Development of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) for migrants to Western societies: an international Delphi consensus process

Background Through the World Health Assembly Resolution, ‘Health of Migrants’, the international community has identified migrant health as a priority. Recommendations for general hospital care for international migrants in receiving-countries have been put forward by the Migrant Friendly Hospital Initiative; adaptations of these recommendations specific to maternity care have yet to be elucidated and validated. We aimed to develop a questionnaire measuring migrant-friendly maternity care (MFMC) which could be used in a range of maternity care settings and countries. Methods This study was conducted in four stages. First, questions related to migrant friendly maternity care were identified from existing questionnaires including the Migrant Friendliness Quality Questionnaire, developed in Europe to capture recommended general hospital care for migrants, and the Mothers In a New Country (MINC) Questionnaire, developed in Australia and revised for use in Canada to capture the maternity care experiences of migrant women, and combined to create an initial MFMC questionnaire. Second, a Delphi consensus process in three rounds with a panel of 89 experts in perinatal health and migration from 17 countries was undertaken to identify priority themes and questions as well as to clarify wording and format. Third, the draft questionnaire was translated from English to French and Spanish and back-translated and subsequently culturally validated (assessed for cultural appropriateness) by migrant women. Fourth, the questionnaire was piloted with migrant women who had recently given birth in Montreal, Canada. Results A 112-item questionnaire on maternity care from pregnancy, through labour and birth, to postpartum care, and including items on maternal socio-demographic, migration and obstetrical characteristics, and perceptions of care, has been created - the Migrant Friendly Maternity Care Questionnaire (MFMCQ) – in three languages (English, French and Spanish). It is completed in 45 minutes via interview administration several months post-birth. Conclusions A 4-stage process of questionnaire development with international experts in migrant reproductive health and research resulted in the MFMCQ, a questionnaire measuring key aspects of migrant-sensitive maternity care. The MFMCQ is available for further translation and use to examine and compare care and perceptions of care within and across countries, and by key socio-demographic, migration, and obstetrical characteristics of migrant women

Is research data used in education for health professionals on management of Female Genital Cutting? : results from Sweden

Introduction Since the 1980s, refugees have come to Sweden from the Horn of Africa, where the majority of women have undergone Female Genital Cutting (FGC). Sweden was the first country in the West to outlaw the practice in 1982, later it became illegal for a Swedish resident to perform FGC abroad. The Swedish government has allocated research funding and has put a lot of effort into prevention and management by means of writing guidelines and organized professional training activities for best practices of persons with FGMC. Methods We have explored to what extent empirical data from the international research field is used in professional education and policy documents from Swedish health authorities since the 1990s. We performed a systematic review of scientific papers, books, guidelines and grey literature reports from Sweden. We focus on outcomes related to maternity care (maternal, perinatal mortality) and youth health counselling (menstruation disorders, sexuality). Results The evidence-based knowledge from perinatal and maternal death audits had not been used in an appropriate way, basic medical knowledge on dysmenorrhea was neglected, and qualitative data on sexual health among women with FGC was not acknowledged in the documents. Conclusion Swedish authorities have worked to improve the health outcomes among women with FGC. However, evidence-based knowledge has been underused, thereby increasing the risk for harm in spite of good intentions

FGM alerts and expert assessments from healthcare providers : legal case analysis

Introduction: Sweden legislated against FGM in 1982. Since then, nearly 90 suspected cases have reached the police and prosecutor. A few of the reports were alerts from healthcare professionals, but the bulk of them originated from daycare and social services sectors. Healthcare providers play a prominent role as experts in forensic investigations. Methods: Cases of suspected FGM originating from healthcare providers who have reported suspected, performed, or planned FGM were analylzed to determine the role of healthcare providers as experts in assessing whether FGM has been performed, and, if so, to what extent. Results: Very few cases analyzed had sufficient indictable evidence; two cases during 35 years were brought to court. The review revealed inconsistencies in the medical assessment processes during which medical experts reached divergent conclusions about FGM status. Conclusion: Variations in normal anatomy and also in cutting procedures make genital assessments by healthcare providers very difficult. It is of utmost importance that appropriate medical experts are summoned in FGM criminal investigations, since these processes often involve radical measures from the police and prosecutor, such as detention of legal custodians and compulsory medical genital examinations of young girls in order to obtain a legally valid medical certificate for an eventual court proceeding

The increasing demand for reconstructive clitoral surgery among circumcised women living in Europe : A nexus analysis

Introduction: The demand for the surgical technique of clitoral reconstructive surgery introduced by Pierre Foldès is increasing globally despite lack of evidence of its benefits weighed against its potential harms. Methods: In an ongoing study, we use nexus analysis to study the introduction of the surgery in Sweden. In nexus analysis, one simultaneously reviews current discourses, actors and settings to understand a particular phenomenon. In this analysis we seek to determine who is promoting the surgery, in what settings, and what discourses are offered to interpret the phenomenon. Results: Preliminary results, in line with other studies from social science literature, suggest that reconstructive clitoral surgery as a biomedical practice is a response to Western discourses on ‘female genital mutilation’: discourses that label cut women as ‘mutilated’, sexually deprived and less feminine than uncut women. These discourses in themselves are harmful to women and may cause them to seek a surgical solution that may not actually lead to improved outcomes. Conclusion: A new biomedical surgical procedure has been introduced and is generally praised, despite the lack of evidence to prove beneficial outcomes. This surgery is embedded in a powerful discourse that may negatively affect far more women than those who opt for surgery. The negative effects of female genital cutting should be carefully addressed in campaigning in order not to stigmatize already cut women further

Transnational surrogacy - reproductive rights for whom?

Comment on Informed consent in medical decision-making in commercial gestational surrogacy: a mixed methods study in New Delhi, India

Intimate partner violence among HIV infected and uninfected pregnant women delivering at a National Hospital in Tanzania: using a modified screening tool

Background: Worldwide Intimate Partner Violence (IPV) is a major public health problem, affecting all women and vulnerable groups such as HIV-infected women. This study aimed to test the applicability of assessment of IPV using a simple screening tool, among women giving birth at Muhimbili National Hospital in Tanzania, to estimate the prevalence and severity of IPV among HIV-infected and uninfected pregnant women, and to assess the odds of IPV among both groups of women. Methods: A questionnaire including screening questions was applied to women delivered at Muhimbili National Hospital to identify those that experienced IPV. Demographics, HIV status, male partner’s alcohol use and sexual behaviour data were also collected. Mean age and proportions of IPV in different groups were calculated. Odds of IPV were estimated using univariate logistic regression. Results: Majority of women (69%) experienced emotional or physical violence, and 31% experienced sexual violence. Sixty-five percent reported a lifetime prevalence of physical, emotional or sexual violence. Majority (82%) of partners of women that experienced IPV were reported as almost solely offenders in sexual violence rather than in emotional or physical violence (44%). Most participants (88%) experienced repeated emotional and physical violence. Regardless of offenders, repeated sexual violence in the preceding year (85%) was more common than physical violence (47%). Experience of IPV in HIV-positive women was comparable to the HIV-negative counterparts. Conclusion: A simple proposed tool detected women experienced IPV before and during pregnancy but found comparable rates of violence between HIV positive and negative women