The Perception of African Immigrant Women Living in Spain Regarding the Persistence of FGM

Approximately 200 million women and girls have undergone female genital mutilation (FGM) worldwide. Migration has spread the practice of FGM around the world, thus making it a global public health issue. The objective of this descriptive qualitative study was to explore the perceptions of Sub-Saharan immigrant women in Spain in relation to the causes of the persistence of FGM. In-depth interviews were carried out with 13 female FGM survivors of African origin, followed by inductive data analysis using ATLAS.ti software. Two main themes emerged from the analysis: (1) A family ritual symbolic of purification and (2) a system of false beliefs and deception in favour of FGM. The FGM survivors living in Europe are aware that FGM is a practice that violates human rights yet persists due to a system of false beliefs rooted in family traditions and deception that hides the reality of FGM from young girls or forces them to undergo the practice. The ritualistic nature of FGM and the threat of social exclusion faced by women who have not had it performed on them contributes to its persistence nowadays.

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The prevention of female genital mutilation in England: what can be done?

Journal of Public Health ◽

10.1093/pubmed/fdy128 ◽

2018 ◽

Vol 41 (3) ◽

pp. e261-e266 ◽

Cited By ~ 5

Author(s):

E Plugge ◽

S Adam ◽

L El Hindi ◽

J Gitau ◽

N Shodunke ◽

...

Keyword(s):

Public Health ◽

Female Genital Mutilation ◽

Public Health Issue ◽

Global Public Health ◽

Criminal Offence ◽

Genital Mutilation ◽

Awareness Raising ◽

The Uk ◽

The Impact ◽

Female Genital

Abstract Background Female genital mutilation (FGM) is a global public health issue. Women in the UK are at risk of FGM and its adverse health consequences but little is known about its practice. Since 1985 it has been a criminal offence to perform FGM in the UK and further legislation has tightened the law but FGM continues. Methods Four community researchers from the Kenyan, Nigerian, Somalian and Sudanese communities in Oxford conducted focus groups and interviews with 53 people to understand the communities’ beliefs about how best to prevent FGM. Results Participants believed that the current UK legislation alone was not sufficient to tackle FGM and might in fact be counterproductive by alienating communities through its perceived imposition. They felt that there had been insufficient consultation with affected communities, awareness raising and education about the legislation. Community-led solutions were the most effective way to tackle FGM. Conclusions FGM adversely affects communities globally. In the UK, researchers from affected communities gathered data demonstrating the feasibility and importance of involving communities in FGM prevention work. Further research is needed to understand how best to prevent FGM in affected communities and, very importantly, to examine the impact of the UK legislation relating to FGM.

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Effects of COVID-19 Pandemic on Female Genital Mutilation/Cutting and Child, Early or Forced Marriages in Kenya, Uganda, Ethiopia and Senegal

10.21203/rs.3.rs-690662/v1 ◽

2021 ◽

Author(s):

Tammary Esho ◽

Dennis J. Matanda ◽

Timothy Abuya ◽

Sintayehu Abebe ◽

Yeshitila Hailu ◽

...

Keyword(s):

