Women’s Empowerment as It Relates to Attitudes Towards and Practice of Female Genital Mutilation/Cutting of Daughters: An Ecological Analysis of Demographic and Health Surveys From 12 African Countries

Background: Women’s empowerment may play a role in shaping attitudes towards female genital mutilation/cutting (FGM/C) practices. We aimed to investigate how empowerment may affect women’s intention to perpetuate FGM/C and the practice of FGM/C on their daughters in African countries.Materials and methods: We used data from Demographic and Health Surveys carried out from 2010 to 2018. The countries included in our study were Benin, Burkina Faso, Chad, Côte d´Ivoire, Ethiopia, Guinea, Kenya, Mali, Nigeria, Senegal, Tanzania, and Togo. This study included 77,191 women aged 15–49 years with at least one daughter between zero and 14 years of age. The proportion of women who reported having at least one daughter who had undergone FGM/C as well as the mother’s opinion towards FGM/C continuation were stratified by empowerment levels in three different domains (decision-making, attitude to violence, and social independence) for each country. We also performed double stratification to investigate how the interaction between both indicators would affect daughter’s FGM/C.Results: The prevalence of women who had at least one daughter who had undergone FGM/C was consistently higher among low empowered women. Tanzania, Benin, and Togo were exceptions for which no differences in having at least one daughter subjected to FGM/C was found for any of the three domains of women’s empowerment. In most countries, the double stratification pointed to a lower proportion of daughters’ FGM/C among women who reported being opposed to the continuation of FGM/C and had a high empowerment level while a higher proportion was observed among women who reported being in favor of the continuation of FGM/C and had a low empowerment level. This pattern was particularly evident for the social independence domain of empowerment. In a few countries, however, a higher empowerment level coupled to a favorable opinion towards FGM/C was related to a higher proportion of daughters’ FGM/C.Conclusion: Women’s empowerment and opinion towards FGM/C seems to be important factors related to the practice of FGM/C in daughters. Strategies to improve women’s empowerment combined with shifts in the wider norms that support FGM/C may be important for achieving significant reductions in the practice.

Combining Theory and Research to Validate a Social Norms Framework Addressing Female Genital Mutilation

Female Genital Mutilation (FGM) is a harmful practice with no benefits and considerable harm to girls and women who undergo it. In 2016, the United Nations Joint Program to Eliminate FGM, funded the development and subsequent validation of a monitoring and evaluation framework to understand the relationship between social norms and practicing FGM. Evidence on the framework was gathered through a pilot study in Ethiopia. This paper uses cross-sectional quantitative data from the pilot to operationalize the framework and determine what factors are associated with practicing FGM. A total of 554 and 481 participants answered the question “Have you undergone FGM?” and “Do you know a family member who has undergone FGM?” respectively. Overall, 65% of participants said they had undergone FGM and 32% said they knew someone in their family who had undergone FGM. Predictors of not undergoing FGM included most progressive attitudes vs. less progressive attitudes about FGM and relationship to identity [OR: 1.9 (95% CI: 1.1–3.3)]; region [Afar vs. Addis Ababa: OR: 0.09 (95% CI: 0.02–0.5); Southern Nations Nationalities and People's Regions vs. Addis Ababa: OR: 0.1 (95% CI: 0.05–0.3)], being 36 years old and above vs. 10–19 years (OR: 0.2 (95% CI: 0.1 to 0.7)) and being single, never married vs. married or engaged (OR: 2.8 (95% CI: 1.1–7.0)]. Predictors of knowing a family member who has not undergone FGM included: Higher knowledge vs. lower knowledge [OR: 0.3 (95% CI: 0.1–0.5)]; if the family expected you to abandon FGM, you had a greater odds of knowing a family member who had not undergone FGM [43.6 (95% CI: 2.7–687.8)]; coming from Southern Nations, Nationalities and People's Region was associated with a lower odds of knowing a family member who had not undergone FGM [0.3 (95% CI: 0.1–0.6)]. Being a female influential vs. female caregiver was associated with a higher odds of knowing a family member who had not undergone FGM [2.9 (95% CI: 1.01–5.2)]. This paper has allowed us to validate a theory and research based social norms framework, specifically examining how social and behavior change communication can be used as a mechanism for shifting norms around a given harmful practice. Now that this model has been developed and validated, it is likely to provide a foundation to study the direct and indirect impacts of social norms programming on changing harmful practices, such as FGM.

