Female Genital Mutilation/cutting Research Articles

Investigating Factors Associated with Migration and Cultural Adaptation in Relation to Change in Attitudes and Behavior towards Female Genital Mutilation/Cutting (FGM/C) among Populations from FGM/C-Practicing Countries Living in Western Countries: A Scoping Review

A growing body of evidence indicates a significant decrease in support for female genital mutilation/cutting (FGM/C) within post-migration communities in Western countries. Addressing knowledge gaps and comprehending the factors associated with FGM/C discontinuation in these communities is crucial. The objective of this scoping review is to describe the effects of migration and cultural change on factors supporting FGM/C cessation in migrant communities. The review, from 2012 to 2023, included the following databases: Embase, PubMed, Google Scholar, Swisscovery, CINAHL, APA PsycInfo, and gray literature. Applying the PRISMA-ScR framework, we identified 2819 studies, with 17 meeting the inclusion criteria. The results revealed seven key factors shaping attitudes and behavior toward FGM/C abandonment: (1) legislation against FGM/C, (2) knowing that FGM/C is not a religious requirement, (3) enhancing education about the practice, (4) migration and cultural change, (5) awareness of the harmful effects of FGM/C, (6) a positive view of uncut girls, and (7) a sense of self-agency. These findings highlight factors on a social, community, interpersonal, and personal level that enhance the abandonment of the practice. Further research in the FGM/C field will gain more accuracy in understanding and accounting for these multilevel factors in post-migration settings, offering valuable insights for targeted interventions to promote the cessation of the practice.

(092) Mental and Sexual Health Outcomes Associated with Female Genital Mutilation/Cutting in Africa: A Systematic Narrative Synthesis

Abstract Introduction 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. Objective This study's objective was to collate evidence on mental and sexual health outcomes associated with female genital mutilation/cutting in Sub-Saharan Africa Methods The study employed a scoping review and narrative synthesis approach and conducted 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. Results 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. Conclusions 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. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Amref International University and Aga Khan University Hospital.

The comparison of sexual function in types I and II of female genital mutilation

BackgroundFemale genital mutilation has many sexual, physical, and psychological consequences. The present study aimed to examine the relationship between Female Genital Mutilation/Cutting (FGM/C), and Sexual Function among circumcised women in Sardasht City, Iran.”MethodsIn this present cross-sectional study, 197 women who were mutilated entered the study by simple random sampling from two healthcare centers in Sardasht, Iran. A gynecologist first performed a genital examination to identify the type of female genital mutilation of participants. Subsequently, Socio-demographic and FGM/C-related characteristics checklist and the female sexual function index questionnaire were completed by interview method. Data were analyzed using SPSS 23 software.ResultsType I and II of female genital mutilation were performed in 73.1 and 26.9% of the participants, respectively. The age range of performing female genital mutilation in type I and II of female genital mutilation was 4–10 years old in 67.4% and 71.1% respectively. Traditional practitioners/local women carried out the circumcision in all of the participants, and Sunnah/tradition was reported as the most common reason for doing this procedure. The average total score of FSFI index in type I and II of female genital mutilation was 23.5 ± 2.0 and 17.4 ± 2.39, respectively. In all domains of FSFI, women with type II of female genital mutilation obtained lower scores than women with type I.ConclusionCircumcised women have reduced scores in all domains of FSFI, and the severity of sexual dysfunction is related to the type of FGM/C. Considering the prevalence of female genital mutilation and its adverse effects, it is imperative to initiate cultural improvements through education and awareness. By educating and raising awareness among individuals about this issue, we can foster positive changes and address the problem effectively.

Knowledge, attitudes, and practices of Female Genital Mutilation / Cutting among healthcare providers in two public hospitals in Egypt: A cross-sectional study.

