Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation

Female genital mutilation (FGM) is a practice that is carried out on young girls and women in 29 countries in Africa and the Middle East, as well as some Asian countries (WHO, 2008). Migration from these countries to Australia has led to an increasing number of midwives caring for women with FGM and educating families in order to prevent this harmful and illegal practice. However very little is known about the challenges midwives face in delivering care and education and what professional development and workplace strategies might better support midwives. This presentation reports on a synthesis of the peer reviewed literature published between 2004 and 2014 undertaken to identify the knowledge, experiences and needs of midwives globally with respect to FGM. This review forms part of a larger research project funded by the Department of Health and Aging to examine the obstetric outcomes of women who have FGM and midwives experiences in Australia. Ten papers were included in the review, two from lower-middle income counties and eight from high income countries. The findings indicate that midwives lack technical knowledge and cultural competency to adequately care for women. Midwives, particularly those in lower-middle income counties where FGM was traditionally practiced were found to face significant challenges in their efforts to advocate for the abandonment of the practice. Training for midwives in the area of FGM was limited. Only one study reported the outcomes of an education initiative that was found to be beneficial. Professional education and training, a working environment supported by guidelines and responsive policy and community education, were suggested are necessary to enable midwives to improve the care of women with FGM and advocate against the practice. Implications for midwifery in NSW include the need for specialised education and training for midwives on FGM, alongside opportunities for collaborative practice in contexts that support the effective reporting of FGM to authorities. Our research project will seek to further examine the implications of this review through a nation-wide survey of Australian midwives and focus group discussions with midwives in selected hospital s in NSW

Particle-in-cell simulations of circularly polarised Alfvén wave phase mixing: A new mechanism for electron acceleration in collisionless plasmas

In this work we used Particle-In-Cell simulations to study the interaction of circularly polarised Alhén waves with one dimensional plasma density inhomogeneities transverse to the uniform magnetic field (phase mixing) in collisionless plasmas. In our preliminary work we reported discovery of a new electron acceleration mechanism, in which progressive distortion of the Alfvén wave front, due to the differences in local Alfvén speed, generates an oblique (nearly parallel to the magnetic field) electrostatic field. The latter accelerates electrons through the Landau resonance. Here we report a detailed study of this novel mechanism, including: (i) analysis of broadening of the ion distribution function due to the presence of Alfvén waves; and (ii) the generation of compressive perturbations due to both weak non-linearity and plasma density inhomogeneity. The amplitude decay law in the inhomogeneous regions, in the kinetic regime, is demonstrated to be the same as in the MHD approximation described by Heyvaerts & Priest (1983, A&A, 117, 220)

Understanding the Experiences and Needs of Migrant Women Affected by Female Genital Mutilation Using Maternity Services in Australia.

Female genital mutilation (FGM) is a cultural practice defined as the partial or total removal of the external female genitalia for non-therapeutic reasons. Changing patterns of migration in Australia and other high-income countries has meant that maternity care providers and health systems are caring for more pregnant women affected by this practice. The aim of the study was to identify strategies to inform culturally safe and quality woman-centred maternity care for women affected by FGM who have migrated to Australia. An Appreciative Inquiry approach was used to engage women with FGM. We conducted 23 semi-structured interviews and three focus group discussions. There were four themes identified: (1) appreciating the best in their experiences; (2) achieving their dreams; (3) planning together; and (4) acting, modifying, improving and sustaining. Women could articulate their health and cultural needs, but they were not engaged in all aspects of their maternity care or considered active partners. Partnering and involving women in the design and delivery of their maternity care would improve quality care. A conceptual model, underpinned by women's cultural values and physical, emotional needs, is presented as a framework to guide maternity services

A survey of Australian midwives’ knowledge, experience, and training needs in relation to female genital mutilation

