AbstractFemale Genital Mutilation (FGM) affects approximately 200 million women worldwide (WHO, 2016), with 103,000 women and girls with FGM thought to be living in the UK. Of specific concern is pregnancy and childbirth due to the negative obstetric consequences caused by FGM. The transition to parenthood is challenging for new mothers and is known to be complicated by migration status. Thus, the research question for this thesis is: what are the post-partum experiences and needs of women with FGM using NHS services in the UK? A focused ethnographic (FE) approach conceptualized the postpartum experiences and needs of women with FGM. A FE approach ensured a culturally contextualized understanding of the phenomena and ensured contextual factors influencing women’s experiences were understood and incorporated. A three-phase approach, reflecting the macro, meso and micro levels ensured contextual grounding in culture and a robust understanding of women’s experiences throughout the pregnancy and postpartum journey.
A documentary analysis (DA) of health policies relating to FGM, showed a top-down approach to healthcare used by the UK government and health authorities. There was a heavy focus on antenatal and labour and birth and while culturally sensitive care was noted as important, guidance on implementation is lacking. Interviews with Key informants (KI) (Policy makers, Police, midwives) displayed the top-down approach to healthcare, resulting in tension between KI who had direct interaction with women with FGM, and those who did not. Women interviewed were happy with the care they received overall, but they voiced the dominance of the law during the antenatal period, and the top-down approach to healthcare provision. The importance of the postpartum period (PPP) was highlighted, and women expressed the need for additional support during this time.
This thesis highlights the top-down approach to maternity care for women with FGM used by the NHS, and how this approach decreases the ability of healthcare providers to deliver culturally sensitive care, silencing women’s voices. A ‘cradle model’ is proposed to activate women and increase support mechanisms they feel are needed. This model lifts and supports women to achieve their best health outcomes. Limitations include the ethical restriction of allowing only English-speaking women to participate, the unknown degree of assimilation of women, and the small sample size. Strengths include the wide range of healthcare professionals interviewed, and the conceptualization of the issue from the macro, meso and micro levels providing a detailed context to women’s experiences. This is the first study to exclusively research the postpartum experiences of women with FGM in the UK using NHS services. Women need a holistic approach to care, which extends to postpartum needs and considers individual circumstances and contexts beyond FGM. Recommendations for future policy and research include a mapping of maternity care for women with FGM; increased understanding of the importance of social networks for women who have migrated and understanding the experience of healthcare practitioners providing care to women with FGM. A Patient and Public Involvement and Engagement (PPIE) framework would ensure women’s voices are heard.
|Date of Award||Aug 2021|
|Supervisor||Elizabeth Bailey (Supervisor), Hazel Barrett (Supervisor) & Katherine Brown (Supervisor)|