Preferences for deinfibulation (opening) surgery and female genital
mutilation service provision: a UK qualitative study
Abstract
Objective: To explore the views of female genital mutilation (FGM)
survivors, men, and healthcare professionals (HCPs) on the timing of
deinfibulation surgery and NHS service provision. Design: Qualitative
study informed by the sound of silence framework. Setting: Survivors and
men were recruited from three FGM prevalent areas of England. HCPs and
stakeholders were from across the UK. Sample: 44 survivors, 13 men and
44 HCPs. 10 participants at two community workshops and 30 stakeholders
at a national workshop. Methods: Hybrid framework analysis of 101
interviews and three workshops. Results: There was no consensus across
groups on the optimal timing of deinfibulation for survivors who wished
to be deinfibulated. Within group, survivors expressed a preference for
deinfibulation pre-pregnancy and HCPs antenatal deinfibulation. There
was no consensus for men. Participants reported that deinfibulation
should take place in a hospital setting and be undertaken by a suitable
HCP. Decision making around deinfibulation was complex but for those who
underwent surgery it helped to mitigate FGM impacts. Whilst there were
examples of good practice, in general, FGM service provision was
sub-optimal. Conclusion: Deinfibulation services need to be widely
advertised. Information should highlight that the procedure can be
carried out at different time points, according to preference, and in a
hospital by suitable HCPs. Future services should ideally be developed
with survivors, to ensure that they are clinically and culturally
appropriate. Guidelines would benefit from being updated to reflect the
needs of survivors and to ensure consistency in provision. Study
registration number ISRCTN 14710507