Sexual and reproductive health to include Female Genital Mutilation Dr Hilary Cooling Dr Susanna Hall Bristol Sexual Health Services .
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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
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
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