Female genital cutting: an evidence-based approach to clinical management for the primary care physician.

The United States has more than 1.5 million immigrants from countries in Africa and the Middle East where female genital cutting (FGC) is known to occur. Often, FGC occurs in infancy and childhood in the countries where it is practiced, but patients of any age can present with complications. Lack of understanding of this common problem can potentially alienate and lower quality of care for this patient population. We provide an introduction to the practice of FGC and practice guidelines for the primary care physician. We reviewed original research, population-based studies, and legal research from PubMed, Scopus, CINAHL plus, PsycINFO, and Legal Trac. The terms searched included female genital cutting, female genital circumcision, and female genital mutilation alone and with the term complications or health consequences; no limit on date published. Legal databases were searched using the above terms, as well as international law and immigration law. Editorials and review articles were excluded. This review discusses the different types of FGC, important cultural considerations for physicians caring for patients with FGC, the common early and late medical complications and their management, and psychosocial issues associated with FGC. Current laws pertaining to FGC are briefly reviewed, as well as implications for patients seeking asylum status in the United States because of FGC. Finally, the article presents evidence-based, culturally sensitive approaches to discussions of FGC with girls and women for whom this is an issue.

Barriers and facilitators to public health insurance enrollment in newly arrived immigrant adolescents and young adults in New York state.

This study was designed to identify barriers and facilitators to enrollment in public health insurance programs in immigrant adolescents and young adults. Focus groups were held in English, Spanish and Mandarin to assess barriers and facilitators to insurance enrollment. Twenty-nine students participated in the focus groups, 11 Chinese speakers, 13 English speakers and 5 Spanish speakers. They were between the ages of 18 and 24. The major factors affecting failure to enroll were lack of correct information about enrollment process and qualifications, fear of being reported to immigration, and language barriers. In general, newly arrived students had less information and many more questions. Facilitators to enrollment included perceived need for health insurance, requiring help with medical care costs, and assistance with information gathering. To increase enrollment, we suggest school-based approaches to education and enrollment, increased presence of facilitated enrollers, and increased visibility of existing informational outlets.