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Ayenew AA, Mol BW, Bradford B, Abeje G. Prevalence of female genital mutilation and associated factors among women and girls in Africa: a systematic review and meta-analysis. Syst Rev 2024; 13:26. [PMID: 38217004 PMCID: PMC10785359 DOI: 10.1186/s13643-023-02428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/11/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Female genital mutilation (FGM) has zero health benefits. It can lead to short- and long-term risks and complications, including physical, sexual, and mental health and well-being of girls and women. It is a worldwide public health issue with more than 80% prevalence in Africa. It is a global imperative to strengthen work for the elimination, and the United Nations Sustainable Development Goal (SDG) strives to eliminate FGM and monitor the progress made. However, one of a challenge in tracking progress is establishing baseline prevalence data within regions and countries. Therefore, this review aimed to pool the prevalence of FGM in Africa and identify the promoting factors among women and girls. METHODS This review was conducted according to the PRISMA checklist guideline. Both published and unpublished studies conducted from 2012 onwards were eligible. Studies written in non-English languages were excluded. To retrieve relevant studies; PubMed/Medline, Google Scholar, Science Direct, African Journals Online databases, and African Index Medicus (AIM) were searched using a combination of searching terms. The Newcastle-Ottawa Assessment Scale (NOS) tool was used to assess the quality of each included study. The Cochran's Q chi-square and I2 statistical tests were used to evaluate the heterogeneity of the included studies. The Funnel plot and Egger's regression test (p value < 0.05) were used to evaluate meh publication bias. We used STATA for analysis and the overall and subgroup pooled effect size was estimated using the random effect model with DerSimonian and Laired pooled effect method. The overall prevalence of FGM and the adjusted odds ratio (AOR) with 95%CI (confidence interval) for contributing factors were calculated and presented using a forest plot. RESULT This study included 155 primary studies conducted on the prevalence and/or factors associated with FGM in Africa. The pooled prevalence of FGM was 56.4% (95%CI 49.7-63.6). The primary factors promoting the practice of FGM were family history of circumcision (AOR = 13.71, 95%CI 9.11-20.62), being a Muslim religion follower (AOR = 3.51, 95%CI 2.61-4.71), poor wealth index (AOR = 1.38, 95%CI1.27-1.51), higher age (AOR = 2.95, 95%CI 2.49-3.38), not attending formal education (AOR = 3.28, 95%CI 2.62-4.12), and rural residency (AOR = 2.27, 95%CI 1.84-2.80). CONCLUSION The prevalence of FGM in Africa was found to be high. This study also observed a variation in FGM prevalence across regions and countries and a slight temporal decline over the study period. As the global community enters the final decade dedicated to eliminating FGM, there remains much to be done to achieve the elimination goal.
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Affiliation(s)
- Asteray Assmie Ayenew
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
- Department of Midwifery, Bahir University College of Medicine and Health Science, Bahir Dar, Ethiopia.
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Billie Bradford
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Gedefaw Abeje
- Department of Reproductive Health, Bahir Dar University, Amhara, Ethiopia
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2
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Akinsulure-Smith AM, Min M. What African immigrant service providers can teach us about the needs of African immigrant survivors of FGM/C. Health Care Women Int 2023; 45:463-474. [PMID: 37010566 PMCID: PMC11062593 DOI: 10.1080/07399332.2023.2196247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
Health and social service providers who immigrated from regions with high Female Genital Mutilation/Cutting (FGM/C) prevalence rates can provide unique insights on serving women with FGM/C experience. Specifically, we investigated African immigrant service providers' knowledge, experience, attitudes about FGM/C, and their recommendations on how to provide services to immigrants from sub-Saharan Africa who have experienced FGM/C. Derived from a larger study, interviews of 10 African service providers were selectively analyzed with a particular attention to cultural insights that could inform the framework in Western destination countries on how to serve women and girls with FGM/C experience.
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Affiliation(s)
- Adeyinka M Akinsulure-Smith
- Department of Psychology, The City College of New York, New York, New York, USA
- The Graduate Center, City University of New York, New York, New York, USA
| | - Moonkyung Min
- Werklund School of Education, University of Calgary, Calgary, Canada
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3
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Kalengo N, Musinguzi LK, Twikirize JM. “You must cut that long and stinking thing”: uncovering the lived experiences of uncircumcised pokot women in North-Eastern Uganda. BMC Womens Health 2022; 22:433. [PMCID: PMC9636792 DOI: 10.1186/s12905-022-02005-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Female circumcision remains a dominant practice among the Pokot of North-Eastern Uganda. This paper explores the lived experiences of uncircumcised Pokot women, as they continue to live in a community, where the practice is cherished.
Methods
This qualitative study adopted an ethnographic research design. The study was based on thirty [30] serial interviews with 15 uncircumcised women in the Pokot local language between August and October 2021. Five [5] Key Informant Interviews were also conducted with key informants from Amudat District. A Focus Group Discussion with women, irrespective of their circumcision status, was organized as an entry point to identify the initial uncircumcised woman. Uncircumcised women were recruited using respondent-driven sampling while key informants were purposively selected. Data were analyzed thematically. Participants were allocated codes to ensure anonymity.
Results
Participants expressed understanding of female circumcision, and the procedure although they were not circumcised. Denial of participation in community and cultural functions, rejection by elders and relatives, difficulties in getting marriage partners, denial of conjugal rights and basic needs, refusal to give names to their children, and home desertion were the negative experiences reported by uncircumcised women. Sexual enjoyment during sexual intercourse, epitomized by the ease of reaching orgasms, fewer complications while giving birth as well as reduced risk of exposure to sexually transmitted diseases were mentioned by participants as their positive experiences.
Conclusion
Uncircumcised Pokot women continue to experience unbearable challenges since female circumcision is perceived as the only rite of passage to womanhood. This calls for intensified awareness of the population on the challenges associated with female circumcision refusal while demonstrating the positive experiences mentioned by uncircumcised women, that can be exploited as the beacon of hope.
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Mahmood KI, Shabu SA, M-Amen K, Saleh AM, Ahmed H, Mzori BQ, Shabila NP. Knowledge, attitudes, and positions of religious leaders towards female genital cutting: A cross-sectional study from the Kurdistan Region of Iraq. PLoS One 2022; 17:e0265799. [PMID: 36318575 PMCID: PMC9624424 DOI: 10.1371/journal.pone.0265799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 10/17/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Understanding the perspectives of the key players in the community regarding female genital cutting (FGC) is very important for directing preventive programs. Religious leaders help shape community behaviors, which is highly pertinent in the case of FGC as it is frequently perceived to be a religious requirement. This study assesses religious leaders' knowledge, attitudes, and positions towards FGC in the Kurdistan Region of Iraq. METHODS This cross-sectional study was conducted in the Kurdistan Region of Iraq. It included a purposive sample of 147 local religious leaders (khateebs) representing the three governorates of Erbil, Sulaimaniyah, and Duhok. A self-administered questionnaire was used to collect data about the religious leaders' knowledge, attitude, and position towards FGC. RESULTS The participants identified reduction of the sexual desire of women as the main benefit (37%) and risk (24%) of FGC. Cultural tradition and religious requirements were the main reported reasons for practicing FGC. About 59% of the religious leaders stated that people ask for their advice on FGC. Around 14% of the participants supported performing FGC, compared to 39.1% who opposed it. Religious (73.9%) and cultural (26.1%) rationales were the main reasons given for supporting FGC. Being a cultural practice with harmful effects (53.5%) and lack of clear religious evidence (46.6%) were the main reasons for being against FGC. Around 52% of the participants recommended banning FGC by law, while 43.5% did not support banning it. A statistically significant association (P = 0.015) was found between religious leaders' residence and their position on performing FGC. More than 46% of those residing in Duhok were against performing FGC, compared to lower proportions in Erbil (38.8%) and Sulaimaniyah (30%). CONCLUSION Religious leaders believed that cultural tradition was the main reason behind practicing FGC and they believed that FGC is not common in KRI, and even that it is decreasing. The religious leaders in our study reported that they could have an influential role in the FGC issue due to their position in the community. There was no statistically significant association between religious leaders' age, education level, or work experience and their position on performing FGC. However, a statistically significant association was found between religious leaders' residence and their position on performing FGC. A conclusive decision concerning the prohibition of FGC needs to be made by religious authorities. Health awareness activities incorporating FGC risks should be carried out to inform religious leaders at different levels of religious positions. Further research exploring perspectives of religious authorities concerning religious leaders' inconclusive judgment about FGC is deemed necessary.
