FGM: doctors should question at-risk women during prenatal consultations

Obstetricians say more needs to be done to identify cases of female genital mutilation in early pregnancy to manage complications that can arise

Doctors have endorsed a call for questions about female genital mutilation (FGM) to be a requirement when they see women from affected communities for prenatal appointments.

Khadija Gbla, a director of No FGM Australia, is due to give birth to her first child in February and struggled to find satisfactory medical care after disclosing she had FGM. She has now been classified as a “high risk” pregnancy and has a midwife to help her with her birth plan.

Gbla, 26, who was born in Sierra Leone, was astounded she was not asked in her first Adelaide consultation if she had FGM, among standard questions on her family history of diseases such as heart disease and diabetes.

“FGM made it quite difficult, it does have an impact on pregnancy and it’s been very negative from the get go,” she said.

“In Adelaide there’s not a lot of knowledge in FGM so I have a lot of anxiety about it. I’m very stressed out. But I’m one of the lucky ones, what about the women who have it and don’t say anything? What about the women who don’t even know they have it? They need to be taken care of.”

Gbla said women from FGM-affected communities, such as west African countries, Pakistan, Iraq, Egypt and Indonesia, should be asked if they had FGM when they first went to a doctor or midwife.

Obstetrician Greg Jenkins, who conducts a weekly high-risk antenatal clinic at Auburn hospital in western Sydney, has treated many pregnant women with FGM and said it was certainly something doctors needed to know about.

“We would take the view that those who are raised in communities where FGM is practiced, when they book into maternity unit they should be asked if they have a personal history of FGM,” he said.

“It’s something we see reasonably often so we have a specific service to cater for it.”

Jenkins said discussions about FGM should happen well before an expectant mother reached the delivery room, and doctors should be more aware of the risks it posed.

“It definitely should happen ... overall increasing awareness is an important thing and then equipping people with information that they need in treating them is important,” he said.

Jenkins said the risks associated with FGM could be greatly reduced with the right treatment before the delivery.

His fellow obstetrician and former Australian Medical Association president Dr Andrew Pesce agreed that doctors needed targeted education campaigns.

“FGM was not on anyone’s radar of my generation when I was trained unless they were trained in an area of those communities, it was not something that they would ever give a thought to,” he said.

“We need to have systems in place which alert midwives and doctors of these issues.”

Pesce said the lack of data on how many women with FGM lived in Australia and how many girls were at risk of FGM was a big problem for doctors, who needed a system to obtain better data.

“Clinicians in all walks need to have some demographic data occasionally presented to them which makes them think about issues facing their community,” he said.

“FGM comes up in hospitals when women are in labour and all of a sudden the doctor finds out when it’s too late to talk about. No clinic wants to be in that situation.”

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