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Inghels J, Van de Velde S, Biegel N, Kimani S, Van Eekert N. The medicalisation of female genital cutting in Kenya: a threefold exposition. CULTURE, HEALTH & SEXUALITY 2024:1-17. [PMID: 38860944 DOI: 10.1080/13691058.2024.2363412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/30/2024] [Indexed: 06/12/2024]
Abstract
In Kenya, the prevalence of Female Genital Cutting (FGC) is slowly decreasing. Simultaneously, the practice is increasingly being performed by healthcare providers rather than traditional circumcisers, which may pose the risk of legitimising the practice. To date, the underlying mechanisms remain poorly understood. Using the 1998, 2008-09, and 2014 Kenyan Demographic Health Surveys, this study aims to enhance understanding by mapping both FGC prevalence and medicalisation rates across birth cohorts and ethnic groups. Additionally, the study delves into data from the Kisii community, where FGC medicalisation is particularly high, to examine the association between medicalisation and a mother's social position, as she is typically the primary decision-maker regarding the practice. Findings reveal that the coexisting trends of decreasing prevalence and increasing medicalisation exhibit significant ethnic variation. Among the Kisii, greater wealth is associated with higher odds of a medicalised cut compared to a traditional cut, while higher education and media use are linked to higher odds of not undergoing cutting at all compared to a medicalised cut. Our findings nuance the international community's premise that the medicalisation of FGC hinders the eradication of the practice.
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Affiliation(s)
- Jolien Inghels
- Centre for Population, Family, and Health, Department of Sociology, University of Antwerp, Antwerp, Belgium
- FWO, Fonds Wetenschappelijk Onderzoek, Research Foundation Flanders, Brussels, Belgium
| | - Sarah Van de Velde
- Centre for Population, Family, and Health, Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Naomi Biegel
- Centre for Population, Family, and Health, Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Samuel Kimani
- African Coordinating Centre for Abandonment of FGM/C, University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - Nina Van Eekert
- Centre for Population, Family, and Health, Department of Sociology, University of Antwerp, Antwerp, Belgium
- FWO, Fonds Wetenschappelijk Onderzoek, Research Foundation Flanders, Brussels, Belgium
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Ahinkorah BO, Budu E, Seidu AA, Agbaglo E, Adu C, Ameyaw EK, Ajayi AI, Yaya S. Female genital mutilation/cutting among girls aged 0-14: evidence from the 2018 Mali Demographic and Health Survey data. BMC Womens Health 2024; 24:180. [PMID: 38491504 PMCID: PMC10943842 DOI: 10.1186/s12905-024-02940-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/30/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Female genital mutilation/cutting (FGM/C) is considered a social norm in many African societies, with varying prevalence among countries. Mali is one of the eight countries with very high prevalence of FGM/C in Africa. This study assessed the individual and contextual factors associated with female FGM/C among girls aged 0-14 years in Mali. METHODS We obtained data from the 2018 Mali Demographic and Health Survey. The prevalence of FGM/C in girls was presented using percentages while a multilevel binary logistic regression analysis was conducted to assess the predictors of FGM/C and the results were presented using adjusted odds ratios with associated 95% confidence intervals (CIs). RESULTS The results indicate that more than half (72.7%, 95% CI = 70.4-74.8) of women in Mali with daughters had at least one daughter who has gone through circumcision. The likelihood of circumcision of girls increased with age, with women aged 45-49 having the highest odds compared to those aged 15-19 (aOR = 17.68, CI = 7.91-31.79). A higher likelihood of FGM/C in daughters was observed among women who never read newspaper/magazine (aOR = 2.22, 95% CI = 1.27-3.89), compared to those who read newspaper/magazine at least once a week. Compared to women who are not circumcised, those who had been circumcised were more likely to have their daughters circumcised (aOR = 53.98, 95% CI = 24.91-117.00). CONCLUSION The study revealed the age of mothers, frequency of reading newspaper/magazine, and circumcision status of mothers, as factors associated with circumcision of girls aged 0-14 in Mali. It is, therefore, imperative for existing interventions and new ones to focus on these factors in order to reduce FGM/C in Mali. This will help Mali to contribute to the global efforts of eliminating all harmful practices, such as child, early and forced marriage and female genital mutilation by 2030.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Clinical Medicine, University of New South Wales Sydney, Sydney, Australia
- REMS Consultancy Services Limited, Sekondi-Takoradi, Western region, Ghana
| | - Eugene Budu
- Korle Bu Teaching Hospital, P.O. Box, 77, Accra, Ghana
| | - Abdul-Aziz Seidu
- REMS Consultancy Services Limited, Sekondi-Takoradi, Western region, Ghana.
- Centre for Gender and Advocacy, Takoradi Technical University, P.O. Box 256, Takoradi, Ghana.