Female Genital Mutilation ◽

Cross Sectional Study ◽

Talk Shows ◽

Cross Sectional ◽

Genital Mutilation ◽

Alternative Approaches ◽

Women And Girls ◽

Harmful Traditional Practices ◽

Depth Interviews ◽

Female Genital

Abstract Background The effects of COVID-19 on harmful traditional practices such Female Genital Mutilation/Cutting (FGM/C) and Child, Early or Forced Marriages (CEFM) have not been well documented. We examined how the COVID-19 pandemic has affected FGM/C and CEFM in Kenya, Uganda, Senegal, and Ethiopia. Methods A cross-sectional study design with a mixed methods approach was used. Household surveys targeting women and men aged 15–49 years in Kenya (n = 312), Uganda (n = 278), Ethiopia (n = 251), and Senegal (n = 208) were conducted. Thirty-eight in-depth interviews with programme implementers and policymakers were carried out in Kenya (n = 17), Uganda (n = 9), Ethiopia (n = 8), and Senegal (n = 4). Results In Kenya, the COVID-19 pandemic has contributed to the increase in both FGM/C and CEFM cases. Minimal increase of FGM/C cases was reported in Uganda and a significant increase in CEFM cases. In Ethiopia, the COVID-19 pandemic had a limited effect on changes in FGM/C and CEFM. In Senegal, there were minimal effects of COVID-19 on the number of FGM/C and CEFM cases. The pandemic has negatively affected implementation of interventions by the justice and legal system, the health system, and civil societies. Conclusions The pandemic has had varied effects on FGM/C and CEFM across the four countries. Across the four countries, the pandemic has negatively affected implementation of interventions by the various sectors that are responsible for preventing and responding to FGM/C and CEFM. This calls for innovative approaches in intervening in the various communities to ensure that women and girls at risk of FGM/C and CEFM or in need of services are reached during the pandemic. Evidence on how effective alternative approaches such as the use of call centres, radio talk shows and the use of local champions as part of risk communication in preventing and responding to FGM/C and CEFM amid COVID-19 is urgently required.

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Sexual Function in Women With and Without Female Genital Mutilation in Reproductive Age in South of Iran

10.21203/rs.3.rs-256453/v1 ◽

2021 ◽

Author(s):

Mahshid Bokaie ◽

Samaneh Hatefi ◽

Shahnaz Mojahed ◽

Nasibeh Roozbeh

Keyword(s):

Sexual Function ◽

Female Genital Mutilation ◽

Reproductive Age ◽

Public Health Issue ◽

P Value ◽

Women Of Reproductive Age ◽

Genital Mutilation ◽

Significant Difference ◽

The Impact ◽

Female Genital

Abstract Objectives: Female genital mutilation (FGM) is an important public health issue, especially in developing countries and it is still done in some parts of Iran. This study aimed to investigate the effect of FGM on the sexual function of women of reproductive age in Hormozgan province/IRAN.Study design: This study is a descriptive-analytical case-control study that was conducted in 2020 on 209 married women of reproductive age (15-49) in rural areas of Minab and Sirik counties in Hormozgan province/IRAN. Main outcome measures: The reliable and valid questionnaire FSFI for assessing female sexual function in the two groups was used after to obtain informed and voluntary consent from all participants and data with SPSS v: 16 software and with using descriptive/ Analytical statistics tests with a significant level of 0.05 were examined. Results: There is a significant difference between mutilated and non-mutilated women in the total score of sexual function(22.18±3.23 versus 23.41±2.52 respectively, p=0.023) and the domains of lubrication(3.04±0.62 versus 3.3±0.53 respectively, P=0.000), orgasm(3.81±0.63 versus 4.08±0.47 respectively, P=0.003), and sexual satisfaction(5.09±0.1 versus 5.37±0.87 respectively, P=0.017) But in the domains of desire, arousal, and pain in the two groups was no significant difference(P-value>0.05). Conclusion: FGM maybe leads to sexual dysfunction. Although most women were reluctant to perform mutilation on their daughters, more educational Actions are suggested to educate women about the impact of female mutilation on their sexual function. Counseling programs are also recommended to improve the sexual function of mutilated women.

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Improving care for women and girls who have undergone female genital mutilation/cutting: qualitative systematic reviews

Health Services and Delivery Research ◽

10.3310/hsdr07310 ◽

2019 ◽

Vol 7 (31) ◽

pp. 1-216 ◽

Cited By ~ 6

Author(s):

Catrin Evans ◽

Ritah Tweheyo ◽

Julie McGarry ◽

Jeanette Eldridge ◽

Juliet Albert ◽

...

Keyword(s):

