Number of health providers trained in FGC management and counseling
The number of health providers who have been trained to manage the complications resulting from female genital cutting (FGC) procedures, including obstetric/gynecological related, as well as psycho-social, in a specific time period (depending on how often the program holds trainings) in a geographical area of interest.
Number and characteristics of providers trained within a specified time period. If targeting and/or linking to inequity, classify trainees by areas served (poor/not poor) and disaggregate by area served.
Training program records, disaggregated by sex, type of provider, location (community, region, or province), area in which they work (urban or rural)
This indicator is an output measure for programs designed to provide training to health service providers in the management and counselling of complications, both physical and psychosocial, resulting from FGC procedures. Health care professionals in countries where FGC is practiced, as well as in developed countries with large numbers of immigrants and refugees from countries where this practice is indigenous, face the challenge of providing compassionate, culturally-sensitive care to cut women who present with unique physical and emotional issues. Where the practice is the norm, health workers may have never seen uncut adult female genitalia and may lack understanding of how the practice unnecessarily removes healthy tissue. Where the practice is uncommon, health workers are often unaware that the health problems of their patients are related to FGC and do not have the skills to handle related complications that may affect reproductive health, pregnancy and delivery, as well as a woman’s sexual life (Mohamud et al, 2002).
Common types of gynaecological complications from FGC are:
- Keloids (scar formation)
- Wound infection, including tetanus
- Stenosis (thickening or narrowing of the vagina due to scarring)
- Vaginal synechia (labial adhesion)
- Vaginal obstruction
- Vesicovaginal fistula (opening between the bladder and the vagina)
- Rectovaginal fistula (opening between the rectum and the vagina)
- Urinary incontinence (Jones, Diop, Askew and Kaboré, 1999).
The recommended management for obstetric complications includes the following:
- Psychological support: The physical and psychological trauma of FGC is likely to leave women terrified of childbirth and trigger anxiety and depression.
- Assessment at the first antenatal care visit: The extent of damage and degree of the physical barrier must be determined.
- Advice on the importance of good nutrition: Women with FGC may try to limit the size of the baby by cutting down on food, hoping that a smaller baby will result in an easier birth.
- Monitoring urinary tract infections: Women with FGC can experience difficulty in emptying the bladder due to scar tissue. They are also more prone to urinary tract infection and vaginal infection.
- Defibulation: Early defibulation (surgically opening the vaginal opening) has the advantage that it makes vaginal examinations possible, avoids the need for a suitably trained person to perform it at delivery, and prevents excessive blood loss at delivery (Rashid and Rashid, 2007).
This indicator will provide a measure of coverage of trained personnel per geographic area of interest, and will help monitor whether or not a program is attaining its target number of providers trained.
This indicator provides a count of providers trained, but not how well they integrate the information disseminated or how well they use it in their own practice.
training, female genital cutting (FGC)
Bloom S. “Violence Against Women and Girls: A Compendium of Monitoring and Evaluation Indicators.” USAID, IGWG, and MEASURE Evaluation, 2008.
Mohamud A., Ringheim K, Bloodworth S., and Gryboski K. Girls at Risk: Community Approaches to End Female Genital Mutilation and Treating Women Injured by the Practice. Reproductive Health and Rights – Reaching the Hardly Reached, 2002.
Jones H., Diop N., Askew I., and Kaboré I. Female Genital Cutting Practices in Burkina Faso and Mali and Their Negative Health Outcomes. Studies in Family Planning, 1999:30(3), 219-230.
Rashid, M. and Rashid, M. H. Review: Obstetric management of women with female genital mutilation. The Obstetrician and Gynecologist. 2007:9, 95-101.
Johnson, C. E. et al. Challenges Faced by Healthcare Providers in the Obstetrical Care and Management of Circumcised Women. Berman Sexual Health: Women’s Sexual Health Topics and Information. http://www.bermansexualhealth.com/sexual-health/pain/23-challenges-faced-by-healthcare-providers-in-the-obstetrical-care-and-management-of-circumcised-women