Crista Johnson-Agbakwu

Arizona State University | ASU · Southwest Interdisciplinary Research Center

Underserved communities were disproportionately affected during the coronavirus (COVID-19) pandemic. Limited data exist on the impact of COVID-19 among refugee populations because refugee status is not often classified in electronic medical record (EMR) systems, unlike race or primary language. The study aim was to evaluate the PCR-based prevalence...

Although a large number of Muslim refugees have resettled in the United States for the last decades, few studies have looked into maternal healthcare access and utilization among Muslim refugee women in the country. This qualitative study was conducted to explore the factors influencing maternal healthcare access and utilization among Muslim refuge...

The past decades have seen large numbers of Somali women migrate across the globe. It is critical for healthcare workers in host countries to understand healthcare needs of Somali women. The majority of Somali female migrants experience female genital cutting (FGC). The most common type in Somalia is Type 3 or infibulation, the narrowing of the vag...

This paper assesses literature regarding the sexual and reproductive healthcare (SRH) needs of resettled refugee women who experienced gender-based violence (GBV) and trauma-informed care (TIC) principles utilized among SRH service providers. A systematic search identified relevant studies published between 2000 and 2021; no articles found reflecte...

Background The Women’s Health Needs Study (WHNS) collected information on the health characteristics, needs, and experiences, including female genital mutilation (FGM) experiences, attitudes, and beliefs, of women aged 18 to 49 years who were born, or whose mothers were born, in a country where FGM is prevalent living in the US. The purpose of this...

To evaluate the quality of Electronic Health Record (EHR) documentation practices of Female Genital Cutting (FGC) by medical providers. A retrospective chart review study of 99 patient encounter notes within the University of Minnesota health system (inclusive of 40 hospitals and clinics) was conducted. Extracted data included but was not limited t...

Every day, two or three women die because of pregnancy or childbirth. Nearly 80% of these deaths are preventable. These outcomes disproportionately impact racialized populations, including Black and Indigenous women, who are two to three times more likely to die. The Practical Playbook III: Working Together to Improve Maternal Health is a guide for...

Introduction: The maternal health experiences of African immigrant women, their utilization of health care services, and the effects on maternal health have received limited attention in research. This research explored the maternal health experiences of African immigrant women residing in Clarkston, Georgia, and their use of health services. Metho...

Community health workers are members of two groups whose short- and long-term health has been uniquely shaped by the COVID-19 pandemic: health workers and the oft-marginalized populations that they serve. Yet, their wellbeing, particularly of those serving resettled refugees, before and during the pandemic has been largely overlooked. Drawing from...

Background Self-reporting female genital cutting (FGC) status and types by patients and clinicians is often inconsistent and inaccurate, particularly in community settings where clinically verifiable genital exams are not feasible or culturally appropriate. Aim In this study we sought to discern whether integrating multiple dimensions of participa...

Background Visual imagery has been used to educate healthcare providers, patients, and the lay public on female genital cutting (FGC) typology and reconstructive procedures. However, culturally inclusive, diverse, and anatomically accurate representation of vulvas informed by women possessing lived experience of FGC is lacking. Aim We sought to ap...

Refugees may be at higher risk of cervical dysplasia. The prevalence of screening, pathology, risk factors, and management of patients in our Refugee Women’s Health Clinic (RWHC) was assessed. A retrospective review of RWHC patient records between 2009 and 2015 assessed demographic factors, medical history, initial chief complaint, prevalence of sc...

While Female Genital Mutilation/Cutting (FGM/C) continues to garner global attention, FGM/C-affected migrant communities, who are often racialized minorities in the U.S., face additional challenges which may impact their physical and mental health and well-being. It has been proposed that an overly narrow focus on the female genitalia or FGM/C stat...

To identify research and gaps in literature about FGM/C–related attitudes and experiences among individuals from FGM/C–practicing countries living in the United States, we conducted a scoping review guided by Arksey and O’Malley’s framework. We searched Medline (OVID), Embase (OVID), PubMed, and SCOPUS and conducted a grey literature search for stu...

