Female Genital Mutilation/cutting Research Articles

COVID-19 and Female Genital Mutilation/Cutting and child marriage: An online multi-country cross sectional survey.

Female Genital Mutilation/Cutting (FGM/C) and child marriage are prevalent in many countries in Asia and Africa. These practices are a violation of human rights and have significant impacts on the physical and mental well-being of those affected. COVID-19 restrictions such as lockdowns and closure of schools may have influenced the occurrence of FGM/C and child marriage. This analysis reported on the impact of these restrictions on FGM/C and child marriage. The International Sexual Health And REproductive Health (I-SHARE) research team organised a multi-country online survey. Sampling methods included convenience samples, online panels, and population-representative samples. Data collected included the impact of COVID-19 restrictions on the occurrence, intention to practice and change in plans to organise FGM/C and child marriage. Data were analysed from 14 countries that reported on FGM/C and child marriage using basic descriptive statistics. Given it was an online survey, we had more responses from urban areas. Among the 22,724 overall participants, 8,829 participants (38.9%) responded to the survey items on FGM/C and child marriage and were included in this analysis. 249 (3.4%) participants stated that FGM/C occurred in their community during COVID-19. Out of this, COVID-19 affected the plans of 26 (20%) participants intending to organise circumcision and 15% of participants planned to organise FGM/C earlier. People with a worry about finances during COVID-19 were more likely to have an earlier plan to organise FGM/C during COVID-19. In total, 1,429 (13%) participants reported that child marriage occurred in their community. The pandemic affected plans of 52 (13%) participants intending to arrange child marriage and 7.7% (29/384) participants expressed intent to arrange the marriage sooner than planned. People with financial insecurities during COVID-19 were more likely to arrange a child marriage earlier. Thus, our study found that the pandemic impacted plans related to FGM/C and child marriage practices, resulting in many carrying out the practices sooner or later than initially planned.

Comparison of Menstrual Symptoms in University Students with and without Female Genital Mutilation/Cutting.

The aim of this study was to compare the menstrual symptoms and dysmenorrhea in university students who underwent Female genital mutilation/cutting (FGM/C), in Mogadishu, Somalia, and students who did not undergo FGM/C in Ankara, Türkiye. A comparative cross-sectional study design was used. Among the participants with FGM/C, 88.5% were Type 1 and the age at FGM/C was 8 years. The pain severity was 6.20±2.54 in women with FGM/C and was higher than that of those without FGM/C (5.97±2.32), but no significant difference was found. Among those who had FGM/C, 66% had a menstrual duration of 3-5 days, while 52.0.% of those who did not have FGM/C had a menstrual duration of 6-8 days (p<0.05). While 85.1% of those without FGM/C had a menstrual cycle of 21-35 days, 35% of those with FGM/C had a menstrual cycle of less than 20 days (p<0.05). It was found that 95% of those who have undergone female circumcision and 90.2% of those who have not had dysmenorrhea (p<0.05). Painkillers were always used by 28% of women with FGM/C and 26.3% of women without FGM/C (p<0.05). The total MSS score of those who have not had FGM/C was 3.34±0.72 and the score of those who have had FGM/C was 2.91±0.74 (p<0.05). The negative effects sub-dimension score was found to be higher in the non-FGM/C group with 3.20±0.75, while the coping methods sub-dimension score was higher in the FGM/C group with 2.91±1.13 (p<0.05). FGM/C is still common in Somalia. Our study results showed that having FGM/C may cause differences in dysmenorrhea and menstrual symptoms. Efforts to increase students' effective coping with menstrual symptoms and dysmenorrhea are thought to be useful.

Female genital mutilation/cutting in women delivering in France: An observational national study.

International migration from source countries has meant that clinicians in high income countries, that is, receiving countries, are increasingly caring for affected women affected by female genital mutilation/cutting (FGM/C). The aim of the present study was to assess the prevalence of FGM/C among women at childbirth, and its association with pregnancy outcomes. This was an observational study using data from a cross-sectional population-based study from the French National Perinatal Survey of 2021 (ENP) conducted in all maternity units in mainland France and including all women delivering a live birth during 1 week in March 2021 (N = 10 928). We estimated the FGM/C prevalence using (i) the diagnosed cases and (ii) the indirect prevalence estimated by UNICEF in each source country. We compared population characteristics and perinatal outcomes between women diagnosed with FGM/C and two groups: (i) women originating in source countries and diagnosed as without FGM/C and (ii) all women without diagnosis of FGM/C whatever the country of birth. Diagnosed prevalence of FGM/C was 95% (95% CI: 0.78-1.14] and the indirect computed estimation prevalence was estimated at 1.53% (95% CI: 1.31-1.77) in 113 and 183 women, respectively. Labor and delivery outcomes were globally similar in women with FGM/C and the other two groups. Only episiotomy was more frequently performed in women with FGM/C than in the other two groups. In receiving countries, obstetric outcomes of women with FGM/C can be similar to those of other women, which does not preclude need of further research and training to provide the most appropriate care, including enhanced attention to diagnosis.

