Seeking culturally safe care: a qualitative systematic review of the healthcare experiences of women and girls who have undergone female genital mutilation/cutting

Evans, Catrin; Tweheyo, Ritah; McGarry, Julie; Eldridge, Jeanette; Albert, Julie; Nkoyo, Valentine; Higginbottom, Gina Marie Awoko

Abstract

OBJECTIVE
To explore the experiences of accessing and receiving healthcare related to female genital mutilation/cutting (FGM/C) across the life course, from the perspective of women and girls who have undergone FGM/C.

DESIGN
A systematic review of qualitative research studies, using a thematic synthesis approach.

METHODS
Inclusion criteria were qualitative studies (including grey literature) of any design, from OECD countries, of any date and any language. Sixteen electronic databases were searched from inception to December 2017, supplemented by reference list searching. Papers were screened, selected and quality appraised by two reviewers using established tools from the Joanna Briggs Institute (JBI). NVivo software was utilised to extract study characteristics and code study findings. An inductive thematic synthesis approach was undertaken to identify descriptive themes and interpret these into higher order analytical constructs. Confidence in the review findings was assessed using GRADE-CERQual.

RESULTS
Fifty seven papers (from 55 distinct studies) from 14 different OECD countries were included (50% published within the last eight years). One third of studies focused exclusively on maternity care experiences, whereas others covered a range of foci. No studies reported explicitly on girls’ experiences or on experiences of health-service led safeguarding interventions. Only three studies addressed psychological care. The synthesis developed 17 descriptive themes, organised into five analytical constructs. These related to: communication; access to care; experiences of cultural dissonance/integrity; disempowering care experiences and positive care encounters. The themes illuminate significant challenges to obtaining timely and holistic care (especially for deinfibulation), and highlight different ways in which women may experience care as disrespectful, unsafe and disempowering. Key elements of ‘culturally safe care’ are identified.

CONCLUSIONS
This review has highlighted key knowledge gaps, especially around (i) girls’/unmarried women’s experiences, and, (ii) the impact of recent safeguarding interventions. There is an ongoing need for community engagement, service development and staff training.

Citation

Evans, C., Tweheyo, R., McGarry, J., Eldridge, J., Albert, J., Nkoyo, V., & Higginbottom, G. M. A. (2019). Seeking culturally safe care: a qualitative systematic review of the healthcare experiences of women and girls who have undergone female genital mutilation/cutting. BMJ Open, 9(5), 1-23. https://doi.org/10.1136/bmjopen-2018-027452

• Journal Article Type: Article
• Acceptance Date: Apr 15, 2019
• Online Publication Date: May 29, 2019
• Publication Date: May 29, 2019
• Deposit Date: May 17, 2019
• Publicly Available Date: May 31, 2019
• Journal: BMJ Open
• Electronic ISSN: 2044-6055
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 9
• Issue: 5
• Article Number: e027452
• Pages: 1-23
• DOI: https://doi.org/10.1136/bmjopen-2018-027452
• Keywords: General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/2060927
• Publisher URL: https://bmjopen.bmj.com/content/9/5/e027452
• Contract Date: May 17, 2019