Female Genital Mutilation / Cutting (FGM/C), also known as female circumcision, is a human rights violation and is still happening to date. Every woman or girl has the right to be protected from this harmful practice. Egypt has adopted a multi-layered strategy to end FGM/C nationwide. Even though considerable progress has been made throughout the country, the practice and inequality still exist. In 2021, The Egyptian Family Health Survey results showed a decrease in the prevalence of circumcision among ever-married women, reaching about 86%, compared to 92% in the latest public estimate of the Demographic Health Survey 2015, where 87% of all women between 15 and 49 years old are circumcised, of which 42.4% reported being circumcised by a healthcare professional (HCP) compared to a reported 47% in 2021. This study aimed to assess healthcare providers' knowledge, attitudes, and practices in two public hospitals in 2 governorates in Egypt using a validated questionnaire conducted among HCPs in Cairo (Urban) and Gharbia (Rural) governorates. A pre-tested questionnaire comprising 38 close-ended questions was used. The study population included 223 HCPs in Cairo and Gharbia governorates, of which 63.7% were women and 36.3% were men, with an average age of 42 years (42±5). 49.8% of the respondents are from an urban area. In the knowledge domain, the highest consequence identified was reduced sexual feelings. In attitudes, almost 63% believed that FGM/C should continue, while 65% agreed that the HCPs have a role in eliminating FGM/C. Almost 4% of our respondents have performed an FGM before, 45% had FGM in their household, and 62% would perform FGM on their daughters. HCPs' integration within the communities allows them to play a crucial role in preventing the practice. It is of utmost importance to compensate for the gap in the curricula of medical schools through informal learning activities and continuing medical education programs for sexual and reproductive health and rights and human rights, as legislation and law enforcement alone cannot eliminate FGM/C from society.

A survey on midwives/nurses’ knowledge and application of clinical guidelines in the midwifery care of women with Female Genital Mutilation/Cutting (FGMC) in Nigeria

A survey on midwives/nurses’ knowledge and application of clinical guidelines in the midwifery care of women with Female Genital Mutilation/Cutting (FGMC) in Nigeria

A Scoping Review of Female Genital Mutilation and its Effects on Sexual Function and Sexual Satisfaction

The practice of female circumcision (FC), particularly female genital mutilation/cutting (FGM/C), has been controversial as it is regarded as physically and mentally harmful and violates human rights. The purpose of this study is to perform a scoping review aiming to evaluate and compare the effects of FC and FGM/C on the sexual function of the affected women, including the Google Scholar, EBSCO Discovery Service, PubMed, ProQuest Health & Medical Complete, and Wiley Online Library between the year 1999 to 2020. The following keywords were used: ‘Female Circumcision’, ‘Female Genital Mutilation, ‘Female Genital Cutting’, ‘Female Circumcision and Sexual Function’, and ‘Female Circumcision and Sexual Satisfaction. A total of 72 articles related to FC and sexual function or satisfaction were retrieved, and 30 articles met the inclusion criteria. Based on the analysis of the final 30 articles, most of the articles described the detrimental effects of FGM/C on sexual function and sexual satisfaction. However, future studiesMaround the less invasive types of FGM/C are required to better reflect on FGM/C on female health. FGM is detrimental to female sexual satisfaction. However, a different method of FC that is less invasive may provide different outcomes. Therefore, a comprehensive guideline on proper FC techniques is needed for education among medical practitioners to prevent any adverse effects on sexuality.

Weekly Market (Lumo) Women Vendors’ Awareness and Understanding of Female Genital Mutilation/Cutting Fgm/C: (Case Study: Bureng and Brikama Ba Weekly Markets)

The fundamental objectives of this study were to investigate into the weekly market (locally call “lumoo”) elderly women and young women vendors’ level knowledge of female genital mutilation/cutting (FGM/C), its causes, negative impacts, preventive methods; and services needed by survivors. The study was a descriptive survey and purposive random sampling technique was used to select the respondents. The survey concentrated on six core areas: level of knowledge of FGM/C, Level of understanding of FGM/C, Level of knowledge of the causes of FGM/C, Level of knowledge of the negative impacts of FGM/C, Level of knowledge of the support services needed by survivors of FGM/C; and Level of knowledge of the preventive methods of FGM/C. Because of limited resources, the study took approximately one year and five months. Structured questionnaires were used to collect the data from participants. The data was presented and analyzed using tables and percentage. The results indicate high level of awareness of FGM/C among the sample population. It practices though negatively affects all survivors, participants are deeply divided on stopping it. Regardless of government being principal protectors of all children, participants feel everyone is needed both in supporting survivors, perpetrators and the fight against it for subsequent eradication.

