Female Genital Mutilation (FGM/C) Related Lower Urinary Tract Symptoms (LUTS) and Humanitarian Health Work : A Qualitative Study on Expert Views

Abstract

Female genital mutilation and cutting (FGM/C) is an ancient tradition that is still prevalent in parts of the world, even though it is known to be a harmful practice and is recognised as a form of gendered and sexual violence. It has various negative impacts on the health of survivors, the most common long-term impacts being pelvic pains, lower urinary tract symptoms (LUTS) such as incontinence, and psychological symptoms such as post traumatic disorder syndrome (PTDS) (Andro et al., 2014; Klein et al, 2018; Köbach et al., 2018; Payne et al., 2019).

FGM/C and related LUTS are highly sensitive health problems, and such topics are not easy to address in the health care services. Additionally, it is an under researched topic and especially in humanitarian context it not acknowledged even in the communities where it is prevalent. There seems to be a cloud of silence around this phenomenon and often sensitive and intimate topics regarding sexual and reproductive health are stigmatized leaving the people living with such health problems silenced. There is not enough competence on FGM/C and related LUTS among health care professionals globally and even less so in humanitarian context.

With this thesis my aim was to explore this phenomenon and find out how FGM/C related LUTS are acknowledged and addressed in humanitarian health care professionals’ encounters with the survivors and what are the factors that are making this phenomenon invisible. I also wanted to understand how FGM/C related LUTS are addressed in humanitarian spaces and whether humanitarian health care professionals felt themselves proficient enough on this sensitive topic. The empirical data of the thesis consisted of Key Informant Interviews (KIIs), that were analysed by means of Thematic Analysis (TA). From my analysis I recognised five main themes: (1) stigma, (2) the context of humanitarian health work, (3) the preparedness of health care professionals to address FGM/C related LUTS, (4) trust in patient encounters and (5) solutions.

The findings of this thesis validate the stigmatizing nature of FGM/C related LUTS and implies that they are not acknowledged or addressed in the humanitarian context by health care professionals. They need more training on FGM/C and its’ health impacts to achieve the needed preparedness to address FGM/C and related LUTS. Also, more awareness on the topics of FGM/C related LUTS as well as FGM/C and LUTS is needed among the public as well to break the various layers of silences around these sensitive health issues. Additionally, trust seemed to be a key-factor in successful encounters with humanitarian health care professionals and survivors.

Humanitarian context is often perceived as something happening “somewhere else” and health issues that do not comply with the western body image are easily regarded as something “other. Also, the global health discourse tends to be gendered and matters such as FGM/C related LUTS are not trendy issues. Further, in a world where any kind of leakages such as urinal incontinence are heavily stigmatized, we can start to comprehend the intricate silences that the survivors of FGM/C with related LUTS must unravel to live a healthy life.