title: A qualitative study exploring how Somali women exposed to female genital mutilation experience and perceive antenatal and intrapartum care in England.
abstract: OBJECTIVE
  To explore how Somali women exposed to female genital mutilation experience and perceive antenatal and intrapartum care in England. We explored women's perceptions of deinfibulation, caesarean section and vaginal delivery; their experiences of care during pregnancy and labour; and factors that affect ability to access these services, in order to make recommendations about future practice.
  
  
  METHODS
  A descriptive, exploratory qualitative study using face-to-face semistructured interviews. Interviews were audio-recorded, transcribed and data were analysed using a thematic approach. An interpreter was used when required (n=3).
  
  
  METHODS
  Participants recruited from 2 community centres in Birmingham, England.
  
  
  METHODS
  Convenience and snowball sample of 10 Somali women resident in Birmingham, who had accessed antenatal care services in England within the past 5 years.
  
  
  RESULTS
  3 core themes were interpreted: (1) Experiences of female genital mutilation during life, pregnancy and labour: Female genital mutilation had a significant physical and psychological impact, influencing decisions to undergo deinfibulation or caesarean section. Women delayed deinfibulation until labour to avoid undergoing multiple operations if an episiotomy was anticipated. (2) Experience of care from midwives: Awareness of female genital mutilation from midwives led to open communication and stronger relationships with women, resulting in more positive experiences. (3) Adaptation to English life: Good language skills and social support networks enabled women to access these services, while unfavourable social factors (eg, inability to drive) impeded.
  
  
  CONCLUSIONS
  Female genital mutilation impacts Somali women's experiences of antenatal and intrapartum care. This study suggests that midwives should routinely ask Somali women about female genital mutilation to encourage open communication and facilitate more positive experiences. As antenatal deinfibulation is unpopular, we should consider developing strategies to promote deinfibulation to non-pregnant women, to align with current guidelines. Women with unfavourable social factors may require additional support to improve access to English antenatal care services.
authors.affiliation: Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Moxey
authors.affiliation: Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
authors.forename: Laura L
authors.identifier: http://orcid.org/0000-0002-4018-3855
authors.initials: LL
authors.lastname: Jones
mesh_terms: D000069:Acculturation; D000328:Adult; D001294:Attitude to Health / Q000208:ethnology*; D019093:Circumcision, Female / Q000208:ethnology / Q000523:psychology*; D065246:Culturally Competent Care; D036861:Delivery, Obstetric / Q000523:psychology*; D004739:England; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011295:Prenatal Care / Q000523:psychology*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012998:Somalia / Q000208:ethnology
keywords: ANTENATAL CARE; FEMALE GENITAL MUTILATION; MIDWIVES; QUALITATIVE RESEARCH; SOMALI WOMEN