Female genital mutilation/cutting as a ground for asylum in France

AbstractThis study examines how France's national asylum legislation has changed politically and ideologically from following a gender‐blind policy to recognizing gender‐based violence as a ground for asylum. Among European countries, France receives the largest number of female asylum seekers (FAS) from sub‐Saharan African (SSA) countries, where female genital mutilation/cutting (FGM/C) is practiced. Although France was one of the first countries to recognize FGM/C as a reason for granting asylum, it was reluctant to accept FAS as a “particular social group (PSG).” This article analyzes the increase in asylum claims based on FGM/C in the 2000s and examines the political discourses on changing asylum legislation up to the 2010s. Data from official reports of government organizations were examined to investigate the decisions on asylum applications involving FGM/C. France changed its policies in the 2000s to include gender equality in its republican identity due to ultra‐right party and social campaigns criticizing male members of minority groups for violence and discrimination against women. The then conservative government exploited these circumstances and enacted restrictive immigration laws that addressed FGM/C grievances partially; the succeeding socialist government recognized FGM/C as a ground for asylum. This study concludes by arguing that the 2011 European directive was a turning point for French asylum legislation to include gender‐sensitive interpretation of the grounds under the Convention on the Status of Refugees, in line with European policy. However, the status of SSA women and girls remains uncertain while they are subjected to medical examination and the application range of PSG could be reconsidered.

Potentially traumatic experiences pre-migration and adverse pregnancy and childbirth outcomes among women of Somali- and Kurdish-origin in Finland

BackgroundWomen in precarious conditions in their countries of origin, especially those who have left the country as refugees, may have been victims of serious mental and physical violence. These potentially traumatic experiences may threaten women’s reproductive health. This study examines the prevalence of potentially traumatic experiences pre-migration and female genital mutilation/cutting (FGM/C) and their associations with adverse reproductive outcomes among migrant women of Somali- and Kurdish-origin who have been pregnant in Finland.MethodsSurvey and register data of the participants of the Finnish Migrant Health and Wellbeing Study (Maamu), conducted in 2010–2012, were used. Women of 18 to 64 years of age, 185 Somali- and 230 Kurdish-origin, who had at least one pregnancy or birth in Finland were included in the analysis. The survey data were linked to the Finnish Medical Birth Register, the Register of Induced Abortions, and the Care Register for Health Care until 2018. For each outcome, logistic regression was used and adjusted for age, body mass index, time lived in Finland, and the number of births.ResultsA total of 67% of Somali-origin and 71% of Kurdish-origin women had experienced potentially traumatic experiences pre-migration and 64% of Somali- and 32% of Kurdish-origin women had also undergone FGM/C. In Kurdish-origin women, complications during pregnancy (e.g. bleeding in the first trimester, known or suspected fetal abnormality, signs of fetal hypoxia, death of the fetus and other problems) were significantly more common among women without potentially traumatic experiences (70%) than among women with potentially traumatic experiences (48%) (p-value 0.005). No associations between potentially traumatic experiences or FGM/C and other adverse reproductive outcomes were observed among Somali- or Kurdish-origin women.ConclusionPast trauma is common among Somali- and Kurdish-origin women and this needs to be evaluated in maternity care. However, we found no association between potentially traumatic experiences pre-migration and adverse reproductive outcomes.