Research on female genital mutilation/cutting (FGM/C) and mental health has largely failed to address the role of disparate experiences of the circumcision event, ongoing health impacts, and unique contexts of western resettlement. This study’s objective was to examine how FGM/C and associated stressors related to mental health outcomes among Somal...

COVID-19 can be life-threatening to individuals with chronic diseases. To prevent severe outcomes, it is critical that we comprehend pre-existing molecular abnormalities found in common health conditions that predispose patients to poor prognoses. In this study, we focused on 14 pre-existing health conditions for which increased hazard ratios of CO...

Introduction: There is scant evidence on the health morbidities experienced by Somali women and girls affected by female genital mutilation/cutting (FGM/C) and their resultant health-seeking behavior in the USA as compared to those who have not undergone the procedure. To fill this gap, we conducted a comprehensive examination of health morbidity...

In 2020, healthcare workers faced the COVID-19 pandemic amidst other salient sociopolitical stressors. This study, therefore, set out to examine associations between personal, work-related and contextual factors and three outcomes – stress, burnout and turnover intention – at a critical juncture in the pandemic. In December 2020, we recruited a bro...

Objectives: To promote the recognition and care of patients with female genital mutilation/cutting (FGM/C), we aimed to evaluate the awareness, clinical experience and knowledge of FGM/C among female pelvic medicine and reconstructive surgery (FPMRS) specialists. FGM/C is a cultural practice whereby there is removal of external female genitalia fo...

A brief set of recommendations regarding ethical standards and practice guidelines as a prerequisite to clitoral reconstruction following female genital mutilation/cutting (FGM/C)

After decades of refugee displacement, Somalis are at increased risk for poor mental health. However, uptake of treatment referrals in primary care is low among Somalis compared to other refugee groups. The objective of this analysis was to understand specific resistances to US mental health care contributing to this gap in coverage. One hundred an...

Objective: Automated and accurate identification of refugees in healthcare databases is a critical first step to investigate healthcare needs of this vulnerable population and improve health disparities. This study developed a machine-learning method, named refugee identification system (RIS) that uses features commonly collected in healthcare data...

Background Approximately 545,000 women and girls in the USA have undergone Female Genital Mutilation/ Cutting (FGM/C) or have mothers from a country where FGM/C is practiced. Women and girls living with FGM/C in the USA may experience stigma and bias due to their FGM/C, immigration, racial, and language status. Health care provider attitudes toward...

This study reviewed social support research with refugees in resettlement by assessing the scope of scholarship and examining methodological approaches, definitions, theoretical frameworks, domains, and sources of support. The scoping review followed a systematic approach that retained 41 articles for analysis. The findings indicate that refugee re...

Background: COVID-19 poses a life-threatening endangerment to individuals with chronic diseases. However, not all comorbidities affect COVID-19 prognosis equally. Some increase the risk of COVID-19 related death by more than six folds while others show little to no impact. To prevent severe outcomes, it is critical that we comprehend pre-existing m...

Background: Female genital mutilation/cutting (FGM/C) is a cultural practice that includes procedures that intentionally alter or cause harm to female genital organs for nonmedical reasons, affecting ∼200 million women and girls globally. Health care providers in the United States often lack confidence to provide appropriate FGM/C-related care, and...

Background: Female genital mutilation/cutting (FGM/C) is associated with adverse sexual, reproductive and psychological sequelae. The aim of this study was to quantitatively explore factors related to satisfaction with FGM/C-related care in the US focusing on access to care, health service utilization, and women's experiences. Methods: A communi...

Background The COVID-19 pandemic has exposed disproportionate health inequities among underserved populations, including refugees. Public safety net health care systems play a critical role in facilitating access to care for refugees, and informing coordinated public health prevention and mitigation efforts during a pandemic crisis. Objective To e...

Background: Approximately 545,000 women and girls in the USA have undergone Female Genital Mutilation/ Cutting (FGM/C) or have mothers from a country where FGM/C is practiced. Women and girls living with FGM/C in the USA may experience stigma and bias due to their FGM/C, immigration, racial, and language status. Health care provider attitudes towar...

