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Table 3 Reported experience of FGMC in clinical practice

From: Female genital mutilation and cutting: a systematic literature review of health professionals’ knowledge, attitudes and clinical practice

Reference Country Had seen patients with FGMC Managed women or girls with FGMC/FGMC complications; used prevention measures Has performed FGMC or has been asked to perform FGMC Clinical Guidelines/Clinical Education to support practice
Publications from African Countries
 Kaplan et al. 2013 [22] Gambia 41 % - had seen a girl with complications of FGM/C 41% - had seen a girl with complications of FGM/C 8 % - had performed FGM/C NRa
69 % - FGM/C is practiced in my family/household
 Ali et al. 2012 [23] Sudan NR NR 81 % had performed FGM/C during their career NR
Each of these midwives had performed 5–88 FGM/C procedures in the previous year
 Rasheed et al. 2011 [25] Egypt NR NR None of the nurses had performed FGM/C NR
 Refaat 2009 [26] Egypt NR NR 19 % - performed FGM/C NR
34 % of those who perform FGM/C reported complications among patients
 Onuh et al. 2006 [28] Nigeria NR NR 7 % - currently practice FGM/C NR
14 % have practiced FGM/C in the past
58 % - will perform FGM/C in the future if compelled to do so
Publications from “Western Countries”
 Caroppo et al. 2014 [29] Italy 71 % - never met or assisted a woman with FGM/C despite working in an asylum seeker facility 76 % - stated they would refer the woman for care elsewhere, with many different options provided   34 % were aware of guidelines/procedures for the management of women with FGM/C
 Purchase et al. 2013 [30] UK 87 % - had been involved in the care of a girl/woman with FGM/C   3 midwives had been asked to perform FGM/C in a child or to re-infibulate after delivery 26 % - had sufficient training in FGMC
20 % - had seen >10 cases    31 % - reported that the hospital/trust had screening for FGM/C procedures
21 % - there was an FGM/C specialist (obstetrician or midwife) at the hospital trust
40 % - had training in de-infibulation
 Relph et al. 2013 [31] UK 59 % had been involved in the care of a woman with FGM/C NR NR NR
 Moeed et al. 2012 [20] Australia and New Zealand 76 % see women from African countries and from the Middle East 47 % had seen at least one woman or girl with complications related to FGMC – “most commonly” urinary problems; problems in labour and dyspareunia 21 % - of O&G specialists asked to re-infibulate after birth NR
75 % saw at least one woman with FGM/C in the last 5 years “A few” reported psychosexual complications 12 % - of those who had been asked had done so:
Most saw 1–5 women with FGMC in the last 5 years   38 % of the FGM/C workers had heard of re-suturing taking place; one respondent indicated that re-suturing had taken place >50 times
2 (0.5 %) respondents had been asked to perform FGM/C on a baby, young girl or woman
One was asked on 1–5 occasions; the other 6–10 occasions
1 % of the O&G specialists had convincing evidence that the procedure was done in Australia or NZ
10 % of the FGM/C workers were aware of convincing evidence that the procedure was being performed in Australia or NZ
 Hess et al. 2010 [32] USA 43 % - of certified nurse- midwives had seen women with FGM/C in their practice Problems associated with FGMC not discussed consistently   NR
20 % discussed circumcision of daughters, nieces, grand- daughters “Often” or “Always”
78 % never discussed infertility
 Kaplan-Marcusan et al. 2009 [33] Spain 2001 NR 91 % of paediatricians had an interest in FGM/C NR
6 % - of all HP surveyed had seen cases in practice   42 % of paediatricians were aware of guidelines and protocols
7 % - of paediatricians saw FGM/C
2004
16 % - had seen FGMC in practice
19 % – of paediatricians saw FGM/C
FGM/C was seen by females more often than males
 Leye 2008 [34] Belgium 58 % had seen women or girls with FGM/C in their practice Consulted regarding complications: 2 % [6] respondents had been asked to perform FGM/C in Belgium  
Most common forms: 1 % - acute complications 4 % [13] had been asked whether FGMC could be performed in Belgium 51 % wanted guidelines on FGM/C
56 – infibulation 1 % - fertility problems 9.5 % [31] gynaecologists had heard that FGM/C had been performed in Belgium 45 % sought more information about FGM/C after seeing patients with FGM/C
40 – Excision 2 % - psychological problems  
3 – sunnab 4 % - fistulae
7 patients , 14 years old 15 % - pregnancy and delivery problems
23 patients 15–18 years old 18 % - chronic pain
The rest were 19 years or older 19 % - urinary tract infections
Patients were from: Somalia, Ethiopia, and other including Nigeria, Egypt, Mali, Senegal 41 % - sexual dysfunction
  35 % - of those looking after pregnant women tried to persuade the mother not to perform FGMC if the child was a daughter
65 % - said they would not do any prevention
 Zaidi et al. 2007 [35] UK 80 % had seen women with FGM/C in their practice NR NR NR
 Tamaddon et al. 2006 [36] Sweden 60 % had seen at least one patient with FGM/C 39 % - had seen patients with long-term complications of FGM/C 5 % - had been asked about performing FGM/C in Sweden; 4 of these were paediatricians NR
1 % - had seen patients with complications due to recently performed FGC 10 % - had been asked to perform reinfibulation after birth
2 of these 7 were paediatricians, 4 midwives, 1 gyneacologist
 Jager et al. 2002 [37] Switzerland 51 % - had seen women with FGM/C in their practice in Switzerland NR 21 % - had been asked to re-infibulated after birth FGM/C is not included in the undergraduate medical curriculum
73 % - from the French-speaking region of Switzerland had seen women with FGM/C in their practice   2 gyneacologists have been asked to perform FGM/C in young girls There is no reporting system for FGM/C
4 gyneacologists were asked where FGMC could be performed in Switzerland
12 gyneacologists said that they knew of FGM/C being performed in Switzerland
  1. aNR = Not reported; bSunna- Equivalent to the WHO Type 1 – cliteridectomy