deinfibulation for treating urologic complications of type III female genital mutilation: A systematic review.

Effa E, Ojo O, Ihesie A, Meremikwu MM.

ABSTRACT

BACKGROUND: Women and girls who have undergone type III female genital mutilation (FGM) may suffer urologic complications such as recurrent urinary tract infections, obstruction, stones, and incontinence. OBJECTIVE: To assess the effectiveness of deinfibulation for preventing and treating urologic complications in women and girls living with FGM. SEARCH STRATEGY: The following major databases were searched from inception to August 2015: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, SCOPUS, Web of Science, and ClinicalTrials.gov without language restrictions. SELECTION CRITERIA: Randomized controlled studies (RCTs) or observational studies with controls were considered. DATA COLLECTION AND ANALYSIS: We screened the results of the search independently for potentially relevant studies and applied inclusion and exclusion criteria for the full texts of the relevant studies. RESULTS: No RCTs were found. We found three case reports and a retrospective case review, all of which were excluded. CONCLUSION: There is no evidence on the use of deinfibulation to improve urologic complications among women with type III FGM. Current clinical practice may be informed by anecdotal evidence from case reports. Appropriate RCTs and observational studies with comparison groups in countries where FGM is common are needed. PROSPERO registration: CRD42015024901.

This article can be accessed in this LINK

Deinfibulation for preventing or treating complications in women living with type III female genital mutilation: A systematic review and meta-analysis.

FREEInt J Gynaecol Obstet. 2017 Feb;136 Suppl 1:13-20. doi: 10.1002/ijgo.12056.

Deinfibulation for preventing or treating complications in women living with type III female genital mutilation: A systematic review and meta-analysis.

Okusanya BO, Oduwole O, Nwachuku N, Meremikwu MM.

ABSTRACT

BACKGROUND: Deinfibulation is a surgical procedure carried out to re-open the vaginal introitus of women living with type III female genital mutilation (FGM). OBJECTIVES: To assess the impact of deinfibulation on gynecologic or obstetric outcomes by comparing women who were deinfibulated with women with type III FGM or women without FGM. SEARCH STRATEGY: Major databases including CENTRAL, MEDLINE, and Scopus were searched until August 2015. SELECTION CRITERIA: We included nonrandomized studies that compared obstetric outcomes of women with deinfibulation, type III FGM (not deinfibulated during labor), and no FGM. DATA COLLECTION AND ANALYSIS: Quality of evidence was determined following the GRADE methodology. Summary measures were calculated using odds ratios at 95% confidence intervals. RESULTS: We found no randomized controlled trials. We included four case-control studies. The quality of evidence was very low. Compared with women with type III FGM at delivery, deinfibulated women had a significant reduction in the risk of having a cesarean delivery or postpartum hemorrhage. Compared with women without FGM, deinfibulated women had a similar risk of episiotomy, cesarean delivery, vaginal lacerations, postpartum hemorrhage, and blood loss at vaginal delivery. The length of second stage of labor, mean maternal hospital stay, and Apgar scores less than 7 were also comparable. CONCLUSIONS: Low-quality evidence suggests deinfibulation improves birth outcomes for women with type III FGM.

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The odd couple: using biomedical and intersectional approaches to address health inequities.

FREEGlob Health Action. 2017 Jan – Dec;10(sup2):1326686. doi:10.1080/16549716.2017.1326686.

The odd couple: using biomedical and intersectional approaches to address health inequities.

Hankivsky O, Doyal L, Einstein G, Kelly U, Shim J, Weber L, Repta R.

ABSTRACT

BACKGROUND: Better understanding and addressing health inequities is a growing global priority. OBJECTIVE: In this paper, we contribute to the literature examining complex relationships between biological and social dimensions in the field of health inequalities. Specifically, we explore the potential of intersectionality to advance current approaches to socio-biological entwinements. DESIGN: We provide a brief overview of current approaches to combining both biological and social factors in a single study, and then investigate the contributions of an intersectional framework to such work. RESULTS: We offer a number of concrete examples of how intersectionality has been used empirically to bring both biological and social factors together in the areas of HIV, post-traumatic stress disorder, female genital circumcision/mutilation/cutting, and cardiovascular disease. CONCLUSION: We argue that an intersectional approach can further research that integrates biological and social aspects of human lives and human health and ultimately generate better and more precise evidence for effective policies and practices aimed at tackling health inequities.

This article can be accessed in this LINK

Punishment of Minor Female Genital Ritual Procedures: Is the Perfect the Enemy of the Good?

Dev World Bioeth. 2017;17(2):134–140.

Punishment of Minor Female Genital Ritual Procedures: Is the Perfect the Enemy of the Good?

Jacobs AJ, Arora KS

ABSTRACT

Female genital alteration (FGA) is any cutting, removal or destruction of any part of the external female genitalia. Various FGA practices are common throughout the world. While most frequent in Africa and Asia, transglobal migration has brought ritual FGA to Western nations. All forms of FGA are generally considered undesirable for medical and ethical reasons when performed on minors. One ritual FGA procedure is the vulvar nick (VN). This is a small laceration to the vulva that does not cause morphological changes. Besides being performed as a primary ritual procedure it has been proposed as a substitute for more extensive forms of FGA. Measures advocated or taken to reduce the burden of FGA can be punitive or non-punitive. Even if it is unethical to perform VN, we argue that it also is unethical to attempt to suppress it through punishment. First, punishment of VN is likely to cause more harm than good overall, even to those ostensibly being protected. Second, punishment is likely to exceed legitimate retributive ends. We do not argue in favor of performing VN. Rather, we argue that non-punitive strategies such as education and harm reduction should be employed.

