Exploring barriers to seeking health care among Kenyan Somali women with female genital mutilation: a qualitative study.

经历女性生殖器割礼的肯尼亚索马里妇女就医障碍探讨:一项定性研究

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2020
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Abstract
Female genital mutilation/cutting (FGM/C) is a cultural practice associated with health consequences, women rights and deprivation of dignity. Despite FGM/C-related health consequences, circumcised women may encounter additional challenges while seeking interventions for reproductive health problems. Experiences of women/girls while accessing health services for reproductive health problems including FGM/C-related complications in poor, remote and hard to reach areas is poorly understood. We sought to explore barriers to care seeking among Somali women with complications related to FGM/C in public health facilities in Kenya.We drew on qualitative data collected from purposively selected women aged 15-49 years living with FGM/C, their partners, community leaders, and health providers in Nairobi and Garissa Counties. Data were collected using in-depth interviews (n = 10), key informant interviews (n = 23) and 20 focus group discussions. Data were transcribed and analyzed thematically using NVivo version 12.Barriers were grouped into four thematic categories. Structural barriers to care-seeking, notably high cost of care, distance from health facilities, and lack of a referral system. Concerns regarding perceived quality of care also presented a barrier. Women questioned health professionals' and health facilities' capacity to offer culturally-sensitive FGM/C-specific care, plus ensuring confidentiality and privacy. Women faced socio-cultural barriers while seeking care particularly cultural taboos against discussing matters related to sexual health with male clinicians. Additionally, fear of legal sanctions given the anti-FGM/C law deterred women with FGM/C-related complications from seeking healthcare.Structural, socio-cultural, quality of service, and legal factors limit health seeking for reproductive health problems including FGM/C-related complications. Strengthening health system should consider integration of FGM/C-related interventions with existing maternal child health services for cost effectiveness, efficiency and quality care. The interventions should address health-related financial, physical and communication barriers, while ensuring culturally-sensitive and confidential care.
女性生殖器残割/切割(FGM/C)是一种与健康后果、妇女权利受损及尊严被剥夺相关的文化习俗。尽管面临与FGM/C相关的健康后果,经历过割礼的女性在针对生殖健康问题寻求干预措施时,仍可能遇到额外的挑战。在贫困、偏远和难以企及的地区,女性/女童在获取针对包括FGM/C相关并发症在内的生殖健康问题的医疗服务时的经历,目前尚知之甚少。本研究旨在探讨在肯尼亚公立医疗机构中,患有FGM/C相关并发症的索马里女性在寻求照护时所面临的障碍。 我们利用了在内罗毕县和加里萨县通过目的性抽样收集的定性数据,受访对象包括经历过FGM/C的15至49岁女性及其伴侣、社区领袖以及医疗卫生服务提供者。数据通过深入访谈(n = 10)、关键知情人访谈(n = 23)和20场焦点小组访谈进行收集。数据经转录后,使用NVivo 12版本软件进行了主题分析。 就医障碍被归为四个主题类别:寻求照护的结构性障碍,尤其是高昂的医疗费用、与医疗机构的距离较远以及缺乏转诊系统;对医疗服务感知质量的担忧同样构成了障碍,女性对医务人员和医疗机构提供具备文化敏感性的FGM/C专项护理的能力,以及确保保密性和隐私性的能力提出了质疑;女性在就医时面临社会文化障碍,特别是关于与男性临床医生讨论性健康相关问题的文化禁忌;此外,由于反FGM/C法律的存在,对法律制裁的恐惧也阻碍了患有FGM/C相关并发症的女性寻求医疗卫生服务。 结构、社会文化、服务质量和法律因素限制了针对包括FGM/C相关并发症在内的生殖健康问题的求医行为。卫生系统的强化应考虑将FGM/C相关干预措施与现有的妇幼健康服务相整合,以实现成本效益、高效率和优质照护。干预措施应着力解决与健康相关的经济、地理及沟通障碍,同时确保提供具有文化敏感性并严格保密的医疗照护。
Reference Key
kimani2020exploringbmc Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Kimani, Samuel;Kabiru, Caroline W;Muteshi, Jacinta;Guyo, Jaldesa;
Journal bmc international health and human rights
Year 2020
DOI
10.1186/s12914-020-0222-6
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