Article Text

Original research
Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations
  1. Sharon Dixon1,
  2. Claire Duddy1,
  3. Gabrielle Harrison2,
  4. Chrysanthi Papoutsi1,
  5. Sue Ziebland1,
  6. Frances Griffiths3,4
  1. 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2University Hospitals Coventry and Warwickshire, NHS Trust, Coventry, UK
  3. 3Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
  4. 4Warwick Medical School, University of Warwick, Coventry, UK
  1. Correspondence to Dr Sharon Dixon; sharon.dixon{at}


Objectives Little is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients.

Setting Primary care in England.

Data sources Realist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients.

Primary outcome measure This realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated.

Results 124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations.

Conclusions There is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities’ health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation.

PROSPERO registration number CRD42018091996.

  • primary care
  • health policy
  • organisation of health services
  • quality in healthcare

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  • Contributors SD and FG wrote and developed the study protocol and the initial programme theory, and conducted the data analysis and synthesis. SZ contributed to the study design and development, writing and data presentation advice and expertise, analysis and theory development. CP provided methodological guidance and advice. CD and GH read and agreed on abstracts and data for final inclusion. CD assisted with study searching and data management. All authors contributed to the development and writing of this article.

  • Funding SD was funded by a National Institute for Health Research (NIHR) in-practice fellowship (IPF-16-10-03, 2016-2018) during this research project. CD is supported by an NIHR Research Methods Programme Systematic Review Fellowship (NIHR-RM-SR-2017-08-018). SZ is an NIHR Senior Investigator. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests SD is a trustee of Oxford Against Cutting. Following this project, she has acted as the Royal College of General Practitioners college representative for female genital mutilation. SD has held small grants to develop and report on the patient and public involvement project that underpinned this research. There are no other author competing interests to declare.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information. For this realist review we analysed published literature that is in the public domain.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.