The prevalence and risk of Female Genital Mutilation/Cutting among migrant women and girls in the Netherlands: An extrapolation method

Attitude and intention of migrant populations in the Netherlands regarding female genital mutilation/cutting

BACKGROUND

Due to migration, the practice female genital mutilation/cutting (FGM/C) has become an issue of concern in high-resource countries such as the Netherlands. It was therefore of utmost importance to explore the attitude and intention of migrant populations in the Netherlands towards FGM/C, which may be leveraged to promote its elimination. Therefore, the aim of the present study was to explore the attitude and intention of migrant populations in the Netherlands regarding FGM/C.

METHODS

A qualitative study design was employed using Theory of Planned Behaviour (TPB) as a framework for the analysis. Data were collected using focus-group discussions (FGDs) and individual interviews. The FGDs and individual interviews were audio-recorded and transcribed verbatim. The main topics of the interviews were based on the constructs of TPB (attitude, subjective norms, perceived behavioral control and intention). Thus, concerning the development of categories, we opted for a hybrid form using a deductive as well as an inductive approach.

RESULTS

A total of 55 participants, 15 men and 40 women (9 born in the Netherlands) participated in the study. The findings showed that as a result of migration and regardless of country of origin and gender, many participants have changed their attitudes towards the abandonment of FGM/C. None of the participants intended to have FGM/C performed on their daughters. Generally, the social pressure to perform FGM/C seems to be lower in the Netherlands when compared to the country of origin. Most participants felt confident in their ability to resist social pressure. However, some participants feared that they might succumb to social pressure or feared that their daughters would undergo FGM/C without their consent.

CONCLUSION

This study aimed to explore the attitude and intention of migration populations in the Netherlands regarding FGM/C. Our findings showed that the study participants had no intention to perform FGM/C on their daughters. As a consequence of acculturation process, interest in the practice of FGM/C could wane following migration. Nonetheless, some pressure to perform FGM/C still exists after migration. Newly arrived migrants and those more vulnerable to social pressure, may benefit from educational interventions that increases knowledge and awareness about various aspects of the practice, with an emphasis on empowering those individuals in facing social pressure.

Estimating the indirect prevalence of female genital mutilation/cutting in Switzerland

Background

We updated the indirect estimates for women and girls living with Female Genital Mutilation Cutting (FGM/C) in Switzerland, using data from the Swiss Federal Statistical Office of migrant women and girls born in one of the 30 high-prevalence FGM/C countries that are currently living in Switzerland.

Methods

We used Yoder and Van Baelen’s “Extrapolation of FGM/C Countries’ Prevalence Data” method, where we applied DHS and MICS prevalence figures from the 30 countries where FGM/C is practiced, and applied them to the immigrant women and girls living in Switzerland from the same 30 countries.

Results

In 2010, the estimated number of women and girls living with or at risk of FGM/C in Switzerland was 9059, whereas in 2018, we estimated that 21,706 women and girls were living with or at risk of FGM/C.

Conclusion

Over the past decade, there have been significant increases in the number of estimated women and girls living with or at risk of FGM/C in Switzerland due to the increase in the total number of women and girls originally coming form the countries where the practice of FGM/C is traditional.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10875-w.

Beyond illegality: Primary healthcare providers' perspectives on elimination of female genital mutilation/cutting

AIMS AND OBJECTIVES

To report primary healthcare providers' perspectives on elimination of female genital mutilation/cutting (FGM/C).

BACKGROUND

Eradication of FGM/C by 2030 is one of the United Nations Sustainable Development goals. World Health Organization recognises the unique role of nurses and other primary healthcare providers. However, their voices on the current legislative approach are underreported. These voices are important in informing directions that can expedite achievement of the global goal.

DESIGN

Qualitative interpretivist phenomenology.

METHODS

This qualitative study used purposive sampling approach and involved 19 individual interviews conducted face to face or by telephone with Australian primary healthcare providers. Data collected between October and December 2019 were transcribed verbatim and thematically analysed. Three themes exploring Australian healthcare providers' perspectives on elimination of FGM/C were identified, namely understanding Australian laws against FGM/C; perspectives on culturally sensitive education; and exploring public awareness raising activities in Australia. This study was guided by Consolidated Criteria for Reporting Qualitative Research, the checklist for qualitative studies.