Abandoning female genital mutilation/cutting (FGMC) is an emerging but costly parental investment strategy in rural Ethiopia

Female genital mutilation or cutting (FGMC) has profound consequences for an estimated 200 million women world-wide, yet affected communities often resist efforts to end the practice. Marriage market dynamics have been proposed as key to this resistance, because where FGMC is normative, parents are motivated to cut their daughters to improve their marriage prospects. Some economists have also argued that financial gain, through bride wealth payments, incentivises parents to cut daughter's at time of marriage. Bride wealth, however, does not necessarily equal net economic return, confounding efforts to test this assumption. Here we use detailed data on the financial value of all exchanges at marriage from Ethiopian Arsi Oromo agropastoralists to assess their association with FGMC. We also explore the idea that parents must replace FGMC with other forms of investment (e.g., education) when cutting practices are rejected. Multivariate multilevel Bayesian models were run using data from the first marriages of 358 women to assess the association between FGMC status and education and marriage-related outcomes: bride wealth payments, dowry costs, and age at marriage. Being cut is associated with lower dowry costs and earlier age at marriage but does not predict bride wealth paid by the groom's family. School attendance is associated with higher bride wealth, particularly for women with four or more years of education, and with later age at marriage. These findings indicate that bride wealth payments do not maintain FGMC among the Arsi Oromo. While we find a relative economic loss for parents from FGMC abandonment through higher value dowry gifts, this may be traded-off against the health benefits to uncut daughters. These findings point to the emergence of new norms, whereby Arsi Oromo parents reject cutting for their daughters and prefer their daughters-in-law to be educated.

Use of machine learning methods to understand discussions of female genital mutilation/cutting on social media.

Female genital mutilation/cutting (FGM/C) describes several procedures that involve injury to the vulva or vagina for nontherapeutic reasons. Though at least 200 million women and girls living in 30 countries have undergone FGM/C, there is a paucity of studies focused on public perception of FGM/C. We used machine learning methods to characterize discussion of FGM/C on Twitter in English from 2015 to 2020. Twitter has emerged in recent years as a source for seeking and sharing health information and misinformation. We extracted text metadata from user profiles to characterize the individuals and locations involved in conversations about FGM/C. We extracted major discussion themes from posts using correlated topic modeling. Finally, we extracted features from posts and applied random forest models to predict user engagement. The volume of tweets addressing FGM/C remained fairly stable across years. Conversation was mostly concentrated among the United States and United Kingdom through 2017, but shifted to Nigeria and Kenya in 2020. Some of the discussion topics associated with FGM/C across years included Islam, International Day of Zero Tolerance, current news stories, education, activism, male circumcision, human rights, and feminism. Tweet length and follower count were consistently strong predictors of engagement. Our findings suggest that (1) discussion about FGM/C has not evolved significantly over time, (2) the majority of the conversation about FGM/C on English-speaking Twitter is advocating for an end to the practice, (3) supporters of Donald Trump make up a substantial voice in the conversation about FGM/C, and (4) understanding the nuances in how people across cultures refer to and discuss FGM/C could be important for the design of public health communication and intervention.

Exploring the association between perceived male attitudes and female attitudes toward the discontinuation of Female Genital Mutilation/Cutting in Egypt.

There are 200 million girls and women alive worldwide that have undergone the practice of Female Genital Mutilation/Cutting (FGM/C) and 4 million girls are at risk of undergoing the practice each year. FGM/C provides no known health benefits, while puts a plethora of medical, psychological, and sexual health risks into perspective. One of the countries where the prevalence of FGM/C is the highest in the World, even though local authorities legally banned the practice in 2008, is Egypt. Within the Egyptian context, there are several complex socioeconomic, religious, and cultural drivers that influence the familial decision making of the daughters being cut. Female attitudes hold great significance in the process, because mothers and female family members are typically the prime decision makers at the daughter's circumcision. However, whilst FGM/C is often performed to enhance marriageability and address male preferences, in practicing communities there is little to no open communication between men and women about the practice, making women rely on their perceptions on FGM/C related expectations of men. Even though the connection between female and perceived male attitudes toward the discontinuation was established almost 20 years ago, since then to our knowledge little is known about the further characteristics of this association. Therefore, this study aims to explore the association between female and perceived male attitudes within families of a younger cohort and moreover attempts to provide a more layered picture of it within different levels of education. To explore the relation between female and perceived male attitudes toward the discontinuation of FGM/C we conducted a 3-step binary logistic regression model. Our results show that women are significantly less likely to favor a continuation of FGM/C if they think men are disapproving of the practice, compared to women that think men want it to continue. The strength of this association partially varies between the different levels of education as it is less pronounced at the level of secondary education, compared to the reference group. In alignment with previous findings in the literature, women were more likely to support the discontinuation of FGM/C if they believed that men want the practice to discontinue as well and vice versa. At a higher level of secondary education however this association is less pronounced. This result concludes that the role of perceived male attitudes should be an important factor associated with female ones and studied further, and underlines the importance of education in women empowerment.

