The association between physical complications following female genital cutting and the mental health of 12-year-old Gambian girls: A community-based cross-sectional study

Serious life events and associated PTSD in Gambian girls exposed to female genital cutting

Introduction

Poor mental health, such as post-traumatic stress disorder (PTSD), has been reported after female genital cutting (FGC). However, data documenting adverse consequences of FGC have insufficiently considered confounding factors, such as other traumatising events. Here, we examined the extent to which FGC versus other serious life events disturbed Gambian girls subjected to FGC. We additionally assessed the prevalence of PTSD and the extent to which it was attributed to FGC versus other serious life events.

Methods

We conducted a cross-sectional study with a community-based sample of 12 years-old Gambian girls who had been subjected to FGC (N = 125). Using structured interviews, we assessed serious life events and probable PTSD related to the event that the girls cited as bothering them the most.

Results

Most of the girls reported several serious life events in addition to FGC, such as witnessing violence, experiencing violence or assaults, death of a close relative, and being exposed to natural disasters or serious accidents, for an average 4.5 events per girl. Around one-sixth of the girls (16.8%) stated that FGC was the event that currently bothered them the most, whereas the majority (75.2%) emphasised other experiences. The girls who said they were most troubled by other events reported more impaired daily functioning than those most bothered by FGC. Overall, we found a prevalence of probable PTSD of 19.2%. Of 24 PTSD cases, one was attributed to the experience of FGC, and the remaining 23 were attributed to other events.

Conclusion

Our findings indicate that FGC is less important than other serious life events in explaining high rates of PTSD in Gambian girls. Associations established in the field between FGC and adverse mental health must be interpreted with caution because girls who have undergone FGC may be severely exposed to other traumatising events.

Legal Awareness and Practices of Female Genital Mutilation/Cutting (FGM/C) among United Arab Emirates Medical Practitioners

Female genital mutilation/cutting (FGM/C), due to its regional occurrence, is a marginalized issue in the international arena. The aim of the study was to verify reasons for performing a procedure prohibited by international and domestic law. A cross-sectional study was conducted among nurses and doctors practicing in the UAE. The study was conducted from the 1 of January 2020 to the 31 of December 2021. The total number of recruited individuals who agreed to participate was 120, with the rate of return being 82%. About half of the participants (n = 59, 49.2%) have seen FGM/C patients in their UAE practice. Regarding medical staff, the total knowledge score concerning possible complications of the performed procedure was assessed at 64%, i.e., at a moderate level. None of our study participants had previously performed any type of FGM/C. However, 6.7% were willing to do it upon a mother's or guardian's request. About 83% of study participants stated that FGM/C should be halted internationally. Only 26.7% of the medical practitioners were aware of UAE law concerning FGM/C, while 50% had no knowledge concerning this issue. The present study reveals that cultural conditions take priority over medical knowledge, making medical practitioners inclined to accept the circumcision of girls and women. The crucial goals of future activities should focus on sensitizing society and the medical community, the need to create clear laws penalizing the practice, and the legal obligation to report the circumcision of a girl or woman.

Mental and sexual health outcomes associated with FGM/C in Africa: a systematic narrative synthesis

There are gaps in evidence regarding mental and sexual outcomes and associated interventions for women with Female Genital Mutilation/Cutting (FGM/C) living in Africa. This study employed a narrative synthesis to collate evidence on mental and sexual health outcomes. A systematic search of bibliographic databases and websites was performed using appropriate keywords and studies published in English from January 1, 2010 to March 25, 2022. 25 studies were retrieved and reported mental and sexual health complications associated with FGM/C. Most studies, n = 13 studies reported on sexual health outcomes including sexual pain, orgasm and sexual desire problems at sexual arousal and difficulties in lubrication. Mental health outcomes were reported in four studies including depression which was most prominent followed by somatisation and anxiety, Post Traumatic Stress Disorder (PTSD) and sleep disorder. Studies did not highlight combined mental and sexual health interventions. The findings of this narrative synthesis reveal the need to prioritise provision of mental and sexual health care services for women with FGM/C. The study recommends strengthening of health systems in Africa through awareness building, training and capacity building of primary health and specialist health workers in offering mental and sexual health care to women with FGM/C.

FUNDING

This work was self-funded.

No relationship found between female genital cutting and intimate partner violence across six sub-Saharan African countries

Female genital cutting (FGC) and intimate partner violence (IPV) are highly prevalent forms of violence against women, and the UN has encouraged strengthening policy linkages between FGC and IPV programme work (UN Women, Female genital mutilation/cutting and violence against women and girls. Strengthening the policy linkages between different forms of violence. UN Women, 2017a). However few studies have examined the relationship between these behaviours. This study addresses two research gaps identified by the UN; (a) whether women with FGC are more likely to experience physical or sexual IPV, and (b) whether women's IPV experiences are associated with their support for FGC. Multilevel multivariate logistic regression models were run using Demographic and Health Survey data from 6 sub-Saharan African countries (Burkina Faso, Ethiopia, The Gambia, Ivory Coast, Kenya and Nigeria, n33,170). Our results show no association between FGC and IPV. Women with FGC are not at greater risk of experiencing IPV, and women who experienced IPV in the preceding year are not more likely to support FGC. Further, the importance of individual and community factors differ; IPV experience is influenced by individual factors, whereas FGC support is more influenced by ethnic group characteristics. Although the proposition that FGC and IPV could be tackled collaboratively is attractive for policy makers, these results are important because they indicate that eradication programmes will be more effective when targeted at specific behaviours.