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How confident are healthcare professionals in addressing FGM?

Dr Raheal Gabrasadig was awarded a WONDER research grant to support her study "Female genital mutilation: Knowledge, training and experience of healthcare professionals at a London Hospital". The study shows that around 3/4 of healthcare professionals face barriers that prevent healthcare professionals from speaking to patients about FGM and that they need and want more training.

As part of WONDER's commitment to supporting vulnerable women and girls, and promoting education, WONDER is pleased to be able to continue to provide information on FGM in the UK and how it can best be tackled. Previously we published a paper on the prevalence of FGM in the City of Westminster, finding that around 7% of schoolgirls were at risk. 

This new study, published in the "Archives of Disease in Childhood" shows that across the range of healthcare professionals, including nurses, midwives and doctors, who were surveyed, all were aware of what FGM was. However, almost three quarters felt that they would benefit from more training on the subject and only one fifth felt confident in discussing the issue with patients - the three key factors contributing to this lack of confidence were lack of knowledge of FGM, and two factors related to the fact that FGM is almost exclusively carried out in immigrant communities: the language barrier and fear of appearing to be insensitive. 

picture: James Palinsad

We would encourage health professionals to request their hospitals to put on training on FGM which addresses these three key factors. 

The paper was also presented at the 2015 BAPSCAN congress. 


Female genital mutilation: Knowledge, training and experience of healthcare professionals at a London Hospital (online here)

The World Health Organisation defines female genital mutilation (FGM) as "procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons." Since 1985 it has been a criminal offence in the UK to perform FGM, or to assist a girl in performing FGM on herself.

This study was based at a district general hospital in London with a high prevalence of patients originating from countries where FGM is practiced. We aimed to assess healthcare professionals’ knowledge and confidence in managing FGM, as this underpins their ability to respond adequately to the medical needs of patients with FGM and safeguard girls and young women from the practice.

A confidential survey was distributed within the hospital from January-March 2014. 157 healthcare professionals responded.  35% were midwives (n=51), 45% medical doctors (N=71), 19% nursing (N=30), 3% other (N=5).

100% of respondents stated they knew what FGM was and 71.4% felt they would benefit from further training on the subject.  Only 21% of respondents stated that they would feel comfortable discussing FGM with patients. Most healthcare professionals had not read any guidelines relating to FGM (65.3%). Midwives were more likely to have read guidelines compared with any other profession (p=0.001).

Interestingly, 73% felt there were barriers that prevent healthcare professionals from speaking to patients about FGM. On a scale of 1-5 (1= not important at all, to 5= very important), lack of knowledge of FGM was rated as the most important barrier with a mean rating of 4.3 out of 5, followed by a language barrier (rating= 4.1) and fear of appearing culturally insensitive (rating=3.9).

We have identified what are perceived by healthcare professionals to be the most significant barriers to discussing FGM with patients. We suggest that future training should particularly focus on overcoming these barriers. One potential approach would be specialised communication training provided by people who are already familiar with working with women who have suffered FGM. These barriers should be addressed if we are to identify and protect all girls and young women who are potential or actual victims of FGM.

Authors: Dr R Gabrasadig, Mr F Asamoah, Dr N Wilson