The current national COVID-19 mortality rate for Black Americans is 2.1 times higher than that of Whites. In this commentary, we provide historical context on how structural racism undergirds multi-sector policies which contribute to racial health inequities such as those highlighted by the COVID-19 pandemic. We offer a concrete, actionable path fo...

Health of refugee women encompasses a range of health conditions across their reproductive health and includes obstetrics and gynecological health as well as general preventive and psychosocial health. For refugee women, cultural and/or religious beliefs around sexual behavior, prenatal care, breastfeeding, cancer screening, contraception, intimate...

Female genital mutilation/cutting (FGM/C) is outlawed in much of the world but still mainly occurs from infancy-age 15. Many at-risk and FGM/C-affected girls live in the US. No standard pediatric training exists. A questionnaire assessing FGM/C education, knowledge, diagnostic confidence and external genital examination (EGE) approach was sent to p...

The traditional practice of Female Genital Cutting (FGC) has gained increased global attention due to the influx of immigrants and refugees from countries where this practice is indigenous. Research is beginning to provide insight into the complexity of psychosexual sequelae among women with FGC. Validated measures of sexual function within unique...

Female genital mutilation or cutting (FGM/C) involves medically unnecessary cutting of parts or all of the external female genitalia. It is outlawed in the United States and much of the world but is still known to occur in more than 30 countries. FGM/C most often is performed on children, from infancy to adolescence, and has significant morbidity a...

Introduction: Clitoral reconstruction (CR) is a controversial surgical procedure performed for women who have undergone medically unnecessary, often ritualistic genital cutting involving the clitoris. Such cutting is known by several terms; we will use female genital mutilation/cutting (FGM/C). Treatments offered to women affected by complications...

Female Genital Mutilation/Cutting (FGM/C) is a procedure involving the partial or total removal of the external female genitalia for non‐therapeutic reasons which can result in genitourinary, obstetric and psychosexual complications1. According to UNICEF, at least 200 million girls and women have undergone FGM/C2. The available estimates are based...

Background Arizona is among the top U.S. states for Somali refugee resettlement. Efforts are underway to elucidate the gaps, barriers and/or assets in FGC-related care, build community knowledge, and enhance the provision of health care and social services for FGC-affected women in Arizona. Methods A community-based survey utilizing respondent dri...

Objectives. To examine if exposure to victimization (e.g., homicide, violence, sexual assault, arson, kidnapping) is related to health problems, health care access and barriers, and health needs—beyond the effects of female genital mutilation or cutting (FGM/C)—among Somali women and adolescent girls. Methods. We collected original survey data in 2...

This study examined maternal and reproductive health (MRH) access of Somali refugees in the U.S. across four access dimensions (willingness to seek care, gaining entry to the health system, seeing a primary provider and seeing a specialist). We conducted a cross-sectional survey of 427 Somali refugee reproductive-age women in Franklin County, Ohio....

Migration from countries where female genital cutting (FGC) is practiced means women’s healthcare providers need to meet this population’s unique healthcare needs. We explored providers’ FGC-related experience, knowledge of the cultural practice, prior training, attitudes towards medicalization, including reinfibulation, and clinical practice. An o...

We seek to clarify and assess the underlying moral reasons for opposing all medically unnecessary genital cutting of female minors, no matter how severe. We find that within a Western medicolegal framework, these reasons are compelling. However, they do not only apply to female minors, but rather to non-consenting persons of any age irrespective of...

To promote safe and positive health outcomes by utilizing culturally relevant evidence-based interventions for immigrant and refugee women survivors of intimate partner violence, their active participation in research is critical. With 43.6 million immigrants and refugees living in the United States, there is a need for research studies to eliminat...

Objective: Somali refugee women are known to have poor health-seeking behavior with a higher proportion of adverse pregnancy outcomes compared to US-born women. Yet unknown is how they avoid obstetrical interventions. This study sought to identify perceived protective mechanisms used to avoid obstetric interventions as well as the underpinning fact...

