Female Genital Mutilation/cutting Research Articles

Analysing Normative Influences on the Prevalence of Female Genital Mutilation/Cutting among 0-14 Years Old Girls in Senegal: A Spatial Bayesian Hierarchical Regression Approach.

Background: Female genital mutilation/cutting (FGM/C) is a harmful traditional practice affecting the health and rights of women and girls. This has raised global attention on the implementation of strategies to eliminate the practice in conformity with the Sustainable Development Goals (SDGs). A recent study on the trends of FGM/C among Senegalese women (aged 15–49) which examined how individual- and community-level factors affected the practice, found significant regional variations in the practice. However, the dynamics of the practice among girls (0–14 years old) is not fully understood. This paper attempts to fill this knowledge gap by investigating normative influences in the persistence of the practice among Senegalese girls, identify and map ‘hotspots’. Methods: We do so by using a class of Bayesian hierarchical geospatial modelling approach implemented in R statistical software (R Foundation for Statistical Computing, Vienna, Austria) using R2BayesX package. We employed Markov Chain Monte Carlo (MCMC) techniques for full Bayesian inference, while model fit and complexity assessment utilised deviance information criterion (DIC). Results: We found that a girl’s probability of cutting was higher if her mother was cut, supported FGM/C continuation or believed that the practice was a religious obligation. In addition, living in rural areas and being born to a mother from Diola, Mandingue, Soninke or Poular ethnic group increased a girl’s likelihood of being cut. The hotspots identified included Matam, Tambacounda and Kolda regions. Conclusions: Our findings offer a clearer picture of the dynamics of FGM/C practice among Senegalese girls and prove useful in informing evidence-based intervention policies designed to achieve the abandonment of the practice in Senegal.

Female Genital Mutilation/Cutting among Somali Women in the U.S. State of Arizona: Evidence of Treatment Access, Health Service Use and Care Experiences.

Background. Female genital mutilation/cutting (FGM/C) is associated with adverse sexual, reproductive and psychological sequelae. The aim of this study was to quantitatively explore factors related to satisfaction with FGM/C-related care in the US focusing on access to care, health service utilization, and women’s experiences. Methods. A community-based survey of 879 Ethnic Somali and Somali Bantu women using snowball sampling was conducted in Arizona. Bivariate, multivariable and ordered logistics analyses assessed the relationship between the aforementioned factors measured along six dimensions: non-discrimination, physical, economic, informational, health system accessibility and individual-level health service use factors. Findings. Most participants possessed FGM/C (77.4%), namely Type III (40.2%). FGM/C related health service use was low (14.3%). Perceived discrimination was associated with reduced satisfaction in care (OR = 0.22; CI 0.13–0.37). For FGM/C-specific variables, only recollection of adverse physical or psychological events at the time of circumcision predicted service use (OR = 3.09; CI 1.67–5.68). Somali Bantu (OR = 0.10; CI 0.02–0.44) and highly acculturated women (OR = 0.39; CI 0.17–0.86) had lower odds of service use. Conclusions. Achieving respectful care and outreach to women affected by FGM/C has contextual complexity. However, the clinical implications and insights provided may have broader impacts on advancing health equity for FGM/C-affected women.

A Cross-sectional Study on the Prevalence of Cervical Dysplasia Among Women With Female Genital Mutilation/Cutting

