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Published on: June 13, 2021
Understanding the implementation of specialist maternity services for pregnant women with FGM/C in Germany: a
Lisa Welcland1,2, Marina A S Daniele3, Isabel Runge4
1Centre for Research in Maternal and Child Health, City St. George's University of London, London, UK. Lisa.Apini-Welcland@citystgeorges.ac.uk.
Background:
Female Genital Mutilation/Cutting (FGM/C) comprises all procedures involving the partial or total removal of the external female genitalia or any other injury to the female genital organs for non-medical reasons. There are about 600.000 women in Europe estimated to live with the consequences of FGM/C, of whom about 104.000 are residing in Germany. Less is known about maternity service provision for affected women living in Germany. An exploratory case study was conducted to examine the implementation of specialist services for women with FGM/C in a German Maternity Unit. This publication reports findings from a situation analysis exploring how specialist services were embedded into routine care.
Methods:
Data was collected using a mixed-methods design. A retrospective data analysis of clinical records from women with FGM/C who gave birth between 2020 and 2023 was conducted. Qualitative data provided insights of maternal health professionals experiences working within a specialist service for women with FGM/C. The two datasets were analyzed separately and then interpreted together using Normalization Process Theory. This approach was chosen to understand the underlying mechanisms involved in implementing a complex intervention inside a real-life context.
Results:
Results revealed that services were operationalized by using a trauma-informed approach adopted to individual needs and recorded inside women's birth plans. Supportive mechanisms during the implementation were the presence of experienced colleagues, champions with sufficient position of authority in the service, an intrinsic motivation amongst staff, and accessible expert advice. Challenges were late midwifery contact, lack of time during consultations and fragmented postnatal care. Areas for further research could explore opportunities to address service fragmentation and focus on mechanisms to improve clinical coding.
Conclusions:
Specialist maternity services for women with FGM/C requires trauma-informed care, interprofessional collaboration and structural support. Systemic barriers such as fragmented care pathways, late access to midwifery care, and limited consultation time need to be further addressed to ensure equitable care in the long term. The best-practice model provides insights into the delivery of individualized maternity care for women affected by FGM/C and may inform the development of future models of care.
Trial Registration:
DRKS00030704 (15.02.2024).