How to Apply Health Prevention

Introduction

While Health can be interpreted as the absence of illness and disease, complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 2018). Health promotion is referred to improve health, enhance the quality of life for all the people and is also the process of empowering people to have more control over their health (Baggott, 2011). For example, for an individual to perform certain functions and to reach the state of complete mental, physical, and social wellbeing, the individuals ought to reach the state of complete complex combination of physical, mental, emotional, and social health factors (Baggott, 2011) & (WHO, 2018). This report identifies the health risk effects of Female Genital Mutilation/ Cutting (FGM/C) and substantial ways in which FGM/C impacts on individual especially among migrant communities living in the UK. The report also aims to encourage health prevention education through community-based awareness with necessary resources that will help preventing the health consequences of FGM among migrant communities. Since Ottawa charter happened, improvement of health and wellbeing have been done to improve health promotion (WHO, 2018). Health promotion is therefore factors that contribute to the health and wellbeing of the whole community.

Rationale

While Female Genital Mutilation/Cutting (FGM/C) is considered as a public human violation and health issue, other serious health conditions linked to FGM/C including hemorrhage, pelvic inflammatory, shock, infection, urinary retention, psychological issues, post traumatic, stress disorder (PSTD), pain, shock, anxiety (WHO, 2017). The negative health effect of FGM harms and causes injury to female organ and dramatically affects millions of girls worldwide mainly within migrant communities in the UK (United Nations Children’s Fund, 2019). FGM/C is a practice that involves the intentional removal or alteration of part of all the female external genitalia also known as the vulva for non-medical purposes (WHO, 2013). (National Health Services Choices, NHS Choices, 2017)

One of the major health risks linked to FGM/C includes stress, emotional and psychological impact on health, excessive bleeding, urine retention, anxiety, and depression. Hence, FGM/C is crude, dangerous and has no health benefit. FGM/C has become a significant health risk among the migrant communities living in Lamberth and Southwark. Many health professionals worldwide and particularly in the UK lacks knowledge and guidelines about the short and long health impacts and complications on female genital mutilation (NHS Choices, 2017). FGM/C is mostly practice by migrant communities especially among teenagers aged 5 and young people aged 20 years old (WHO, 2017) & (NFGMC 2020).

In order to reduce the growing of GFM/C and the negative health issues related to FGM/C among migrant communities, prevention education which bring about a great boost towards preventing the health risk of FGM/C is an intervention designed towards preventing the growing of FGM/C among the targeted population. Many health and care professionals lack knowledge on health effects of FGM/C. Therefore, prevention education is required at the societal level to protect and promote the health and wellbeing of the undivided population (Naidoo & Wills, 2018). Raising awareness of the negatives consequences resulting from FGM/C are important for the targeted population. Therefore, health professionals require training on how to assist and care for those, who have undergone FGM/C referrals (Department of Health, 2016) In order to understand the prevalence of FGM/C within the context of migrant communities, the author have chosen to concentrate on Lamberth and Southwark in London, which have registered over 250 cases of FGM/C between 2016 and 2017 (Southwark’s Joint Strategic Needs Assessment, 2018).

Background

Female Genital Mutilation/Cutting FGM/C is considered as an unseen incident due to his nature and practice. It is the procedure of removing healthy external genitalia from girls and women for socio- cultural, religious and beliefs reasons (WHO, 2017). Over the past years, there has been an increase in the number of female genital mutilation among teenagers aged 5 and young people aged 20 years old among migrant communities living in the UK (WHO, 2017). Female Genital Mutilation/ Cutting (FGM/C) is the term given to various traditional practices involving the conscious removal or alteration of part or all the female external genitalia, also known as the vulva for non-medical nor non-therapeutic grounds (WHO, 2017) & UNICEF, (2016). This presents significant provocations to girls aged 5 and young people aged 20 years old, who experienced FGM. According to WHO (2016), FGM/C is classified into four types. Considering the fact that, this is a traditional practice, therefore change in practicing communities is slow (Royal College of Nursing, 2013). Despite having been criminalized in the UK in 1985, there has not yet been a single successful prosecution in the UK (Cloward, 2016). Despite been illegal in the UK since 1985, FGM/C continues to be practiced within migrant communities in the UK (Trust for London, 2016). Study undertook by Nijboer et al., (2020) pointed out that, the parents of these teenagers acknowledged the legislation in the UK, always find ways to thwart it by going to another European member state where it is believed that, there is less possibility of inculpation (Nijboer et al., 2020).

Epidemiology

Epidemiology is seen as the foundation of public health (DH, 2012). It is focused on how diseases occur in individuals and population, including impairments and disability and find strategies to avert illnesses (WHO.2016). It has been recognized that epidemiology’s goal is to minimize harms and maximize the health benefits through direct activities, including fair treatment, social justice, and protection of vulnerable populations (Dawson, 2011).

