Fabienne Richard

Institute of Tropical Medicine | ITM · Department of Public Health

The provision of optimal, equitable and gender-sensitive health-care to women and girls with FGM/C is challenging. Research indicates that health-professionals in receiving countries lack knowledge, confidence and competence in managing FGM/C. In order to develop policies that are suitable to the wide heterogeneity of women from FGM/C practising gr...

Background The provision of optimal, equitable and gender-sensitive health care to women and girls with FGM/C is challenging. Research indicates that health professionals in receiving countries lack knowledge, confidence and competence in managing FGM/C. In order to develop policies that are suitable to the wide heterogeneity of women from FGM/C pr...

The practice of female genital mutilation (FGM) is a social norm embedded in the patriarchal system and is resistant to change due to its roots in the tradition of the practising communities. Despite this difficulty in change, some women succeed in changing their attitudes towards the practice. In trying to understand what makes these women change...

FGM/C type IIIb in a 16-month old girl from Mali ( a , b ), admitted with acute retention of urine and acute renal failure, Mali.

Femawle Genital Mutilation/Cutting (FGM/C) comprises all procedures that involve partial or total removal of the external female genitalia or injury to the female genital organs that are medically unnecessary (i.e. performed primarily for cultural or religious reasons), especially when done without the consent of the affected person. Such procedure...

Labial and Clitoral adhesion. Examples of convergence of inner labia under the glans and intersection with clitoral hood.

Pictures without FGM/C and without lesions. This chapter will help the physician:

Informed consent is essential to ensuring a trauma-informed, survivor-centered, ethical process that respects the (developing) autonomy of a patient.

Please note that when WHO refers to labia minora and majora such terms are now replaced by inner and outer labia.

Growing numbers of women are showing interest in clitoral reconstructive surgery after ‘Female Genital Mutilation’. The safety and success of reconstructive surgery, however, has not clearly been established and due to lack of evidence the World Health Organization does not recommend it. Based on anthropological research among patients who requeste...

Purpose of Review The goal of this paper is to discuss the juxtapositions between FGM/C and other medically unjustified genital alterations performed on adult women (aesthetical genital surgeries) and on children (male circumcision and intersex genital surgeries). The authors join the debate from their position as professionals working in Belgium’s...

Selon la dernière étude de prévalence (2012), on estime qu'environ 13 000 femmes excisées et 4000 filles à risque vivent en Belgique. Définir la meilleure approche stratégique en matière de prévention des mutilations génitales féminines (MGF) reste un défi. Ainsi la place de l'examen des organes génitaux externes des filles lors des visites de méde...

Background: Female Genital Mutilation remains a public health concern with negative consequences on women’s health. It is a harmful practice and recognized in international discourses on public health as a form of gender-based violence of which women are not only victims but also perpetrators. The practice of FGM remains a social norm which is diff...

Background Female Genital Mutilation (FGM) remains a public health concern with negative consequences on women’s health. It is a harmful practice and recognized in international discourses on public health as a form of gender-based violence of which women are not only victims, but also perpetrators. Although the practice of FGM remains a social nor...

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...

Ce chapitre explore les interventions qui altèrent ou lèsent intentionnellement les organes génitaux externes des femmes pour des raisons non médicales, interventions appelées « mutilations génitales féminines » (MGF) et communément connues sous le terme générique « excision ». Après avoir exposé les divers types de MGF, leur prévalence, leur histo...

Purpose of Review To describe the multidisciplinary approach of the Brussels-based referral center, one of the two centers for women living with female genital mutilation (FGM) in Belgium. This approach is contextualized and compared to the latest literature on the subject. Recent Findings According to the World Health Organization, women who have...

Background Across the Africa region and beyond, the last decade has seen many countries introducing policies aimed at reducing financial barriers to obstetric care. This article provides evidence of the cost and effects of national policies focussed on improving financial access to caesarean and facility deliveries in Benin, Burkina Faso, Mali and...

