Prior to coming to Ann Arbor, Christa Johnson-Agbakwu, who completed the Robert Wood Johnson Clinical Scholars Program at the University of Michigan (U-M) in 2008, had no previous experience with health services research. But she had already charted an impressive course to improve women’s health here and around the world. Her focus: the care of women who have been subjected to genital cutting, also known as female circumcision or female genital mutilation (FGM). An alarming number of women throughout Asia, Africa and the Middle East have been subjected to FGM as part of a religious or cultural ritual, including a significant component of the refugee population in the U.S.
She traces her interest in FGM back to her senior year in college, where a history course on women in precolonial Africa led to a project on female genital mutilation. She would encounter the topic again during medical school while working with a New York City-based organization that assisted African women arriving in the U.S. “Many were affected by the practice,” she says. “That solidified my desire to pursue gynecology as a career, and to learn more about genital cutting from a public health perspective.” While in residency at George Washington University, many of these women became Johnson’s patients. One of her mentors was former Robert Wood Johnson Clinical Scholar Janice Blanchard M.D., Ph.D., who encouraged Johnson to consider the program after residency.
While some of her fellow residents discouraged Johnson from “delaying” her career for a non-traditional fellowship, Blanchard had a different perspective. “She kept telling me ‘you’re on to something,’” recalls Johnson. “She helped me see how I might be able to transform care and policy for an entire population across the U.S.”
“She kept telling me ‘you’re on to something,’” recalls Johnson. “She helped me see how I might be able to transform care and policy for an entire population across the U.S.”
She applied to all four program sites, but chose Michigan “hands down.” She credits U-M's program leadership with going above and beyond to schedule additional interviews with U-M faculty members who would understand her interest in FGM, including a professor in the Department of Anthropology. “Other sites pressed me to change my focus,” she says, “but Michigan understood it and encouraged me to pursue it.” Following her interviews, she recalls stating emphatically, “I must be here.”
That level of support continued as Johnson looked for a way to conduct research with this unique population from Ann Arbor. Her idea was unprecedented: conduct community-based participatory research with a group of Somali women living in Columbus, Ohio. “The program’s national advisory committee said it was impossible,” remembers Johnson. “But the program leadership at U-M had my back. They committed to mentoring me and ensuring I’d have the infrastructure I needed to succeed.”
Succeed she did.
Using a mixed methods approach, Johnson conducted the largest ever study of health disparities among victims of FGM in the U.S. “Every skill and tool I used came out of my training the program,” she says.
After Michigan, her goal was to develop a best practices clinic for women impacted by FGM, addressing the barriers to care she had identified and continuing her research. She found a clinical and academic home at Maricopa Integrated Health System and Arizona State University, working with Phoenix’s Somali community.
The clinic, the first and only of its kind in Arizona, is now a model for others in the U.S. Recognized by the U.S. Department of Health and Human Services (DHHS) as an expert in refugee women’s health and genital cutting, Johnson was awarded a DHHS grant to lead a multi-year, multi-site study to transform outcomes for women effected by the practice through provider competency, education and care. “My studies at Michigan made it all possible,” she acknowledges.