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Affiliation(s)
- Kazhan I. Mahmood
- Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq
| | - Sherzad A. Shabu
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq
| | - Karwan M-Amen
- Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Iraq
- Center of Research and Strategic Studies, Lebanese French University, Erbil, Kurdistan Region, Iraq
- * E-mail:
| | - Abubakir M. Saleh
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq
- Faculty of Nursing, Department of Nursing, Tishk International University, Erbil, Iraq
| | - Hamdia Ahmed
- College of Health Sciences, Hawler Medical University, Erbil, Iraq
| | | | - Nazar P. Shabila
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq
- Department of Medical Laboratory Sciences, College of Health Sciences, Catholic University in Erbil, Erbil, Iraq
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Oztig LI. Does local resistance impact the transnational normative environment? The case of female genital mutilation (FGM). Health Care Women Int 2022:1-21. [PMID: 36194445 DOI: 10.1080/07399332.2022.2129644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
More than 200 million girls and women today are estimated to have gone through female genital mutilation (FGM). In this study, I make a novel contribution to the global literature on FGM by examining domestic resistance to the anti-FGM norm in the context of norm diffusion processes. I provide a novel theoretical perspective to the study of FGM by introducing a compromise-building approach. According to this approach, strong local resistance to a transnational norm that obligates the removal of harmful traditional practices might motivate some transnational norm advocates to support a compromise solution to minimize harm, leading to normative contestation in the transnational domain. This approach is illustrated by the rise of advocacy for medicalized and minor forms of FGM as a harm reduction strategy as a result of the continuation of traditional forms of FGM. The compromise-building approach also brings a new theoretical perspective to the literature on norm diffusion.
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Affiliation(s)
- Lacin Idil Oztig
- Department of Political Science and International Relations, Faculty of Economics and Administrative Sciences, Yildiz Technical University, Istanbul, Turkey
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Contribution of between region and neighborhood variation of socioeconomic factors on the practice of female genital mutilation/cutting: a multilevel analysis of Tanzanian national surveys. J Biosoc Sci 2022:1-12. [DOI: 10.1017/s0021932022000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
This study aimed to assess to what extent differences in socioeconomic factors between regions correlate to dramatic disparities in the prevalence of female genital mutilation/cutting (FGM/C) across Tanzania. The data from the 2004, 2010, and 2016 Tanzania Demographic Health Surveys were used in this analysis. The estimates from multilevel variance components for FGM/C were compared before and after adjusting for socioeconomic variables (residence, marital status, education, and wealth quintile) and age. The three-level structure of the sample sorted women into individual (level-1), neighborhood (level-2), and regional (level-3) categories. The pooled data included a total of 27587 women of reproductive age with a median age (IQR) of 29 (21–36) years. The random-effects results revealed that of the total age-adjusted variance in FGM/C, 76.7% was attributed to the between region and neighborhood differences. Despite the large between region variations, only 3.7% was explained by socioeconomic factors. Despite the large contribution of between region and neighborhood differences to variance in FGM/C prevalence, less of this variation was explained by socioeconomic factors. Therefore, it is possible that maternal and reproductive educational programs tailored to such neighborhood differences, beyond socioeconomic factors alone, could contribute to a radical shift in perspective for regions with high prevalence.
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Farouki L, El-Dirani Z, Abdulrahim S, Akl C, Akik C, McCall SJ. The global prevalence of female genital mutilation/cutting: A systematic review and meta-analysis of national, regional, facility, and school-based studies. PLoS Med 2022; 19:e1004061. [PMID: 36048881 PMCID: PMC9436112 DOI: 10.1371/journal.pmed.1004061] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Female genital mutilation/cutting (FGM/C) is a nonmedical procedure entailing the modification of the external female genitalia. A description of the prevalence and distribution of FGM/C allows the tracking of progress toward ending FGM/C by 2030 (Sustainable Development Goal (SDG): target 5.3). This systematic review aimed to examine FGM/C prevalence and types, by World Health Organization (WHO) region and country. METHODS AND FINDINGS A systematic search using Medical Subject Headings (MeSH) and keywords from 2009 to March 24, 2022 was undertaken in MEDLINE, PubMED, PsycINFO, Web of Science, and Embase to identify studies presenting FGM/C prevalence. Abstract and full-text screening, quality assessment, and data extraction were undertaken by 2 reviewers. Only nationally representative studies were included in the meta-analysis. Pooled FGM/C prevalence was estimated by random-effects meta-analysis using generalized linear mixed models (GLMMs). FGM/C prevalence with 95% confidence intervals (CIs), prediction intervals (PIs), and FGM/C type were presented separately by women aged 15 to 49 years and girls aged 0 to 14 years. A total of 163 studies met the inclusion criteria and 30 were included in the meta-analysis, of which 23 were from the WHO African Region (AFR), 6 from the Eastern Mediterranean Region (EMR), and 1 from the South East Asian Region (SEAR). These studies included data from 406,068 women across 30 countries and 296,267 girls across 25 countries; the pooled prevalence estimate of FGM/C among women aged 15 to 49 years was 36.9% (95% CI: 19.6% to 58.3%; PI: 0.4% to 99.0%), and 8.27% (95% CI: 3.7% to 17.3%; PI: 0.1% to 89.3%) among girls aged 0 to 14 years. Among included countries, this gave a total estimated prevalence of 84,650,032 women (95% CI: 45,009,041 to 133,834,224) and 13,734,845 girls with FGM/C (95% CI: 6,211,405 to 28,731,901). Somalia had the highest FGM/C prevalence among women (99.2%), and Mali had the highest among girls (72.7%). The most common type of FGM/C among women was "flesh removed" (Type I or II) in 19 countries. Among girls, "not sewn closed" (Type I, II, or IV) and "flesh removed" (Type I or II) were the most common types in 8 countries, respectively. Among repeated nationally representative studies, FGM/C decreased for both women and girls in 26 countries. The main limitation of the study methodology is that estimates were based on available published data, which may not reflect the actual global prevalence of FGM/C. CONCLUSIONS In this study, we observed large variation in FGM/C prevalence between countries, and the prevalence appears to be declining in many countries, which is encouraging as it minimizes physical and physiological harm for a future generation of women. This prevalence estimate is lower than the actual global prevalence of FGM/C due to data gaps, noncomparable denominators, and unavailable surveys. Yet, considerable policy and community-level interventions are required in many countries to meet the SDG target 5.3. TRIAL REGISTRATION Registration: CRD42020186937.
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Affiliation(s)
- Leen Farouki
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Zeinab El-Dirani
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sawsan Abdulrahim
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Christelle Akl
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Chaza Akik
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Stephen J. McCall
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Jones GL, Mitchell CA, Hirst JE, Anumba DOC. Understanding the relationship between social determinants of health and maternal mortality: Scientific Impact Paper No. 67. BJOG 2022; 129:1211-1228. [PMID: 35139580 DOI: 10.1111/1471-0528.17044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Within this document we use the terms pregnant woman and women's health. However, it is important to acknowledge that it is not only people who identify as women for whom it is necessary to access care. Obstetric and gynaecology services and delivery of care must therefore be appropriate, inclusive and sensitive to the needs of those individuals whose gender identity does not align with the sex they were assigned at birth.
