**5. Complications of FGM/C in sexual and reproductive health provisions**

All participants stressed the importance of consistently screening pregnant women for FGM/C and clearly recording the information at the antenatal care stage before women go into labour. The participants stated that this could help prevent complications during childbirth, such as prolonged labour and unplanned caesarean sections and episiotomies. Routine screening and the correct use of information were reported to facilitate appropriate planning and the prevention of trauma during childbirth. However, it was reported that this was often hindered by women's refusal to be physically examined and by the poor recording of information. This is exemplified in this excerpt from one midwife:

*One of the doctors is the one who usually do … the anterior cuts … they actually do cut where they have been stitched … the registrar would decide where the cut's gonna*  *[sic] be … exactly where they will be placed … someone came in labour and no one knew the woman had FGM … and then it is bit of panic, and what can we do … Type III – a baby is not gonna [sic] come out … normally, if it is Type III, you would do one cut up, and then two up that way, and then afterwards sew the edges … so that it is not bleeding … and then do construction work afterwards.*

Another midwife concurred, adding the following:

*and this poor girl had to have three episiotomies … one anterior and two posterior, to get her baby out. Because the baby was pressing against her vaginal wall I guess … and it started opening that diameter … a centimetre … the baby was never going to come out, so she had three cuts! And we had to get one of our consultants to come and do the delivery, because she needed a lot of work, and repair work done … so she had to go to theatre to get everything repaired, and hopefully, next time she'd have another baby, she should've been ok.*

These experiences were also reported to affect other important medical procedures. A doctor expressed difficulties when conducting pap smear examinations on infibulated women:

*so the first lady that I ever met … I was quite convinced that … that was what I was seeing … she had a very severe form of uterine prolapse … which sounds like shouldn't have happened … cause she had been stitched all up … and when this lady came, I could see that she had been … eh … I am actually sure whether it would have been Type II or Type III, but certainly stitched together for the large part. So the pap smear was difficult … so I didn't know whether to tell her that's the reason or I didn't know whether to tell her whether it is due to menopause … so it is not really not relevant to say why … so say sorry it hurts and I just do what I need to do.*

Cross-cultural training as evidenced in this data is a key to efficient services to women presenting to sexual and reproductive health services with FGM/C. SRHPs' experiences of caring for women with FGM/C in Western Australia reveal many frustrations and difficulties of providing care for these women. Appropriate training and policy framework and clear clinical guidelines for the care of women living with FGM/C are imperative in meeting the special needs of these women. The value of adequate experience, knowledge and skills in this area cannot be overstated.

### **5.1 Training needs**

The participants reported their concerns regarding the inadequate training available for working with women living with FGM/C. All of the participants stated that the existing training was inadequate and, additionally, that they were not provided with adequate time or support from their employers to participate. They also commented on the lack of an adequate curriculum. One participant said:

*more training would be useful … I know there is some training based in XXXX hospital … and I had an opportunity to do some of that training yesterday … and … I mean … it is important to do more training … sometimes I think training would make me understand this is Type II …*

**41**

**6. Conclusion**

*Experiences of Sexual and Reproductive Healthcare Professionals Working with Migrant Women…*

peer educators for women living with FGM/C, improving the processes of service

*probably more training by people who are very much from that culture and understand all the in's and out's … And then give good advice as to how someone who is not from that culture might approach the issue. Because within our own culture, we have many ideas of healthcare, even within one culture every person is different. It* 

Other participants stated the need for integrated curricula in tertiary and professional training courses for doctors and midwives to enable them to acquire adequate skills for addressing FGM/C in their practice. One participant commented that the training is extremely basic and only provides limited information on FGM/C:

*I think focusing less on the types and pictures … and focusing more on the effects that it has on the women's lives … and how we can talk to people about it, and how we can educate people … but it is more about what can we do … educating ourselves than rather just analysis of FGM … But the fact that a child is screaming … it makes me sad that they are living with it and the effects it has on people. It makes me want to know more and what can I do … I used to examine women but in this role I am currently doing antenatal care … which is why I need to know how to ask these questions.*

Another concern was expressed regarding the content of the existing training. It was reported that, for a long time, the same content has been delivered yearly, with

A midwife agreed and stated that, 'It's usually the same information … it hasn't changed.' Some of the participants also expressed the need to be provided with training opportunities and supported by their employers if they were to be well

*I used to be a staff development officer at XXXX hospital, and the staff are inundated with 'you have to do this, you have to do that' … (lack time for training), and* 

There is a need for healthcare policies to integrate appropriate modules in curricula for training healthcare professionals to facilitate efficient and appropriate service delivery to women with FGM/C. This has to be based on the cultural diver-

This study focused on the experiences of healthcare professionals providing sexual and reproductive healthcare to women living with FGM/C in Western Australia and aimed to contribute to the wider body of knowledge regarding healthcare professionals working with women living with FGM/C in Western

*she [the trainer] would come and talk to our staff, she would literally take you through the types … the medical side, and same thing every year … same PowerPoint presentation, every year. And you knew you were never gaining anything from it … every year, but the same thing … quite a number of years …* 

*probably five years … listening to the same thing … being delivered.*

equipped to deal with FGM/C in their patients. One midwife said:

sity in Western Australia and the larger Australian society.