Politicization of international aid: Religious responses to criminalizing female genital mutilation in Sudan

International aid to protect women and girls against religiously sanctioned violence in predominantly Muslim countries is prone to politicization and opposition by conservative religious actors. In Sudan religious leaders had varied responses to an internationally funded campaign to criminalize female genital mutilation/cutting (FGM/C) in 2009. In the capital Khartoum, this campaign provoked politicization of aid and counter- mobilization by national conservative religious leaders, while in the eastern town of Gedarif local religious leaders supported criminalization. Based on fieldwork conducted from 2008 to 2018, the study suggests that the power based of religious leaders and their inclusion in, or exclusion from, anti- FGM/C efforts accounted for this differential response. Even when successful, the inclusion of religious leaders as “agents of change” strengthened their power and the role of religion in state and society to levels that may endanger the rights of women and girls.

Attitudes towards wife-beating justification and its association with female genital mutilation - analysis of ever-married Somali women in the 2020 Somali Health and Demographic Survey.

In Somalia, despite its prohibition, female circumcision persists alongside significant intimate partner violence. This study examines the prevalence of wife-beating justification among Somali women and its link to the perception that female genital mutilation/cutting (FGM/C) is a religious obligation. We studied 7726 married Somali women 15-49y of age from the 2020 Somali Health and Demographic Survey. Using χ2 tests and logistic regression, we examined wife-beating justification by covariates and its connection to the perception that FGM/C is a religious obligation. The prevalence of women justifying wife-beating for any of six reasons was 56.5% (95% confidence interval [CI] 55.3 to 57.6). A higher prevalence of wife-beating justification was found among women 35-49y of age (59.9% [95% CI 57.8 to 61.9]), without education (57.7% [95% CI 56.5 to 59.0]), rural residents (57.8% [95% CI 56.3 to 59.2]), with lower socio-economic status (60.4% [95% CI 58.7 to 62.1]) and married before age 18y (58.4% [95% CI 56.7 to 60.1]). Adjusted for covariates, logistic regression analyses indicated a significant association between wife-beating justification and the belief that FGM/C is mandated by religion (adjusted odds ratio 1.40 [95% CI 1.17 to 1.68], p<0.001). Wife-beating justification is alarmingly common among Somali women and significantly associated with the belief that FGM/C is mandated by religion. Further research is necessary to investigate the drivers behind the acceptance of domestic violence, its impact on women's mental health and well-being and its association with FGM/C acceptance.

Challenges perceived by social workers to prevent FGM/C in Bavaria: a prospective, cross-sectional survey

BackgroundWorldwide, at least 230 million girls and women are affected by female genital mutilation/ cutting (FGM/C). FGM/C violates human rights and can cause irreparable harm and even lead to death. In 2022, more than 100,000 survivors of FGM/C lived in Germany, and more than 17,000 girls were considered at risk. Due to the increasing number, there is a need to improve the skills of professionals not only to treat FGM/C but also to prevent it, aiming to maintain or improve women’s physical and mental health. However, previous studies mostly focused on health care providers, even though other professionals such as social workers, play an important role in the provision of sexual and reproductive health (SRH) care and are often the first point of contact. Therefore, the study’s main objective was to understand challenges perceived by social workers in pregnancy counselling centres in the provision of good quality of SRH care for girls and women suffering from or endangered by FGM/C.MethodsA quantitative self-administered cross-sectional online survey was sent by e-mail in 2021 to all pregnancy counselling centers in the German federal state of Bavaria.ResultsAmong the 141 participants, 82% reported no or insufficient FGM/C knowledge and barriers to provide the best quality of care. The main findings were language obstacles (82.7%), perceived client’s fear or shame (67.9%) and cultural difficulties (45.7%). Furthermore, participants also reported a lack of competence on the professional side (29.6%). Importantly, most participants (129 of 141; 92%) expressed interest in training.ConclusionProviding comprehensive good quality sexual and reproductive health care to women and girls affected from or endangered by FGM/C is challenging. The study revealed the importance of strengthening the skills of social workers and suggested the following strategies: (1) enhancing FGM/C knowledge and skills (including specialized competences e.g., in mental health) by improving training and information material for the target group, (2) improving referral pathways and addressing deficits in the existing care system (e.g. with health or legal institutions), and (3) developing trusting relationships with cultural (or traditional) mediators to build strong community networks.

