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.

Teaching About Female Genital Mutilation: Complex Question of Cultural Relativism and Preventive Movement

This study aims to investigate three things. First, how is the tendency of the perspective used in discussing the issue of female circumcision in society; second, what is the value base that distinguishes the practice of female circumcision in one society from another; and third, how each value base in the practice of female circumcision is realized or transformed in the feminist movement. The research was carried out with a qualitative approach where data were obtained using a literature study method by reading books, journal articles and various reports on the practice of female circumcision. The results show that studies that discuss the practice of female circumcision tend to be discussed in five perspectives, namely in the perspective of gender, culture, health, religion and law. In practice, female circumcision has a different value base from one society to another. The value bases used in female circumcision include women's initiation into adulthood; purification or cleansing, beautification; and female fertility. Different value bases become the basis for feminists to make efforts to prevent the practice of female circumcision, starting from the level of binding regulations to prevent the practice of female circumcision, community participatory dialogue to abandon the practice of female circumcision, and empowering women through education and the economy.

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.