Factors Linked to Female Genital Mutilation Practice Among Women Living In Alungu Village of Mandera County, Kenya.

Female Genital Mutilation/Cutting (FGM/C) is a harmful traditional practice with severe health complications, deeply rooted in many sub-Saharan African countries. In Kenya, the prevalence of FGM/C is 15% in women aged between 15 and 49 years. The Kenyan Somalis practice FGM/C with a prevalence above 90%. FGM/C practice continues to persist in Alungu village, Mandera County in the North Eastern of Kenya despite efforts by anti-FGM programs. However, the underlying factors behind FGM practice in the area have not been explored. Objective: To assess factors contributing to female genital mutilation practice among women living in Alungu village of Mandera County, Kenya. This study utilised a descriptive cross sectional design. The study population was women of reproductive age (from 18 to 49 years) who resided in Alungu village in Mandera County, Kenya. A study sample of 98 women was selected using simple random sampling technique. Data was collected using a researcher-administered questionnaire and analysed using the Statistical Package for Social Science (SPSS). Most of the respondents were aged 35 - 44 (45.8%), married (100%), had no formal education (74.7%) and had no formal employment (89.2%). All participants agreed that traditional beliefs, customs and rite of passage to womanhood contributed to FGM, 90.4% of the participants acknowledged that FGM is a symbol of ethnic identity and inclusivity. Factors affecting prevention of and response to FGM were low involvement of women in anti-FGM programs (91.6%); support for FGM by local leaders and elders (100%); failure by authorities to take action against those perpetuating FGM (100%); indifference to FGM practice continuation among local religious and political leaders (96.4%) and poor enforcement of existing laws against FGM (100%). A wide range of socio-cultural factors did contribute to FGM practice among women living in Alungu village, Mandera County.

Migrant Men's Views and Experiences towards Female Genital Mutilation/Cutting (FGM/C) and its Prevention and Care in OECD Countries: A Qualitative Systematic Review Protocol

Objective: This review aims to synthesise male migrants' views and experiences about the provision of care services for survivors of FGM/C and related prevention strategies in healthcare settings in OECD countries. Introduction: Concerns among survivors about FGM/C care access relate to the potential impact of newly enacted laws in the healthcare service delivery and whether their decisions to seek care are acceptable to their current or future male partners. Little is known about their male partners' views. Inclusion Criteria: The review will consider articles that include male migrants of all ages who have close relationships with survivors and live in OECD countries. In studies comprising (men and women), where perspectives of men are reported separately, they will be included. Non-OECD countries' studies will be excluded. Methods: The databases to be searched will include Ovid MEDLINE, EBSCOhost, CINAHL, ASSIA, Ovid Embase, PsycINFO, Cochrane Library, J.B.I. Databases and hand-searching of relevant journals. Unpublished studies will be searched through OpenGray and websites of national and international organisations working on FGM/C, including the National Health Services and World Health Organisation. The search will identify English-language publications from January 2002 onwards. Titles and abstracts will be reviewed first, and then full texts will be screened by two independent reviewers against the inclusion criteria. Any disagreements will be resolved through discussion or a third reviewer. The result will be critically appraised for methodological quality. Data extraction results will be synthesised and evaluated for credibility and dependability.

