Community Conversations: The Importance of Community Engagement in Improving the Care and Reducing the Risk of Female Genital Cutting U.S. Department of Health and Human Services Office on Women’s Health Final Grantee Meeting Hilary Chester, PhD U.S. Conference of Catholic Bishops/Migration and Refugee Services Bridging Refugee Youth and Children’s Services

Overarching Goal: Decrease the likelihood that currently impacted refugee communities will continue to practice Female Genital Cutting and improve the practical response of service providers (health and medical practitioners, educators, child and family services, and those working directly in refugee resettlement) who encounter a girl or woman who has undergone FGC or is at risk. Funded by a cooperative agreement with the U.S. Department of Health and Human Services/Office on Women’s Health

Our community informed approach aims to: Understand the practice and determine needs from community perspective Create resources with content that is community driven, relevant and meaningful, and meets their stated needs Engage the refugee community in creating and promoting the messaging and resources designed throughout the project

Methodology: Focus groups: single gender, English and mono-lingual with interpreters; adults and teens with parent present; informed consent; incentives provided Year 1: Semi-structured and open-ended questions Year 2: Review of resource mock-ups and drafts IRB review and determined oversight not necessary Community Host Agencies—Refugee Resettlement Programs of Catholic Charities of Houston, TX Catholic Charities of San Antonio, TX Catholic Charities of Salt Lake City, UT Catholic Charities of Minneapolis, MN & the International Institute of Minnesota Catholic Charities of Washington, DC

Methodological Challenges: Conceptualizing community engagement: Most refugee women anticipated being research subjects Overwhelming majority of service providers (resettlement program staff) promoted focus groups as trainings for refugee women Reframing focus group participants as: Subject Matter Experts Project Contributors & Content Creators Ideal Consumer Audience

Total Year 1 Participants: 97

Year 1 Focus Groups with Impacted Populations Background Questions Age, countries of origin, countries of asylum; Time residing in the U.S.? FGC Related Questions Is FGC important in your home country; in your current community? What does this practice mean for the girls or women; for the community more generally? Medical Questions How would you describe medical care; women’s health care in U.S.? pregnancy, labor and delivery in particular? Have you, friend or relative had positive/negative experiences related to FGC with medical provider? Recommendations Ideas to improve care and interactions with medical providers related to FGC and women’s health generally? What do you think teachers, case workers, or other service providers should know? Do you think there are alternatives for this practices?

Key observations and findings that informed the resources we developed: Women with FGC had range of experiences with medical providers—and many suggestions for improvement; Women find medicalization of pregnancy, labor, and delivery confusing and difficult to navigate; Younger women in the communities are much less likely to have experienced FGC; Women have difficulty talking to their daughters about their physical development/maturation Very few women are supportive of continuing the practice, and highlight the medical complications and changing opinions within their communities

Key Deliverables Raising a Girl: A Handbook for Newcomer Mothers and Daughters Starting a Conversation with Your Doctor Preparing for Labor and Delivery in the U.S. Factsheets for Educators Medical Providers Resettlement Providers Child Welfare Service Professionals

Feedback from Professionals and Researchers To learn about provider needs, BRYCS exhibited at conferences tailored to relevant audiences: Ethiopian Community Development Council Annual Gathering 2nd International Expert Meeting on FGM/C North American Refugee Health Conference American Public Health Association Child Welfare League of America National Conference on Child Abuse and Neglect American Professional Society on the Abuse of Children Annual Colloquium

To Explore and Download Resources: www.BRYCS.org https://brycs.org/blog/female-genital-cutting-fgc/ For more information: hchester@usccb.org