*isn't helpful if doctors are trained to provide the wrong approach …*

*DOI: http://dx.doi.org/10.5772/intechopen.93353*

delivery. A doctor made this statement:

nothing new incorporated. A midwife stated:

*plus you have to do your work …*

It was also suggested by the participants that professionals who have backgrounds working with women living with FGM/C would be ideal if trained as *Experiences of Sexual and Reproductive Healthcare Professionals Working with Migrant Women… DOI: http://dx.doi.org/10.5772/intechopen.93353*

peer educators for women living with FGM/C, improving the processes of service delivery. A doctor made this statement:

*probably more training by people who are very much from that culture and understand all the in's and out's … And then give good advice as to how someone who is not from that culture might approach the issue. Because within our own culture, we have many ideas of healthcare, even within one culture every person is different. It isn't helpful if doctors are trained to provide the wrong approach …*

Other participants stated the need for integrated curricula in tertiary and professional training courses for doctors and midwives to enable them to acquire adequate skills for addressing FGM/C in their practice. One participant commented that the training is extremely basic and only provides limited information on FGM/C:

*I think focusing less on the types and pictures … and focusing more on the effects that it has on the women's lives … and how we can talk to people about it, and how we can educate people … but it is more about what can we do … educating ourselves than rather just analysis of FGM … But the fact that a child is screaming … it makes me sad that they are living with it and the effects it has on people. It makes me want to know more and what can I do … I used to examine women but in this role I am currently doing antenatal care … which is why I need to know how to ask these questions.*

Another concern was expressed regarding the content of the existing training. It was reported that, for a long time, the same content has been delivered yearly, with nothing new incorporated. A midwife stated:

*she [the trainer] would come and talk to our staff, she would literally take you through the types … the medical side, and same thing every year … same PowerPoint presentation, every year. And you knew you were never gaining anything from it … every year, but the same thing … quite a number of years … probably five years … listening to the same thing … being delivered.*

A midwife agreed and stated that, 'It's usually the same information … it hasn't changed.' Some of the participants also expressed the need to be provided with training opportunities and supported by their employers if they were to be well equipped to deal with FGM/C in their patients. One midwife said:

*I used to be a staff development officer at XXXX hospital, and the staff are inundated with 'you have to do this, you have to do that' … (lack time for training), and plus you have to do your work …*

There is a need for healthcare policies to integrate appropriate modules in curricula for training healthcare professionals to facilitate efficient and appropriate service delivery to women with FGM/C. This has to be based on the cultural diversity in Western Australia and the larger Australian society.

## **6. Conclusion**

This study focused on the experiences of healthcare professionals providing sexual and reproductive healthcare to women living with FGM/C in Western Australia and aimed to contribute to the wider body of knowledge regarding healthcare professionals working with women living with FGM/C in Western

*Psycho-Social Aspects of Human Sexuality and Ethics*

*[sic] be … exactly where they will be placed … someone came in labour and no one knew the woman had FGM … and then it is bit of panic, and what can we do … Type III – a baby is not gonna [sic] come out … normally, if it is Type III, you would do one cut up, and then two up that way, and then afterwards sew the edges … so* 

*and this poor girl had to have three episiotomies … one anterior and two posterior, to get her baby out. Because the baby was pressing against her vaginal wall I guess … and it started opening that diameter … a centimetre … the baby was never going to come out, so she had three cuts! And we had to get one of our consultants to come and do the delivery, because she needed a lot of work, and repair work done … so she had to go to theatre to get everything repaired, and hopefully, next time she'd* 

These experiences were also reported to affect other important medical procedures. A doctor expressed difficulties when conducting pap smear examinations on

*so the first lady that I ever met … I was quite convinced that … that was what I was seeing … she had a very severe form of uterine prolapse … which sounds like shouldn't have happened … cause she had been stitched all up … and when this lady came, I could see that she had been … eh … I am actually sure whether it would have been Type II or Type III, but certainly stitched together for the large part. So the pap smear was difficult … so I didn't know whether to tell her that's the reason or I didn't know whether to tell her whether it is due to menopause … so it is not really not relevant to say why … so say sorry it hurts and I just do what I* 

Cross-cultural training as evidenced in this data is a key to efficient services to women presenting to sexual and reproductive health services with FGM/C. SRHPs' experiences of caring for women with FGM/C in Western Australia reveal many frustrations and difficulties of providing care for these women. Appropriate training and policy framework and clear clinical guidelines for the care of women living with FGM/C are imperative in meeting the special needs of these women. The value of adequate experience, knowledge and skills in this area cannot be overstated.

The participants reported their concerns regarding the inadequate training available for working with women living with FGM/C. All of the participants stated that the existing training was inadequate and, additionally, that they were not provided with adequate time or support from their employers to participate. They also commented on the lack of an adequate curriculum. One participant said:

*more training would be useful … I know there is some training based in XXXX hospital … and I had an opportunity to do some of that training yesterday … and … I mean … it is important to do more training … sometimes I think training would* 

It was also suggested by the participants that professionals who have backgrounds working with women living with FGM/C would be ideal if trained as

*make me understand this is Type II …*

*that it is not bleeding … and then do construction work afterwards.*

Another midwife concurred, adding the following:

*have another baby, she should've been ok.*

infibulated women:

*need to do.*

**5.1 Training needs**

**40**

Australia. Individuals reported both unique experiences and commonalities within the context of their interviews. SRHPs providing services to women living with FGM/C in Western Australia identified a gross lack of adequate training services capable of equipping SRHPs to expertly meet the needs of women living with FGM/C. Significant changes are required to provide adequate care for women living with FGM/C in Western Australia.
