FGM/C Community Evaluation

FGM/C is a complex public health issue with many cultural, gender, class, and traditional layers as well as social, economic, medical, and legal ramifications. Changes in community practices and health-seeking behaviors are unlikely when programs are perceived by community as attacking and criticizing local culture and values, and/or as driven by outsiders (UNDP/UNFPA/WHO/World Bank, 2010).

In 2014, at the request of the community, Maine Access Immigrant Network (MAIN) and PFH began engaging community members and healthcare providers in conversations around FGM/C. In 2016, with federal funding, the HER Initiative – Honor our bodies, Educate our communities, Respect our heritage – was established. Community members, public health professionals and researchers came together as equal partners to co-create knowledge and practice aimed at preventing FGM/C and increasing access to quality, culturally appropriate healthcare in Maine.

The Initiative was built on the belief that through education and dialogue, myths surrounding FGM/C could be dispelled, clinical services to women who had experienced FGM/C improved, and relationships strengthened. Informed by research, various safe spaces were created, and resources developed. This included:

• HER Sisters were community women trained to engage with and act as role models to young girls and women.
• HER Cafes were informal, social gatherings where community members could engage in conversations around womanhood, immigration, healthcare, birthing practices, and motherhood. These cafes were co-facilitated by community health workers and researchers which allowed them to be held simultaneously in multiple language (e.g. Somali, French, Arabic, and English) and individualized support provided as needed.
• Maine Conversations brought together community members, faith leaders, community health workers, clinicians, HER sisters, and legislators in an equitable, non-partisan way. Various forums were used including didactic presentations, grand rounds, panel discussions, town hall meetings, and conference presentations.
• HER Research was undertaken using a community-based participatory action research framework. The findings were often used to ignite conversations, dispel Maine-specific misconceptions, and empower the community to enter dialogues from a scientific base.

Facilitating conversations around FGM/C provided a window into the lives of women, children, and families. Bridging cultural disconnections and providing both healthcare providers and community members with safe platforms to meet as equals, HER ripple effects were evident in both the breadth and depth of engagement: 900+ courageous conversations; largest sample size in the USA; influence on state legislative policies and federal FGM/C studies; and changes in knowledge and practices.