Understanding the uptake of HIV testing among women in Liberia: the role of female genital mutilation/cutting

Past studies show that the processes of female genital mutilation/cutting (FGM/C) on women can increase their susceptibility to HIV infection. This is because genital tears or ruptures, scars and wounds from FGM/C may expose survivors to heightened risks of contracting sexually transmitted infections, including HIV, if they engage in unsafe sexual practices. Hence, there is the need to promote HIV screening and testing among this population. Yet, in Liberia, there is a dearth of studies exploring the uptake of HIV testing among women who have experienced FGM/C. To understand this relationship, we used the 2019–2020 Liberia Demographic and Health Survey (LDHS) and employed logistic regression analysis to answer the following questions: (1) Are FGM/C survivors less likely to have been tested for HIV compared to non-FGM/C women; and (2) How does this disparity in the uptake of HIV testing differ by women’s marital status? We found that survivors of FGM/C were less likely to have been tested for HIV than non-FGM/C women, even after accounting for theoretically relevant variables (OR = 0.83, p < 0.01). In response to our second question, we found that survivors of FGM/C who were formerly married were less likely to have been tested for HIV compared to their non-FGM/C counterparts (OR = 0.48, p < 0.01). These findings highlight the importance of trauma-informed HIV prevention strategies in Liberia, and the need for policymakers to take a holistic approach to addressing the challenges that FGM/C survivors, especially formerly married women, may face in accessing HIV prevention and testing services, and to work towards creating a more inclusive and supportive environment for all at-risk groups.

The Place of Women in the Implementation of FGC Interventions on the Psychosocial Wellbeing of the Girl Child in Marani Sub-County, Kisii County, Kenya

In Kenya, Female Genital Mutilation/Cutting (FGC) is a cultural practice that is widely practiced. Despite interventional efforts to end FGC, progress has been limited both in preventing it and caring for girls and women who have already undergone the cut. The practice has persisted, albeit with some changes. This study sought to examine the place of women in the implementation of FGC interventions on the psychosocial wellbeing of the girl child in Marani Sub-County, Kenya. The study was anchored on the step change theory. The study used interviews and questionnaires to collect qualitative and quantitative data. In this context, quantitative data was collected using questionnaires, analyzed quantitatively. Qualitative data (words/propositions) was collected through key informant interviews, focus group discussions, and analyzed descriptively. The study revealed that stress, stigma, isolation, and marital problems were main psychological effects. Findings from this study conclude that FGC is an ongoing practice within the Gusii community with women and health professionals being the main perpetrators though its practice has reduced drastically compared to previous years. The study recommends an adoption of alternative rites of passage to eliminate the practice. This can be possible through re-socialisation of community members on the need to change this negative tradition for the psychosocial wellbeing of the girl child.

What women want: A reflexive thematic analysis of the healthcare experiences of women with female genital mutilation/cutting in South Australia

BackgroundGlobal migration has seen an increase in female genital mutilation/cutting (FGM/C) cases observed in countries where it is not part of the cultural norm. This shift has led to many healthcare professionals (HCPs) reporting a lack of knowledge and skills necessary to support the needs of women with FGM/C. AimTo explore the experiences and needs of women with FGM/C accessing women’s health services in South Australia. MethodsWomen with FGM/C were recruited through purposive and snowball sampling to participate in one-to-one semi-structured interviews. The voice recorded interviews were transcribed verbatim, coded, and analysed using Braun and Clarke’s reflexive thematic analysis to determine themes. FindingsTen migrant and refugee women living in South Australia, were interviewed. Four themes and 13-subthemes were identified. The main themes were, 1) the healthcare experience, 2) cultural values shape the healthcare experience, 3) speaking up about female genital cutting and 4) working together to improve healthcare experiences. DiscussionWomen’s cultural needs, not their health needs, play a fundamental role on how women experienced healthcare services. When women’s cultural values and traditions are acknowledged by HCPs, they are more likely to trust and feel confident to engage with services and seek medical support. Areas identified for improvement included access to the right interpreters, having more time during appointments, opportunities for continuity of care and the inclusion of family in care and treatment decisions. ConclusionWomen with FGM/C have specific health and cultural needs that can be met through education and provision of woman-centred care.

