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Midwives' Experiences in Providing Care and Counselling to Women with Female Genital Mutilation (FGM) Related Problems

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      Abstract

      Aim. The aim of this study was to elucidate midwives experiences in providing care and counselling to women with FGM related problems. Setting. The study was conducted at a maternity clinic in Hargeisa, Somaliland. Method. A qualitative, inductive study were performed with eight midwives living in Somaliland. The interviews had semi-structured questions. Content analysis was used for the analysis. Findings. The main findings of the present study were how midwives are challenged by culture and religion when providing FGM counselling. The most prominent challenge is the perception that FGM is an important part of the culture and from this point of view the midwives work is apprehended as interfering and subverting the Somali culture. Having personal experience of FGM emerged as a benefit when counselling women. Conclusion. There is a contradiction between the professional actions of performing FGM despite a personal belief against FGM. Midwives as a professional group could be important agents of change and further research is needed about the midwives role in this process.

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      Most cited references 35

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      Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.

      Qualitative content analysis as described in published literature shows conflicting opinions and unsolved issues regarding meaning and use of concepts, procedures and interpretation. This paper provides an overview of important concepts (manifest and latent content, unit of analysis, meaning unit, condensation, abstraction, content area, code, category and theme) related to qualitative content analysis; illustrates the use of concepts related to the research procedure; and proposes measures to achieve trustworthiness (credibility, dependability and transferability) throughout the steps of the research procedure. Interpretation in qualitative content analysis is discussed in light of Watzlawick et al.'s [Pragmatics of Human Communication. A Study of Interactional Patterns, Pathologies and Paradoxes. W.W. Norton & Company, New York, London] theory of communication.
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        Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries.

        Reliable evidence about the effect of female genital mutilation (FGM) on obstetric outcome is scarce. This study examines the effect of different types of FGM on obstetric outcome. 28 393 women attending for singleton delivery between November, 2001, and March, 2003, at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan were examined before delivery to ascertain whether or not they had undergone FGM, and were classified according to the WHO system: FGM I, removal of the prepuce or clitoris, or both; FGM II, removal of clitoris and labia minora; and FGM III, removal of part or all of the external genitalia with stitching or narrowing of the vaginal opening. Prospective information on demographic, health, and reproductive factors was gathered. Participants and their infants were followed up until maternal discharge from hospital. Compared with women without FGM, the adjusted relative risks of certain obstetric complications were, in women with FGM I, II, and III, respectively: caesarean section 1.03 (95% CI 0.88-1.21), 1.29 (1.09-1.52), 1.31 (1.01-1.70); postpartum haemorrhage 1.03 (0.87-1.21), 1.21 (1.01-1.43), 1.69 (1.34-2.12); extended maternal hospital stay 1.15 (0.97-1.35), 1.51 (1.29-1.76), 1.98 (1.54-2.54); infant resuscitation 1.11 (0.95-1.28), 1.28 (1.10-1.49), 1.66 (1.31-2.10), stillbirth or early neonatal death 1.15 (0.94-1.41), 1.32 (1.08-1.62), 1.55 (1.12-2.16), and low birthweight 0.94 (0.82-1.07), 1.03 (0.89-1.18), 0.91 (0.74-1.11). Parity did not significantly affect these relative risks. FGM is estimated to lead to an extra one to two perinatal deaths per 100 deliveries. Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive FGM.
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          Using qualitative research.

          A renewed urgency has emerged in the qualitative health research community concerning the utility of qualitative research. This urgency is the result of several converging trends in health care research, including the elevation of practical over basic knowledge, proliferation of qualitative health research studies, and the rise of evidence-based practice as a paradigm and methodology for health care. Diverse conceptualizations of use and users exist, and these have different implications for understanding, demonstrating, and enhancing the utility of qualitative research findings. Issues affecting the utilization of these findings include the varied ways in which they are conceived, presented, synthesized, signified, and translated, and the complex repertoire of skills required to activate the knowledge transformation cycle in qualitative health research fully.
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            Author and article information

            Affiliations
            1Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
            2Development Studies, Hargeisa, Somaliland, Somalia
            3Department of Health Sciences, Faculty of Medicine, Lund University, 221 00 Lund, Sweden
            Author notes

            Academic Editor: Johanne Sundby

            Journal
            Obstet Gynecol Int
            Obstet Gynecol Int
            OGI
            Obstetrics and Gynecology International
            Hindawi Publishing Corporation
            1687-9589
            1687-9597
            2013
            18 September 2013
            : 2013
            24163698 3791569 10.1155/2013/785148
            Copyright © 2013 Elisabeth Isman et al.

            This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Categories
            Research Article

            Obstetrics & Gynecology

            Comments

            This study provides an interesting insight into the challenges midwifes are faced with regarding care and counseling of women who did undergo FGM. The finding that the strongest challenges for the midwives are religion and culture as well as the women are the driving forces behind the perpetuation of FGM corresponds to the findings of other research. The finding of this study, that personal experience and health education as well as information regarding religion had the strongest influence on the midwives’ change of opinion, indicates that strengthening the competence of midwives might have a crucial influence on change and elimination of the practice of FGM.

            2015-06-11 14:58 UTC
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