The Challenge of Addressing the Health Care Needs of Immigrant Women Who Suffered Female Genital Mutilation/Cutting, in Spain
By Professor María del Mar Pastor Bravo
The contentious issue of Female Genital Mutilation/Cutting (FGM/C) poses unique challenges to health promotion and health care around the globe. FGM/C is defined by the World Health Organization (WHO) as “all procedures that involve injury to the female genital organs for non-medical reasons”*. This set of traditional practices is one of the most extreme expressions of gender-based violence and a violation of women’s rights,affecting some 200 million women and girls in over forty countries on five continents. It is estimated that 500,000 women living in the European Union (EU) have been subjected to FGM/C, and that 180,000 girls and women are at risk of undergoing FGM/C every year.In Spain, approximately 17,000 women and girls have either been mutilated or are at risk of being so.Despite the large numbers of women affected, it has been documented that availability and quality of care in Spain and Europe remain a challenge. WHO has set priorities to eradicate FGM/C, encouraging researchers to document the dramatic consequences of this practice.It is expected that such knowledge will help health care providers in Western countries better understand the experience of women who suffer the consequences of FGM/Cand provide transcultural, respectful care.
The article “Living with mutilation: A qualitative study on the consequences of female genital mutilation in women's health and the healthcare system in Spain” (Midwifery, 66, 119–126) reports the results of a study based on interviews with genitally-cut migrants who had given birth in the Spanish National Healthcare System. The study objective was to better understand the perspective of these women on health care. Participants reported physical, psychological, obstetric and sexual complications that could be linked back to FGM/C. Among immediate physical consequences they described hemorrhage and intense pain, with related difficulty urinating. Long-term complications were also mentioned that could be ascribed to this practice, including recurrent urinary infections and hepatitis B. Psychological consequences identified through the interviews included fear, emotional pain, rage, frustration, anguish, sadness, depression, and post-traumatic stress disorder. Women suffered changes in their sexuality, such as fear of engaging in sexual intercourse, dyspareunia (decrease in sexual pleasure), and difficulties in reaching orgasm. They also experienced complications during pregnancy with a greater need for episiotomies, instrumental deliveries, and caesarean deliveries. Furthermore, participants reported that health care professionals did not openly address the issue of FGM/C, never discussing with them the implications of their condition at any phase of care.
The lack of acknowledgement and information-sharing regarding FGM/C does not represent adequate care for this population. As a universal, publicly funded system, the Spanish National Healthcare System, as other health care systems in the EU, should be responsive to changes in the population it serves. Given how rapidly the demographic profile of the European population is evolving, monitoring changes in population needs and establishing appropriate responses, including training of health care professionals, is essential for immigrants but important for all users.
*WHO (2018) Fact Sheet: Female Genital Mutilation. https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation
María del Mar Pastor Bravo, PhD
Faculty of Nursing, University of Murcia