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Affiliation(s)
| | | | - Jane E Hirst
- Royal College of Obstetricians and Gynaecologists, London, UK
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Abidogun TM, Alyssa Ramnarine L, Fouladi N, Owens J, Abusalih HH, Bernstein J, Aboul-Enein BH. Female genital mutilation and cutting in the Arab League and diaspora: A systematic review of preventive interventions. Trop Med Int Health 2022; 27:468-478. [PMID: 35348264 DOI: 10.1111/tmi.13749] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Female Genital Mutilation and Cutting (FGM/C) is an act of gender-based violence (GBV) and a global public health issue with well-documented adverse outcomes. With the rise in global migration, there is an increasing prevalence of FGM/C among Arab diaspora living in the West and Global South. What remains unclear is how to reduce the practice. This study was designed to identify interventions exerting an effect on reducing the practice of FGM/C. METHODS A systematic review of peer-reviewed articles was conducted on interventions targeting individuals and/or the broader community to prevent FGM/C within the Arab League and its diaspora, up to December 2021. Databases searched included PubMed, Medline, Web of Science, PsycINFO, EMBASE, CINAHL, BIOSIS, ASSIA and Scopus. Quality assessment used the Mixed Methods Appraisal Tool (MMAT) 2018. RESULTS Twelve of 896 studies met the inclusion criteria. Eight interventions relied entirely on education with short-term gains but unchanged practices. Three interventions used social marketing and mixed media. Only one study took a multi-sectoral approach. CONCLUSIONS At a macro level, opportunities to reduce or to end the practice of FGM/C exist through legislation, policy, a public health approach grounded in gender equality and human rights. Using multi-sectoral actions that consider the social context and challenge social norms at macro, meso and micro levels appears more effective than individual-level interventions. Promoting advocacy and developing supportive environments to reduce GBV, enhance gender equality and empower communities is crucial for interventions to succeed and achieve the Sustainable Development Goal target of FGM/C abandonment by 2030.
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Affiliation(s)
- Tolulope M Abidogun
- School of Public Health, Department of Health Policy & Management, University of Maryland, College Park, Maryland, USA
| | - Leah Alyssa Ramnarine
- School of Public Health, Department of Health Policy & Management, University of Maryland, College Park, Maryland, USA
| | - Negin Fouladi
- School of Public Health, Department of Health Policy & Management, University of Maryland, College Park, Maryland, USA
| | - Janine Owens
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Howeida H Abusalih
- Epidemiology Program, College of Health Sciences and Rehabilitation, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Joshua Bernstein
- A.T. Still University of Health Sciences, Kirksville, Missouri, USA
| | - Basil H Aboul-Enein
- Department of Health Science, College of Health & Wellness, Johnson & Wales University, Providence, Rhode Island, USA.,Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Martínez‐Linares JM, López‐Entrambasaguas OM, Fernández‐Medina IM, Berthe‐Kone O, Fernández‐Sola C, Jiménez‐Lasserrotte MDM, Hernández‐Padilla JM, Canet‐Vélez O. Lived experiences and opinions of women of sub‐Saharan origin on female genital mutilation: A phenomenological study. J Clin Nurs 2022; 32:2547-2558. [PMID: 35312126 DOI: 10.1111/jocn.16294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to describe and understand the lived experiences and opinions of sub-Saharan women living in Spain in relation to female genital mutilation. BACKGROUND Female genital mutilation is a bloody procedure with serious consequences for the health of women and girls. Understanding mutilated women's lived experiences plays a crucial role in the management of health consequences and could help healthcare professionals to provide assistance to these women. DESIGN A descriptive phenomenological study was carried out. The COREQ checklist was followed as guidance to write the manuscript. METHODS A total of 12 in-depth interviews were conducted. Interviews were recorded, transcribed and analysed using ATLAS.ti 9.0. RESULTS Two themes with four subthemes were identified from the data analysis: 1) 'The traumatic experience of female circumcision' with the subthemes 'Female mutilation is a physical and psychological torture procedure' and 'recognising and coping with negative emotions'; 2) 'The fight for the eradication of female genital mutilation' which contains the subthemes 'the need for a real sociocultural change at the origin' and '"I want to be the last": Personal development leads to sociocultural change'. CONCLUSIONS Female genital mutilation was experienced by women as a very aggressive and traumatic event. It causes considerable negative emotions that last over time. Although there is a tendency to reject the practice, in women's countries of origin, there is social pressure for girls to be mutilated. RELEVANCE TO CLINICAL PRACTICE Caring for women who have suffered from female genital mutilation requires awareness of the traumatic experience they underwent when they were girls. Healthcare professionals play a crucial role in eradicating female genital mutilation. Apart from education, preventive measures may include specific recommendations when girls are travelling to the country of origin and participatory action research.
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Affiliation(s)
| | | | | | - Ousmane Berthe‐Kone
- Surgical Critical Resuscitation Ward Torrecárdenas University Hospital Almeria Spain
| | - Cayetano Fernández‐Sola
- Nursing, Physiotherapy and Medicine Department University of Almería Almería Spain
- Faculty of Health Sciences Autonomous University of Chile Santiago Chile
| | | | | | - Olga Canet‐Vélez
- Nursing Department Faculty of Health Sciences Blanquerna University Ramon Llull Barcelona Spain
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Kartal YA, Yazici S. Female genital mutilation: Experiences, attitudes and perceptions of Somali female students living in Turkey. Perspect Psychiatr Care 2021; 57:1937-1943. [PMID: 33749836 DOI: 10.1111/ppc.12769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/28/2021] [Accepted: 02/24/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study aimed to investigate the experiences, attitudes, and perceptions of Somali female students regarding female genital mutilation/cutting (FGM/C). DESIGN AND METHODS One hundred seventeen Somali female students participated in this qualitative study. The data were collected in semi-structured focus group interviews. FINDINGS It was determined that most (49.9%) of these girls were exposed to type-2 FGM/C. Eighty-eight percent of the girls participating in the study stated that they support the continuation of this practice in future generations. PRACTICE IMPLICATIONS For risk groups in Turkey, organizing health education programs, training healthcare professionals in Turkey about FGM/C, and creating awareness are recommended.
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Affiliation(s)
- Yasemin A Kartal
- Department of Midwifery, Faculty of Health Sciences, University of Health Sciences, Istanbul, Turkey
| | - Saadet Yazici
- Department of Midwifery, Faculty of Health Sciences, University of Health Sciences, Istanbul, Turkey
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12
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Akinsulure-Smith AM, Wong T, Min M. Addressing Female Genital Cutting among service providers in New York. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2021; 52:202-212. [PMID: 34556896 DOI: 10.1037/pro0000381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Tracy Wong
- Brooklyn College. City University of New York
| | - Moonkyung Min
- The City College of New York, City University of New York
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13
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Mohamud A, Qureshi Z, de Wildt G, Jones L. Exploring Perceptions of Female Genital Mutilation/Cutting Abandonment (FGM/C) in Kenyan Health Care Professionals. QUALITATIVE HEALTH RESEARCH 2021; 31:1976-1989. [PMID: 34085846 PMCID: PMC8552390 DOI: 10.1177/10497323211015967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Female genital mutilation/cutting (FGM/C) remains a global problem. We aimed to explore Kenyan health care professionals' (HCPs) perceptions of FGM/C abandonment and, in particular, those focused on those serving Maasai communities who continue to practice FGM/C. Using a grounded theory Straussian approach, 18 interviews were conducted with HCPs in Kajiado County, Kenya, to understand perceptions of FGM/C as a cultural practice, identify barriers and facilitators to abandonment, and explore attitudes to medicalization (FGM/C conducted by HCPs) and alternatives of FGM/C. Within a substantive theory, one core category ("FGM/C persists but can be abandoned") comprised two subcategories: "exploring the influencers of persistence" and the "roadmap to abandonment." HCPs believed collaborative multilateral efforts were necessary to support successful abandonment and that "enlightening" the community needed to focus on changing the perception of FGM/C as a social norm alongside a health risk educational approach. Future effective intervention is needed to support the abandonment of FGM/C in Kenya.
