BACKGROUND:
FGM/C affects around 230 million women worldwide. Most research conducted in the global north explores survivors’ experience of general healthcare, rarely focusing upon FGM/C specialist service provision.

OBJECTIVES:
To explore the role of midwives as FGM/C experts and inform development of midwife-led optimal models of FGM/C specialist healthcare globally.

METHODS:
This PhD mixed methods study included: A survey of specialist clinics and purposively-sampled interviews with nine service leads Ethical concerns: - bias and subjectivity challenges when conducting research amongst one’s peer group, power dynamics between researcher and interviewees. Dual role of researcher and specialist midwife.

RESULTS:
28 specialist clinics were identified across the UK, mostly for pregnant and non-pregnant women. 71% were midwife-led (30% working alone); 30% diaspora-led.. Few services provided well-resourced multidisciplinary teams with trauma counsellors, health advocate-interpreters or psychosexual therapists. Guidelines around safeguarding, referral pathways and timing of deinfibulation were extremely variable. Midwife-leads were flexible, passionate activists campaigning for healthcare improvements; leading community engagement events; providing psychosexual education; performing FGM/C diagnosis and deinfibulation; and conducting complex safeguarding assessments, often encompassing intersectional violence. Their philosophy embraced concepts of social justice and health equity. Service leads sought to introduce models of care that were holistic, person-centred, culturally-sensitive and trauma-informed, creating safe female spaces. Additional invisible work included funding applications to employ multidisciplinary team members; ‘rule-bending’ and ‘playing the game’ to create and maintain holistic accessible care pathways; multi-agency training; FGM/C health consequences information and medical reports for asylum seekers.

CONCLUSIONS:
FGM/C specialists often work outside of traditional professional roles, including care of women throughout their sexual and reproductive lifecycle. Tensions existed between:- midwives’ professional obligations as ‘street-level-bureaucrats’ versus building trusted relationships; and the emotional toll versus their passion and commitment.

KEY MESSAGE:
FGM/C specialist services are often marginalised reflecting the marginalised status of FGM/C survivors. Midwives are experts in FGM/C care and advocating for improving healthcare service design. Poster session 1 (Group A)