Purpose To determine the health status of women before, during, and after the war, and to explore women’s perceived health needs and current access to healthcare. Methodology/approach Individual interviews and focus groups were conducted in urban and rural areas. A total of 52 women participated in the study (N = 52; Individual Interviews, n = 12;...

Purpose: This study aimed to investigate the effect of steady-state exposure to flibanserin, a 5-HT1A agonist/5-HT2A antagonist approved for the treatment of hypoactive sexual desire disorder in premenopausal women, on the single-dose pharmacokinetics of the contraceptive steroids ethinylestradiol and levonorgestrel in healthy premenopausal women....

Recently, there has been a significant increase in individuals seeking refuge in many western countries. Upon arrival, refugee women face challenges in accessing and utilizing critical prenatal care. We conducted a mixed-methods study, combining a patient exit survey and focus groups to understand the experiences of multi-ethnic refugee women in ac...

There is little evidence about family planning knowledge, attitudes, and use among couples in post-conflict Democratic Republic of the Congo. We used qualitative descriptions to analyze data from 75 participants. Intimate partner violence (IPV) was common among participants. They were aware of family planning methods; however, IPV and fears of side...

Purpose of Review Global migration trends necessitate that health care providers, regardless of location, address sequelae from female genital cutting (FGC). Surgical interventions to treat sexual dysfunction in this population are proliferating despite limited evidence of their impact. We conducted a scoping review to describe interventions to add...

Introduction: Psychological, interpersonal, and sociocultural factors play a significant role in making one vulnerable to developing a sexual concern, in triggering the onset of a sexual difficulty, and in maintaining sexual dysfunction in the long term. Aim: To focus on psychological and interpersonal aspects of sexual functioning in women and...

Aims: This study aimed to highlight the salient sociocultural factors contributing to sexual health and dysfunction and to offer recommendations for culturally sensitive clinical management and research as well for an ethically sound sexual health care, counseling and medical decision-making. Background: There are limited data on the impact of s...

Posttraumatic stress disorder (PTSD), anxiety, and depression are common mental health disorders in the refugee population. High rates of violence, trauma, and PTSD among refugee women remain unaddressed. The process of implementing a mental health screening tool among multiethnic, newly arrived refugee women receiving routine obstetric and gynecol...

Objective: This study aimed to assess rates of Papanicolaou (Pap) testing and associations between religion-related factors and these rates among a racially and ethnically diverse sample of American Muslim women. Materials and methods: A community-based participatory research design was used in partnering with the Council of Islamic Organization...

Newly-arrived African refugees are a vulnerable group of immigrants for whom no validated acculturation measures exist. A valid measurement tool is essential to understand how acculturative processes impact health and health disparities. We adapted the Bicultural Involvement Questionnaire (BIQ) to characterize its reliability among ethnic Somali wo...

Refugees are resilient survivors who have been displaced from war-torn countries where there was limited access to quality medical care and preventive health. Moreover, possessing low socioeconomic status, malnutrition, infectious diseases, and poor social support may have a deleterious impact on their health. Thus, caring for refugees provides an...

Objectives: Somali women are at increased risk of adverse pregnancy outcomes. Anxiety and perceived stigmatization toward female genital cutting (FGC) further fuels an atmosphere of miscommunication and distrust, contributing to poorer health outcomes. While the attitudes and experiences of Somali refugee women toward healthcare are widely known,...

. This pilot study explored health care providers’ perceptions of barriers to providing health care services to Somali refugee women. The specific aim was to obtain information about providers’ experiences, training, practices and attitudes surrounding the prenatal care, delivery, and management of women with Female Genital Cutting (FGC). Methods ....

PURPOSE: We partnered with the only U.S. clinic exclusively focusing on reproductive health needs of refugee women. To inform this clinic's outreach strategies, we examined patients' prenatal care utilization patterns and identified patient characteristics associated with inadequate utilization. BACKGROUND: Evidence suggests refugee women are at hi...

Purpose: An educational curriculum on breast health was created for Somali refugee women based on priorities identified in a community needs assessment which explored their experiences and utilization of preventive health services. The goals were: to develop community capacity by initiating a “train-the-trainer program; increase health literacy in...