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Affiliation(s)
- Ayaan Mohamud
- University of Birmingham, Birmingham, United Kingdom
| | | | | | - Laura Jones
- University of Birmingham, Birmingham, United Kingdom
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14
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Surgical management of female genital mutilation-related morbidity: A scoping review. J Plast Reconstr Aesthet Surg 2021; 74:2467-2478. [PMID: 34219039 DOI: 10.1016/j.bjps.2021.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Over 200 million women and girls worldwide have suffered from the partial to total removal of external female genitalia for nonmedical purposes, referred to as female genital mutilation (FGM). Survivors of FGM may develop debilitating physical and psychological long-term sequelae. This is the first study to examine the scope of the extant surgical literature on the management of FGM-related morbidity. METHODS A systematic scoping review of five major research citation databases was conducted. RESULTS A total of 190 articles from 29 countries met the inclusion criteria. The majority (76%) were primary source articles and from obstetrics and gynecology literature (71%). Reported interventions for FGM-related morbidity were defibulation, cyst excision, clitoral and vulvar reconstruction, urological reconstruction, peripartum procedures, labial adhesion release, and reinfibulation. CONCLUSIONS Surgery for FGM complications spans multiple specialties, which suggests multidisciplinary collaboration benefit. Plastic and reconstructive surgeons have a clear role in the multidisciplinary care team for these patients. This scoping review identified a paucity of high-quality evidence with respect to functional quality of life outcomes and long-term follow-up.
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Shabila NP. Changes in the prevalence and trends of female genital mutilation in Iraqi Kurdistan Region between 2011 and 2018. BMC WOMENS HEALTH 2021; 21:137. [PMID: 33794859 PMCID: PMC8017769 DOI: 10.1186/s12905-021-01282-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/25/2021] [Indexed: 11/29/2022]
Abstract
Background Female genital mutilation (FGM) is commonly practiced in Iraqi Kurdistan Region, where there are extensive efforts to combat the practice over the last decade. This study aimed to determine the trends and changes in the FGM prevalence in Iraq between 2011 and 2018 and assess their associated factors. Methods Secondary data analysis of the Iraq Multiple Indicator Cluster Survey 2011 and 2018 was carried out to calculate the prevalence and the relative changes in the prevalence of FGM for 2011 and 2018 by governorate. The change in the prevalence was compared with the changes in other exposure variables such as age, education level, wealth, and area of residence over the same period. Results The prevalence of FGM in 2018 was high in Erbil and Suleimaniya governorates (50.1% and 45.1%). The prevalence of FGM decreased remarkably from 2011 to 2018 in all governorates of the Iraqi Kurdistan Region. The decrease in the prevalence was statistically significant in Erbil and Suleimaniya. FGM prevalence declined remarkably in all age, education level, residence area groups, and most economic level groups. Such decline was associated with a significant increase in the education level, wealth, and urban residence. The decline was highest in the younger age groups, with a relative change of − 43.0% among 20–24 years and − 39.2% among 15–19 years. The decline was also highest in those with secondary and higher education (relative change = −32%). The decline was higher in rural areas than in urban areas (relative change = −35.3% and − 27.4%, respectively). The decline was higher among the poorest and second wealth quintile (relative change = −38.8% and − 27.2%, respectively). Conclusion The trend of FGM in Iraqi Kurdistan Region declined remarkably and significantly from 2011 to 2018. Further decline is predicted because of having lower rates and a higher decline in the younger age groups. However, the rates remained high in Erbil and Suleimaniya governorates that need further intensifying the preventive measures. The education level of women plays a primary role in decreasing the prevalence and should be considered in future efforts to ban the practice.
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Affiliation(s)
- Nazar P Shabila
- Department of Community Medicine, Hawler Medical University, Erbil, Iraq.
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Akweongo P, Jackson EF, Appiah-Yeboah S, Sakeah E, Phillips JF. It's a woman's thing: gender roles sustaining the practice of female genital mutilation among the Kassena-Nankana of northern Ghana. Reprod Health 2021; 18:52. [PMID: 33648528 PMCID: PMC7923333 DOI: 10.1186/s12978-021-01085-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/24/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The practice of female genital mutilation (FGM/C) in traditional African societies is grounded in traditions of patriarchy that subjugate women. It is widely assumed that approaches to eradicating the practice must therefore focus on women's empowerment and changing gender roles. METHODS This paper presents findings from a qualitative study of the FGM/C beliefs and opinions of men and women in Kassena-Nankana District of northern Ghana. Data are analyzed from 22 focus group panels of young women, young men, reproductive age women, and male social leaders. RESULTS The social systemic influences on FGM/C decision-making are complex. Men represent exogenous sources of social influence on FGM/C decisions through their gender roles in the patriarchal system. As such, their FGM/C decision influence is more prominent for uncircumcised brides at the time of marriage than for FGM/C decisions concerning unmarried adolescents. Women in extended family compounds are relatively prominent as immediate sources of influence on FGM/C decision-making for both brides and adolescents. Circumcised women are the main source of social support for the practice, which they exercise through peer pressure in concert with co-wives. Junior wives entering a polygynous marriage or a large extended family are particularly vulnerable to this pressure. Men are less influential and more open to suggestions of eliminating the practice of FGM/C than women. CONCLUSION Findings attest to the need for social research on ways to involve men in the promotion of FGM/C abandonment, building on their apparent openness to social change. Investigation is also needed on ways to marshal women's social networks for offsetting their extended family familial roles in sustaining FGM/C practices.
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Affiliation(s)
| | - Elizabeth F Jackson
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Evelyn Sakeah
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Upper East Region, Ghana
| | - James F Phillips
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
- School of Public Health, Columbia University, New York, NY, USA
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Essén B, Mosselmans L. How to ensure policies and interventions rely on strong supporting facts to improve women's health: The case of female genital cutting, using Rosling's Factfulness approach. Acta Obstet Gynecol Scand 2021; 100:579-586. [PMID: 33305361 PMCID: PMC8248391 DOI: 10.1111/aogs.14059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022]
Abstract
Rosling et al’s book Factfulness aims to inspire people to use strong supporting facts in their decision‐making, with 10 rules of thumb to fight dramatic instincts. In this paper, the Factfulness framework is applied to female genital cutting (FGC), in order to identify possible biases and promote evidence‐based thinking in studies on FGC, clinical guidelines on management of FGC, and interventions aimed at abolishing FGC. The Factfulness framework helps to acknowledge that FGC is not a uniform practice and helps address that variability. This framework also highlights the importance of multidisciplinarity to understand causalities of the FGC issue, which the authors argue is essential. This paper highlights the fact that FGC is a dynamic practice, with changes in the practice that are ongoing, and that those changes are different in different contexts. The “zero tolerance” discourses on FGC fail to acknowledge this. Factfulness encourages us to be more critical of methodologies used in the area of FGC, for example when estimating girls at risk of FGC in migration contexts. Factfulness provides the tools to calculate risks rather than judgments based on fear. This may help limit stigmatization of women with FGC and to allocate resources to health problems of migrant women based on real risks. The framework also calls for more research and production of less biased facts in the field of FGC, in order to improve interventions aimed at abolishing FGC, and clinical guidelines for the treatment of FGC. Factfulness is a useful and structured foundation for reflection over constructs, biases and disputes surrounding FGC, and can help improve the quality of future evidence‐based interventions and education that address the actual needs of women with FGC and girls at risk of FGC.
