The reproductive health needs of Somali women affected by female genital mutilation living in Manchester, United Kingdom

N.H. Mullin (1), H. Lovel (2), Z. Mohammed (3)

Highfield Clinic, Widnes, Cheshire, UK (1); University of Manchester School of Primary Care, Manchester, UK (2); Central Manchester Primary Care Trust, Manchester, UK (3)

Background: Female genital mutilation (FGM), usually type 3 (the most severe form), affects over 90% of Somali women. FGM is illegal in the UK. There is a rapidly increasing Somali population in Manchester. In other parts of the UK, special African Well Woman Clinics have been set up to provide culturally sensitive reproductive health care to women affected by FGM.

Objectives: A health needs assessment was carried out to discover the reproductive health needs of Somali women affected by FGM; and to ascertain if a community family planning service could provide an acceptable service to these women.

Design and methods: A systematic literature search on FGM was performed. Somali women, men and Somali health professionals were interviewed individually for a video commissioned by the World Health Organisation. Focus groups comprising of representatives from the local Somali population were brought together to discuss topics of concern. A health questionnaire was developed from the discussions of the focus groups and was completed by other members of the Somali community.

Results: Qualitative and quantitative analysis was used. FGM was reported to have influences across the life course. The main themes were consistent with the world literature. FGM in childhood is normal in Somali and is often associated with acute health problems including pain, bleeding, infection and urinary retention. Menstrual problems may occur in puberty, sometime necessitating de-infibulation (re-opening). In later life there may be sexual problems, effects on fertility and childbirth. We discovered socioeconomic and sociocultural reasons facilitating continuation and factors against FGM. Women complained of a lack of knowledge and understanding by UK doctors and midwives. This Somali population expressed a desire to have easy and timely access to the FGM reversal operation (before marriage and pregnancy) rather than having to wait to see the local female hospital gynaecologist.

Conclusions: The adult Somali female population in Manchester suffers many complications of FGM. There is a need for an improved FGM reversal service in Manchester. This could be provided by the local family planning service when an acceptable location for the clinic is established and medical staff with gynaecological experience have been trained in the simple reversal procedure. Further work on FGM issues is being carried out within the Somali community.