The aim of the study was to assess the prevalence of cervical dysplasia among migrant women with female genital mutilation/cutting (FGM/C) at a specialized clinic in Switzerland. This is a descriptive retrospective cross-sectional study. We reviewed the electronic medical records of all women who attended a specialized FGM/C clinic at the Geneva University Hospitals between 2010 and 2016. We examined sociodemographic data, sexually transmitted infections, FGM/C types, Pap smear results, and follow-up in women diagnosed with cervical dysplasia. Three hundred sixty records were reviewed and 338 women were included. The average age was 33 years (SD = 7.47 years). Most women were from Eritrea and Somalia (n = 204, 60.4%) and had FGM/C type III (n = 188, 55.6%). A total of 12.4% (n = 42) of the patients had abnormal Pap smears: 1.5% (n = 5) with atypical squamous cells of undetermined significance (ASCUS) with high-risk human papillomavirus (HPV), 7.9% (n = 27) with low-grade squamous intraepithelial lesion (LSIL), and 2.9% (n = 10) with high-grade squamous intraepithelial lesion or higher (HSIL +). Of the 37 patients with dysplasia, 22 (59.4%) completed follow-up and 15 (40.5%) received incomplete follow-up. The prevalence of high-grade squamous intraepithelial lesion+ among migrant women with FGM/C is high (2.95%) compared with the general Swiss population (0.58%). Follow-up for cervical dysplasia must be improved by increasing provider knowledge of this patient population and by addressing barriers to care.

Female genital mutilation: Experiences, attitudes and perceptions of Somali female students living in Turkey.

This study aimed to investigate the experiences, attitudes, and perceptions of Somali female students regarding female genital mutilation/cutting (FGM/C). One hundred seventeen Somali female students participated in this qualitative study. The data were collected in semi-structured focus group interviews. It was determined that most (49.9%) of these girls were exposed to type-2 FGM/C. Eighty-eight percent of the girls participating in the study stated that they support the continuation of this practice in future generations. For risk groups in Turkey, organizing health education programs, training healthcare professionals in Turkey about FGM/C, and creating awareness are recommended.

Predictors of Female Genital Mutilation or Cutting Among Daughters of Women in Guinea, West Africa

Background and Objective: In some African countries like Guinea, female genital mutilation/cutting (FGM/C) has been considered as an essential social norm in ensuring girls’ and women’s virginity by reducing their sexual desires. This study aimed at examining the factors associated with FGM/C among daughters of women aged 15-49 in Guinea. Methods: Using the 2018 Guinea Demographic and Health Survey, we analyzed data on 10,721 women of reproductive age (15-49 years) who had at least one daughter. A two-level multi-level logistic regression analysis was fitted and the random and fixed effects together with their corresponding 95% credible intervals (95% CrIs) were presented. Results: Women of all age categories had higher odds of having circumcised daughters with the substantially highest odds among those aged 35-39 (aOR=26.10, CrI=11.22-53.94) compared to those aged 15-19. “FGM/C was higher among daughters of circumcised mothers (aOR=5.50, CrI=3.11-9.72), compared to those who were not circumcise. Compared to Muslims, women who were either animists or had no religion were more likely to circumcise their daughters (aOR=2.13, CrI=1.12-4.05). Conversely, women with secondary/higher education, whose partners had secondary/higher education, Christians, women of richest wealth index and those who lived in the Faranah and N’zerekore regions were less likely to circumcise their daughters. Conclusion and Implications for Translation: The current study revealed that individual and contextual factors are associated with FGM/C among daughters of women aged 15-49 in Guinea. The findings imply that eliminating FGM/C in Guinea requires multifaceted interventions such as advocacy and educational strategies like focus group discussions, peer teaching, mentor-mentee programs in regions noted with the FGM/C practice. This will help achieve the Sustainable Development Goal 5.3 which focuses on eliminating all harmful practices, such as child, early and forced marriage and female genital mutilation by 2030. Copyright © 2021 Ahinkorah. et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Evaluating changes in the prevalence of female genital mutilation/cutting among 0-14 years old girls in Nigeria using data from multiple surveys: A novel Bayesian hierarchical spatio-temporal model.