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Affiliation(s)
- Birgitta Essén
- Department of Women's and Children's Health/IMCH, Uppsala University, Uppsala, Sweden
| | - Luce Mosselmans
- Department of Women's and Children's Health/IMCH, Uppsala University, Uppsala, Sweden
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Powell RA, Yussuf M. Medical narrative and religious norm driving cut type and medicalization changes in female genital mutilation/cutting in Somaliland. Health Care Women Int 2021; 43:722-745. [PMID: 33395365 DOI: 10.1080/07399332.2020.1853730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The authors' aim was to examine if the nature of female genital mutilation/cutting (FGM/C) in Somaliland is changing and any contributing factors. In this mixed method qualitative study the researchers used 24 focus groups, 20 key informant interviews and 28 in-depth interviews with multiple stakeholders. We found a shift from the pharaonic to Sunna cut, an age decrease at which FGM/C is performed and an increase in its medicalization. Shift in cut type and medicalization appears to be partly a response to the medical narrative of anti-FGM/C campaigns, partly an intertwining of messaging regarding health risks and religious norms. We recommend a need to consider programs that reflect upon the utility and appropriateness of moving the dominant narrative to issues around the right to bodily integrity and bodily autonomy, and melding that messaging with the Islamic discourse on protecting health that focuses on collective welfare.
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Weny K, Silva R, Snow R, Legesse B, Diop N. Towards the elimination of FGM by 2030: A statistical assessment. PLoS One 2020; 15:e0238782. [PMID: 33021973 PMCID: PMC7537854 DOI: 10.1371/journal.pone.0238782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 08/24/2020] [Indexed: 12/28/2022] Open
Abstract
In 2015, UN member states committed to eliminate female genital mutilation (FGM) by 2030 as part of the Sustainable Development Agenda. To reach this goal, interventions need to be targeted and guided by the best available evidence. To date, however, estimates of the number of girls and women affected by FGM and their trends over time and geographic space have been limited by the availability, specificity and quality of population-level data. We present new estimates based on all publicly available nationally representative surveys collected since the 1990s that contain both information on FGM status and on the age at which FGM occurred. Using survival analysis, we generate estimates of FGM risk by single year of age for all countries with available data, and for rural and urban areas separately. The likelihood of experiencing FGM has decreased at the global level, but progress has been starkly uneven between countries. The available data indicate no progress in reducing FGM risk in Gambia, Guinea-Bissau, Mali and Guinea. In addition, rural and urban areas have diverged over the last two decades, with FGM declining more rapidly in urban areas. We describe limitations in the availability and quality of data on FGM occurrence and age-at-FGM. Based on current trends, the SDG goal of eliminating FGM by 2030 is out of reach, and the pace at which the practice is being abandoned would need to accelerate to eliminate FGM by 2030. The heterogeneity in trends between countries and rural vs urban areas offers an opportunity to contrast countries where FGM is in rapid decline and explore potential policy lessons and programmatic implications for countries where the practice of FGM appears to remain entrenched.
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Affiliation(s)
- Kathrin Weny
- Technical Division, United Nations Population Fund, New York, New York, United States of America
- * E-mail:
| | - Romesh Silva
- Technical Division, United Nations Population Fund, New York, New York, United States of America
| | - Rachel Snow
- Technical Division, United Nations Population Fund, New York, New York, United States of America
| | - Berhanu Legesse
- Technical Division, United Nations Population Fund, New York, New York, United States of America
| | - Nafissatou Diop
- Technical Division, United Nations Population Fund, New York, New York, United States of America
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Batyra E, Coast E, Wilson B, Cetorelli V. The socioeconomic dynamics of trends in female genital mutilation/cutting across Africa. BMJ Glob Health 2020; 5:e003088. [PMID: 33051284 PMCID: PMC7554470 DOI: 10.1136/bmjgh-2020-003088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/31/2020] [Accepted: 08/16/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The majority of women who undergo female genital mutilation/cutting (FGM/C) live in Africa. Although the UN Sustainable Development Goals call for intensified efforts to accelerate the abandonment of FGM/C, little is known about where in Africa the declines in prevalence have been fastest and whether changes in prevalence differ by women's socioeconomic status. METHODS We use data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys for 23 African countries, collected between 2002 and 2016, and covering 293 170 women. We reconstruct long-term cohort trends in FGM/C prevalence spanning 35 years, for women born between 1965 and 1999. We compute absolute and relative changes in FGM/C prevalence and differentials in prevalence by women's education and urban-rural residence. We examine whether socioeconomic differences in FGM/C are converging or diverging. FINDINGS FGM/C prevalence has declined fastest (in relative terms) in countries with lower initial prevalence, and more slowly in countries with higher initial prevalence. Although better-educated women and those living in urban areas tend to have lower prevalence, in some countries the opposite pattern is observed. Socioeconomic differentials in FGM/C have grown in the majority of countries, particularly in countries with moderate-to-higher overall prevalence. CONCLUSIONS The documented relationship between absolute and relative FGM/C prevalence rates suggests that in settings with higher initial prevalence, FGM/C practice is likely to be more entrenched and to change more slowly. There is substantial variation between countries in socioeconomic differentials in prevalence and their changes over time. As countries change from higher to lower overall prevalence, socioeconomic inequalities in FGM/C are increasing.
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Affiliation(s)
- Ewa Batyra
- Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ernestina Coast
- Department of International Development, London School of Economics and Political Science, London, UK
| | - Ben Wilson
- Department of Methodology, London School of Economics and Political Science, London, UK
- Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Valeria Cetorelli
- Headquarters, United Nations Relief and Works Agency for Palestine Refugees in the Near East, Amman, Jordan
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Azeze GA, Williams A, Tweya H, Obsa MS, Mokonnon TM, Kanche ZZ, Fite RO, Harries AD. Changing prevalence and factors associated with female genital mutilation in Ethiopia: Data from the 2000, 2005 and 2016 national demographic health surveys. PLoS One 2020; 15:e0238495. [PMID: 32881931 PMCID: PMC7470370 DOI: 10.1371/journal.pone.0238495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/18/2020] [Indexed: 11/18/2022] Open
Abstract
Setting Female genital mutilation (FGM) is a traditional surgical modification of the female genitalia comprising all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for cultural or nontherapeutic reasons. It can be harmful and violates girls’ and women’s human rights. FGM is a worldwide problem but mainly practiced in Africa. FGM is still widely practiced in Ethiopia despite being made a criminal offence in 2004. Objective Using data from three Ethiopian Demographic Health Surveys (EDHS) conducted in 2000, 2005 and 2016 the objective was to assess changes in prevalence of FGM and associated factors among women of reproductive age and their daughters. Methods EDHS datasets for the three surveys included data on FGM prevalence and socio-demographic factors. After weighting, the data were analysed using frequencies, proportions and the chi square test for trend. Categorical variables associated with FGM in 2016 were compared using OpenEpi and presented as prevalence ratios (Pr) with 95% Confidence Intervals (CI). Levels of significance were set at 5% (P<0.05). Results There was overall decline in FGM prevalence (from 79.9% to 74.3% to 65.2%, P<0.001), especially in younger women aged 15-19 years, and in the proportion of women who believed that the practice should continue (from 59.7% to 28.3% to 17.5%, P<0.001). There was also a decreasing trend of FGM in the daughters of the mothers who were interviewed, with prevalence significantly lower in mothers who had not themselves undergone FGM. Most (88.3%) women with FGM had the surgery as a child with the procedure mainly performed by a traditional circumciser (87.3%). Factors associated with higher FGM prevalence and lack of progress over the sixteen years included living in certain regions, especially Somali where FGM prevalence remained consistently >95%, lack of school education, coming from rural areas and living in less wealthy households. Conclusion Although progress has been slow, the prevalence of FGM in Ethiopia has declined over time. Recommendations to quicken the trajectory of decline targeting integrated interventions to high prevalence areas focusing on mothers, fathers, youngsters, religious leaders and schools and ensuring that all girls receive some form of education.
