Access to care services

During the thematic discussion on access to care services for FGM survivors, members of the COP FGM expressed the necessity of addressing a number of issues, such as:  

In South Sudan, the government’s lack of response to care for FGM survivors.  

In Sierra Leone, the difficulty of providing specialised care services to FGM survivors due to the lack of government initiative, but also the difficulty of involving health professionals and practitioners due to the gap between some who support the practice and others who do not.  

On the other hand, the need and a strong pressure from civil society on the government to remind them of the commitments made at the international level, and even at the national level, to provide a necessary service to survivors of SGBV.  

In Canada, the issue of FGM is not yet the subject of an action plan involving the establishment of specific care services for FGM survivors. This is the current challenge that civil society is working on. On the other hand, there is increasing progress. The government has just funded some civil society organisations specialising in the issue of FGM in Canada. So there is hope for more dialogue, public education and services for girls at risk. Modules for different service providers are being developed and public education/information is planned. The next challenge for civil society would be to include FGM in the national action plan on GBV in order to provide specific and specialized care services for FGM survivors.  

In Kenya, care services for FGM survivors are often privately provided. Therefore, there are private doctors who perform defibulation and reconstructive surgery. Counselling/therapy are services that are also provided by private clinics and are only available to those who can afford it and who are aware of their trauma and its impact on their lives: “Very important, because I didn’t know that we carry trauma and therefore need therapy for a long time” (FGM survivor).  

To the question raised about whether: do women who undergo FGM understand that they need medical care?  

For some COP FGM members, many women often do not have an understanding of their bodies and therefore do not believe that FGM has a negative effect on their bodies.  

For others, it is a process, a life trajectory that takes time, and health professionals should also support survivors in this process: “As a FGM survivor living in Canada, I had to prepare my gynaecologist when I had a Pap test. I am open about my quest for holistic healing, but I don’t know how many survivors are on the same level. Therapy and counselling are expensive and usually not covered by insurance. The other day I had survivors contact me for reconstructive surgery and I could not get help for them” (a FGM survivor).    

According to the results of the Health sector involvement in the management of female genitalmutilation/ cutting in 30 countries, which maps health care policies and services in 30 countries, a number of facts are reported:  

Training of health professionals on FGM/C was conducted in 24 of the responding countries (10 countries of origin: Burkina Faso, Egypt, Ethiopia, Gambia, Ghana, Kenya, Mali, Sierra Leone, Somaliland, Sudan; and 14 countries of migration : Australia, Austria, Belgium, Finland, France, Ireland, Italy, Netherlands, Norway, Portugal, Spain, Sweden, United Kingdom, United States).  

Among the 10 countries of origin, training was reported to be systematic in eight countries, as FGM is included in one or more curricula for health professionals. In the countries of migration, only half of the 14 countries have systematic training, while the other half provide it on an ad hoc basis.  

This study also highlights the importance and duty of health professionals to provide health education on FGM to their patients.   

All these findings lead us to the following conclusion: the need to strengthen the training of health professionals on FGM and the need for these professionals to be much more proactive and to open a dialogue in order to better explore the health needs and demands of women affected by FGM.  

A study has been carried out in this context in Belgium: “The needs and demands in terms of sexual and reproductive health and rights of women living with FGM in Brussels”.  

This study teaches us, for example, that in order to explore the needs and demands of women affected by FGM in terms of sexual and reproductive health and rights in a comprehensive approach, taking into account different aspects of sexual and reproductive health such as contraception, access to care, sexuality and gender-based violence, it would be necessary to adopt an approach that consists of questioning FGM survivors about their needs and demands in terms of health in general, and from this diagnosis, it will be easier to better understand and identify the needs of FGM survivors.   

This will also allow us to assess the extent to which existing services meet the needs of survivors, and to see how these services can be improved in order to promote the health of girls and women affected by FGM.  

It would be important for any professional working with FGM survivors to ensure and promote the health of FGM survivors by asking themselves 

• What are the health needs of an FGM survivor?   
• To what extent do or should the services offered meet the needs of these women?   
• How could our services be improved?     

The purpose of this diagnosis will allow us as health professionals, health care institutions, government authorities, etc. to develop concrete actions within these services to promote the well-being and health of FGM survivors.   

Therefore, simple access to information is not enough. Women must also have the opportunity to talk about their experiences and express their needs. Our results also indicate that FGM patients want professionals to address “intimate” topics such as sexuality, female genital mutilation, violence and genital health problems. They want professionals to make the first move (Florquin, Stéphanie (2021)).  

When we allow them to express their experiences, we find that women affected by FGM have a need for information about health in general.  

We share some of the recommendations of this study to strengthen the training and information of professionals and thereby strengthen the care services available to FGM survivors.  

HOW TO STRENGTHEN PROFESSIONAL TRAINING AND INFORMATION ?  

– Strengthen knowledge of FGM and its consequences among health and social professionals. This involves identifying specific information needs and setting up appropriate resources.  

– Strengthen the information available to professionals about the possible consequences of FGM: what may be related to FGM, and what may not (or probably not, or not necessarily).   

– Integrate the issue of FGM into the training of all health professionals who may have to deal with migrant women (including general practitioners and midwives) on the health needs of FGM survivors.   

– Strengthen the training of professionals and future professionals in the psychosocial sector in the care of women survivors of FGM.  

– Train health professionals and social workers so that they are better able to explain the possible consequences that FGM can have on people’s health, while remaining attentive to the specific situation of each patient and not attributing health problems universally to all those affected by FGM.   

– Encourage health and mental health professionals to discuss issues related to FGM with patients (FGM survivors) in order to give them the opportunity to talk about these issues and potential health problems. This requires initial and ongoing training.   

– Strengthen professionals’ knowledge of FGM by identifying their need for information and creating and adapting tools.   

– Ensure that gender-based violence, including FGM, is included in the compulsory initial training of future professionals (communication, health, psychological, legal).