A survey on midwives/nurses’ knowledge and application of clinical guidelines in the midwifery care of women with Female Genital Mutilation/Cutting (FGMC) in Nigeria

Introduction:
The WHO clinical guideline in managing women with FGMC has been published to support high-quality, evidence-based midwifery care. Midwives/nurses represent the primary providers of women with FGMC during pregnancy and childbirth and are critical to providing high-quality care reducing mortality/morbidity associated with the procedure. The correct application of guidelines limits serious obstetric consequences in women with FGMC. Therefore, the aim of this study was to assess midwives/nurses’ knowledge of and application of the WHO guidelines in the care of women with FGMC.

Material and Methods:
An online survey was conducted in September 2021 assessing the midwives/nurses’ knowledge and application of the WHO guideline in midwifery care of women with FGMC across government-owned tertiary, state and primary healthcare facilities in Osun State, Nigeria. Ethical clearance was obtained from the relevant institution.

Results:
A total of 352 midwives/nurses working in maternity units responded to the survey. Of the 333 valid entries, 57% have cared for more than ten women with FGMC in this order: Type II 28%; Type I 27%; Type III 22%; Type IV 1% and 22% were unsure of the type. About half (52%) had no knowledge of the WHO guidelines. Over 73% (n=259) of the sample did not apply the WHO guideline in practice, and 20% declared using a different guideline. The different guideline referred to by the midwives/nurses were a combination of factors considered during care, such as wound dressing, religion, health education, counselling, and clinical experience.

Conclusions:
Knowledge and application of clinical guidelines in the care of women with FGMC in Osun state is suboptimal. This study recommends adaptation and implementation of the WHO guideline to support standardisation of care while addressing potential barriers and facilitators that can influence the uptake of guidelines in the different healthcare facilities. There is an urgent need to develop and disseminate clinical guidelines amongst midwives/nurses providing midwifery care for women with FGMC in Osun state.