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Affiliation(s)
- Gedion Asnake Azeze
- Department of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
- * E-mail:
| | - Anita Williams
- Medical Department, Luxembourg Operational Research Unit (LuxOR), Médecins Sans Frontières - Operational Centre Brussels, Luxembourg, Luxembourg
| | - Hannock Tweya
- International Union against Tuberculosis and Lung Disease, Paris, France
- The Lighthouse Clinic, Lilongwe, Malawi
| | - Mohammed Suleiman Obsa
- Department of Anesthesia, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Taklu Marama Mokonnon
- Department of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Zewde Zema Kanche
- Department of Pharmacy, College of Health Science and Medicine Wolaita Sodo University, Sodo, Ethiopia
| | - Robera Olana Fite
- Department of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Anthony D. Harries
- International Union against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Prevalence and risk factors of female genital mutilation in Egypt: a systematic review. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Fite RO, Hanfore LK, Lake EA, Obsa MS. Prevalence of female genital mutilation among women in Ethiopia: A systematic review and meta-analysis. Heliyon 2020; 6:e04403. [PMID: 32743087 PMCID: PMC7385462 DOI: 10.1016/j.heliyon.2020.e04403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/07/2020] [Accepted: 07/03/2020] [Indexed: 01/11/2023] Open
Abstract
Background Female genital mutilation affects the social, psychological, spiritual and physical well-being of women. In Ethiopia, studies regarding the female genital mutilation were conducted in various settings and years. Objective This systematic review and meta-analysis was aimed to summarize the prevalence of female Genital Mutilation in Ethiopia. Methods A systematic search of articles was conducted in PubMed, African Journals Online (AJOL), Excerpta Medica database (EMBASE), SCOPUS, Web of Science, and JSTOR. Data were extracted using a standardized data extraction format prepared in Microsoft Excel. The data were analyzed using STATA version 11 software. Cochrane Q statistic was used to assess the presence of significant between-study heterogeneity. I2 was used to quantify between-study heterogeneity. A leave-one-out sensitivity analysis and subgroup analysis based on a study period and setting were done. The funnel plot and Egger's regression tests were used to measure the presence of substantial publication bias. The pooled estimated prevalence of female genital mutilation was conducted using a DerSimonian and Laird random effects model. Results The pooled prevalence estimate of FGM was 77.28% (95% CI: 55.81, 98.76). The pooled prevalence was higher in studies conducted from 2013-2017 (78.39%, 95%CI: 48.24, 108.54) and studies conducted in Hospital (92.02: 95%CI: 55.81, 98.76). Conclusion The prevalence of Female Genital Mutilation is high. Therefore, interventions that are focused on health education, social support and advocacy are recommended.
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Affiliation(s)
- Robera Olana Fite
- Department of Nursing, College of Health Sciences and Medicine, Wolaita Sodo University, Ethiopia
| | - Lolemo Kelbiso Hanfore
- Department of Nursing, College of Health Sciences and Medicine, Wolaita Sodo University, Ethiopia
| | - Eyasu Alem Lake
- Department of Nursing, College of Health Sciences and Medicine, Wolaita Sodo University, Ethiopia
| | - Mohammed Suleiman Obsa
- Department of Anesthesia, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Ameyaw EK, Tetteh JK, Armah-Ansah EK, Aduo-Adjei K, Sena-Iddrisu A. Female genital mutilation/cutting in Sierra Leone: are educated women intending to circumcise their daughters? BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2020; 20:19. [PMID: 32703226 PMCID: PMC7376916 DOI: 10.1186/s12914-020-00240-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/15/2020] [Indexed: 11/10/2022]
Abstract
Background Female genital mutilation/cutting (FGM/C) has been recognized as a gross violation of human rights of girls and women. This is well established in numerous international legal instruments. It forms part of the initiation ceremony that confers womanhood in Sierra Leone. Girls and women who are subjected to this practice are considered to be ready for marriage by their parents and communities and are rewarded with celebrations, gifts, and public recognition. Following this, we examined the relationship between education and women’s FGM/C intention for their daughters in Sierra Leone. Methods We used cross-sectional data from the women’s file of the 2013 Sierra Leone Demographic and Health Survey (SLDHS) to explore the influence of education on FGM/C intention among women in the reproductive age (15–49). A sample of 6543 women were included in the study. Our analysis involved descriptive computation of education and FGM/C intention. This was followed by a two-level multilevel analysis. Fixed effect results were reported as Odds Ratios and Adjusted Odds Ratios with their respective credible intervals (CrIs) whilst results of the random effects were presented as variance partition coefficients and median odds ratios. Results Our findings showed that women who had no formal education were more likely to intend to circumcise their daughters [aOR = 4.3, CrI = 2.4–8.0]. Among the covariates, women aged 20–24 [aOR = 2.3, CrI = 1.5–3.4] were more likely to intend to circumcise their daughters compared to women between 45 and 49 years old. Poorest women were more likely to report intention of circumcising their daughters in the future compared with the richest [aOR = 2.1, CrI = 1.3–3.2]. We noted that, 63.3% of FGM/C intention in Sierra Leone is attributable to contextual factors. Conclusion FGM/C intention is more common among women with no education, younger women as well as women in the lowest wealth category. We recommend segmented female-child educational and pro-poor policies that target uneducated women in Sierra Leone. The study further suggests that interventions to end FGM/C need to focus on broader contextual and social norms in Sierra Leone.
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Affiliation(s)
- Edward Kwabena Ameyaw
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | - Justice Kanor Tetteh
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer Kwesi Armah-Ansah
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Kofi Aduo-Adjei
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Cappa C, Thomson C, Murray C. Understanding the association between parental attitudes and the practice of female genital mutilation among daughters. PLoS One 2020; 15:e0233344. [PMID: 32437387 PMCID: PMC7241784 DOI: 10.1371/journal.pone.0233344] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/03/2020] [Indexed: 12/16/2022] Open
Abstract
Female genital mutilation is a harmful traditional practice that violates girls' right to health and overall well-being. Most research cites social acceptance, marriageability, community belonging, proof of virginity, curbing promiscuity, hygiene, and religion as motivations for the practice. It is generally assumed that individual attitudes of parents and other family members have an impact on decisions related to the cutting of girls, and that such attitudes are influenced by social norms. The aim of this study is to understand how parental attitudes towards the practice of female genital mutilation influence decision making related to the cutting of girls. Data from 15 Demographic and Health Surveys were analyzed to assess whether couples with at least one living daughter aged 0 to 14 years share the same opinions about the continuation of the practice, and to what extent couples' opinions are associated with the risk of daughters being cut. The analysis reveals that a significant percentage of couples hold discordant opinions on the continuation of the practice including in countries where the practice is very common. While a daughter's likelihood of being cut is much higher when both parents think the practice should continue, the analysis also shows that many cut girls have parents who oppose the practice. It further suggests that female genital mutilation is more prevalent among daughters whose mothers want the practice to continue and whose fathers are opposed or undecided, compared to daughters with fathers who are the sole parent supporting its continuation. Understanding the extent to which parental opinions influence decisions and which girls are most likely to be cut is essential for developing appropriate interventions aimed at promoting the abandonment of the practice.
