sexual and reproductive health to include female genital mutilation dr hilary cooling dr susanna...

Sexual and reproductive health to include Female Genital Mutilation

Dr Hilary CoolingDr Susanna Hall

Bristol Sexual Health Serviceswww.bristolsexualhealth.nhs.uk

• Global issues of womens’ reproductive health and rights

• UK scene setting• Sexual and reproductive health services and

migrant populations• Case study about Female Genital

Mutilation/Cutting (FGM) and the issues this raises

Global Perspective

• WHO: Reproductive Health and Rights• Core issues worldwide:– Choice of number and spacing of children– Choice of safe methods– Supported by education– Free from coercion

United Kingdom Perspective

• Background to sexual health services– NHS Regulations (1974)- enhanced confidentiality– Self referral to any clinic– Free treatment– Integration of sexual health services

– Support to use service – Clinics in localities around Bristol– Interpreters – face to face, telephone

Contraception and Family Planning Services

• All contraception is free in the UK• Wide range of methods available

• Long acting reversible contraception (LARC) provision is encouraged and supported by national guidance

Unplanned Pregnancy and Abortion

• Abortion legal in the UK• Requires 2 doctors’ signatures to agree the

grounds of the abortion• Majority of abortions are funded by the NHS

• Bristol increasing ease of access• Migrant issues including payment

Reproductive Health

• NHS Cervical Screening Programme to prevent cancer of cervix (“PAP smears”)

• Initially introduced in1964• Improved in 1988 by a computerised recall

system• HPV screening and immunisation

• Access through primary care or sexual health

Sexually transmitted infection including HIV

• National screening initiatives– Chlamydia Screening Programme

• National drive to increase numbers of women screened for HIV– Antenatal screening: chlamydia, HIV, syphilis,

Hepatitis B– Primary care

Psychosexual counselling

Specialist counsellors:• counselling for sexual problems• couple counselling

Sexual Assault

• Affects 1 in 4 women in their lifetime• ~ 95% do not report the assault• Sexual assault referral centres (SARCs)

developed nationally

• Bristol- “The Bridge”

Female Genital Mutilation (FGM)

• Female genital cutting• “female circumcision” partial or total removal of

the external female genitalia, or other injury to the female genital organs for non-medical reasons.

FGM and UK law

Female Circumcision Prohibition Act (1985)Female Genital Mutilation Act (2004):• FGM is illegal in England, Scotland and Wales• whether it is committed against a United

Kingdom national or permanent United Kingdom resident

• in the UK or abroad• maximum penalty of 14 years in prison

Estimated figures for those at risk of FGM

UK:up to 100,000 women10,000 to 20,000 girls

Bristol• Black African

population 7600 estimate (2011)

• More than 1600 girls 3-15 yrs in Bristol schools

Specialist advice for FGM

• Minority ethnic woman and girls clinic • Sexual health services – staff with specialist

skills • Community education/awareness raising

(with women and men)• Multi-agency network – services for women,

protection of children, schools, police

“Sahra” aged 28

She attends a sexual health clinic with her husband, both from Somalia, married for 2 years.

• She complains of pain and discomfort with attempts at sexual intercourse, and problems passing urine

• Examination shows vagina almost completely closed

FGM

• “opening” surgery – referral pathway to gynaecology for general or local anaesthetic procedure

• referral to midwife if already pregnant, for “opening” before labour

• protection of children (safeguarding) – daughters (not yet born), sisters, etc

Sexual and reproductive health

• pregnancy planning/unplanned pregnancy• Contraception• Sexually transmitted infections (STIs)• HIV• psychosexual counselling

Thank youAny questions?

Further informationFORWARD (UK)http://www.forwarduk.org.uk/key-issues/fgmWorld Health Organisationhttp://www.who.int/topics/female_genital_mutilation/en/

United Nations Population Fund (UNFPA)http://unfpa.org/gender/practices1.htm Integrate Bristolhttp://integratebristol.org.uk/documentary/

South West Safeguarding and Child Protection Procedures

http://www.online-procedures.co.uk/swcpp/contents/guidance-child-protection/female-genital-mutilation/

The Bridgewww.turntothebridge.orgFaculty of Sexual and Reproductive Healthcarewww.fsrh.orgRoyal College of Obstetricians and Gynecologistswww.rcog.org.uk

National Institute for Health and Clinical Excellence www.nice.org.uk

NHS Cancer Screening Programmeswww.cancerscreening.nhs.ukNational Chlamydia Screening Programme IPPF www.ippf.org/enfpa www.fpa.org.ukMedical Foundation for AIDS & Sexual Healthwww.medfash.org.uk