Health Care ◽

Service Delivery ◽

Pregnant Women ◽

Systematic Reviews ◽

Female Genital Mutilation ◽

Genital Mutilation ◽

Women And Girls ◽

The Uk ◽

Experienced Female ◽

Female Genital

Background In a context of high migration, there are growing numbers of women living in the UK who have experienced female genital mutilation/cutting. Evidence is needed to understand how best to meet their health-care needs and to shape culturally appropriate service delivery. Objectives To undertake two systematic reviews of qualitative evidence to illuminate the experiences, needs, barriers and facilitators around seeking and providing female genital mutilation-/cutting-related health care from the perspectives of (1) women and girls who have experienced female genital mutilation/cutting (review 1) and (2) health professionals (review 2). Review methods The reviews were undertaken separately using a thematic synthesis approach and then combined into an overarching synthesis. Sixteen electronic databases (including grey literature sources) were searched from inception to 31 December 2017 and supplemented by reference list searching. Papers from any Organisation for Economic Co-operation and Development country with any date and in any language were included (Organisation for Economic Co-operation and Development membership was considered a proxy for comparable high-income migrant destination countries). Standardised tools were used for quality appraisal and data extraction. Findings were coded and thematically analysed using NVivo 11 (QSR International, Warrington, UK) software. Confidence in the review findings was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation – Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. All review steps involved two or more reviewers and a team that included community-based and clinical experts. Results Seventy-eight papers (74 distinct studies) met the inclusion criteria for both reviews: 57 papers in review 1 (n = 18 from the UK), 30 papers in review 2 (n = 5 from the UK) and nine papers common to both. Review 1 comprised 17 descriptive themes synthesised into five analytical themes. Women’s health-care experiences related to female genital mutilation/cutting were shaped by silence and stigma, which hindered care-seeking and access to care, especially for non-pregnant women. Across all countries, women reported emotionally distressing and disempowering care experiences. There was limited awareness of specialist service provision. Good care depended on having a trusting relationship with a culturally sensitive and knowledgeable provider. Review 2 comprised 20 descriptive themes synthesised into six analytical themes. Providers from many settings reported feeling uncomfortable talking about female genital mutilation/cutting, lacking sufficient knowledge and struggling with language barriers. This led to missed opportunities for, and suboptimal management of, female genital mutilation-/cutting-related care. More positive experiences/practices were reported in contexts where there was input from specialists and where there were clear processes to address language barriers and to support timely identification, referral and follow-up. Limitations Most studies had an implicit focus on type III female genital mutilation/cutting and on maternity settings, but many studies combined groups or female genital mutilation/cutting types, making it hard to draw conclusions specific to different communities, conditions or contexts. There were no evaluations of service models, there was no research specifically on girls and there was limited evidence on psychological needs. Conclusions The evidence suggests that care and communication around female genital mutilation/cutting can pose significant challenges for women and health-care providers. Appropriate models of service delivery include language support, continuity models, clear care pathways (including for mental health and non-pregnant women), specialist provision and community engagement. Routinisation of female genital mutilation/cutting discussions within different health-care settings may be an important strategy to ensure timely entry into, and appropriate receipt of, female genital mutilation-/cutting-related care. Staff training is an ongoing need. Future work Future research should evaluate the most-effective models of training and of service delivery. Study registration This study is registered as PROSPERO CRD420150300012015 (review 1) and PROSPERO CRD420150300042015 (review 2). Funding The National Institute for Health Research Health Services and Delivery Research programme.

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The impact of community led alternative rite of passage on eradication of female genital mutilation/cutting in Kajiado County, Kenya: A quasi-experimental study

PLoS ONE ◽

10.1371/journal.pone.0249662 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249662

Author(s):

Samuel Muhula ◽

Anthony Mveyange ◽

Samuel Oji Oti ◽

Martha Bande ◽

Hellen Kayiaa ◽

...

Keyword(s):