Evidence from the WHO (2017), and the UNICEF, (2016), reported that, more than 200 million women and teenager's girls have undergone FGM (WHO, 2017) & (UNICEF (2016). It is also estimated that, 170,000 women and girls are living with the legacy of FGM, and 65,000 child and adolescents. To date, most of the evidence published by UNICEF shows that the number of girls who have undergone FGM/C is growing and these girls are more likely to suffer from depression, flashbacks, and Post- Traumatic Stress Disorder (PTSD) (UNICEF, 2017). Aged 13 or under are at this moment at risk of mutilation (HSCIC, 2015)

Within the UK, there are 137,000 women and girls living with the consequences of FGM/C (Health and Social Care Information Centre, (HSCIC, 2015) & (Forward UK, 2021). In 2016, there were over 16,000 attendants at the NHS hospitals and GP practices relating FGM National Health Service (NHS, 2016). The Trust for London (TFL, 2014) published that, around 137,000 women and girls affected by FGM/C were permanently resident in England and Wales (NHS, 2015) & (TSF, 2014). These teenage girls were born in countries where it is practiced (TSF, 2014).

Large city such as London, Birmingham, Manchester, Leicester, Slough, and Coventry, Shefield, Reading, Milton Keynes, Cardiff, Nottingham, Northampton, and Bristol are cities where FGM/C is predominant (HSCI, 2015) & (TSF, 2014). In fact, it has been reported that the city of London has the highest rate of with 4.7 %, including over 8% in Peckham and Camberwell Green (Joint Need Assessment, 2018) compared to 0.5 % in England and Wales as a whole (HSCi, 2015). Report published by the Health and Social Care Information Center (HSCIC, 2015) showed that 43% of the total number of the cases where the age at the time of being cut was known (HSCIC, 2015).

FGM/C has long-term health consequences including Constant pain, Gynecological, post-traumatic stress disorder (PTSD), Flashbacks to the time of the cutting/ Nightmares and other sleep problems and complications during childbirth/Infertility (NHS Choices, 2017) & (UNICEF, 2017). Numerous studies have reported the psychological effects for those, who undergone FGM/C. Glover et al, (2017) study to understand women experiences of FGM/C showed that, the target groups suffer severe mental health, including depression, post-traumatic stress and other mood disorders were affecting the mental health of the targeted group. further, a qualitative study undertaken by Moxey and Jones, (2012) to explore how Somali women were exposed to FGM/C showed that, FGM/C has no health benefits for girls and women who experienced FGM/C (Glover et al., 2017).

Simultaneously, a qualitative study undertook by Hamdia et al., (2019) to understand the long and short health consequences of FGM/C found that many among the participants lacked knowledge about the health consequences and long-term effect of FGM/C procedure. It could be said that, identifying the turning point in the change of attitudes and beliefs towards the practice of FGM/C among the targeted population will deflect the practice of FGM/C. It has been showed that Health complications tend to occur associated with uncontrolled symptoms, emotional distress, and social isolation (NHS, 2016) & (Vaske, 2016).

Assessment

Epidemiology is seen as the foundation of public health (DH, 2012). On the other hand, health need assessment (HNA) aims to develop a general and comprehensive community profile of the health status (National Institute for Health and Care Excellence (NICE, 2013). It is a tool and a process by which public and health professionals try to identify the current and future needs of people in a community purposely for providing relevant and accurate needs and services (Nice guidelines, 2013). In health and care settings, assessment can be seen as planning of care to collect and analyzing data (NICE, 2013). Therefore, assessment should be considered of economic, environmental, and cultural factors that determine a community (Nice guidelines, 2013). Based on Nice guidelines, FGM/C assessment can only be carried out through observation, census, surveys, and data because of the sensitivity of FGM (NHS, 2018). For identifying those who are at risk or have undergone FGM/C screening tool as well as observation and data is used to identify the targeted group (JNA, 2018). Furthermore, family history or coming from where FGM/C is practiced including qualitative and quantitative research.

There is a strong link between FGM/C and health inequality (WHO. 2021) & (Marmot, 2017). Studies undertook by WHO (2017) pointed out that. social influences and poor health are linked to the growth of FGM/C. Hence, FGM/C rates differ according to women’s socioeconomic status. Families and communities as well as cultures in which FGM/C is performed have varied reasons for practicing FGM/C (NHS, 2018). Several factors were associated with FGM practices including daughters age, parent education level, residence, health education, culture, religious mothers' circumcision history (WHO, 2017, Marmot, 2017). With this in mind they are also cultural influences which contribute to the practice of FGM/C and are plausible based on their cultural beliefs (NHS, 2018). These are some of the reasons which influence health inequalities among the targeted population.

