Proportion of health service delivery points that provide FGM-related medical and/or psychological services to girls and women

Definition:

The number and proportion of health service delivery points providing medical and/or psychological services and referrals for girls and women who have undergone female genital mutilation (FGM).

This indicator is calculated as:

Number of health service delivery points that provide FGM-related medical and/or psychological services to girls and women/ Total number of health service delivery points

Data Requirements:

Review of FGM service or client records from health service delivery points. Alternatively, surveys or interviews with health care staff on FGM services provided or with clients on FGM services received. Data elements include type of service provided/received (medical or psychological) and whether it was provided/received on site or referred to another service delivery point. The indicator can be disaggregated by province and district, urban/rural location, type of service delivery point (public, private, community-based), and client characteristics (age, ethnicity, religion, etc.).

If FGM service data are not available through the health information system, it is recommended that the data be collected using a census-based approach (i.e., from all primary care sites in the target area). For validation purposes, the data collector may conduct brief follow-up interviews with a subset of clients.

If targeting and/or linking to inequity, classify service delivery points by location (poor/not poor) and disaggregate by location.

Data Sources:

Health information systems that collect information on FGM services, client records, surveys, and interviews from primary care sites, staff, and clients.

Purpose:

This indicator provides a coverage estimate of the extent to which healthcare facilities offer medical assistance and referral services for girls and women affected by FGM, in addition to preventive measures. Women impacted by FGM encounter distinct physical and psychological challenges. The health implications of FGM vary from immediate issues (such as bleeding, intense pain, shock, infections, and difficulties urinating) to future risks during childbirth (like the need for cesarean sections, bleeding after delivery, stillbirths, and childbirth complications), threats to sexual health (such as discomfort during sex, diminished sexual interest, and inability to achieve orgasm), post-traumatic stress disorder, and other persistent mental health concerns, along with ongoing infections of the urinary tract and reproductive system.

The term “service delivery point” encompasses any recognized public or private facility (including those operated by nongovernmental organizations) that offers medical care, like hospitals, clinics, and health centers. Because most international effort has been directed toward eradication of FGM, less attention has been placed on serving the neglected health needs of the estimated 200 million women who have been subjected to the practice. Meeting the physical and mental health needs of women who have undergone FGM is a critical component in providing comprehensive reproductive health care.

Issues:

While the indicator measures coverage of health services for girls and women with FGM complications, it does not evaluate the quality and outcomes of the care and does not address the actual availability of care. It is important to note the distinction between whether a site offers a given service (in other words that the service is defined to be part of the site’s constellation of services) and whether a site has the resources it needs to actually carry out a given service at an adequate level of quality. Although many interviewees may report that FGM medical and/or psychological services are offered, a significant proportion of these sites may not be currently offering the services because they do not have a provider who has been trained in FGM care in the past three years or the site may not have all the appropriate supplies and instruments needed to care for FGM clients.

Lack of accuracy and quality control in record keeping and health information systems can also impact the validity of this indicator.

References:

Measuring effectiveness of female genital mutilation elimination: A compendium of Indicators. Prepared and published by UNFPA and UNICEF on behalf of the UNFPA-UNICEF Joint Programme on the elimination of female genital mutilation: Accelerating Change, 2020.

UNFPA. Female genital mutilation. 2024. United Nations Population Fund.

Jones H., Diop N., Askew I., and Kaboré I. Female Genital Cutting Practices in Burkina Faso and Mali and Their Negative Health Outcomes. Studies in Family Planning, 1999:30(3), 219-230.

PATH. Female Genital Mutilation-The Facts. Compiled by Reymond L., Mohamud A., and Ali N.
Available at: http://www.path.org/files/FGM-The-Facts.htm