Burkina Faso, like many low and middle income countries, has been taking a range of actions to address its poor maternal and neonatal health indicators. In 2006 the government introduced an innovative national subsidy scheme for deliveries and emergency obstetric care in public facilities. This article reports on a complex evaluation of this policy...

Les mutilations génitales féminines (MGF) touchent les pays occidentaux aussi bien que les pays africains : elles sont devenues un « enjeu » tant au niveau international que national. En Belgique, en 2012, une recherche-action sur les signalements de filles à risque d’excision a été initiée. Les différentes étapes de la recherche – l’échantillonnag...

This paper complements the other papers in the Lancet Series on midwifery by documenting the experience of low-income and middle-income countries that deployed midwives as one of the core constituents of their strategy to improve maternal and newborn health. It examines the constellation of various diverse health-system strengthening interventions...

Background This paper explores women’s experience and perception of cesarean birth in Burkina Faso and its social and economic implications within the household. Methods Five focus groups comprising mothers or pregnant women were conducted among residents of Bogodogo Health District in Ouagadougou to assess the perceptions of cesarean section (CS)...

Despite being ranked 3rd among the countries having highest burden of stillbirths, it remains a neglected priority in Pakistan. We review the evidence regarding social and biomedical understanding of stillbirths by both communities and healthcare providers. The terminology used to define stillbirth worldwide remains inconsistent. Not only do the he...

User fee exemption for delivery and emergency obstetric care is a policy that has recently been introduced by a large number of countries, particularly in Africa, with the aim of enhancing access to care and improving maternal and neonatal outcomes. In 2011, the FEMHealth project was established with EC funding to conduct multi- disciplinary evalua...

Several countries have recently introduced maternal health care fee exemptions as a quick win approach to reach MDG 5 goals. It has also been argued that these policies were relevant first steps towards universal health coverage (UHC). The scope and contents of the benefits package covered by these policies vary widely. First evaluations raised que...

Caesarean section (CS) is a major obstetrical intervention which can save the life of both mother and child in case, in particular, of obstructed labour or ante partum haemorrhage. The WHO Global Survey on Maternal and Perinatal Health conducted in Asia, Africa and Latin America showed large inequalities in access to and wide variations in practice...

As part of a multidisciplinary project (public health, political and social mobilization, and anthropology) to improve quality and access to emergency obstetric care – the AQUASOU project (2003-2006) - we implemented several activities tied to improving access to quality Caesarean Section (CS) in Bogodogo District, Ouagadougou, Burkina Faso. To dec...

La première décennie du nouveau millénaire a connu une augmentation importante du financement mondial pour la santé. Lorsque le bilan des Objectifs du millénaire pour le développement (OMD) a été présenté publiquement mi-2010, l’OMD 5 portant sur la santé maternelle a révélé le moins de progrès. La santé maternelle a-t-elle raté le train ? Le secré...

The ratio of maternal morbidity and mortality in developing countries is high. The World Health Organization (WHO) and public health specialists promote case review audits as a means of improving quality of obstetric care. This refl ects the need for high reactivity in health personnel's management of obstetric complications. Within an action-resea...

The first decade of the new millennium saw an upsurge in global financing for health. When the world took stock of progress on the Millennium Development Goals in mid-2010 the one addressing maternal health showed the least progress. Did maternal health miss the boat? In mid-2010 the Secretary-General of the United Nations launched a "Global Strate...

The first decade in the new millennium has seen a significant increase in world health funding. When the summary of the Millennium Development Goals (MDGs) was publicly unveiled in mid-2010, MDG 5 (Maternal Health) revealed the least progress. Did maternal health miss the boat? The Secretary-General of the United Nations (UN) took the opportunity t...

Introduction: To reduce financial barriers to health care services presented by user fees, Burkina Faso adopted a policy to subsidize deliveries and emergency obstetric care for the period 2006-2015. Deliveries and caesarean sections are subsidized at 80%; women must pay the remainder. The worst-off are fully exempted. METHODS The aim of this arti...

