Hindawi Publishing Corporation Obstetrics and Gynecology International Volume 2013, Article ID 149640, 12 pages http://dx.doi.org/10.1155/2013/149640 Research Article Providers’ Perceptions of Challenges in Obstetrical Care for Somali Women Jalana N. Lazar, 1 Crista E. Johnson-Agbakwu, 2 Olga I. Davis, 3 and Michele P.-L. Shipp 4 1 Lifestages Samaritan Centers for Women, 2200 Philadelphia Drive, Suite 101, Dayton, OH 45406, USA 2 School of Social Work, Southwest Interdisciplinary Research Center (SIRC), College of Public Programs, Arizona State University, 411 North Central Avenue, Suite 720, MC 4320, Phoenix, AZ 85004, USA 3 Hugh Downs School of Human Communication, Principal Investigator, Community Engagement/Outreach Core (CEOC), Southwest Interdisciplinary Research Center (SIRC), College of Public Programs, Arizona State University, 411 North Central Avenue, Suite 720, MC 4320, Phoenix, AZ 85004, USA 4 College of Health Sciences, Walden University, 100 Washington Avenue South, Minneapolis, MN 55401, USA Correspondence should be addressed to Crista E. Johnson-Agbakwu; cejohn11@asu.edu Received 29 March 2013; Revised 27 August 2013; Accepted 2 September 2013 Academic Editor: Johanne Sundby Copyright © 2013 Jalana N. Lazar et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Tis pilot study explored health care providers’ perceptions of barriers to providing health care services to Somali refugee women. Te specifc 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. Individual semi- structured interviews were conducted with 14 obstetricians/gynecologists and nurse midwives in Columbus, Ohio. Results. While providers did not perceive FGC as a signifcant barrier in itself, they noted considerable challenges in communicating with their Somali patients and the lack of formal training or protocols guiding the management of circumcised women. Providers expressed frustration with what they perceived as Somali patients’ resistance to obstetrical interventions and disappointment with a perception of mistrust from patients and their families. Conclusion. Improving the clinical encounter for both patients and providers entails establishing efective dialogue, enhancing clinical and cultural training of providers, improving health literacy, and developing trust through community engagement. 1. Introduction Somalis represent the largest infux of African refugees to the United States of America (USA) [1]. Tey began arriving in the early 1990s when their country became engulfed in armed conficts and its citizens were forced to fee for survival [1–3]. Repeated humanitarian crises in Somalia contributed to the continual exodus of millions of Somalis throughout the years. Te 2011 report from the US Department of Homeland Security [4] identifes Somalia as one of the leading African countries for refugee admissions in the USA. In Ohio, the Somali Community Association of Ohio (SCAO) estimated that more than 45,000 Somali refugees/immigrants had resettled in Columbus, Ohio, in 2010, with an estimated 200 arriving each month due to both direct resettlement and secondary migration [5, 6]. Columbus and Franklin county ofcials projected this number to be closer to 80,000, which would represent the second largest population of Somalis in the USA (behind Minnesota) and would account for 42% of all immigrants in Ohio [1, 7]. Tis increasing demographic diversity among Columbus residents has a profound impact on local population health profles and health care needs. Somali immigrants form a very homogeneous population linguistically, religiously, and culturally. According to the Ohio Department of Public Safety [8], 99.9% of Somalis in Columbus are Sunni Muslims and share the same ethnic background (except for a minority Bantu group). Tey are also linked by similar experiences of violence, trauma, loss, food insecurity, and grief. An important shared cultural factor among Somali women is the traditional practice of Female Genital Cutting (FGC), otherwise known as Female Circumcision (FC) or Female Genital Mutilation (FGM),