This article can be accessed in this LINK

Reconciling female genital circumcision with universal human rights

Dev World Bioeth. 2017 Sep 18. doi: 10.1111/dewb.12173. [Epub ahead of print]

Reconciling female genital circumcision with universal human rights

Gordon JS

ABSTRACT

One of the most challenging issues in cross-cultural bioethics concerns the long-standing socio-cultural practice of female genital circumcision (FGC), which is prevalent in many African countries and the Middle East as well as in some Asian and Western countries. It is commonly assumed that FGC, in all its versions, constitutes a gross violation of the universal human rights of health, physical integrity, and individual autonomy and hence should be abolished. This article, however, suggests a mediating approach according to which one form of FGC, the removal of the clitoris foreskin, can be made compatible with the high demands of universal human rights. The argument presupposes the idea that human rights are not absolutist by nature but can be framed in a meaningful, culturally sensitive way. It proposes important limiting conditions that must be met for the practice of FGC to be considered in accordance with the human rights agenda.

This article can be accessed in this LINK

Sexual counselling for treating or preventing sexual dysfunction in women living with female genital mutilation: A systematic review.

Int J Gynaecol Obstet. 2017 Feb;136 Suppl 1:38-42. doi: 10.1002/ijgo.12049. Sexual counselling for treating or preventing sexual dysfunction in women living with female genital mutilation: A systematic review. 

Okomo U, Ogugbue M, Inyang E, Meremikwu MM.

ABSTRACT

BACKGROUND: Female sexual dysfunction is the persistent or recurring decrease in sexual desire or arousal, the difficulty or inability to achieve an orgasm, and/or the feeling of pain during sexual intercourse. Impaired sexual function can occur with all types of female genital mutilation (FGM) owing to the structural changes, pain, or traumatic memories associated with the procedure. OBJECTIVES: To conduct a systematic review of randomized and nonrandomized studies into the effects of sexual counseling with or without genital lubricants on the sexual function of women living with FGM. SEARCH STRATEGY: Cochrane Central Register of Controlled Trials, MEDLINE, African Index Medicus, SCOPUS, LILACS, CINAHL, ClinicalTrials.gov, Pan African Clinical Trials Registry, and other databases were searched to August 2015. The reference lists of retrieved studies were checked for reports of additional studies, and lead authors contacted for additional data. SELECTION CRITERIA: Studies of girls and women living with any type of FGM who received counselling interventions for sexual dysfunction were included. DATA COLLECTION AND ANALYSIS: No relevant studies that addressed the objective of the review were identified. CONCLUSIONS: Despite a comprehensive search, the authors could not find evidence of the effects of sexual counseling on the sexual function of women living with FGM. Studies assessing this intervention are needed.

This article is available in this LINK

Psychological and counselling interventions for female genital mutilation.

Int J Gynaecol Obstet. 2017 Feb;136 Suppl 1:60-64. doi: 10.1002/ijgo.12051.

Psychological and counselling interventions for female genital mutilation.

Smith H, Stein K.

ABSTRACT

Women and girls living with female genital mutilation (FGM) are more likely to experience psychological problems than women without FGM. As well as psychological support, this population may need additional care when seeking surgical interventions to correct complications of FGM. Recent WHO guidelines recommend cognitive behavioral therapy for women and girls experiencing anxiety disorders, depression, or post-traumatic stress disorder. The guidelines also suggest that preoperative counselling for deinfibulation, and psychological support alongside surgical interventions, can help women manage the physiological and psychological changes following surgery. This synthesis summarizes evidence on women’s values and preferences, and the context and conditions that may be required to provide psychological and counselling interventions. Understanding women’s views, their own ways of coping, as well social and cultural factors that influence women’s mental well-being, may help identify the types of interventions this population needs at different times and stages of their lives.

This article is available in this LINK

Obstetric fistula and sociocultural practices in Hausa community of Northern Nigeria.

Women Birth. 2017 Mar 7. pii: S1871-5192(17)30076-8. doi: 10.1016/j.wombi.2017.02.009. [Epub ahead of print]

Obstetric fistula and sociocultural practices in Hausa community of Northern Nigeria.

Amodu OC, Salami B, Richter S.

ABSTRACT 

BACKGROUND: Obstetric Fistula is a childbirth injury that disproportionately affects women in sub-Saharan Africa. Although poverty plays an important role in perpetuating obstetric fistula, sociocultural practices has a significant influence on susceptibility to the condition. AIM: This paper aims to explore narratives in the literature on obstetric fistula in the context of Hausa ethno-lingual community of Northern Nigeria and the potential role of nurses and midwives in addressing obstetric fistula. DISCUSSION: Three major cultural practices predispose Hausa women to obstetric fistula: early marriages and early child bearing; unskilled birth attendance and female circumcision and sociocultural constraints to healthcare access for women during childbirth. There is a failure to implement the International rights of the girl child in Nigeria which makes early child marriage persist. The Hausa tradition constrains the decision making power of women for seeking health care during childbirth. In addition, there is a shortage of nurses and midwives to provide healthcare service to women during childbirth. CONCLUSION: To improve health access for women, there is a need to increase political commitment and budget for health human resource distribution to underserved areas in the Hausa community. There is also a need to advance power and voice of women to resist oppressive traditions and to provide them with empowerment opportunities to improve their social status. The practice of traditional birth attendants can be regulated and the primary health care services strengthened.

This article is available in this LINK