Background: In contrast to other European countries, the Swiss health care system does not deal with the specific needs of women with female genital mutilation (FGM) in a consistent manner, though migrants from countries where FGM is commonly practised are living in Switzerland. Methods: For this study, the interaction of women who had undergone FGM, with the Swiss health services was analysed both from the perspective of the women concerned and that of health care professionals (doctors and midwives). The methods used were mainly qualitative, including focus group discussions with 29 women from Somalia and Eritrea and telephone interviews with 37 health care professionals. Results: It is estimated that some 6000 girls and women with FGM could be living in Switzerland. The fact that health care providers rarely see such patients and the absence of professional guidelines give rise to misunderstandings. Counselling of the women is often inadequate, and there is a striking lack of communication about FGM between health care providers and users, as well as within the women's communities. As a surprising finding, reinfibulation is carried out in Switzerland when requested by the patient. Conclusions: This study shows that at present the specific gynaecological and obstetric health care needs of migrant women who have undergone FGM are not adequately addressed in the Swiss health system. The situation could be easily improved by taking into consideration the fairly simple measures suggested by the women and the health care providers taking part in this study. Key points asterisk inside circle sign Due to international migration, female genital mutilation (FGM) has become an issue of increasing concern in host countries such as Switzerland. asterisk inside circle sign Objectives of this study were to analyze how immigrant women with FGM experience gynaecological/obstetrical care in the Swiss health care system, and to investigate if gynaecologists/obstetricians and midwives treat and counsel FGM related complications adequately. asterisk inside circle sign Specific health care needs of women with FGM should - and easily could - be better considered by the Swiss health care system. asterisk inside circle sign Recommended measures include capacity building and professional guidelines on FGM for health care providers; and access to culturally appropriate information and self-help groups for the communities concerned. © European Public Health Association 2005; all rights reserved.

Migration Female genital mutilation Switzerland health care Reinfibulation FGM

Eritrea Communication Europe health care personnel interpersonal communication human community middle aged health service Professional-Patient Relations priority journal Health Services Needs and Demand interview health care cost Humans Adolescent counseling occupation female qualitative analysis Circumcision, Female automutilation Article experience health care adult migration midwife physician Somalia Quality of Health Care Interviews Emigration and Immigration Delivery of Health Care patient practice guideline Switzerland Focus Groups gynecology obstetrics