The Millennium Development Goals (MDGs) were defined in 2001, making poverty the central focus of the global political agenda. In response to MDG targets for health, new funding instruments called Global Health Initiatives were set up to target specific diseases, with an emphasis on "quick win" interventions, in order to show improvements by 2015....

The implementation of policies remains a huge challenge in many low-income countries. Several factors play a role in this, but improper management of existing knowledge is no doubt a major issue. In this article, we argue that new platforms should be created that gather all stakeholders who hold pieces of relevant knowledge for successful policies....

To estimate the number of women with female genital mutilation (FGM) living in Belgium, the number of girls at risk, and the target population of medical and social services (MSSs) concerned. Data about prevalence of FGM from the most recently published Demographic and Health Surveys and Multiple Indicator Cluster Surveys were applied to females li...

The Millennium Development Goals (MDGs) were defined in 2001, making poverty the central focus of the global political agenda. In response to MDG targets for health, new funding instruments called Global Health Initiatives were set up to target specific diseases, with an emphasis on “quick win” interventions, in order to show improvements by 2015....

Lack of access to quality care is the main obstacle to reducing maternal mortality in low-income countries. In many settings, women must pay out-of-pocket fees, resulting in delays, some of them fatal, and catastrophic expenditure that push households into poverty. Various innovative approaches have targeted the poor or exempted specific services,...

The huge majority of the annual 6.3 million perinatal deaths and half a million maternal deaths take place in developing countries and are avoidable. However, most of the interventions aiming at reducing perinatal and maternal deaths need a health care system offering appropriate antenatal care and quality delivery care, including basic and compreh...

Near-miss cases often arrive in critical condition in referral hospitals in developing countries. Understanding the reasons why women arrive at these hospitals in a moribund state is crucial to the reduction of the incidence and case fatality of severe obstetric complications. This paper discusses how near-miss audits can empower the hospital teams...

Objective: To describe the implementation of facility-based case reviews (medical audits) in a maternity unit and their effect on the staff involved. Design: Cross-sectional descriptive study. Setting: A 26-bed obstetric unit in a district hospital in Ouagadougou, Burkina Faso. Sample: Sixteen audit sessions conducted between February 2004 a...

To assess the effects of a comprehensive intervention (staff training, equipment, internal clinical audits, cost sharing system, patients-providers meetings) in improving cesarean delivery access and quality in an urban district of Burkina Faso. We conducted a before-after study in the health district sector 30 in Ouagadougou between 2003 and 2006....

In January 2005, a cost-sharing system was introduced into Secteur 30 health district, an urban district of the city of Ouagadougou, with the aim of improving access to emergency obstetric care for pregnant women in the district. The cost-sharing covers emergency transport and caesarean deliveries. The direct costs are shared between four parties:...

To describe the implementation of a cost-sharing system for emergency obstetric care in an urban health district of Ouagadougou, Burkina Faso and analyse its results after 1 year of activity. Service availability and use, service quality, knowledge of the cost-sharing system in the community and financial viability of the system were measured befor...

Although dealing with medical error and malpractice is still a difficult task, there has been a growing interest on this topic. In Portugal, the limited data suggests a growing problem not adequately recognized by professionals and authorities. This paper summarizes some of the epidemiological evidence on medical error, and draws the scenario of th...

In Morocco, the majority of maternal deaths and severe obstetrical complications occurs outside a health structure. If accessibility to a referral hospital is clearly a problem, this problem can be exacerbated by the perception that women and their family have of the quality of care received in these maternity services. The objective of this articl...

BACKGROUND: In Morocco, the majority of maternal deaths and severe obstetrical complications occurs outside a health structure. If accessibility to a referral hospital is clearly a problem, this problem can be exacerbated by the perception that women and their family have of the quality of care received in these maternity services. The objective of...