Goals setting

Goal setting is referred to as a process which allows health and care professionals to plan, to assist and to identify individual’s needs and upcoming plans towards achieving wishing outcomes. Within health and care settings, it is a tool that aims to help health and care professionals to ensure that, the patient’s needs are met. This is how SMART comes into force to set goals that are within reason and are attainable. Therefore, it is crucial that SMART goals, which are realistic, timely, specific, measurable and achievable. To address the care needs of FGM/C health prevention education will be designed to educate and raise awareness among the targeted population. It is important to address this issue with a specific intervention for preventing the risk of health effects of FGM/C.

Hence, the following care plan will focus on prevention education of FGM/C. which will help access information that can help the survivors of FGM/C and their families. From this, leaflets, signposts, and seminars will enhance awareness for those who are potentially at risk of FGM/C. Monitoring those who have undergone FGM/C helps to identify those who are at risk of the practice, since professionals' team is usually unaware of FGM/C signs for. Both SMART goals and prevention education are realistic and can be measured though its extent towards prevention education to ensure that services meet the needs of girls and young people affected by FGM/C. These goals can be achievable since the current prevention education is achieved through actual measurements and interventions (Marmot, 2017).

Intervention

Efforts have been made internationally, nationally and locally towards the elimination of the practice of FGM/C (WHO, 2018) & (NHS, 2016). Within the UK, interventions based on prevention education towards curbing the growing of FGM/C. Intervention such as Tannahill’s health promotion model is applicable model based on the needs for FGM/C, which is based on prevention, education, and protection (Marmot, 2017). Since health promotion encompasses factors which include socioeconomic conditions and environmental knowledge, it will be plausible that, health education and prevention should be based on cultural beliefs (Scriven, 2010). Observing is essential for health prevention education, since it helps to demonstrate that efforts have had a measurable impact on expected outcomes the effectiveness of the intervention (Scriven, 2010). These interventions that are focuses on the model listed above are therefore strategies towards prevention education to acknowledge the health effects of FGM/C.

Health prevention education is the first step to acknowledge that the practice of FGM/C exists; therefore, through national and local activities including patient leaflet information, signposts to increase awareness of the negatives impacts of FGM/C (Scriven, 2010). Through this intervention, the targeted communities can access information continuously for enhancing awareness and more information regarding FGM/C (Royal College of Nursing, 2017). It should be noted that it is difficult to gain a correct picture of how many young people and girls have undergone or are at risk of FGM/. However, these interventions were not based on cultural aspects. Research by WHO (2017) highlights the circumstances that cause the continuation of FGM/C. There are a number of factors in addition to a girl’s or woman’s community that could increase the risk of being exposed to FGM/C (NHS, 2018). Social influences and poor health are linked to the incidence of FGM/C. Hence, FGM/C rates differ according to women’s socioeconomic status (Royal College of Nursing, 2017)

Health and professional settings should monitor survivors of FGM/C. This second step will help FGM/C survivors and their families to receive direct intervention and cognitive support carried out by the health professionals' team. Since this closeness with patients and the community’s means they can provide support with health education and health prevention for the targeted communities (Scriven, 2010). Further research is required on culturally sensitive health promotion to see the outcomes when involved churches, mosques leaders and universities to raise awareness and to prevent the health effects of FGM/C. This approach will be beneficial towards reducing the probability of girls and young people from being at risks of FGM/C.

Evaluation

The goals listed above are planned to educate and prevent FGM/C among the targeted populations to prevent the growing rates of FGM/C. Since the health effects of FGM/C are not well understood and developed, prevention education is still yet to be interventions towards stopping FGM/C. It is therefore plausible that, the UK government alongside multidisciplinary agencies enhance realistic approaches towards effective prevention education based on cultural beliefs. These interventions are key points for the safeguarding and the health of girls and young people. However, for these interventions, to be effective interventions should be also focused on community behavior change to allow the targeted communities to gain more knowledge of the negative health effects of FGM/C. Study undertaken by Foldes et al., (2018) found that, social influence including reluctance to disclose the information about FGM/C, the fear for societal exclusion on parents and communities. From a public health perspective, it would be plausible to address the issue of FGM/C nationally; yet, it can also be very cost-effective.

Conclusion

Health promotion encompasses distinct types of health activities that are essential for health and care professionals that move beyond a focus on individual towards a wider range of social, economic, environmental, and cultural interventions. The issue of health effects related to FGM/C among migrant communities has contributed too many health issues has been discussed is this essay. FGM/C being one of the considerable health dangers girls and young people has been exposed. SMART goals and interventions have been selected to address the issue of RGM/C. Although the use patient leaflet information of and signposts were not being effective towards prevention education of the health impact of FGM/C. Therefore, national prevention and education are required to reduce its negative health effects. The essay also has demonstrated that, migrant communities practice FGM/C in a country where it is not customary and even illegal. FGM/C is of public health concern due to its associated negative health and wellbeing. Further studies are needed for effective interventions to see how health professionals should assist and help girls who have undergone FGM/C. This essay is a great example of health promotion, through this essay we can see that various health models of health promotion through the epidemiology contribute to raise awareness and improve the health and well-being of the individual, the community and the whole population.

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