Diagnoses and Procedures of Inpatients with Female Genital Mutilation/Cutting in Swiss University Hospitals: A Cross-Sectional Study

Background: Female genital mutilation/Cutting (FGM/C) can result in short and long-term complications, which can impact physical, psychological and sexual health. Our objective was to obtain descriptive data about the most frequent health conditions and procedures associated with FGM/C in Swiss university hospitals inpatient women and girls with a diagnosis of FGM/C. Our research focused on the gynaecology and obstetrics departments. Methods: We conducted an exploratory descriptive study to identify the health outcomes of women and girls with a coded FGM/C diagnose who had been admitted to Swiss university hospitals between 2016 and 2018. Four of the five Swiss university hospitals provided anonymized data on primary and secondary diagnoses coded with the International Classification of Diseases (ICD) and interventions coded in their medical files. Results: Between 2016 and 2018, 207 inpatients had a diagnosis of FGM/C. The majority (96%) were admitted either to gynaecology or obstetrics divisions with few genito-urinary and psychosexual conditions coded.Conclusions: FGM/C coding capacities in Swiss university hospitals are low, and some complications of FGM/C are probably not diagnosed. Pregnancy and delivery represent key moments to identify and offer medical care to women and girls who live with FGM/C. Trial registration: This cross-sectional study (protocol number 2018-01851) was conducted in 2019, and approved by the Swiss ethics committee.

BOOK REVIEW: MARIA KIMINTA’S FIGHT AGAINST FGM

Maria Kiminta’s personal account, Kiminta: A Maasai’s Fight against Female Genital Mutilation, is a survivor memoir which reveals her genital mutilation and her comprehensive range of vision on FGM in an audacious, argumentative, and persuasive fashion. It lucidly and pragmatically recounts her first-hand experiences as a Maasai FGM survivor; thus, it is an essential memoir on FGM advocating the global movement to eradicate the horrendous practice. The memoir is also significant in that it renders the readers the resources/arguments to realize the violence and depth of excruciating pain on female sex, to understand “loss to development as a whole” (Kiminta 2015: 44), and to support the movement. Her memoir focuses on a pivotal stage of her life, that is, her clitoridectomy and her holistic findings related to FGM as part of her anti-FGM activism in Germany. Her simultaneous placing of arguments and counter arguments to justify her claims/arguments with fact/data enables her to achieve an objective tone in her memoir. In so doing, she indistinctly divides the memoir into seven parts, such as her clitoridectomy at the age of ten in Kenya, causes behind FGM practice, strategies to execute FGM, impacts of FGM, points of claim and counter claim, hindrances to implementation of anti-FGM Acts, and her recommendations.

Female adolescents and the future of female genital mutilation/cutting: a report from an endemic area

Background: Despite collaborative efforts aimed at its eradication, Female Genital Mutilation/Cutting (FGM/C) continuesin endemic areas. Objective: To evaluate the experience and preparedness of female adolescents to protect their future daughters from FGM/C. Methods: A cross-sectional survey involving adolescent secondary school girls in North Central Nigeria. Participants were secondary school students who completed the study’s self-administered questionnaire after informed parental or participant’s consent. Data management was with SPSS 20.0 (IBM, USA), P-value <0.05 was significant. Results: There were 2000 participants aged 13-19 years (mean 15.56±1.75), prevalence of FGM/C was 35.0%, awareness was 86.1%, mutilation was performed between infancy and eight years of age (mean 3.85±3.24 years), 644(32.2%) desire to mutilatetheir future daughters, 722(36.1%) expressed support for FGM/C and 63.1% of victims of FM/C reported adverse post-mutilation experiences. Support for FGM/C was associated with low social class (P0.0010), opinion that FGM/C has benefit (P0.001) and desire to mutilate future daughters (P0.001) while awareness of efforts to eradicate FMG/C was 813(40.7%). Conclusion: FGM/C remains prevalent with potential support for its continuation among female adolescents despite reported adverse post-mutilation experiences. The multi-pronged approach to eradicate FGM/C should prioritize re-orientation for adolescent girls, rehabilitation of mutilated girls and girl child formal education. Keywords: Female genital mutilation/cutting; female circumcision, harmful traditional practices, adverse childhood experiences.

Living with FGM: Improving Knowledge and Skills of Health Care Providers in Iraqi Kurdistan

Background: Despite the high prevalence of female genital mutilation in many settings and the health consequences associated with it, many healthcare providers have limited knowledge of female genital mutilation and limited skills for preventing and managing related complications. With Knowledge of this Important matter aim of this study is to determine the effectiveness of TOT workshops on the knowledge and skills of social workers working with girls and women affected by FGM.Methods: To demonstrate the findings, a quasi-experimental study was conducted with a pre and post-assessment. There were 44 participants who worked with FGM victims across Iraqi Kurdistan. Socio-demographic details of the participants who have collected knowledge on psychosexual and physical care, psychosexual skills, and referral programs were assessed using a continuum scale of 0 to 4. Descriptive and inferential statistics were carried out for the analysis.Results: The results showed that participants' knowledge and skills improved in relation to psychosexual and physical care for girls and women living with FGM and referral programs for them. The paired sample t-test carried showed a significant increase in knowledge among participants in psychosexual and physical care for girls and women living with FGM (f=9.25, df=1, P=.001), Psychosexual skills (f=-8.20, df=1, P=.001), and FGM victims referral Programs (t=12.95, df=1, P=.001). Follow-up test also showed that these changes were constant from post-test to follow-up.Conclusions: Preparing the social workers on the integration of physical and psychosocial care for girls and women living with FGM in their existing activities would equip them in providing holistic care for them in addressing the emerging psychosexual problems.