© 2017 Australian College of Midwives Background: Female genital mutilation (FGM) involves partial or total removal of the external female genitalia or any other injury for non-medical reasons. Due to international migration patterns, health professionals in high income countries are increasingly caring for women with FGM. Few studies explored the knowledge and skills of midwives in high income countries. Aim: To explore the knowledge, experience and needs of midwives in relation to the care of women with FGM. Methods: An online self-administered descriptive survey was designed and advertised through the Australian College of Midwives’ website. Results: Of the 198 midwives (24%) did not know the correct classification of FGM. Almost half of the respondents (48%) reported they had not received FGM training during their midwifery education. Midwives (8%) had been asked, or knew of others who had been asked to perform FGM in Australia. Many midwives were not clear about the law or health data related to FGM and were not aware of referral paths for affected women. Conclusion: As frontline providers, midwives must have appropriate up-to-date clinical skills and knowledge to ensure they are able to provide women with FGM the care they need and deserve. Midwives have a critical role to play in the collection of FGM related data to assist with health service planning and to prevent FGM by working closely with women and communities they serve to educate and advocate for its abandonment. Therefore, addressing educational gaps and training needs are key strategies to deliver optimal quality of care

Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation: A review of global experience

© 2014 Elsevier Ltd. Objective: to identify how midwives in low and middle income countries (LMIC) and high income countries (HIC) care for women with female genital mutilation (FGM), their perceived challenges and what professional development and workplace strategies might better support midwives to provide appropriate quality care. Design: an integrative review involving a narrative synthesis of the literature was undertaken to include peer reviewed research literature published between 2004 and 2014. Findings: 10 papers were included in the review, two from LMIC and eight from HIC. A lack of technical knowledge and limited cultural competency was identified, as well as socio-cultural challenges in the abandonment process of the practice, particularly in LMIC settings. Training in the area of FGM was limited. One study reported the outcomes of an education initiative that was found to be beneficial. Key conclusions: professional education and training, a working environment supported by guidelines and responsive policy and community education, are necessary to enable midwives to improve the care of women with FGM and advocate against the practice. Implications for practice: improved opportunities for midwives to learn about FGM and receive advice and support, alongside opportunities for collaborative practice in contexts that enable the effective reporting of FGM to authorities, may be beneficial and require further investigation

A systematic review of doctors' experiences and needs to support the care of women with female genital mutilation

© 2015 International Federation of Gynecology and Obstetrics. Background Female genital mutilation (FGM) involves partial or complete removal of the external female genitalia or other injury for non-therapeutic reasons. Little is known about the knowledge and skills of doctors who care for affected women and their practice in relation to FGM. Objectives To examine the FGM experiences and educational needs of doctors. Search strategy A structured search of five bibliographic databases was undertaken to identify peer-reviewed research literature published in English between 2004 and 2014 using the keywords "female genital mutilation," "medical," "doctors," "education," and "training." Selection criteria Observational, quasi-experimental, and non-experimental descriptive studies were suitable for inclusion. Data collection and analysis A narrative synthesis of the study findings was undertaken and themes were identified. Main results Ten papers were included in the review, three of which were from low-income countries. The analysis identified three themes: knowledge and attitudes, FGM-related medical practices, and education and training. Conclusions There is a need for improved education and training to build knowledge and skills, and to change attitudes concerning the medicalization of FGM and reinfibulation

The role of men in abandonment of female genital mutilation: A systematic review

© 2015 Varol et al. Background: Men in their roles as fathers, husbands, community and religious leaders may play a pivotal part in the continuation of female genital mutilation (FGM). However, the research on their views of FGM and their potential role in its abandonment are not well described. Methods: We undertook a systematic review of all publications between 2004 and 2014 that explored men's attitudes, beliefs, and behaviours in regards to FGM, as well as their ideas about FGM prevention and abandonment. Results: We included twenty peer-reviewed articles from 15 countries in the analysis. Analysis revealed ambiguity of men's wishes in regards to the continuation of FGM. Many men wished to abandon this practice because of the physical and psychosexual complications to both women and men. Social obligation and the silent culture between the sexes were posited as major obstacles for change. Support for abandonment was influenced by notions of social obligation, religion, education, ethnicity, urban living, migration, and understanding of the negative sequelae of FGM. The strongest influence was education. Conclusion: The level of education of men was one of the most important indicators for men's support for abandonment of FGM. Social obligation and the lack of dialogue between men and women were two key issues that men acknowledged as barriers to abandonment. Advocacy by men and collaboration between men and women's health and community programs may be important steps forward in the abandonment process

