Tag Archives: Delivery of Health Care

The concept concerned with all aspects of providing and distributing health services to a patient population.

Female Genital Mutilation as a Concern for Special Operations and Tactical Emergency Medical Support Medics

J Spec Oper Med. 2017 Winter;17(4):14-17.

Female Genital Mutilation as a Concern for Special Operations and Tactical Emergency Medical Support Medics.

Wittich AC.


Female genital mutilation (FGM), frequently called female genital cutting or female circumcision, is the intentional disfigurement of the external genitalia in young girls and women for the purpose of reducing libido and ensuring premarital virginity. This traditional, nontherapeutic procedure to suppress libido and prevent sexual intercourse before marriage has been pervasive in Northern Africa, the Middle East, and the Arabian peninsula for over 2,500 years. FGM permanently destroys the genital anatomy while frequently causing multiple and serious complications. The International Federation of Gynecology and Obstetrics proposed a classification system of FGM according to the specific genital anatomy removed and the extensiveness of genital disfigurement. Although it has been ruled illegal in most countries, FGM continues to be performed
worldwide. With African, Asian, and Middle Eastern immigration to the United States and Europe, western countries are experiencing FGM in regions where these immigrants have concentrated. As deployments of Special Operations Forces (SOF) increase to regions in which FGM is pervasive, and as African, Asian, and Middle Eastern immigration to the United States increases, SOF and Tactical Emergency Medical Support (TEMS) medics will necessarily be called upon to evaluate and treat complications resulting from FGM. The purpose of this article is to educate SOF/TEMS medical personnel about the history, geographic regions, classification of procedures, complications, and medical treatment of patients with FGM.

This article can be accessed in this LINK


[Genital mutilation of women. A new challenge for the health service]. [Article in Norwegian]

Tidsskr Nor Laegeforen. 1993 Sep 10;113(21):2704-7.
[Genital mutilation of women. A new challenge for the health service]. [Article in Norwegian]
Sundby J, Austveg B
Female circumcision, or genital mutilation is practised around the world. Because of war, conflicts and poverty, many women from cultures involving this practice now enter European communities. Some of them demand circumcision for their children. Genital mutilation of women has serious health effects, and in our societies there is a strong demand for its eradication. The cultural reasons for genital mutilation are varied, but it is not a compulsory part of the Islamic faith. Health workers in Norway may lack knowledge on how to handle these women when they meet them in their daily work. Sometimes unnecessary interventions are performed, sometimes ignorance may cause traumatic experiences for both patient and doctor. This article describes some of the social and cultural background for continued exposure to female mutilation, the health effects and some suggestions for interventions.
There is no LINK to see this article online

Nursing Care of Women Who Have Undergone Genital Cutting

Nurs Womens Health. 2015 Oct;19(5):445-9. doi: 10.1111/1751-486X.12237.

Nursing Care of Women Who Have Undergone Genital Cutting

Tilley DS


Female genital cutting (FGC), commonly called female genital mutilation, affects
millions of women but is poorly understood by many health care providers. FGC
procedures intentionally alter the female genital organs for nonmedical reasons
and include partial or total removal of female genital organs. These procedures,
which have no medical value, are usually done between birth and puberty. Health
consequences vary in severity but can be devastating. Women who have experienced
FGC may be reluctant to seek health care or to disclose their condition to
providers. Suggestions for culturally competent care of women who have
experienced FGC are outlined, focusing on understanding the cultural beliefs and
values of women who have undergone these procedures and providing informed and
sensitive care.

This article can be accessed in this LINK

FGM: dispelling the myths; exploring the facts

Pract Midwife. 2015 Jul-Aug;18(7):18-20.

FGM: dispelling the myths; exploring the facts.

Dixon-Wright R.


Female genital mutilation is a process that affects our practice. It is becoming more common in our ever-diversifying population and therefore education is vitally important to be able to put robust care plans in place. Understanding the psychological and physical difficulties experienced by women of childbearing age can help us to improve the care that we, as maternity healthcare professionals, can deliver. Looking at current research, this article examines some of the presumed cultural and societal beliefs behind the procedure and highlights some new evidence that change is welcomed by women and their families.