RESULTS

"Understanding Australian laws against FGM/C" identified participants' knowledge that FGM/C is illegal in Australia and that mandatory reporting applies if a child is or at risk of being taken oversees for the procedure. Through "Perspectives on culturally sensitive education," the participants argued that education is the key to questioning the practice of FGM/C. "Exploring public awareness-raising activities in Australia" described the need for collective action germane to FGM/C eradication.

CONCLUSIONS

This study emphasised that laws and legislation prohibiting FGM/C need to be complemented with culturally sensitive education and public awareness-raising activities, to produce optimal outcome for the elimination of FGM/C in Australia.

RELEVANCE TO CLINICAL PRACTICE

Voices of these healthcare providers are crucial for FGM/C to be eradicated. Listening and acting on these voices are important in achieving the global sustainable development goal of eradicating FGM/C.

Female genital mutilation - a blind spot in Dutch general practice? A case-control study

BACKGROUND

Women with female genital mutilation or cutting (FGM/C) often suffer from physical and psychosexual problems related to FGM/C. As gatekeepers to the medical system, GPs are often the first to be consulted about these problems. It is as yet unknown if, and to what extent, Dutch GPs identify women with FGM/C or related health problems.

AIM

To investigate how often Dutch GPs register FGM/C and related health problems.

DESIGN & SETTING

A case-control study of anonymised patient records was performed in the Netherlands.

METHOD

Medical records were checked for information on country of origin. Records of women, aged ≥15 years, from countries where FGM/C is practised were compared with those of a case-control.

RESULTS

Although many migrants were registered with the participating GPs, information on country of origin was seldom recorded. Only 68 out of 16 700 patients were identified as women from countries where FGM/C is practised; 12 out of these 68 records contained information about the FGM/C status, but none on the type of FGM/C. There were no significant differences in health problems related to FGM/C between patients with FGM/C and the controls.

CONCLUSION

FGM/C may be a blind spot for GPs and registration of information on migration background could be improved. A larger sample in a future study is needed to confirm this finding. Given the growing global migration, awareness and knowledge on FGM/C, and other migration-related health issues should be part of GP training.

The socioeconomic dynamics of trends in female genital mutilation/cutting across Africa

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.

Estimates of female genital mutilation/cutting in the Netherlands: a comparison between a nationwide survey in midwifery practices and extrapolation-model

Background

Owing to migration, female genital mutilation or cutting (FGM/C) has become a growing concern in host countries in which FGM/C is not familiar. There is a need for reliable estimates of FGM/C prevalence to inform medical and public health policy. We aimed to advance methodology for estimating the prevalence of FGM/C in diaspora by determining the prevalence of FGM/C among women giving birth in the Netherlands.

Methods

Two methods were applied to estimate the prevalence of FGM/C in women giving birth: (I) direct estimation of FGM/C was performed through a nationwide survey of all midwifery practices in the Netherlands and (II) the extrapolation model was adopted for indirect estimation of FGM/C, by applying population-based-survey data on FGM/C in country of origin to migrant women who gave birth in 2018 in the Netherlands.

Results

A nationwide survey among primary care midwifery practices that provided care for 57.5% of all deliveries in 2018 in the Netherlands, reported 523 cases of FGM/C, constituting FGM/C prevalence of 0.54%. The indirect estimation of FGM/C in an extrapolation-model resulted in an estimated prevalence of 1.55%. Possible reasons for the difference in FGM/C prevalence between direct- and indirect estimation include that the midwives were not being able to recognize, record or classify FGM/C, referral to an obstetrician before assessing FGM/C status of women and selective responding to the survey. Also, migrants might differ from people in their country of origin in terms of acculturation toward discontinuation of the practice. This may have contributed to the higher indirect-estimation of FGM/C compared to direct estimation of FGM/C.

Conclusions

The current study has provided insight into direct estimation of FGM/C through a survey of midwifery practices in the Netherlands. Evidence based on midwifery practices data can be regarded as a minimum benchmark for actual prevalence among the subpopulation of women who gave birth in a given year.