Female genital mutilation and women's healthcare experiences with general practitioners in the Netherlands: A qualitative study

OBJECTIVES: While the general practitioner (GP) in the Netherlands is the first point of entry to and gatekeeper of the healthcare system, no study exists to explore the experiences of women with female genital mutilation or cutting (FGM/C) in general practice. Therefore, the aim of this study is to look into the experiences of women with FGM/C in Dutch general practice. METHODS: Semistructured interviews were held with 16 women with FGM/C. Sampling was purposeful. The interview guide and thematic analysis were based on the Illness Perception Model and Kleinman's Explanatory model. Interviews were held in English or Dutch. All data were anonymized, and recordings were transcribed verbatim. Transcripts were coded and thematically analyzed. RESULTS: The women considered FGM/C to be connected to a range of health problems, for which not all of them sought medical care. They had difficulty discussing such a sensitive topic with their GP, did not know their problems could be relieved or perceived GPs to have insufficient knowledge of FGM/C. Lack of time during consultations and overall dissatisfaction with Dutch GP care hampered trust. They strongly preferred the GP to be proactive and ask about FGM/C. CONCLUSION: There is room for improvement as most women would like their GP to discuss their health problems related to FGM/C. GPs should take a proactive attitude and ask about FGM/C. In addition, to develop the trusted relationship

Socio-economic status in relation to smoking: The role of (expected and desired) social support and quitter identity

RATIONALE\nSmoking behavior differs substantially between lower and higher socioeconomic status (SES) groups. Previous research shows that social support for quitting may be more available to higher-SES smokers, and higher-SES smokers may have stronger nonsmoker self-identities (i.e., can see themselves more as nonsmokers).\nOBJECTIVE\nTo investigate how SES influences smoking behavior, taking the role of identity processes and social support into account.\nMETHOD\nA cross-sectional online survey study was conducted among 387 daily smokers from lower, middle and higher-SES groups in the Netherlands in 2014. Educational level was used as an indicator of SES. Expected and desired social support for quitting smoking, expected exclusion from the social network when quitting, identity factors and intention to quit were measured.\nRESULTS\nSmokers from all SES backgrounds desired to receive positive social support if they would quit smoking. Lower-SES smokers expected to receive more negative and practical support than middle or higher-SES smokers. There were no significant differences between SES groups for almost all identity measures, nor on intention to quit. Above and beyond other important influences such as nicotine-dependence, results showed that smokers regardless of SES who expected to receive more positive support tended to have stronger intentions to quit. Moreover, smokers who could see themselves more as being quitters (quitter self-identity) and perceived themselves less as smokers (smoker self-identity), as well as smokers who felt more positive about nonsmokers (nonsmoker group-identity) had stronger intentions to quit. No significant interactions with SES were found.\nCONCLUSION\nThe results suggest that developing ways to stimulate the social environment to provide adequate support for smokers who intend to quit, and developing ways to strengthen identification with quitting in smokers may help smokers to quit successfully. Findings further suggest that the possible-self as a quitter is more important than the current-self as a smoker.FSW - Self-regulation models for health behavior and psychopathology - ou

The subtle hands of self-reactivity in peripheral T cells

Contains fulltext : 221010.pdf (publisher's version ) (Open Access)OBJECTIVES: The aim of the study was (I) to estimate the prevalence of Female Genital Mutilation/Cutting (FGM/C) and distribution of types of FGM/C among migrant girls and women in the Netherlands, and (II) to estimate the number of migrant girls at risk of being cut in the immediate future. METHODS: National population-based survey data regarding FGM/C prevalence were applied to female migrants in the Netherlands who migrated from 29 countries with available nationally representative data on FGM/C. RESULTS: As of January 1st 2018, there were 95,588 female migrants residing in the Netherlands, originating from 29 countries with available nationally representative data on FGM/C. Our findings suggest that about 41,000 women had undergone FGM/C, of which 37% had Type III (infibulation). In total 4,190 girls are estimated to be at risk of FGM/C in the next 20 years, of whom 394 were first-generation girls. CONCLUSION: These findings show the urgency to develop appropriate strategies and policies to prevent FGM/C, to protect girls and women at risk of the practice, and to provide adequate services and support for those affected by FGM/C in the Netherlands

Estimates of female genital mutilation/cutting in the Netherlands: a comparison between a nationwide survey in midwifery practices and extrapolation-model

Background Owing to migration, female genital mutilation or cutting (FGM/C) has become a growing concern in host countries in which FGM/C is not familiar. There is a need for reliable estimates of FGM/C prevalence to inform medical and public health policy. We aimed to advance methodology for estimating the prevalence of FGM/C in diaspora by determining the prevalence of FGM/C among women giving birth in the Netherlands. Methods Two methods were applied to estimate the prevalence of FGM/C in women giving birth: (I) direct estimation of FGM/C was performed through a nationwide survey of all midwifery practices in the Netherlands and (II) the extrapolation model was adopted for indirect estimation of FGM/C, by applying population-based-survey data on FGM/C in country of origin to migrant women who gave birth in 2018 in the Netherlands. Results A nationwide survey among primary care midwifery practices that provided care for 57.5% of all deliveries in 2018 in the Netherlands, reported 523 cases of FGM/C, constituting FGM/C prevalence of 0.54%. The indirect estimation of FGM/C in an extrapolation-model resulted in an estimated prevalence of 1.55%. Possible reasons for the difference in FGM/C prevalence between direct- and indirect estimation include that the midwives were not being able to recognize, record or classify FGM/C, referral to an obstetrician before assessing FGM/C status of women and selective responding to the survey. Also, migrants might differ from people in their country of origin in terms of acculturation toward discontinuation of the practice. This may have contributed to the higher indirect-estimation of FGM/C compared to direct estimation of FGM/C. Conclusions The current study has provided insight into direct estimation of FGM/C through a survey of midwifery practices in the Netherlands. Evidence based on midwifery practices data can be regarded as a minimum benchmark for actual prevalence among the subpopulation of women who gave birth in a given year