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Affiliation(s)
- Claudia Cappa
- Data and Analytics Section, Division of Data, Analytics, Planning and Monitoring, United Nations Children’s Fund, New York, NY, United States of America
- * E-mail:
| | - Claire Thomson
- Data and Analytics Section, Division of Data, Analytics, Planning and Monitoring, United Nations Children’s Fund, New York, NY, United States of America
| | - Colleen Murray
- Data and Analytics Section, Division of Data, Analytics, Planning and Monitoring, United Nations Children’s Fund, New York, NY, United States of America
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Bellizzi S, Say L, Rashidian A, Boulvain M, Abdulcadir J. Is female genital mutilation associated with eclampsia? Evidence from a nationally representative survey data. Reprod Health 2020; 17:68. [PMID: 32434579 PMCID: PMC7238645 DOI: 10.1186/s12978-020-00918-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 05/11/2020] [Indexed: 11/15/2022] Open
Abstract
Background Studies have shown the impact of female genital mutilation (FGM), especially infibulation (WHO type III), on reproductive health, and adverse obstetric outcomes like postpartum haemorrhage and obstructed labour. However, whether an association exists with maternal hypertensive complication is not known. The present study sought to investigate the role of the different types of FGM on the occurrence of eclampsia. Methods The study used data from the 2006 Demographic and health survey of Mali. The proportion of eclampsia in women with each type of FGM and the unadjusted and adjusted odds ratios (OR) were calculated, using women without FGM as reference group. Unadjusted and adjusted OR were also calculated for women who underwent infibulation compared to the rest of the population under study (women without FGM and women with FGM type I, II, and IV). Results In the 3997 women included, the prevalence of infibulation was 10.2% (n = 407) while 331 women did not report FGM (8.3%). The proportion of women reporting signs and symptoms suggestive of eclampsia was 5.9% (n = 234). Compared with the absence of female genital mutilation and adjusted for covariates, infibulation was associated with eclampsia (aOR 2.5; 95% CI:1.4–4.6), while the association was not significant in women with other categories of FGM. A similar aOR was found when comparing women with infibulation with the pooled sample of women without FGM and women with the other forms of FGM. Conclusion The present study suggests a possible association between infibulation and eclampsia. Future studies could investigate this association in other settings. If these findings are confirmed, the possible biological mechanisms and preventive strategies should be investigated.
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Affiliation(s)
- Saverio Bellizzi
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland.
| | - Lale Say
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Arash Rashidian
- Department of Information, Evidence and Research, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Michel Boulvain
- Department of woman, child and adolescent. Division of Gynecology, Geneva University Hospitals, Geneva, Switzerland
| | - Jasmine Abdulcadir
- Department of woman, child and adolescent. Division of Gynecology, Geneva University Hospitals, Geneva, Switzerland
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Njue C, Karumbi J, Esho T, Varol N, Dawson A. Preventing female genital mutilation in high income countries: a systematic review of the evidence. Reprod Health 2019; 16:113. [PMID: 31331357 PMCID: PMC6647166 DOI: 10.1186/s12978-019-0774-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022] Open
Abstract
Background Female genital mutilation (FGM) is prevalent in communities of migration. Given the harmful effects of the practice and its illegal status in many countries, there have been concerted primary, secondary and tertiary prevention efforts to protect girls from FGM. However, there is paucity of evidence concerning useful strategies and approaches to prevent FGM and improve the health and social outcomes of affected women and girls. Methods We analysed peer-reviewed and grey literature to extract the evidence for FGM prevention interventions from a public health perspective in high income countries by a systematic search of bibliographic databases and websites using appropriate keywords. Identified publications were screened against selection criteria, following the PRISMA guidelines. We examined the characteristics of prevention interventions, including their programmatic approaches and strategies, target audiences and evaluation findings using an apriori template. Findings Eleven documents included in this review described primary and secondary prevention activities. High income countries have given attention to legislative action, bureaucratic interventions to address social injustice and protect those at risk of FGM, alongside prevention activities that favour health persuasion, foster engagement with the local community through outreach and the involvement of community champions, healthcare professional training and capacity strengthening. Study types are largely process evaluations that include measures of short-term outcomes (pre- and post-changes in attitude, knowledge and confidence or audits of practices). There is a dearth of evaluative research focused on empowerment-oriented preventative activities that involve individual women and girls who are affected by FGM. Beattie’s framework provides a useful way of articulating negotiated and authoritative prevention actions required to address FGM at national and local levels. Conclusion FGM is a complex and deeply rooted sociocultural issue that requires a multifaceted response that encompasses socio-economic, physical and environmental factors, education and learning, health services and facilities, and community mobilisation activities. Investment in the rigorous longitudinal evaluation of FGM health prevention efforts are needed to provide strong evidence of impact to guide future decision making. A national evidence-based framework would bring logic, clarity, comprehension, evidence and economically more effective response for current and future prevention interventions addressing FGM in high income countries.
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Affiliation(s)
- Carolyne Njue
- The Australian Centre for Public and Population Health Research, Faculty of Public Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
| | | | - Tammary Esho
- Community and Public Health, Technical University of Kenya, PO Box 52428-00202, Nairobi, Kenya
| | - Nesrin Varol
- Sydney Medical School, The University of Sydney, 135 Macquarie St, Sydney, NSW, 2000, Australia
| | - Angela Dawson
- The Australian Centre for Public and Population Health Research, Faculty of Public Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
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Boghossian AS, Freebody J, Moses R, Jenkins G. Risk assessment for antenatal depression among women who have undergone female genital mutilation or cutting: Are we missing the mark? Aust N Z J Obstet Gynaecol 2019; 60:76-81. [PMID: 31197824 DOI: 10.1111/ajo.13001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although prohibited by specific legislation in Australia, patterns of global migration underscore the importance for local clinicians to recognise and manage potential complications associated with female genital mutilation/cutting (FGM/C). The incidence of antenatal depression in Australia is 10% and may be higher among those with a history of FGM/C (RANZCOG 2 statement: Perinatal Anxiety and Depression, 2012). The phenomenon of cultural embedding could represent a protective factor against an increase in mental health problems among these women. AIM To determine whether women who have undergone FGM/C are at greater risk of depression in the antenatal period as defined by the Edinburgh Postnatal Depression Scale (EPDS). MATERIALS AND METHODS A multicentre retrospective case-control study was performed. Participants who had delivered at either of two hospitals, had migrated from FGM/C-prevalent countries and who had undergone FGM/C were assessed and compared with the control group, case-matched by language and religion. RESULTS Eighty-nine cases were included with an equal number of matched controls. No significant difference in the EPDS score was demonstrated when analysed as a continuous variable (P = 0.41) or as a categorical variable with a cut-off score of 12 (P = 0.12). There was no difference in the number of women who identified as having thoughts of self-harm between the two groups. CONCLUSION There was no identified increase in the risk of antenatal depression among women who have undergone FGM/C from high-prevalence countries. Consideration must be given to the utility of the EPDS in this population, as well as factors such as cultural embedding.