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia.
| | - Ebenezer Agbaglo
- Department of English and Communication, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Collins Adu
- Center for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
- L & E Research Consult Ltd, Wa, Upper West Region, Ghana
| | - Anthony Idowu Ajayi
- Sexual Reproductive Maternal Newborn Child and Adolescent Health Unit, African Population and Health Research Center, Manga Close, Off Kirawa Road, Kitisuru, Nairobi, 00100, Kenya
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, The University of Oxford, Oxford, UK
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Zsabokorszky Z, Van de Velde S, Michielsen K, Van Eekert N. Exploring the association between perceived male attitudes and female attitudes toward the discontinuation of Female Genital Mutilation/Cutting in Egypt. FRONTIERS IN SOCIOLOGY 2023; 8:1183989. [PMID: 37520496 PMCID: PMC10374422 DOI: 10.3389/fsoc.2023.1183989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023]
Abstract
Introduction There are 200 million girls and women alive worldwide that have undergone the practice of Female Genital Mutilation/Cutting (FGM/C) and 4 million girls are at risk of undergoing the practice each year. FGM/C provides no known health benefits, while puts a plethora of medical, psychological, and sexual health risks into perspective. One of the countries where the prevalence of FGM/C is the highest in the World, even though local authorities legally banned the practice in 2008, is Egypt. Within the Egyptian context, there are several complex socioeconomic, religious, and cultural drivers that influence the familial decision making of the daughters being cut. Female attitudes hold great significance in the process, because mothers and female family members are typically the prime decision makers at the daughter's circumcision. However, whilst FGM/C is often performed to enhance marriageability and address male preferences, in practicing communities there is little to no open communication between men and women about the practice, making women rely on their perceptions on FGM/C related expectations of men. Even though the connection between female and perceived male attitudes toward the discontinuation was established almost 20 years ago, since then to our knowledge little is known about the further characteristics of this association. Therefore, this study aims to explore the association between female and perceived male attitudes within families of a younger cohort and moreover attempts to provide a more layered picture of it within different levels of education. Methods To explore the relation between female and perceived male attitudes toward the discontinuation of FGM/C we conducted a 3-step binary logistic regression model. Results Our results show that women are significantly less likely to favor a continuation of FGM/C if they think men are disapproving of the practice, compared to women that think men want it to continue. The strength of this association partially varies between the different levels of education as it is less pronounced at the level of secondary education, compared to the reference group. Discussion In alignment with previous findings in the literature, women were more likely to support the discontinuation of FGM/C if they believed that men want the practice to discontinue as well and vice versa. At a higher level of secondary education however this association is less pronounced. This result concludes that the role of perceived male attitudes should be an important factor associated with female ones and studied further, and underlines the importance of education in women empowerment.
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Affiliation(s)
- Zita Zsabokorszky
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Data Science Institute, I-Biostat, Hasselt University, Hasselt, Belgium
| | - Sarah Van de Velde
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Kristien Michielsen
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Nina Van Eekert
- Centre for Population, Family and Health, Department of Sociology, University of Antwerp, Antwerp, Belgium
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Matanda DJ, Van Eekert N, Croce-Galis M, Gay J, Middelburg MJ, Hardee K. What interventions are effective to prevent or respond to female genital mutilation? A review of existing evidence from 2008-2020. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001855. [PMID: 37192150 DOI: 10.1371/journal.pgph.0001855] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/21/2023] [Indexed: 05/18/2023]
Abstract
As the final decade of acceleration towards zero new cases of Female Genital Mutilation (FGM, SDG Target 5.3) by 2030 has begun, increasing the rigour, relevance, and utility of research for programming, policy development and resource allocation is critical. This study aimed to synthesize and assess the quality and strength of existing evidence on interventions designed to prevent or respond to FGM between 2008 and 2020.The study drew on a Rapid Evidence Assessment of the available literature on FGM interventions. The quality of studies was assessed using the 'How to Note: Assessing the Strength of Evidence' guidelines published by the Foreign, Commonwealth and Development Office (FCDO) and strength of evidence using a modified Gray scale developed by the What Works Association. Of the 7698 records retrieved, 115 studies met the inclusion criteria. Of the 115 studies, 106 were of high and moderate quality and were included in the final analysis. This review shows that at the system level, legislation-related interventions must be multifaceted to be effective. Whilst all levels would benefit from more research, for the service level especially more research is needed into how the health system can effectively prevent and respond to FGM. Community-level interventions are effective for changing attitudes towards FGM, but more must be done to innovate with these interventions so that they move beyond affecting attitudes alone to creating behaviour change. At the individual level, formal education is effective in reducing FGM prevalence among girls. However, the returns of formal education in ending FGM may take many years to be realized. Interventions targeting intermediate outcomes, such as improvement in knowledge and change in attitudes and beliefs towards FGM, are equally needed at the individual level.