Female Genital Mutilation ◽

Secondary Data ◽

Sub Saharan Africa ◽

Rite Of Passage ◽

Genital Mutilation ◽

Community Stakeholders ◽

Quasi Experimental ◽

Sub Saharan ◽

The Impact ◽

Female Genital

Introduction In Kenya, Female Genital Mutilation/Cutting (FGM/C) is highly prevalent in specific communities such as the Maasai and Somali. With the intention of curtailing FMG/C prevalence in Maasai community, Amref Health Africa, designed and implemented a novel intervention—community-led alternative rite of passage (CLARP) in Kajiado County in Kenya since 2009. The study: a) determined the impact of the CLARP model on FGM/C, child early and forced marriages (CEFM), teenage pregnancies (TP) and years of schooling among girls and b) explored the attitude, perception and practices of community stakeholders towards FGM/C. Methods We utilised a mixed methods approach. A difference-in-difference approach was used to quantify the average impact of the model with Kajiado as the intervention County and Mandera, Marsabit and Wajir as control counties. The approach relied on secondary data analysis of the Kenya Demographic and Health Survey (KDHS) 2003, 2008–2009 and 2014. A qualitative approach involving focus group discussions, in-depth interviews and key informant interviews were conducted with various respondents and community stakeholders to document experiences, attitude and practices towards FGM/C. Results The CLARP has contributed to: 1) decline in FGM/C prevalence, CEFM rates and TP rates among girls by 24.2% (p<0.10), 4.9% (p<0.01) and 6.3% (p<0.01) respectively. 2) increase in girls schooling years by 2.5 years (p<0.05). Perceived CLARP benefits to girls included: reduction in teenage marriages and childbirth; increased school retention and completion; teenage pregnancies reduction and decline in FGM/C prevalence. Community stakeholders in Kajiado believe that CLARP has been embraced in the community because of its impacts in the lives of its beneficiaries and their families. Conclusion This study demonstrated that CLARP has been positively received by the Maasai community and has played a significant role in attenuating FGM/C, CEFM and TP in Kajiado, while contributing to increasing girls’ schooling years. CLARP is replicable as it is currently being implemented in Tanzania. We recommend scaling it up for adoption by stakeholders implementing in other counties that practice FGM/C as a rite of passage in Kenya and across other sub Saharan Africa countries.

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Estimating the indirect prevalence of Female Genital Mutilation/Cutting in Switzerland

10.21203/rs.3.rs-100859/v1 ◽

2020 ◽

Author(s):

Sara Cottler-Casanova ◽

Jasmine Abdulcadir

Keyword(s):

At Risk ◽

Female Genital Mutilation ◽

Prevalence Data ◽

Genital Mutilation ◽

The Past ◽

High Prevalence ◽

Prevalence Estimates ◽

Women And Girls ◽

Using Data ◽

Female Genital

Abstract ObjectiveTo update the indirect prevalence 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. MethodsWe 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 when FGM/C is practiced, and applied them to the immigrant women and girls living in Switzerland from the same 30 countries.ResultsIn 2010, the estimated indirect prevalence was 9,059 whereas in 2018, the estimated indirect prevalence was 21,706 women and girls living with or at risk of FGM/C.ConclusionOver 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.

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Review of Web-Based Toolkits for Health Care Practitioners Working With Women and Girls Affected by or at Risk of Female Genital Mutilation/Cutting

Journal of Primary Care & Community Health ◽

10.1177/2150132720935296 ◽

2020 ◽

Vol 11 ◽

pp. 215013272093529

Author(s):

Hina Shaikh ◽

Karen A. McDonnell

Keyword(s):

At Risk ◽

Health Professionals ◽

Female Genital Mutilation ◽

Service Providers ◽

Health Sector ◽

Skills Development ◽

Genital Mutilation ◽

Rich Diversity ◽

Women And Girls ◽

Female Genital

Increased migration has given rise to more advocacy efforts against female genital mutilation or cutting (FGM/C), legislation that criminalizes the practice, and guidance to the health sector for managing care of affected groups. More women and girls who have been cut or who are at risk of FGM/C are migrating from regions where it is common to countries where it is not and interacting with health professionals and other community practitioners in these host countries. Despite numerous studies on the negative health impacts of FGM/C, little is known about toolkits on FGM/C that providers can use in their prevention and response efforts. We sought to explore the nature of Internet-based products referenced as toolkits and materials characteristic of toolkits aimed at different service providers who may interact with women and girls affected by FGM/C. Through an online search, we identified 45 toolkits and collected data about each one. We found that the toolkits targeted different audiences and offered a diverse set of information and resources. The majority of toolkits were aimed at health professionals and provided factual and epidemiological-focused content, yet many did not include research evidence, skills development application, or approaches for implementing the toolkit in practice. This review is the first completed in the area of FGM/C to show a rich diversity of online materials. Future toolkits can be improved with the provision of evidence-based information and practical skills development for use by health professionals in implementing best practices in working with women and girls affected by FGM/C.

