Empower Health Workers to Advocate Against Female Genital Cutting

This two-page summary describes research and findings published in the study,
Etude de l’Efficacité de la Formation du Personnel Socio-sanitaire dans l'Education des Client(e)s sur l’Excision au Mali. The research was carried out in 1998 by the Association de Soutien au Développement des Activités de Population (ASDAP), a non-governmental organisation (NGO) and the Ministry of Health, Mali. The study assessed the use of health personnel to combat female genital cutting (FGC), as recommended by the World Health Organization. The study covered 14 rural and urban health centres in the Bamakou and Ségou regions of Mali.

In eight health centres, that served as experimental sites, 59 health workers participated in a three-day training programme on identifying and treating medical complications from FGC and counselling women. These included physicians, midwives, nurses. In the six centres functioning as control sites, 48 health providers were interviewed.

The study included the following findings:

• Nine of ten health providers were opposed to FGC and willing to play an active role in educating their clients about FGC.
• Some providers supported the medicalisation of FGC. Nine percent of the providers who had been trained and 29 percent of those in the control group stated that FGC presents no health risk if performed in hygienic conditions. Thirteen percent of the 107 providers interviewed admitted that FGC is being practiced at their facility. Four providers said they had performed FGC procedures.
• Training did change some providers’ attitudes regarding FGC. Before training, 39 percent of providers thought that an uncut girl had loose morals; after training, 26 percent still held this belief. The proportion of providers who thought that men prefer to marry women who have been cut declined from 32 percent to 28 percent, while the proportion who thought that FGC guarantees a girl’s virginity decreased from 14 percent to 9 percent.
• Providers knowledge of FGC increased dramatically after training. Roughly three in four
  trained providers knew at least three immediate and long-term complications. However, providers were uncomfortable discussing FGC with their clients and felt too rushed due to the large volume of clients during the morning clinic sessions. Group health talks
  were held in only two of the eight experimental clinics. Only six of the 1,105 clients interviewed were counselled about FGC.
• The majority of health providers had provided treatment to girls with complications following FGC. More than one third had to refer a client for further treatment of FGC complications. Nevertheless, providers acknowledged that they have limited competence in caring for FGC complications, even after training.

Policy implications were as follows:

• The Ministry of Health (MoH) of Mali is using the study results to develop a new curriculum to promote standardised, mandatory training on FGC for all health providers.
• Based on the study findings, the MOH issued a policy banning the practice of FGC in its facilities.

The three-day training course was effective in changing provider attitudes toward FGC, but additional training in communication skills is needed to overcome providers reticence to discuss FGC with their clients.

• To eradicate FGC, community education initiatives are needed in addition to clinic education.