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General Practitioners DOCTORS

For women or girls suspected or known to have had FGM management falls into 3 broad categories:

  1. Management of physical symptoms
  2. Management of psychological symptoms
  3. Safeguarding

Dr Raymond’s 4Cs (Copyright Dr Sharon Raymond 2015)-
Screening tool to assess for risk of FGM:

› For all women and girls ask the first 2 questions:
1. Do you come from a community that practices Cutting?
2. Have you or any member of your family been Cut?

› For children ask:
‘Does anyone intend to cut you or anyone you know?’

› For females who are pregnant or have daughters ask:
‘Do you or anyone you know intend to have your daughter(s) cut?’

For any woman or girl at risk of FGM follow your local Safeguarding Procedures.

Talking about FGM with women and girls can be uncomfortable for both the individual and the professional.
It is important to include a question about the FGM status of the woman or girl in your assessment or first contact meeting.
› use a female interpreter where possible and avoid using family members to interpret
› be aware of your own responses and reactions the first time you examine a woman or girl who has undergone FGM to ensure she does not feel uncomfortable or different

KEY QUESTIONS FOR ALL GPS TO ASK WOMEN FROM FGM AFFECTED COMMUNITIES:
Some barriers to asking about FGM which have been raised by doctors include:

  • Lack of time to ask about FGM
  • Concern that FGM is not relevant to the reason for presenting at the clinic
  • Fears that the patient may be triggered for emotional or psychological issues if asked about FGM.

However please view asking about FGM as increasing understanding about the patient and how a range of health issues may be affected by FGM.
IMPORTANTLY: asking about FGM highlights any child protection issues which may be present for daughters of patients with FGM.
FGM should be treated like any “inherited” condition, where a child can be in danger due to the presence of FGM in the mother. Therefore, like other inherited or infectious conditions, family members must be considered as part of a treatment of the parent.

LANGUAGE
When talking with a survivor of FGM, use language which will be appropriate to the clinical setting.
You could ask:
“have you been cut down there?”
“have you had traditional cutting?” or
“have you been circumcised?” and point to your lap area.
Then you could ask “what term do you use to refer to traditional cutting or circumcision?”. Then you can use the term that that person feels most comfortable using.

Why ask about FGM?

It is important to ask whether the woman or girl has been circumcised or cut to:
› raise a topic the woman or girl may be reluctant to discuss
› ensure the she receives the best possible care
› determine and document FGM status for assisting with care and follow up
› enable the woman or girl to receive information about changes she may experience after de-infibulation.
› discuss de-infibulation and re-infibulation with her before labour
› ensure she has access to appropriate services, including psychological and sexual health counselling.

When discussing FGM with the woman or girl, it is important to:

› avoid making assumptions and judgements, however be aware that there may be problems associated with FGM nonetheless that you need to be aware of, including psychological and emotional problems.
› be sensitive to the intimate nature of FGM
› use simple language and ask straightforward questions
› be direct when assessing its impact by asking questions such as, ‘do you experience any pain or difficulties during intercourse?‘, ‘do you have any problems urinating?’ or, ‘have you had any difficulties in childbirth?’
› make the woman or girl feel comfortable and ensure she knows she can come back if she wishes

As doctor or nurse it is vital that you are aware of the potential risks to young women and girls

ASKING ABOUT FGM IS VITAL IN ORDER TO SAFEGUARD DAUGHTERS

IT IS IMPORTANT that you inform the woman or girl that FGM is illegal in Australia and that the law is there to help women and girls
› this can then prevent FGM occurring in the future to her daughters
› opening up a conversation can enable families to receive information about the legalities and health consequences of FGM

understand that not all families want their daughters to undergo FGM however that they may be under pressure to have their daughter circumcised.
Therefore questions to ask are:
“How do you view circumcision?”
“Do you think it is important for girls?” Why?
“Are you aware of any harmful effects of circumcision?”
“Are you worried about your daughter if she is not circumcised?”
“Is there anyone else in the family who may feel strongly that circumcision is important?”
“Are you planning a trip home soon? Are you expecting any family visitors from home?”
“How can we support you to protect your daughter?”

Source:
1. FARREP service co-ordination flow chart
2. No FGM Australia interviews with GPs (2015) Unpublished

RECORD FGM STATUS on the birth notification to ensure the maternal and child health nurse is mindful of any ongoing health concerns, and also to ensure follow up of daughters.

Source Family Planning Victoria’s Service Co-Ordination Guide

DOCTORS ARE MANDATORY REPORTERS IN EVERY STATE AND TERRITORY.
PLEASE ASK QUESTIONS ABOUT FGM IN ORDER TO IDENTIFY GIRLS IN DANGER

FGM Laws in Australia vary from state to state.
For more information on the laws in each state click here

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