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Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation: A review of global experience

Midwifery. 2014 Sep 6. pii: S0266-6138(14)00222-8. doi: 10.1016/j.midw.2014.08.012. [Epub ahead of print]

Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation: A review of global experience.

Dawson A, Turkmani S, Fray S, Nanayakkara S, Varol N, Homer C.


OBJECTIVE: to identify how midwives in low and middle income countries (LMIC) and high income countries (HIC) care for women with female genital mutilation (FGM), their perceived challenges and what professional development and workplace strategies might better support midwives to provide appropriate quality care.

DESIGN: an integrative review involving a narrative synthesis of the literature was undertaken to include peer reviewed research literature published between 2004 and 2014.

FINDINGS: 10 papers were included in the review, two from LMIC and eight from HIC. A lack of technical knowledge and limited cultural competency was identified, as well as socio-cultural challenges in the abandonment process of the practice, particularly in LMIC settings. Training in the area of FGM was limited. One study reported the outcomes of an education initiative that was found to be beneficial.

KEY CONCLUSIONS: professional education and training, a working environment supported by guidelines and responsive policy and community education, are necessary to enable midwives to improve the care of women with FGM and advocate against the practice.

IMPLICATIONS FOR PRACTICE: improved opportunities for midwives to learn about FGM and receive advice and support, alongside opportunities for collaborative practice in contexts that enable the effective reporting of FGM to authorities, may be beneficial and require further investigation.

This article can be accessed in this LINK

Tackling female genital mutilation in the UK.

BMJ. 2013 Dec 4;347:f7150. doi: 10.1136/bmj.f7150.FREE

Tackling female genital mutilation in the UK.

Creighton SM, Liao LM.


As a result of the diaspora of communities that practise female genital mutilation, many more women are now living with genital mutilation in the United Kingdom, and many more girls are at risk. The campaign to end the practice in the UK has been spearheaded by committed and experienced activists (www.forwarduk.org.uk, http://www.equalitynow.org with wide institutional endorsement),1 as reflected in recent intercollegiate recommendations for dealing with the problem.2

The document results from collaboration between the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the Royal College of Nursing, Equality Now, and the Unite union. It merges key points from several existing guidelines3 4 5 6 into a single paper that reiterates the core message: female genital mutilation is a form of child abuse. It points to the importance of data collection and sharing between relevant agencies for effective action. It stipulates appropriate professional care for girls and young women affected by the practice. For the recommendations to be implemented (we hope urgently), a strategic implementation plan with a tight time frame is …

This article can be accessed in this LINK.

Attitudes towards female genital mutilation: an integrative review.

Int Nurs Rev. 2013 Nov 15. doi: 10.1111/inr.12070. [Epub ahead of print]

Attitudes towards female genital mutilation: an integrative review.

Reig Alcaraz M, Siles González J, Solano Ruiz C.

Department of Nursing, University of Alicante, Alicante, Spain.


BACKGROUND: Immigration and globalization processes have contributed to the international dissemination of practices such as female genital mutilation. Between 100 and 400 million girls and women have been genitally mutilated, and every year 3 million girls are at risk of being subjected to female genital mutilation.

OBJECTIVES: The objective of this study was to describe the attitudes towards the practice of female genital mutilation in relation to different health systems and the factors that favour its discontinuation.

METHODS: An integrative review was performed of publications from the period 2006 to 2013 included in the MedLine, PubMed, LILACS, SciELO, CINAHL and CUIDEN databases.

RESULTS: We selected 16 studies focusing on diverse contexts that assessed the attitudes of both men and women regarding the perpetuation of this practice. Ten corresponded to studies conducted in countries of residence. Several areas of investigation were explored (factors contributing to the continuation of female genital mutilation, factors contributing to its discontinuation, feelings about the health system).

LIMITATIONS: It is possible that the relevant studies may not have been included given the limitations of the literature review and the invisibility of the phenomenon studied.