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Affiliation(s)
| | | | | | - Jill Gay
- What Works Association, Washington DC, United States of America
| | | | - Karen Hardee
- What Works Association, Washington DC, United States of America
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King T, Perales F, Sutherland G. Why we need population data on gender norms, and why this is important for population health. J Epidemiol Community Health 2022; 76:620-622. [PMID: 35193954 DOI: 10.1136/jech-2021-217900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/09/2022] [Indexed: 11/04/2022]
Abstract
Gender norms are essential barometers of gender equality; inequitable gender norms are indicative of core inequalities in society that undermine the health of many groups. Fundamentally embedded in the gender system, prescriptive and restrictive gender norms have been shown to have deleterious effects on the health of women, men, girls and boys, as well as gender and sexual minorities. Gender norms are mutable, and there is potential to target and transform harmful and inequitable gender norms to drive gender equality. Gender-transformative approaches are needed, but a necessary first step is to identify and benchmark restrictive and inequitable gender norms, monitor change and progress, and highlight areas where interventions can be targeted for greatest effect. Efforts to do this are currently stymied by a lack of fit-for-purpose data. Routinely collected, population representative data on gender norms is urgently needed. This is vital to supporting and progressing gender equality and will contribute substantially to lifting population health.
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Affiliation(s)
- Tania King
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Francisco Perales
- School of Social Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Georgina Sutherland
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Ahinkorah BO. Factors associated with female genital mutilation among women of reproductive age and girls aged 0-14 in Chad: a mixed-effects multilevel analysis of the 2014-2015 Chad demographic and health survey data. BMC Public Health 2021; 21:286. [PMID: 33541311 PMCID: PMC7863379 DOI: 10.1186/s12889-021-10293-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chad is one of the African countries with high prevalence of female genital mutilation (FGM). The aim of this study was to examine the factors associated with FGM among women aged 15-49 and girls aged 0-14 in Chad. METHODS Data for the study were obtained from the 2014-2015 Chad Demographic and Health Survey. FGM among women aged 15-49 and girls aged 0-14 were the outcome variables. The prevalence of FGM among women and girls were presented using percentages while a mixed-effects multilevel multivariable logistic regression analysis was carried out to assess the factors associated with FGM. The results were presented using adjusted odds ratio with associated 95% confidence intervals. RESULTS The results indicate that more than half (50.2%) of the women and 12.9% of girls in Chad had been circumcised. Among women aged 15-49, level of education, employment status, ethnicity, religion, wealth quintile and community literacy level were significant predictors of FGM. Age, partner's level of education, marital status, employment status, ethnicity, religion and mother's FGM status were associated with FGM among girls aged 0-14. CONCLUSION This study has identified several individual and contextual factors as predictors of FGM among women and girls in Chad. The findings imply the need to adopt strategies aimed at addressing these factors in order to help eliminate the practice of FGM. Government and non-governmental organisations in Chad need to implement policies that enhance media advocacy and community dialogue to help deal with FGM in the country.
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Affiliation(s)
- Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
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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] [MESH Headings] [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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Earp BD, Johnsdotter S. Current critiques of the WHO policy on female genital mutilation. Int J Impot Res 2020; 33:196-209. [PMID: 32457498 DOI: 10.1038/s41443-020-0302-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/12/2023]
Abstract
In recent years, the dominant Western discourse on "female genital mutilation" (FGM) has increasingly been challenged by scholars. Numerous researchers contest both the terminology used and the empirical claims made in what has come to be called "the standard tale" of FGM (also termed "female genital cutting" [FGC]). The World Health Organization (WHO), a major player in setting the global agenda on this issue, maintains that all medically unnecessary cutting of the external female genitalia, no matter how slight, should be banned as torture and a violation of the human right to bodily integrity. However, the WHO targets only non-Western forms of female-only genital cutting, raising concerns about gender bias and cultural imperialism. Here, we summarize ongoing critiques of the WHO's terminology, ethicolegal assumptions, and empirical claims, including the claim that non-Western FGC as such constitutes an extreme form of discrimination against women. To this end, we highlight recent comparative studies of medically unnecessary genital cutting of all types, including those affecting adult women and teenagers in Western societies, individuals with differences of sex development (DSD), transgender persons, and males. In so doing, we attempt to clarify the grounds for a growing critical consensus that current anti-FGM laws and policies may be ethically incoherent, empirically unsupportable, and legally unsustainable.
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Affiliation(s)
- Brian D Earp
- Associate Director, Yale-Hastings Program in Ethics and Health Policy, Yale University, New Haven, CT, 06511, USA. .,The Hastings Center, Garrison, New York, NY, 10524, USA.
| | - Sara Johnsdotter
- Professor of Medical Anthropology, Faculty of Health and Society, Centre for Sexology and Sexuality Studies, Malmö University, SE-205 06, Malmö, Sweden
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