'It is what was handed over to us as our heritage and must not be taken away just like that': Traditional birth attendants' attitudes towards the elimination of intergenerational female genital mutilation/cutting in Osun State, Nigeria.

Female genital mutilation/cutting is a harmful practice that violates the sexual and reproductive health rights of women and girls. The practice is often perpetrated directly or indirectly from one generation to another as a way of preserving the culture, thus making it difficult to tackle using ordinary prevention interventions. The purpose of the study was to assess the attitude of the traditional birth attendants as community leaders towards the elimination of intergenerational female genital mutilation/cutting (FGM/C) of girls and to determine their level of readiness and preparedness towards achieving it in Osun State, Nigeria. A qualitative research design, using the adapted REPLACE community readiness tool to end female genital mutilation/cutting interview guide, was used to individually interview eight traditional birth attendants who were identified through purposive sampling method as community leaders and key informants. Thematic Analysis was used to analyze the data which yielded female genital mutilation/cutting as traditional heritage, defiance against government efforts and debunking all "western" information about dangers of female genital mutilation to women as lies as findings. The current defensive attitudes of the TBAs as community leaders and custodians of the FGM/C tradition are that of denial and resistance which is characterised by misconception and incorrect knowledge about the issue as well as misconception and lack of support for addressing the issue which is an indication of low level of no readiness for any intervention to prevent or eliminate FGM/C in Osun state, Nigeria. Serious engagement and dialogue between policy makers and health professionals on FGM/C and its effects on women is highly recommended for effective FGM/C elimination strategies to be co-developed with community leaders. Such engagements should adopt a non-confrontational, respectful, and honest approach so as to not alienate the TBAs.

Attitudes towards and health consequences of female genital mutilation/cutting: A qualitative study among Somali and Kurdish immigrants and descendants in Denmark

ObjectivesThere is lack of in-depth knowledge of how immigrants who originate from countries where female genital mutilation/cutting (FGM/C) historically is practiced, perceive the practice after migrating to Europe. The aim of this study was to explore the attitude towards FGM/C among immigrants and descendants and the health consequences of living with FGM/C. Study designQualitative methods were used in the form of semi-structured interviews and focus group discussions. Female and male immigrants and descendants in Denmark from Somalia or Kurdish of Iraq/Iran participated in the study. The interview/focus group discussion guides were developed by the European Institute for Gender Equality. Purposely sampling was used, and participants were recruited by use of snowballing through gatekeepers and women’s societies working within the Somali and Kurdish communities. ResultsSixteen persons participated in the study. No descendants had been cut, but all female immigrants had been cut prior to migrating and did not wish to pass on the practice. FGM/C was perceived as a harmful practice with severe sexual and mental health consequences. Women with Somali origin experienced that the practice was falsely associated with their origin, which led to stigmatisation. Women with Kurdish origin lacked healthcare support when suffering sexual consequences of FGM/C. It was generally perceived that the Danish healthcare system lacked cultural sensitivity. ConclusionFGM/C is negatively perceived among Somali and Kurdish immigrants and descendants in Denmark and not practiced among these groups. The Danish healthcare system should adopt a more culturally sensitive approach when addressing sexual health among immigrants and descendants. Denmark and other European countries should work towards destigmatising the immigrant communities when it comes to FGM/C. Larger European studies with primary data are needed to generalise the findings of this study.

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.

Examining the key features of specialist health service provision for women with Female Genital Mutilation/Cutting (FGM/C) in the Global North: a scoping review.

