Access to female genital cutting specialized services in Norway

Abstract

Women with FGC, particularly those subjected to the most severe type (i.e., infibulation), require specialized healthcare interventions such as deinfibulation, a minor surgical procedure performed to prevent or manage maternal and non-maternally related health problems. Seven women’s outpatient clinics in Norway offer deinfibulation by gynecologists with FGC competence. To assess women’s access to these clinics for non-maternal purposes, Mai M. Ziyada conducted repeat semi-structured interviews and focus group discussions with Somali and Sudanese participants and analyzed quantitative cross-sectional online survey data among GPs in Norway. Somali and Sudanese women were motivated to seek healthcare for problems that persisted despite self-management attempts, interfered with their ability to perform expected duties and roles, and caused severe pain. However, lack of knowledge on FGC-related health problems or contradicting information from doctors and peers hindered their identification of these problems as FGC-related; and, subsequently, whether to seek help at FGC-specialized clinics. Instead, they went to their GPs, expecting them to assess whether their health problems were FGC-related. Unfortunately, the women and GPs commonly missed these early opportunities for assessment because of feelings of shame and mutual embarrassment. GPs with experience with patients with FGC-related problems and adequate self-assessed knowledge of FGC typology and medical codes were more likely to consider FGC a potential cause of health problems. Finally, at the FGC-specialized clinics, sexual norms primarily influenced the women’s intentions or decisions to accept or refuse deinfibulation. Another factor that influenced the women’s decisions was their satisfaction with the healthcare providers (e.g., addressing their fears and concerns regarding aesthetics, re-traumatization, and pain). In addition, the findings indicated unmet needs for psychosexual counseling.