CONCLUSIONS: This review demonstrates the strong social pressure to which women are subjected as regards the practice of female genital mutilation. However, many other factors can contribute to eroding beliefs and arguments in favour of this practice, such as the globalization, culture and social environment of countries in the West.

IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurses occupy an essential position in detecting and combating these practices.

This article can be purchased online in this LINK 

Female genital mutilation: classification and management.

Nurs Stand. 2007 Oct 24-30;22(7):43-9; quiz 50.

Female genital mutilation: classification and management.

Bikoo M.

Elizabeth Garrett Anderson and Obstetric Hospital, University College London Hospitals NHS Foundation Trust, London. maligaye.bikoo@uclh.nhs.uk


Female genital mutilation is a deeply rooted cultural tradition observed primarily in Africa and among certain communities in the Middle East and Asia. It has considerable health consequences. Women from the practising communities are increasingly seen within healthcare settings but few healthcare professionals are trained to treat their specific healthcare needs.

There is no link to view this article online.

Circumvention tourism.

Cornell Law Rev. 2012 Sep;97(6):1309-98.FREE

Circumvention tourism.

Cohen G.

Harvard Law School Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics.


Under what circumstances should a citizen be able to avoid the penalties set by the citizen’s home country’s criminal law by going abroad to engage in the same activity where it is not criminally prohibited? Should we view the ability to engage in prohibited activities by traveling outside of the nation state as a way of accommodating cultural or political differences within our polity? These are general questions regarding the power and theory of extraterritorial application of domestic criminal law. In this Article, I examine the issues through a close exploration of one setting that urgently presents them: medical tourism. Medical tourism is a term used to describe the travel of patients who are citizens and residents of one country, the “home country,” to another country, the “destination country,” for medical treatment. This Article is the first to comprehensively examine a subcategory of medical tourism that I call “circumvention tourism,” which involves patients who travel abroad for services that are legal in the patient’s destination country but illegal in the patient’s home country–that is, travel to circumvent domestic prohibitions on accessing certain medical services. The four examples of this phenomenon that I dwell on are circumvention medical tourism for female genital cutting (FGC), abortion, reproductive technology usage, and assisted suicide. I will briefly discuss the “can” question: assuming that a domestic prohibition on access to one of these services is lawful, as a matter of international law, is the home country forbidden, permitted, or mandated to extend its existing criminal prohibition extraterritorially to home country citizens who travel abroad to circumvent the home country’s prohibition? Most of the Article, though, is devoted to the “ought” question: assuming that the domestic prohibition is viewed as normatively well-grounded, under what circumstances should the home country extend its existing criminal prohibition extraterritorially to its citizens who travel abroad to circumvent the prohibition? I show that, contrary to much of current practice, in most instances, home countries should seek to extend extraterritorially their criminal prohibitions on FGC, abortion, assisted suicide, and, to a lesser extent, reproductive technology use to their citizens who travel abroad to circumvent the prohibition. I also discuss the ways in which my analysis of these prohibitions can serve as scaffolding for a more general theory of circumvention tourism.

This article can be accessed in this LINK

Swedish Health Care Providers’ Experience and Knowledge of Female Genital Cutting

Health Care for Women International. 2006 (27)8709-722

Swedish Health Care Providers’ Experience and Knowledge of Female Genital Cutting

Leila Tamaddon, Sara Johnsdotter, Jerker Liljestrand &Birgitta Essén


We sought to evaluate the experiences and knowledge of health care providers in Sweden regarding female genital cutting (FGC) as a health issue. Questionnaires (n = 2,707) were sent to providers in four major cities in Sweden and evaluated by means of descriptive statistics. Twenty-eight percent (n = 769/2,707) responded, of whom 60% had seen such patients. Seven providers, including 2 pediatricians, were suspicious of patients with signs of recent genital cutting. Ten percent had been asked to perform reinfibulation after delivery. Thirty-eight providers had received inquiries about the possibility of performing FGC in Sweden.

This article can be purchased in this LINK