Health care for women with Female Genital Mutilation/Cutting (FGM/C) in the Global North is often described as sub-optimal and focused on maternity care. Specialist FGM/C services have emerged with little empirical evidence informing service provision. The objective of this scoping review is to identify the key features of FGM/C specialist care. The review was conducted in accordance with JBI methodology. Participants: organisations that provide specialist FGM/C care. Concept: components of specialist services. Context: high-income OECD countries. Eligibility criteria included primary research studies of any design from 2012 to 2022, providing a comprehensive description of specialist services. Seven bibliographic databases were searched (MEDLINE, EMBASE, CINAHL, Web of Science, SCOPUS, Cochrane Library and MIC). The components of "specialist" (as opposed to "generalist") services were defined and then applied to an analysis of FGM/C specialist care. FGM/C specialist provision was categorised into primary (essential) and secondary features. Data were extracted and analysed descriptively through charting in tables and narrative summary. Twenty-five papers described 20 unique specialist services across eleven high income countries. Primary features used to identify FGM/C specialist care were:-(i) Named as a Specialist service/clinic: 11/20 (55%); (ii) Identified expert lead: 13/20, (65%), either Midwives, Gynaecologists, Urologist, or Plastic Surgeons; (iii) Offering Specialist Interventions: surgical (i.e., reconstruction and/or deinfibulation) and/or psychological (i.e., trauma and/or sexual counselling); and (iv) Providing multidisciplinary care: 14/20 (70%). Eleven services (in Spain, Sweden, Switzerland, Germany, Italy, Netherlands, France, Belgium, and USA) provided reconstruction surgery, often integrated with psychosexual support. No services in UK, Norway, and Australia offered this. Six services (30%) provided trauma therapy only; 25% sexual and trauma therapy; 15% sexual therapy only; 30% did not provide counselling. Secondary features of specialist care were subdivided into (a) context of care and (b) the content of care. The context related to concepts such as provision of interpreters, cost of care, community engagement and whether theoretical underpinnings were described. Content referred to the model of care, whether safeguarding assessments were undertaken, and health education/information is provided. Overall, the features and composition of FGM/C specialist services varied considerably between, and sometimes within, countries. Global guidelines advocate that specialist care should include access to deinfibulation, mental health support, sexual counselling, and education and information. The review found that these were rarely all available. In some high-income countries women cannot access reconstruction surgery and notably, few services for non-pregnant women mentioned safeguarding. Furthermore, services for pregnant women rarely integrated trauma therapy or psychosexual support. The review highlights a need for counselling (both trauma and psychosexual) and culturally-appropriate sensitive safeguarding assessments to be embedded into care provision for non-pregnant as well as pregnant women. Further research is needed to extract the features of specialist services into a comprehensive framework which can be used to examine, compare, and evaluate FGM/C clinical specialist care to determine which clinical features deliver the best outcomes. Currently a geographical lottery appears to exist, not only within the UK, but also across the Global North.

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 &amp; 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.

Anatomical Reconstruction following Female Genital Mutilation/Cutting.

International migration from high-prevalence regions has increasingly confronted nonendemic countries with female genital mutilation/cutting (FGM/C), and Western-based health care providers have seen a greater demand for surgical reconstruction of female anatomic units. The authors introduce novel surgical techniques developed by the first author for clitoral and vulvovestibular reconstruction and examine operative outcomes. The authors performed a retrospective cohort study of operative outcomes of the omega domed flap, neurotizing and molding of the clitoral stump (NMCS procedure), and anterior obturator artery perforator flap for preputial, clitoral, and vulvovestibular reconstruction, respectively. Between 2014 and 2021, the authors treated patients with all types of FGM/C, and analyzed various data, including demographics, clitoral sensation, and symptoms such as dysmenorrhea, dysuria, dyspareunia, and anorgasmia. The authors aimed to examine the efficacy and safety of these techniques in improving clitoral sensation and reducing symptoms. A total of 119 women (mean age, 31.0 ± 10.4 years) were included. The authors performed the omega domed flap (85%), the NMCS procedure (82%), or the anterior obturator artery perforator flap (36%), and had a 1-year follow-up period, which was attended by 94.1% of patients. Patients reported significant postoperative reduction of dysmenorrhea, dysuria, and dyspareunia, as well as significant improvement of clitoral sensation and ability to achieve orgasm ( P < 0.001). There was 1 major complication (loss of flap) reported. Secondary ambulatory interventions were performed in 10 patients (8.4%). By allowing for safe and effective anatomic reconstruction of the female genitalia, the described surgical techniques represent a new stage of treatment possibilities for women with FGM/C. Therapeutic, IV.

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.