Female genital mutilation/cutting (FGM/C) is considered a public health and human rights concern, mainly concentrated in Africa, and has been targeted for elimination under the sustainable development goals. Interventions aimed at ending the practice often rely on data from household surveys which employ complex designs leading to outcomes that are not totally independent, thus requiring advanced statistical techniques. Combining data from multiple surveys within robust statistical framework holds promise to provide more precise estimates due to increased sample size, and accurately identify 'hotspots' and allow for assessment of changes over time. In this study, rich datasets from six (6) successive waves of the Nigeria Demographic and Health Surveys and Multiple Indicator Cluster Surveys undertaken between 2003 and 2016/17, were combined and analyzed in order to better assess changes in the likelihood and prevalence of FGM/C among 0-14-year old girls in Nigeria. We used Bayesian hierarchical regression models which explicitly accounted for the inherent spatial and temporal autocorrelations within the data while simultaneously adjusting for variations due to different survey methods and the effects of linear and non-linear covariates. Parameters were estimated using Markov chain Mote Carlo techniques and model fit assessments were based on Deviance Information Criterion. Results show that prevalence of FGM/C among 0-14 years old girls in Nigeria varied over time and across geographical locations and peaked in 2008 with a shift from South to North. A girl was more likely to be cut if her mother was cut, supported FGM/C continuation, or had no higher education. The effects of mother's age, wealth and type of residence (urban-rural) were no longer significant in 2016. These results reflect the gains of interventions over the years, but also echo the belief that FGM/C is a social norm thus requiring tailored all-inclusive interventions for the total abandonment of FGM/C in Nigeria.

Beyond illegality: Primary healthcare providers' perspectives on elimination of female genital mutilation/cutting.

To report primary healthcare providers' perspectives on elimination of female genital mutilation/cutting (FGM/C). Eradication of FGM/C by 2030 is one of the United Nations Sustainable Development goals. World Health Organization recognises the unique role of nurses and other primary healthcare providers. However, their voices on the current legislative approach are underreported. These voices are important in informing directions that can expedite achievement of the global goal. Qualitative interpretivist phenomenology. This qualitative study used purposive sampling approach and involved 19 individual interviews conducted face to face or by telephone with Australian primary healthcare providers. Data collected between October and December 2019 were transcribed verbatim and thematically analysed. Three themes exploring Australian healthcare providers' perspectives on elimination of FGM/C were identified, namely understanding Australian laws against FGM/C; perspectives on culturally sensitive education; and exploring public awareness raising activities in Australia. This study was guided by Consolidated Criteria for Reporting Qualitative Research, the checklist for qualitative studies. "Understanding Australian laws against FGM/C" identified participants' knowledge that FGM/C is illegal in Australia and that mandatory reporting applies if a child is or at risk of being taken oversees for the procedure. Through "Perspectives on culturally sensitive education," the participants argued that education is the key to questioning the practice of FGM/C. "Exploring public awareness-raising activities in Australia" described the need for collective action germane to FGM/C eradication. This study emphasised that laws and legislation prohibiting FGM/C need to be complemented with culturally sensitive education and public awareness-raising activities, to produce optimal outcome for the elimination of FGM/C in Australia. Voices of these healthcare providers are crucial for FGM/C to be eradicated. Listening and acting on these voices are important in achieving the global sustainable development goal of eradicating FGM/C.

Medical narrative and religious norm driving cut type and medicalization changes in female genital mutilation/cutting in Somaliland

The authors’ aim was to examine if the nature of female genital mutilation/cutting (FGM/C) in Somaliland is changing and any contributing factors. In this mixed method qualitative study the researchers used 24 focus groups, 20 key informant interviews and 28 in-depth interviews with multiple stakeholders. We found a shift from the pharaonic to Sunna cut, an age decrease at which FGM/C is performed and an increase in its medicalization. Shift in cut type and medicalization appears to be partly a response to the medical narrative of anti-FGM/C campaigns, partly an intertwining of messaging regarding health risks and religious norms. We recommend a need to consider programs that reflect upon the utility and appropriateness of moving the dominant narrative to issues around the right to bodily integrity and bodily autonomy, and melding that messaging with the Islamic discourse on protecting health that focuses on collective welfare.

