June 6, 2011
When a woman who has undergone female genital cutting seeks medical help in many parts of the United States her chances of finding a knowledgeable physician--or talking about her condition--aren't very good.
That's the finding of advocacy group Sauti Yetu Center for African American Women, a nonprofit based in the South Bronx that recently publicized research at a New York conference. They found that few New York clinicians were trained to handle women with the condition and many women felt uncomfortable in their care.
A Phoenix clinic, however, offers a way of doing things differently.
The Refugee Women's Health Clinic cares for immigrants and takes a culturally sensitive approach to female genital cutting. The clinic provides translators, counseling, education and transportation to the facility. It works with agencies that provide diapers, car seats and food stamps for the mothers.
Crista Johnson, an obstetrician-gynecologist, opened the Refugee Women's Health Clinic in 2008. The clinic, she says, has served nearly 2,000 women from 19 countries. Some of Johnson's patients are going through their second birth with her.
Johnson was in New York in April to join the conference about the often unmet medical needs of women in the United States whose genitals have been cut.
During childbirth, women with cut genitals often need special attention. Some may need defibulation, a procedure to open the scar. Some suffer heavy bleeding, deficiency in amniotic fluid during childbirth and gestational diabetes.
Johnson says when women need a Cesarean section because of fetal distress during birth many resist the idea. She says her patients--many from Somalia in east Africa--fear a long recovery time that will keep them from caring for their family. Others worry the surgery will prevent them from having more children and some see surgery of any kind as a sign of impending death.
Johnson says there's also social pressure from family members not to have the surgery and she tries to help the women consider their options in a way that's free from family pressure.
"Trust is a major issue," Johnson said in a phone interview with Women's eNews. "Engaging in open dialogue without judging women affected by this practice is key. Building trust takes time and often may require multiple visits and good continuity of care."
In 2008, the United Nations released an updated statement on ending the practice of female genital cutting while addressing the strong impact it has on the cultures that practice it.
The World Health Organization classifies genital cutting into four categories, with the first three increasing in severity of cutting, though there can be exceptions.
The first three all consist of removal of genital tissue while the fourth category consists of harmful procedures for non-medical purposes, such as piercing.
Type I is partial or total removal of the clitoris or the clitoral hood, while type II is partial or total removal of the clitoris and the labia minora, sometimes with the labia majora, also.
Type III consists of narrowing the vaginal opening, which Johnson says she sees most commonly with complications.