ANTENATAL CARE EQUITY & SOCIAL EQUALITY FOR WOMEN WITH FEMALE GENITAL MUTILATION (FGM) IN SCOTLAND: A MULTI-STAKEHOLDER VIEW

Abstract

This thesis describes a case study of an NHS Scotland antenatal care pathway for women with female genital mutilation (FGM), and includes recommendations for the field of antenatal FGM management. Over the last decade, reports of substandard antenatal FGM management from a rapidly growing population of affected women have increased demands for just and equitable healthcare. Consequently, in 2015, a health board in the central belt of Scotland established a multidisciplinary FGM management programme. To determine the impact of this programme on antenatal care equity and social equality for women with FGM its guidelines, interviews with community midwives (CMWs), FGM specialists, and women with FGM were conducted. The findings were analysed using critical communicative methodology (CCM). The findings on the development, organisation, and delivery of the pathway demonstrate the transformative impact of multidisciplinary resources for FGM management and support on equitable antenatal care access when embedded into routine antenatal policies and practices. The findings also show how the absence of robust monitoring and evaluation processes enables contested practices and limits care equity for non-pregnant women with FGM. Novel contributions of this study link social and emotional FGM training to reciprocal improvements in confidence, trust, and communication between CMWs and women with FGM. FGM specialists who empower women to advocate for themselves and their relationship with the practice of FGM are also found to be central to the delivery of sensitive, relevant, and person-led antenatal care. Furthermore, the interdisciplinary implications of this study offer relevant insight for research, development, and service provision beyond Insight. Most notably, until unjust educational and financial health system policies are challenged, experiences of unresolved intersectional discrimination will continue to disproportionately disadvantage migrant women with FGM.