A system analysis of the mental health services in Norway and its availability to women with female genital mutilation.

This article explores mental health services in Norway and their availability for women subjected to female genital mutilation/cutting (FGM/C). The article focus on the system of communication and referrals from the perspective of health workers, and aims to identify bottlenecks in the system, what and where they are to be found, and analyze how different mental health services deal with Sub Saharan African (SSA) women in general, but in particular with respect to FGM/C. The study was conducted in Oslo, Norway, using a qualitative fieldwork research design, with the use of purposeful sampling, and a semi-structural guideline. One hundred interviews were done with general practitioners (GPs), gynecologists, psychologists, psychiatrists, midwives and nurses. A system analysis is applied using socio-cybernetics as a tool to identify the flow of communication and referrals of patients. The study shows that borders of subsystems, silencing mechanisms, regulations and "attitudes" of the system can lead to women with SSA background having difficulty getting access to the specialist services. High standards for referral letters, waiting lists, out pushing to the lower levels, insecurities around treatment and deference rules silencing mental health issues during consultancies, have a negative impact on the accessibility of services. Consequences are that mental health problems due to FGM/C are under-investigated, under-referred, and under-treated and a silenced problem within the mental health services for women. A better integration of subsystems at the specialist level with the GP scheme is necessary, as well as providing competence on FGM/C to the different levels. It is also important to strengthen and integrating the services at the Municipal level and provide information to SSA women about the low threshold services.

Women human rights defender’s fight against female genital mutilation and child marriages in Africa

ABSTRACT In Africa, Women Human Rights Defenders (WHRDs) have been recognized by the United Nations and other human rights organizations for their fight against female genital mutilation/cutting (FGM/C) of women and girls as young as 5 years old, and child marriages of young and adolescent girls across the continent. This paper acknowledges the instrumental role played by Women Human Rights Defenders in placing gender equality and the human rights of women and girls on the policy agenda of governments on the continent. It further emphasizes to emphasize the need for governments and government leaders to prioritize the support and protection of women, girls, and vulnerable groups across the continent.

Women’s business? A social network study of the influence of men on decision-making regarding female genital mutilation/cutting in Senegal

ABSTRACT There exist two dominant but conflicting views on the role of men in the perpetuation female genital mutilation/cutting (FGM/C). One paints men as culprits, with FGM/C viewed as a manifestation of patriarchal oppression of women. An alternative portrays men as relatively uninvolved in a practice described as ‘women’s business’. These two perspectives lead to divergent predictions: if FGM/C underpins patriarchal structures, men should be expected to be ardent supporters of FGM/C as it bolsters their power and status; if FGM/C is a women’s affair, men should have little involvement. We test these predictions using data from a mixed-method study of norms and social networks in two regions of Senegal. Data show that men comprise 50% of core network members, although they exert influence in different ways in each study site. In South Senegal excision is upheld by men, as well as older women, through a constellation of norms that define FGM/C as prerequisite to marriage and social inclusion. In Central Senegal these gender norms have eroded, opening possibilities for abandonment of FGM/C, and men, particularly fathers, at times successfully advocate this change. This suggests that men can play an important role in ending FGM/C, and should be involved in intervention efforts.

Perceptions of Female Genital Mutilation/Cutting (FGM/C) among Asylum Seekers in New York City.

Female Genital Mutilation/Cutting (FGM/C) affects millions of girls and women globally each year despite widespread criminalization of the practice. Eradication efforts have focused on the health risks associated with FGM/C however, it is important to understand the sociocultural context in which this practice exists. We conducted a cross-sectional study using retrospective chart review and structured interviews with women recruited through the Bellevue/New York University Program for Survivors of Torture. Of the 43 participants enrolled in the study, 88.4% initially indicated there is no benefit of undergoing FGM/C but when prompted, agreed that social acceptance (16.3%), religious approval (11.6%), and better marriage prospects (9.3%) are possible benefits. More sexual pleasure for the women (46.5%), avoiding pain (30.2%), and fewer medical problems (16.3%) were stated as benefits of not undergoing FGM/C. Overall, 40 (93%) participants believed the practice should be discontinued. This study highlights that there may be a perception of social benefit of undergoing FGM/C. Although most participants believed the practice should be discontinued, the complex social milieu within which this practice exists must be addressed.