Exploring the Role of Traditional Women Society Membership Among West African Immigrant Women Who Have Experienced Female Genital Mutilation/Cutting.

This study explores the complex nature of female genital mutilation/cutting (FGM/C) by juxtaposing the mental and sexual health of women who had undergone FGM/C as part of initiation/membership into a traditional women's society (TWS) with those who were also cut but not initiated into a TWS. While considerable differences emerged between TWS members and nonmembers, there was no evidence that TWS membership was protective against the physical and psychological trauma typically ascribed to FGM/C. In fact, the pattern of results would tend to suggest the opposite. Possible explanations for and implications of these findings are discussed.

Amref Alternative Rites of Passage (ARP) model for female genital mutilation/cutting, teenage pregnancies, and child, early and forced marriages in Kenya: a stepped-wedge cluster randomised controlled trial protocol

Background The Amref Alternative Rites of Passage (ARP) model was initiated in 2009. To date, about 20,000 girls have been supported by their communities to denounce female genital mutilation/cutting (FGM/C) and graduate into ‘maturity’ through ARP. While this intervention has been implemented for decades, there is limited evidence of its effectiveness in ending FGM/C. In order to ascertain the effectiveness of this intervention, Amref has developed a digital tracking tool to follow up on girls who have and haven’t gone through the ARP. The key research question is: what effect does ARP have on incidences of FGM/C, teenage pregnancy and child, early and forced marriages among adolescent girls and young women? Methods The study will adopt a stepped-wedge cluster randomised controlled trial design to assess the effectiveness of the ARP model on the incidence of FGM/C; teenage pregnancy; child, early and forced marriage; and educational attainment. We selected one cluster in Kajiado County where recent ARPs have been conducted as the intervention site at the beginning of the study and 3 wards/clusters in Narok County as control sites. Approximately 604 girls aged 10-18 years who reside in selected sites/clusters in Kajiado and Narok counties will be recruited and followed up for 3 years post-exposure. Quantitative data analysis will be conducted at bivariate and multivariate levels. Content/thematic analysis approach will be used to analyse qualitative data. Ethics and dissemination The study obtained ethical approval from the Amref Ethics and Scientific Review Committee (AMREF-ESRC P1051-2021). The findings of this study will be shared with local, national and regional stakeholders working in ending FGM/C, teenage pregnancy, and child, early and forced marriages. Registration – Pan-African Clinical Trials Registry (PACTR202208731662190).

Changing gender norms around female genital mutilation/cutting (FGM/C): a key role for social work in the Global North.

"Female genital mutilation/cutting" (FGM/C) refers to procedures that involve altering the external female genitalia with the aim of reinforcing gendered body norms. The literature has consistently shown that, like various forms of discrimination, the practice is rooted in systems of gender inequality. As a result, FGM/C has increasingly come to be understood in terms of social norms that are by no means fixed. And yet, in the Global North, interventions remain primarily medical in nature, with clitoral reconstruction having emerged as a common means of dealing with related sexual issues. And although treatments can vary greatly depending on the hospitals and physicians involved, sexuality tends to be considered from a gynecological perspective, even when multidisciplinary care is offered. By contrast, gender norms and other socio-cultural factors receive little attention. In addition to highlighting three critical shortcomings in current responses to FGM/C, this literature review also describes how social work can play a key role in overcoming the associated barriers by (1) adopting a holistic approach to sex education, one capable of addressing those aspects of sexuality that lie beyond the scope of a medical consultation; (2) supporting family-based discussions on matters of sexuality; and (3) promoting gender equality, especially among younger generations.