Quality of services offered to women with female genital Mutilation across health facilities in a Kenyan County

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Abstract Background Female genital mutilation (FGM) is a challenge to women’s health, human rights and development. Health as a critical pillar for social justice is key in addressing FGM while executing its core mandate of disease prevention and management. By leveraging opportune moments, events and experiences involving client-provider interactions, relevant FGM-related communications, behavior change and management interventions can be implemented at health facility or community level. It is unclear whether health system is maximizing this strategic position to address FGM in Kenya. Objective Determine the quality of services offered to women with FGM across health facilities in West Pokot county. Methods A mixed quantitative data collection strategies were used. These included: client-provider interactions observations (61) with health care workers (HCWs) and women with FGM seeking services on content and quality of FGM-related care; client-exit interviews (360) with women with FGM seeking services to determine content and services received during consultation with HCWs; and service data abstractions (10) from facility records on services sought/offered. Results A large (76%) proportion of women visiting health facilities experienced FGM at 11-15 years, were married aged 15-19 years (39%), had primary (47.5%) or no education (33%) and income of ˂30 USD/month (43%). Only 14.8% HCWs identified FGM and its related complications (11.5%) during consultations. Few FGM-related prevention interventions were implemented but IEC materials (4.9%) for reinforcing preventive messages were lacking. Adequate (88.5%) infrastructure supporting reproductive health services albeit limited human resources (14.8%) and capacity (42.6%) for FGM prevention and management existed; few health facilities and workers explained the negative consequences of FGM (16%) and need to stop it (15.3%); and data on clients who sought ANC, PNC and FP services were available but no information on women with FGM or those with FGM complications. Conclusion Health systems in high prevalent settings are actively interfacing with women with FGM, despite the primary reason for seeking services not being FGM. Despite high number of women with FGM, diagnosis, prevention and care services, documentation of FGM and its related complications are suboptimal. This underscores the need for health system strengthening in response to FGM with consideration on development of training kits for HCWs, training of HCWs, anchoring of FGM indicators in the HMIS, documentation and IEC material to support FGM prevention at service delivery points, and overall integration of FGM into ongoing health programs.

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