Woman and girl-centred care for those affected by female genital mutilation: a scoping review of provider tools and guidelines

Abstract Background A woman and girl centred, rights-based approach to health care is critical to achieving sexual and reproductive health. However, women with female genital mutilation in high-income countries have been found to receive sub-optimal care. This study examined documents guiding clinicians in health and community service settings in English-speaking high-income countries to identify approaches to ensure quality women and girl-centred care for those with or at risk of female genital mutilation. Method We undertook a scoping review using the integrative model of patient-centredness to identify principles, enablers, and activities to facilitate woman and girl-centred care interactions. We developed an inclusion criterion to identify documents such as guidance statements and tools and technical guidelines, procedural documents and clinical practice guidelines. We searched the databases and websites of health professional associations, ministries of health, hospitals, national, state and local government and non-government organisations working in female genital mutilation in the United Kingdom, Ireland, Canada, The United States, New Zealand, and Australia. The Appraisal of Guidelines for Research and Evaluation tool was used to appraise screened documents. Findings One-hundred and twenty-four documents were included in this scoping review; 88 were developed in the United Kingdom, 20 in Australia, nine in the United States, three in Canada, two in New Zealand and two in Ireland. The focus of documents from the United Kingdom on multi-professional safeguarding (62), while those retrieved from Australia, Canada, Ireland, New Zealand and the US focused on clinical practice. Twelve percent of the included documents contained references to all principles of patient-centred care, and only one document spoke to all principles, enablers and activities. Conclusion This study demonstrates the need to improve the female genital mutilation-related guidance provided to professionals to care for and protect women and girls. Professionals need to involve women and girls with or at risk of female genital mutilation in the co-design of guidelines and tools and evaluation of them and the co-production of health care. </jats:sec

'Midwives are the backbone of our health system': Lessons from afghanistan to guide expansion of midwifery in challenging settings

Background: over the last decade Afghanistan has made large investments in scaling up the number of midwives to address access to skilled care and the high burden of maternal and newborn mortality. Objective: at the request of the Ministry of Public Health (MOPH) an evaluation was undertaken to improve the pre-service midwifery education programme through identification of its strengths and weaknesses. The qualitative component of the evaluation specifically examined: (1) programme strengths; (2) programme weaknesses; (3) perceptions of the programme's community impact; (4) barriers to provision of care and challenges to impact; (5) perceptions of the recently graduated midwife's field experience, and (6) recommendations for programme improvement. Design: the evaluation used a mixed methods approach that included qualitative and quantitative components. This paper focuses on the qualitative components which included in-depth interviews with 138 graduated midwives and 20 key informants as well as 24 focus group discussions with women. Setting: eight provinces in Afghanistan with functioning and accredited midwifery schools between June 2008 and November 2010. Participants: midwives graduated from one of the two national midwifery programmes: Institute of Health Sciences and Community Midwifery Education. Key informants comprised of stakeholders and female residents of the midwives catchment areas. Findings: midwives described overall satisfaction with the quality of their education. Midwives and stakeholders perceived that women were more likely to use maternal and child health services in communities where midwives had been deployed. Strengths included evidence-based content, standardised materials, clinical training, and supportive learning environment. Self-reported aspects of the quality education in respect to midwives empowerment included feeling competent and confident as demonstrated by respect shown by co-workers. Weaknesses of the programme included perceived low educational requirement to enter the programme and readiness of programmes to commence education. Insecurity and geographical remoteness are perceived as challenges with clients' access to care and the ability of midwives to make home visits. Key conclusions: the depth of midwives' contribution in Afghanistan - from increased maternal health care service utilisation to changing community's perceptions of women's education and professional independence - is overwhelmingly positive. Lessons learned can serve as a model to other low resource, post-conflict settings that are striving to increase the workforce of skilled providers. © 2013 The Authors