Female genital mutilation (FGM): An analysis of the silences in maternity care experiences of FGM survivors and the silences of health care professionals providing maternity care to FGM survivors
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AbstractThe consequences of female genital mutilation (FGM) during the perinatal period are significant, but the experiences of FGM survivors accessing maternity care are under-reported in the literature. This thesis reports on the analysis of experiences of FGM survivors in maternity care and the experiences of health care professionals providing such care. This qualitative study was methodologically structured around the Sound of Silence framework which was developed for research with marginalised groups and communities. Two separate cohorts of participants took part in this study; 20 FGM survivors and eight health care professionals. FGM survivors met the inclusion criteria if, (i) they had given birth within the previous few days of data collection, (ii) they and their baby were of sufficient health to be discharged home and, (iii) were able to communicate in one of the languages identified for use in this study; namely Arabic, English and/or French. Health care professionals were excluded from this study if they had provided maternity care within the service where they FGM survivor participants had accessed care. Data analysis was conducted using a combination of thematic and discourse analysis to interpret overarching themes and elicit silences in the dominant discourses that were interpreted across the data. The findings from the analysis suggest that health care professionals’ education and training lacks the cultural context of FGM which seems to have an impact on the provision of maternity services for FGM survivors. Although risk assessments appeared to be dominant in the discourse of maternity care, this discourse appears to constrain health care professionals in maternity services from providing culturally responsive care. This appeared to lead to a silence of cultural sensitivity when providing care to FGM survivors. Themes that were interpreted from the data suggest that mental health services are not seamless in maternity services for FGM survivors which appeared to relate to constraints in care provision as well as knowledge and education and communication issues with and amongst health care professionals. This finding led to the conception of a novel model of cultural silence around FGM which can be used to determine cultural dissonance in health care settings. Furthermore, recommendations include the development of working groups of FGM survivors and key stakeholders in the co-design and production of clinical guidance and education for health care professionals. Strategic planning for the implementation of mental health care collaboration in maternity services is recommended as well as the requirement of further research of mental health care in maternity services for FGM survivors.
PublisherUniversity of Wolverhampton
TypeThesis or dissertation
DescriptionA thesis is submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy.
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