Female genital mutilation is a controversial issue in many countries. The practice causes harm on the victims that is not only physical but also emotional, social and psychological. This paper examines the practice in Australia particularly among the Sudanese immigrants. The paper proposes a plan that can help to bring the practice to a stop. The plan’s implementation, evaluation and costing have also been examined.
Female genital mutilation (FGM) is one of the most highly controversial issues in Australia since refugees and immigrants from several northern African, Middle Eastern and Asian countries began to arrive in the country. In these countries of origin, FGM is a common practice that is tied mainly to cultural beliefs and systems. The reactions of Australia to FGM are a reflection of its dedication to United Nations conventions that uphold the rights of women and children.
The responses are also a component of a broader global movement that is run by the United Nations and that seeks to bring the practice to an end. Ian (2001) argues that “in Australia, under the aegis of the Commonwealth Department of Health, the National Education Program on Female Genital Mutilation (1996-2000) operates on a ‘holistic’, social model of health,” (p. 16). This program is run at the state level and has put in place a number of interventions that seek to address FGM. The interventions include community-based intervention programs and training programs for healthcare workers among many others. These interventions offer support to other legal and welfare programs run by the public sector and the non-governmental organizations.
Female genital mutilation cannot be effectively comprehended or tackled without taking into account its complex nature (Baron & Denmark, 2006). Specifically, FGM is intertwined with gender, cultural, migration, health and human rights issues. The main aim of this paper is to propose a plan that will help to stop female genital mutilation in the Sudanese immigrants in Australia. The plan to stop female genital mutilation proposed in this paper entails an open discussion between the nurse professionals and the parents or guardians of the patient. Most importantly, the plan will integrate the cultural competence of nurses working with newborns and young children from the Sudanese immigrant community in Australia.
Outline of the Plan
Introduction to the plan
Paediatricians and nurse practitioners working with potential victims of FGM have close contacts and associations with the families. They also have the unique responsibility of being guardians of the children’s good health and therefore discussions for the elimination of FGM are a high possibility in cases where there is an observed openness between the practitioners and the patients’ families. Although nurses dealing with FGM potential victims may have fears due to the complex cultural aspect of the practice, such fears cause unfounded projections and may thus be counter-productive. Jaeger, Caflisch and Hohfield (2009) argue that “FGM is not such a great taboo and with the necessary respect, it can be discussed openly,” (p. 28).
Knowledge about one’s position and having adequate information
Nurses and other healthcare practitioners dealing with potential victims of FGM and their families need to have adequate and extensive information concerning the reasons behind the practice, the cultural aspects associated with it, as well as the potential physical, psychological and emotional consequences of the practice. This information provides solid base upon which nurses can make their case and arguments against the practice.
Such information is available and can be found in national guidelines, position papers and brochures. The information needs to be disseminated not only to the nurses but also to the parents and guardians of potential victims of FGM. In addition to having the right and adequate information, nurses also need to know their stand regarding the practice and to stick by it. This however does not mean that they should push their stand down the throats of the victims’ parents/guardians.
Rather, they should hold discussions with the guardians which help to bring out the arguments of both sides of the practice. The discussions will also help the nurses to understand the reasons why the practice is still followed by the member of the community. An effective open discussion about FGM however requires an appropriate setting and effective communication skills on the part of the nurses.
The discussion concerning FGM needs to be conducted over an adequate period of time. Jaeger et al. (2009) argue that “a short conversation in the emergency ward is not likely to be appropriate,” (p. 29). It is also important for the nurse to establish a rapport and trust with the potential victims’ guardians. In situations where the patients’ guardians do not understand the language of the nurse well, the nurse needs to request for the services of a translator. Nevertheless, the translator should be chosen cautiously. For instance, it would not be proper for the nurse to request for the translation services of a child or a man when the discussion is about FGM.
In addition, the nurses should be aware of the perceptions, attitudes and knowledge of the translator towards FGM. This would thus necessitate a separate discussion between the nurse and the translator before the discussion with the potential victim’s guardian. Most importantly, the nurse should ensure that the guardians are comfortable with the translator otherwise the discussion would not be successful. Specifically, the translator should be someone who can be trusted rather than one who will gossip leak the information about the discussion to other members of the migrant community.
An appropriate setting also entails positive attitudes of the nurses. The nurses should be positive and open about the practice. They should be neutral rather than biased against the members of the migrant communities. Respect is of paramount importance in dealing with FGM practices. Respect enables the targets of the intervention to open up and speak more freely about the practice because they feel accepted despite the cultural differences (Key, 1997).
