The reviews presented in this report have focused exclusively on OECD countries, producing findings that are relevant to the UK context. To our knowledge, they are the first to have considered all aspects of FGM/C-related health care at all stages of the life course, in all clinical settings, and to bring together the perspectives of women and health professionals. In addition, in contrast to other systematic reviews in this field, they have, for the first time, included relevant grey literature and papers in languages other than English. As a result, the reviews in this project have been able to present an exceptionally comprehensive and detailed picture of current care experiences. Furthermore, by moving beyond the usual focus on maternity care contexts,63,64 the reviews have been able to advance current knowledge beyond an understanding of experiences (although this is important) to provide a more analytical and holistic interpretation of factors influencing care-seeking, decision-making for deinfibulation surgery, service access and the development of care pathways.
In the last 5 years, the UK has made enormous strides in developing policy, training and commissioning guidance around FGM/C. However, the reviews (which include papers and reports from 22 UK-based studies) suggest that the seeking and providing of FGM/C-related health care is often characterised by processes of silence, secrecy, stigma, shame and stereotyping. Hence, although positive experiences are reported (and greatly appreciated), there still appear to be many challenges. Particularly concerning are the reports of disrespectful care, ad hoc service provision and health professionals who lack clinical and cultural competence.
Many of the challenges relate to FGM/C specifically (e.g. management of deinfibulation or specific mental health needs), but many (e.g. language barriers) also relate to wider challenges in care delivery for migrant populations in a context of super-diversity. Therefore, it is important to consider the findings from these reviews within the wider context of service configuration and resourcing for super-diverse population groups (e.g. provision of accessible and appropriate interpretation services, choice of female health providers, continuity of care models, personalised care models or training of health professionals for culturally safe practice).
Dissemination of the reviews
Activities undertaken to date include:
- publication of the review protocol117
- a national stakeholder event
- presentation to obstetrics and gynaecology registrars across the East Midlands region
- two oral presentations at an international conference in Montreal, Canada, on 28/29 May 2018 [2nd International Expert Meeting on Female Genital Mutilation/Cutting: Sharing Data and Experiences, Improving Collaboration; www.fourwav.es/view/644/info/ (accessed 12 July 2019)]
- two publications (one from each review) in international peer-reviewed journals.139,145
Knowledge translation and impact
- The review findings have been shared with the Nottingham and Nottinghamshire joint FGM/C steering group. A health task force has now been established, with a first meeting in July 2018 to consider how to implement the review findings.
- Two members of the review team (CE and JA) have been invited onto the project oversight committee of a recently funded NIHR HTA research project being conducted by a team at the University of Birmingham [HTA 16/78/04; Female Genital Mutilation: a qualitative study exploring survivors’ and health-care professionals’ views on the timing of deinfibulation surgery (FGM/C Sister Study)].
- The project has led to research capacity development within the team. Valentine Nkoyo has started a PhD at the University of Nottingham focusing on FGM/C prevention as part of its pioneering ‘Rights Lab’. Juliet Albert has received funding from the Health Education England/NIHR Integrated Clinical Academic Pre-doctoral Clinical Academic Fellowship to develop a PhD application on FGM/C.