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Is there a relationship between female genital mutilation/cutting and fistula? A statistical analysis using cross-sectional data from Demographic and Health Surveys in 10 sub-Saharan Africa countries

BMJ Open ◽

10.1136/bmjopen-2018-025355 ◽

2019 ◽

Vol 9 (7) ◽

pp. e025355 ◽

Cited By ~ 1

Author(s):

Dennis Juma Matanda ◽

Pooja Sripad ◽

Charity Ndwiga

Keyword(s):

Statistical Analysis ◽

Female Genital Mutilation ◽

Health Surveys ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Common Belief ◽

Cross Sectional ◽

Genital Mutilation ◽

Sub Saharan ◽

Female Genital

ObjectivesLiterature on associations between female genital mutilation/cutting (FGM/C) and fistula points to a common belief that FGM/C predisposes women to developing fistula. This study explores this association using nationally representative survey data.DesignA secondary statistical analysis of cross-sectional data from Demographic and Health Surveys was conducted to explore the association between FGM/C and fistula.SettingSub-Saharan Africa.ParticipantsWomen aged 15–49 years in Burkina Faso (n=17 087), Chad (n=17 719), Côte d’Ivoire (n=10 060), Ethiopia (n=14 070), Guinea (n=9142), Kenya (n=31 079), Mali (n=10 424), Nigeria (n=33 385), Senegal (n=15 688) and Sierra Leone (n=16 658).Main outcome measuresFistula symptoms.ResultsMultivariate logit modelling using pooled data from 10 countries showed that the odds of reporting fistula symptoms were 1.5 times (CI 1.06 to 2.21) higher for women whose genitals were cut and sewn closed than those who had undergone other types of FGM/C. Women who attended antenatal care (ANC) (adjusted odds ratio (AOR) 0.51, CI 0.36 to 0.71) and those who lived in urban areas (AOR 0.62, CI 0.44 to 0.89) were less likely to report fistula symptoms than those who did not attend ANC or lived in rural areas.ConclusionsSevere forms of FGM/C (infibulation) may predispose women to fistula. Contextual and socioeconomic factors may increase the likelihood of fistula. Multisectoral interventions that concurrently address harmful traditional practices such as FGM/C and other contextual factors that drive the occurrence of fistula are warranted. Promotion of ANC utilisation could be a starting point in the prevention of fistulas.

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Prosecution of female genital mutilation in the United Kingdom: Injustice at the intersection of good public health intentions and the criminal law

Medical Law International ◽

10.1177/0968533220914070 ◽

2019 ◽

Vol 19 (4) ◽

pp. 258-281 ◽

Cited By ~ 1

Author(s):

Marge Berer

Keyword(s):

Public Health ◽

United Kingdom ◽

Criminal Law ◽

Female Genital Mutilation ◽

Public Health Issue ◽

Traditional Practice ◽

Genital Mutilation ◽

The United Kingdom ◽

Health Intentions ◽

Female Genital

Female genital mutilation (FGM) is a harmful traditional practice and a serious public health issue in the countries where it is carried out. It is also a violation of the rights of the girls to whom it is done. The main action taken in the United Kingdom to stop FGM, has been to criminalise it. Public health measures, such as the provision of specialist clinics for those who experience complications of FGM have been implemented as well, and some education in schools is provided. This article is about the injustice that has arisen from the pursuit of prosecutions for FGM in the United Kingdom, in spite of good public health intentions. Since 2012, there have been four criminal cases, several arrests that never came to trial, and for reasons of safeguarding, an unknown number of investigations with the threat of girls being taken into care, and people stopped from travelling with girl children to visit their families in FGM-practising countries. To date, only one criminal case in 2019 – R v. N (FGM) – which is the main subject of this article, has resulted in a guilty verdict. This article outlines this history in relation to the criminal law and uses courtroom observation to analyse what happened in the 2019 case in detail. It argues that the conviction depended on medical opinion and the highly uncertain evidence of two children and was influenced by a spurious link to witchcraft that should never have been permitted in the courtroom. It argues that this conviction is unsafe and should be appealed. It further argues that to use protection orders only because a child’s mother had FGM, in the absence of any evidence of risk, is discriminatory and a form of impermissible racial/ethnic profiling. The article concludes that the United Kingdom should stop recording a history of FGM in women seeking healthcare. It calls for the current law against FGM to be reconsidered and replaced with positive measures for countering FGM which have the support and involvement of the community groups to whom they are addressed.

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