The target and time of the discussion
Discussions about FGM cannot be held with just anyone. Nurses should thus be aware of the cultural practices and values of the community. For instance, it would be easier and more appropriate for the nurses to hold the discussions with mothers of the potential victims rather than with their fathers. Besides, the time of discussion is also important in addressing FGM. Discussions should start when a mother is pregnant and continue immediately the baby is born and later before the child reaches puberty. This is because many communities carry out FGM either on newborn babies or when the children reach between the ages of 3 and 7 (Mandara, 2004). Most, if not all, of FGM practices are conducted before the children reach the puberty stage.
Starting the conversation on FGM
Introducing the discussion on FGM is important and determines whether or not the targets will cooperate with the nurses. A number of conversation openers are effective in steering the discussion the right way. They include: making reference of FGM practice to a different ethnic community; the status of the newborn baby; the experience of the target with her delivery; existence of community pressure to perform FGM; and any plans of the subject to carry out FGM. Even in cases where the target subjects show strong opposition towards FGM, it is important for the nurse to reinforce the arguments against FGM.
Key points during the conversation
The discussion should focus on the merits and demerits of FGM. These would enable the targets to arrive at the conclusion that FGM should not be practiced taking into account all the issues that were raised during the discussion. In addition, cultural motivations, medical issues, the family context and legal aspects should be discussed by the nurse with the targets.
The plan will be implemented in three major steps. The first step is the education of the nurse professionals through workshops, seminars and literature reviews. The education program will be conducted by advanced nurse practitioners and others professionals who are experienced in matters concerning FGM. Nurses will be educated on the general practice of FGM, physical, social, psychological and emotional consequences, legal aspects, medical aspects, and most importantly the cultural aspects of the practice. The education strategy will equip the nurse practitioners with adequate knowledge and information about the practice. This will in turn enable them to make a strong case against the practice and to be cultural competent when handling issues pertaining to FGM.
The second step involves training of the nurse professionals to equip them with skills and attitudes needed to conduct the open discussion. Specifically, nurses will be trained on effective communication skills in issues such as who to talk to about FGM, how to start the conversations, how to handle a seemingly difficult parent/guardian, and how to decline requests made for FGM. Nurses will also be trained on having the right attitude towards the immigrant and refugee communities practicing FGM. This can be done by training the nurses on how to be culturally competent so as to understand the cultural practices of the immigrants and refugees and address them with their cultural aspects in mind (World Health Organization, 2001).
The third step entails hiring the services of interpreters when and if necessary. This will be done keeping in mind that the nurses will be dealing with potential victims and their guardians who have migrated from Sudan and who may not be in a position to understand the English language well. This step shows the cultural competence of the healthcare professionals since language is one of the most influential cultural influences (Papadopoulos, 2006).
Success, failure or progress of the plan will be evaluated through:
The attitudes of the nurses towards the potential victims and their guardians: the attitudes of the nurses both before and after the implementation of the plan will be analyzed to check if nurses’ attitudes are changing for the better. If so, then it means that the plan is effective in addressing FGM (Momoh, 2004).
The knowledge and skills of nurses in handling the targets: nurses require adequate knowledge and information about FGM as well as effective communication skills in tackling the FGM problem. Any improvement in the knowledge and skills of the nurses from the program can be analyzed through questionnaires addressed both to the nurses and the targets. Results from the questionnaires can show which areas the nurses are proficient in and in which areas they need improvement (Rahman & Toubia, 2000).
The number of requests made for FGM: the plan’s effectiveness can also be evaluated by the number of requests for FGM made by the migrant and refugee communities. If the number of requests reduces following the introduction of the plan, it implies that the plan is effective in eliminating FGM and vice versa (Ogunsiji, Wilkes & Jackson, 2007).
The implementation plan will require both financial and human resources especially in four major areas. The education and training programs of the nurse professionals will require money and educators/trainers. The money will go towards purchasing education/training equipment, stationery, venue and remuneration of the educators/trainers. Conducting literature review and disseminating the findings to the nurse professionals will also require both money and human resources. Hiring of the interpreters will require money which will go towards the remuneration of the interpreters.
Conclusion and Recommendation
Examining FGM pinpoints the aspects of the status of women in the countries in which it is practiced. Women’s lives, especially in African countries where the practice is most dominant, are strongly influenced by gender norms and belief systems (Aroian, 2002). Gaining an understanding of these norms and beliefs provides insight into cultural practices that have influenced the continuation of the practice.
Likewise, being sensitive to the cultural aspects of FGM is essential to the educative and awareness-creation approaches that are most successful in putting a stop to the practice. This paper has proposed a plan that can be used to bring FGM to an end. The plan proposed is a conversation-based strategy which entails an open discussion about FGM between the nurse and the target subjects. Such a discussion requires the cultural competence of the nurses.
Besides focusing on this conversation-based prevention strategy, measures should also be taken to expand the education program not only to the immigrant communities living in Australia but also the communities living in the countries of origin. This would prevent the transfer of the practice from the home countries to the countries of settlement. In addition, it will help those women who have already undergone female genital mutilation.
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