“I had a feeling the period did not have an opening to come out:” A qualitative assessment of Type III Female Genital Mutilation/Cutting and menstrual health among Somali communities in Kenya

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Introduction: Type III female genital mutilation/cutting (FGM/C), or infibulation, negatively impacts girls' and women's health and well-being. Some evidence suggests women who have experienced infibulation may have distinct menstrual health challenges. However, the intersection of infibulation and menstrual health is under-explored. The present study documented women's and providers' perspectives on menstrual health and infibulation among Somali communities in Wajir County, Kenya. Methods: = 10) with healthcare providers. Interviews with women explored their reflections on and experiences of FGM/C, including infibulation, menstrual health, and perceived connections between the two. Interviews with healthcare providers explored their perspectives on women's healthcare needs in relation to menstrual health and infibulation. Results: Thematic analysis identified three themes: (1) informal discussion among women shapes their menstruation and infibulation knowledge; (2) multiple factors that shape women's care-seeking for menstrual health concerns; and (3) healthcare providers lack the necessary preparation to address menstrual health concerns among women who have undergone infibulation. Discussion: This study's findings provide insights into the intersections of menstrual health and infibulation within the broader educational, social and healthcare context of Somali communities in rural Kenya. While women learn, interpret, and describe infibulation as a source of acute menstrual health problems, including menstrual pain and irregular bleeding, clinical evidence on this relationship is needed. Findings illuminated multiple factors inhibiting Somali women's receipt of adequate care for menstrual health needs. Additional challenges included women's perceptions of healthcare quality, distrust of formal healthcare providers, and gendered family decision-making processes around healthcare. Healthcare providers' inadequate training and support hindered diagnosis and care for menstrual disorders for women who have and have not experienced infibulation, while confusion about Kenya's FGM/C ban further complicates provider engagement.

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