Female genital mutilation in immigrant populations and cultural competency in health care providers in the United States: A systematic review

Ijeoma S Ihenacho, The University of Texas School of Public Health


Background: Given the adverse health consequences and global nature of female genital mutilation (FGM) and the growing cultural diversity of immigrant populations in the United States, the need for cultural competence in health care delivery in relation to FGM becomes more pressing. In one study of U.S health care providers, a high percentage (40%) of health care providers reported having attended women with FGM, underscoring its prevalence in the U.S. Although the topic of cultural competence has been applied to a range of health care delivery issues, including racial and ethnic disparities in health care systems, no systematic reviews to date have fully explored the topic of cultural competence in relation to FGM. Aims: This study had two aims: 1.) to assess knowledge, attitudes and practices of health care providers in developed countries in relation to FGM; and 2.) to review literature on cultural competence of health professionals in order to explore the effectiveness of interventions aimed at increasing cultural competence for immigrant patient populations affected by FGM. Methods: The following databases were used to conduct a systematic literature review: PubMed (National Library of Medicine); Ovid Medline; CINAHL (Cumulative Index to Nursing and Allied Health); PsychInfo; and EMBASE (ExcerptaMedicadataBASE). Results: The search strategy yielded a total of 26 articles for inclusion in the final review. Three studies indicated a deficiency in health care professionals' knowledge related to FGM, ten studies highlighted the deficiencies in practice related to FGM, and two showed a dearth in both knowledge and practice related to FGM. Eleven studies examined cultural competency, with three highlighting the relevance of cultural competency in health care, three indicating the importance of incorporating cultural competency in health practice, and five showing the effectiveness of applying cultural competence to health professionals' training. A growing body of evidence indicates that interventions are effective in increasing cultural competency for health care providers working with immigrant populations. While research was limited on interventions aimed at increasing cultural competency in relation to FGM in particular, two studies from two countries indicate that health care providers' knowledge and practice related to FGM can be positively enhanced. Conclusions: Determining knowledge, attitudes, and perception with regards to female genital mutilation among health care providers, as well as identifying cultural competency practices in health care systems in immigrant populations, hold the potential to provide important insight into the cultural competence of health care providers on such a sensitive topic, as well as identifying potential gaps in the literature and future research directions. Future research directions should look into appropriate competency, communication, and educational approaches to addressing the gap in knowledge, perceptions, and practice exhibited by health care providers in the United States when broached with the subject of FGM.

Subject Area

Medicine|Public health|Public policy|Ethnic studies|Health care management

Recommended Citation

Ihenacho, Ijeoma S, "Female genital mutilation in immigrant populations and cultural competency in health care providers in the United States: A systematic review" (2014). Texas Medical Center Dissertations (via ProQuest). AAI1569935.