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Affiliation(s)
- Araz S Boghossian
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, Australia
| | - John Freebody
- Department of Radiology, St Vincent's Hospital, Sydney, Australia
| | - Rebecca Moses
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, Australia
| | - Gregory Jenkins
- Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, Australia
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Wahlberg A, Påfs J, Jordal M. Pricking in the African Diaspora: Current Evidence and Recurrent Debates. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00198-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Jimoh AO, Adaji SE, Adelaiye H, Olorukooba AA, Bawa U, Ibrahim HI, Garba C, Mfuh AL, Idris S, Shittu SO. A cross-sectional study of traditional practices affecting maternal and newborn health in rural Nigeria. Pan Afr Med J 2019; 31:64. [PMID: 31007811 PMCID: PMC6457866 DOI: 10.11604/pamj.2018.31.64.15880] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/27/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Certain traditional practices which have negative effects on maternal and child health continue to be practiced in sub-Saharan African countries. A survey was carried out in a rural village in Nigeria to understand the scale and range of these practices. Methods This was a cross-sectional study in which trained interviewers administered pre-tested questionnaires on child-bearing women using questionnaires embedded on android devices. Results The median age of marriage and pregnancy were 15 and 16 years respectively. Home births were high (90.4%) while non-skilled birth attendant was 87.4%. The community had a son preference index ratio of 1:4.1. Up to 81.5% of mothers responded that one form of unhygienic traditional procedure or the other was performed on their children. Time to initiation of breast feeding was in hours in the majority (76.3%) of mothers, with a high rate of use of prelacteal feeds (85.2%). Being an adolescent mother (AOR 0.403, 95%CI 0.203, 0,797) and utilizing a skilled provider at birth (AOR 0.245, 95%CI 0.088, 0.683) were associated with less likelihood of having an unhygienic procedure performed on children. Conclusion The findings of our study suggest that traditional practices which could have negative effects on maternal and child health are still ongoing in the study community. Child protection laws and safeguarding principles could help to reduce these practices and would need to be developed and implemented in these settings where these practices are still prevalent.
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Affiliation(s)
| | - Sunday Enema Adaji
- Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Umma Bawa
- Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Nigeria
| | | | - Comfort Garba
- Community Midwife, CBS Research Group, PRHI, Ahmadu Bello University Zaria, Nigeria
| | - Anita Lukong Mfuh
- Department of Nursing Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Suleiman Idris
- Department of Community Medicine, Ahmadu Bello University Zaria, Nigeria
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Nabaneh S, Muula AS. Female genital mutilation/cutting in Africa: A complex legal and ethical landscape. Int J Gynaecol Obstet 2019; 145:253-257. [PMID: 30779344 DOI: 10.1002/ijgo.12792] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
While international and regional human rights instruments have recognized female genital mutilation/cutting (FGM/C) as one of the most prevalent forms of violence against women and girls, in many African states FGM/C is a deeply entrenched cultural practice. There is a consensus against FGM, as evidenced by its criminalization in several African countries. The mere fact that the practice continues despite legislative measures to protect women and girls against FGM raises the question of whether change can be legislated. The present article summarizes the trends and effectiveness of FGM criminalization in Africa, including prohibition of medicalization of FGM. Against the backdrop of emerging debate on medicalization of FGM as a harm reduction strategy, we also examine its complex legal and ethical implications. The article argues that while criminalization may not be the best means of stopping FGM, it creates an enabling environment to facilitate the overall strategy of African governments in eradication of the practice.
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Affiliation(s)
- Satang Nabaneh
- Centre for Human Rights, Faculty of law, University of Pretoria, Pretoria, South Africa
| | - Adamson S Muula
- Africa Center of Excellence in Public Health and Herbal Medicine (ACEPHEM), Department of Public Health, College of Medicine, University of Malawi, Blantyre, Malawi
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Koski A, Heymann J. Changes in support for the continuation of female genital mutilation/cutting and religious views on the practice in 19 countries. Glob Public Health 2018; 14:696-708. [PMID: 30424713 DOI: 10.1080/17441692.2018.1542016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Campaigns to end female genital mutilation/cutting (FGM/C) have been ongoing for decades. Many countries have adopted legislation that criminalises the practice and programmatic interventions aim to reduce support for it by presenting it as a violation of human rights and by highlighting associated health risks. We used Demographic and Health Survey data from 19 countries to measure national-level trends in the prevalence of FGM/C, reported support for the continuation of the practice, and the belief that it is a religious requirement among men and women. Levels and patterns in each of these outcomes vary markedly between countries. More than half of men and women born in recent years in Guinea and Mali support the continuation of the practice and believe that it is a religious requirement. Support for the continuation of FGM/C has fallen in Benin, Burkina Faso, Chad, Egypt, Ethiopia, Kenya, Senegal, and Tanzania, but has risen in Guinea, Niger, Nigeria, and Sierra Leone. The belief that FGM/C is a religious requirement is common, particularly in countries with high prevalence of cutting. Changes in support for cutting mirror those in the belief that it is a religious requirement.
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Affiliation(s)
- Alissa Koski
- a Department of Epidemiology, Biostatistics, and Occupational Health and the Institute for Health and Social Policy , McGill University , Quebec , Canada
| | - Jody Heymann
- b WORLD Policy Analysis Center, UCLA Fielding School of Public Health , Los Angeles , USA
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Gibson MA, Gurmu E, Cobo B, Rueda MM, Scott IM. Indirect questioning method reveals hidden support for female genital cutting in South Central Ethiopia. PLoS One 2018; 13:e0193985. [PMID: 29718908 PMCID: PMC5931472 DOI: 10.1371/journal.pone.0193985] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 02/21/2018] [Indexed: 11/19/2022] Open
Abstract
Female genital cutting (FGC) has major implications for women’s physical, sexual and psychological health, and eliminating the practice is a key target for public health policy-makers. To date one of the main barriers to achieving this has been an inability to infer privately-held views on FGC within communities where it is prevalent. As a sensitive (and often illegal) topic, people are anticipated to hide their true support for the practice when questioned directly. Here we use an indirect questioning method (unmatched count technique) to identify hidden support for FGC in a rural South Central Ethiopian community where the practice is common, but thought to be in decline. Employing a socio-demographic household survey of 1620 Arsi Oromo adults, which incorporated both direct and indirect direct response (unmatched count) techniques we compare directly-stated versus privately-held views in support of FGC, and individual variation in responses by age, gender and education and target female (daughters versus daughters-in-law). Both genders express low support for FGC when questioned directly, while indirect methods reveal substantially higher acceptance (of cutting both daughters and daughters-in-law). Educated adults (those who have attended school) are privately more supportive of the practice than they are prepared to admit openly to an interviewer, indicating that education may heighten secrecy rather than decrease support for FGC. Older individuals hold the strongest views in favour of FGC (particularly educated older males), but they are also more inclined to conceal their support for FGC when questioned directly. As these elders represent the most influential members of society, their hidden support for FGC may constitute a pivotal barrier to eliminating the practice in this community. Our results demonstrate the great potential for indirect questioning methods to advance knowledge and inform policy on culturally-sensitive topics like FGC; providing more reliable data and improving understanding of the “true” drivers of FGC.
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Affiliation(s)
- Mhairi A. Gibson
- Department of Archaeology and Anthropology, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Eshetu Gurmu
- Centre for Population Studies & Institute of Development and Policy Research, Addis Ababa University, Addis Ababa, Ethiopia
| | - Beatriz Cobo
- Department of Statistics and Operational Research, Science Faculty, University of Granada, Granada, Spain
| | - María M. Rueda
- Department of Statistics and Operational Research, Science Faculty, University of Granada, Granada, Spain
| | - Isabel M. Scott
- Department of Archaeology and Anthropology, University of Bristol, Bristol, United Kingdom
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Todkari N. Female genital mutilation: an update for primary health-care professionals. J Prim Health Care 2018; 10:110-113. [DOI: 10.1071/hc18017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
Female genital mutilation (FGM) has historically been seen as a health concern limited to women living in other parts of the world. However, with the rising number of migrants, refugees and asylum seekers, countries like New Zealand, Australia and Europe have seen a surge in the number of women and girls affected by FGM seeking medical care. This topic is increasingly becoming relevant to primary health-care providers in this country and therefore a good understanding of this practice is important.
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