Section for Trauma, Catastrophes and Forced Migration-Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
PLoS One. 2021 Sep 17;16(9):e0257588. doi: 10.1371/journal.pone.0257588. eCollection 2021.
Girls and women subjected to female genital cutting (FGC) risk experiencing obstetrical, gynecological, sexual, and psychological health problems. Therefore, Norway has established low-threshold specialized healthcare services where girls and women with FGC-related health problems can directly seek medical attention. Nevertheless, we lack data about access to these services, especially for non-maternity-related purposes. In this article, we explore experiences of seeking medical attention for health problems that are potentially FGC-related, aiming to identify factors that hinder or facilitate access to FGC-specialized services.
We conducted a qualitative study in three Norwegian cities employing semi-structured repeat interviews with 26 girls and women subjected to FGC, participant observation, and three validation focus group discussions with 17 additional participants. We thematically analyzed the data and approached access as a dynamic process of interactions between individuals and the healthcare system that lasts from an initial perception of need until reception of healthcare appropriate to that need.
We identified several barriers to healthcare, including 1) uncertainty about FGC as a cause of experienced health problems, 2) unfamiliarity with FGC-specialized services, 3) lack of assessment by general practitioners of FGC as a potential cause of health problems, and 4) negative interactions with healthcare providers. In contrast, factors facilitating healthcare included: 1) receiving information on FGC-related health problems and FGC-specialized services from a non-profit immigrant organization, 2) referral to gynecologists with good knowledge of FGC, and 3) positive interactions with healthcare providers.
Assessing whether FGC is the cause for experienced health problems requires diagnostic competency and should not be left entirely to the patients. We recommend that Norwegian policymakers acknowledge the central role of GPs in the clinical management of patients with FGC-related health problems and provide them with comprehensive training on FGC.
接受女性生殖器切割（FGC）的女孩和妇女面临着产科、妇科、性健康和心理健康问题的风险。因此，挪威设立了低门槛的专门医疗保健服务，接受过 FGC 的女孩和妇女可以直接寻求医疗关注。然而，我们缺乏关于这些服务的获取途径的数据，尤其是与产妇无关的目的。在本文中，我们探讨了寻求与 FGC 相关的健康问题的医疗关注的经验，旨在确定阻碍或促进 FGC 专门服务获取的因素。
我们在挪威的三个城市进行了一项定性研究，采用半结构化重复访谈的方式，对 26 名接受过 FGC 的女孩和妇女进行了访谈，对参与者进行了观察，并与另外 17 名参与者进行了三次验证焦点小组讨论。我们对数据进行了主题分析，并将获取途径视为个体与医疗保健系统之间互动的动态过程，该过程从最初的需求感知一直持续到接受适合该需求的医疗保健。
我们确定了一些医疗保健障碍，包括 1）对 FGC 作为经历的健康问题的原因的不确定性，2）对 FGC 专门服务的不熟悉，3）全科医生对 FGC 作为潜在健康问题的原因缺乏评估，4）与医疗保健提供者的负面互动。相比之下，促进医疗保健的因素包括：1）从非营利性移民组织获得有关 FGC 相关健康问题和 FGC 专门服务的信息，2）转诊给对 FGC 有深入了解的妇科医生，3）与医疗保健提供者的积极互动。
评估 FGC 是否是经历的健康问题的原因需要诊断能力，不应完全由患者承担。我们建议挪威政策制定者承认全科医生在处理与 FGC 相关的健康问题的患者方面的核心作用，并为他们提供有关 FGC 的全面培训。
