Background/Introduction: FGC, also known as female circumcision (FC), is a cultural norm that consist of removal or alteration of parts of the female genitalia. FGC is a procedure described in three main categories, with a fourth category description as a damaging procedure. Type I: Partial or total removal of the clitoris and/or the prepuce (clitoridectomy). Type II: Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision). Type III: Narrowing of the vaginal orifice with creation of a covering seal by cutting and a positioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation). Type IV: All other harmful procedures to the female genitalia for non-medical purposes. For example, pricking, piercing, incising, scraping and cauterization. The impairment of healthy genital material inhibits the normal operation of the body and can cause numerous immediate and long-term genitourinary health consequences. There may be more risk of instantaneous harm with Type III in comparison with Types I and II (World Health Organization [WHO], 2016). FGC can be associated with instantaneous and long-term physiological and psychological condition. Civil wars in several African countries contributed to the increase of African immigrants to North America, which suggests that girls and women from several African countries who may have undergone FGC, might have immigrated to North America.
Methods: A review was performed of publications from 1990- 2017, which coincide with increased migration of African immigrants to North America. The databases included: Cumulative Index to Nursing and Allied Health (CINAHL), MIDLIFE, and EBSCO Psychology and Behavioral Science Collection.
Results/ Findings: The women described caregivers’ behavior as insensitive and a total disregard for their cultural norm, when caregivers became aware that the immigrant women had undergone FGC.
Discussion: Although additional empirical studies are called upon for multiple perspectives to explain this phenomenon of dissonance, discussion include caregivers receiving cultural knowledge about FGC to increase their cultural awareness and perhaps sensitivity toward women living with FGC.
Implication for Nursing Practice: The women’s perceptions about the nursing care were more negative than their views of the physicians. The women expressed that nurses regarded them as “being lazy” and reluctant to cooperate. The women alleged nurses were generally highly insensitive to their postpartum pain (Chalmers & Hashi, 2000). The nurses may have been unaware that women with circumcision mostly experience severe postpartum pain. The nurses may have also perceived FGC to be inconsistence with their world views. The behaviors demonstrated by the nurses may have been associated with cognitive dissonance. According to Cooper (2007), a strong dissonance may cause one to be impolite, resulting in insensitivity and disregard for the cultural norm of others. Decreasing cognitive dissonance can occur with a change in one’s attitude. Therefore, cultural awareness education and training in culture norms of others might promote attitude change and help caregivers to become culturally competent. Additionally, periodically assessment of nurses’ behaviors to identify lack of knowledge of other cultures norms and world views may be essential.
Implication for Nursing Education :Providing nursing students with institutional learning experiences that speak to the delivery of culturally responsive professional care that speaks to their dispositions during patient care might be equally as important as providing them content knowledge to triage health concerns. Inclusions of immigrant health with regards to women living with FGC in North America in both undergraduate and postgraduate nursing curricula may be effective in raising awareness and sensitivity among nurses. This action may prepare nurses to provide culturally competent care as they enter the work setting.
Conclusion: While there were a limited number of studies conducted in North America regarding African women living with FGC, those reviewed provided information in support of recommending additional studies are needed to understand the complexities of ethnocentrism, cognitive dissonance, and how they might impede the delivery of professional care. Understanding African women’s perceptions about FGC and caregiver attitudes and behaviors might provide strategies that assist all involved with more favorable outcomes, as well as reduce marginalization of patients whose medical history includes practices not acceptable in other countries. The reality is that many women undergo FGC and the fact remains they might require medical attention as a result. The medical attention, however, should be provided using an ethic of care, beginning with professional decorum even if the cultural practice is not endorsed personally by the caregiver.