ANXIETY, DEPRESSION, AND HEALTHCARE NAVIGATION AMONG FGM/C SURVIVORS IN THE U.S.: AN ANALYSIS OF PROTECTIVE & RISK FACTORS AND DETERMINANTS OF CARE

Abstract

Female Genital Mutilation/Cutting (FGM/C) is a human rights violation that has profound physical, psychological, and social consequences for millions of women and girls globally. While global research has documented the physical and psychosocial consequences of FGM/C, very few studies have examined the mental health outcomes and service experiences of survivors living in the United States. This mixed methods study aimed to: 1) explore the ways in which protective and risk factors, including social support, resilience, and intimate partner violence, shape the mental health experiences of FGM/C survivors; and 2) identify key barriers, facilitators, and strategies for improving access to and support for mental healthcare for survivors of FGM/C. Life Course Theory and Levesque’s framework were used to guide this study. Using a convergent mixed-methods design, quantitative and qualitative data were collected simultaneously and integrated for interpretation. The quantitative component consisted of an online survey assessing anxiety and depression symptoms, experiences of intimate partner violence (IPV), social support, resilience, and cultural connectedness among survivors of FGM/C. The qualitative component included individual interviews and focus groups with survivors of FGM/C and interviews with mental health professionals and advocacy organizations to capture lived experiences, barriers to care, and strategies for healing and advocacy.Quantitative findings revealed mild levels of anxiety and depression, moderate levels of IPV, moderate perceived social support, low resilience, and moderate cultural connectedness, both within the United States and in their home countries. Qualitative findings enriched these results by illustrating how survivors’ experiences of distress, healing, and help-seeking are shaped by cultural identity, community expectations, and systemic inequities in care. Survivors emphasized the dual role of cultural belonging as both protective and constraining, the emotional burden of silence, and the transformative power of advocacy and collective healing. Taken together, these findings underscore that mental health outcomes among FGM/C survivors must be understood within broader cultural, relational, and structural contexts. The study highlights the urgent need for trauma-informed, culturally responsive systems of care, expanded provider training and education, and policy and funding initiatives that address the specific needs of this population. Ultimately, the results affirm that survivors of FGM/C are not defined by harm but by their resilience, agency, and capacity for healing and transformation.