Postmigratory Perceptions of Female Genital Mutilation: Qualitative Life History Research.

Female genital mutilation/cutting (FGM/C) is a practice, in breach of human rights, which currently extends to European countries. Given that migration to a Western country can involve cultural change, the aim of the present study is to explore the experiences and perceptions of sub-Saharan women regarding FGM/C following migration to Spain. A qualitative exploratory research design utilizing life history methodology was applied. Participants (n = 24) were recruited until data saturation was reached. Sub-Saharan women describe their experience of FGM/C. Once in Spain, they begin to demystify the justifications for which FGM/C is practiced and to break the taboo that surrounds the practice. Migration leads individuals to reflect on the traditional practices from their countries of origin. The nursing profession must accompany migrant women throughout their process of change and provide objective information from a position of cultural understanding, avoiding attitudes that might create a sense of revictimization while their resultant health consequences are being attended to.

The socioeconomic dynamics of trends in female genital mutilation/cutting across Africa

BackgroundThe majority of women who undergo female genital mutilation/cutting (FGM/C) live in Africa. Although the UN Sustainable Development Goals call for intensified efforts to accelerate the abandonment of FGM/C, little...

Labour outcomes with defibulation at delivery in immigrant Somali and Sudanese women with type III female genital mutilation/cutting.

There is a scarcity of studies on labour outcomes with defibulation. This study assessed the outcomes of labour with defibulation at delivery in women with type III female genital mutilation/cutting (FGM/C) compared to labour without defibulation. We identified and reviewed the records of all Somali and Sudanese women who delivered at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 2012 and December 2016. Labour outcomes of women with type III FGM/C who delivered vaginally with defibulation at delivery were compared to the outcomes of women without type III FGM/C who delivered vaginally without defibulation. Data extracted from the records included demographics, registration status, and labour outcomes. During the study period, 1086 Somali and Sudanese women delivered at our institution, with 42% delivering by caesarean section. Among the 631 women with vaginal delivery, 27% had type III FGM/C and delivered with defibulation while 73% did not have type III FGM/C and delivered without defibulation. Demographic and clinical factors were similar between the two groups who delivered vaginally. The outcomes of labour with defibulation at delivery in women with type III FGM/C were not different from women without defibulation, except in regards to instrumental delivery and maternal blood loss. There were also no statistically significant differences between the two groups in neonatal outcomes. Defibulation at delivery is an effective minor surgical procedure that should be in the armamentarium of the healthcare providers managing women with type III FGM/C.   &nbsp.

Healthcare for Women and Girls Who Have Been Subjected to Female Genital Mutilation/Cutting (FGM/C)

Background: Female genital mutilation/cutting (FGM/C) may increase the risk of health consequences in girls and women. Public health policies and guidelines on providing care for this target group should be implemented in the healthcare services. Objectives: The aim of this brief report was to introduce innovations in Swedish healthcare for women and girls who have been subjected to FGM/C in order to advance our knowledge and understanding the adoption, implementation, and potential scale-up of healthcare services for this target group in Iran. Methods: Data were collected from a register study, an inventory of regional guidelines in Sweden, and a literature review. Results: The results show that care offers can be categorized as obstetric and gynecological care, psychosexual consulting, and plastic surgery. The results can be adapted and implemented in an Iranian context by preparing guidelines for providing care for this target group at the region, province, and country level. Conclusions: Another suggestion for improvement of care for women and girls exposed to FGM/C in Iran is the use of diagnosis codes recommended by WHO to register, map, and follow up these patients. Obstetric and gynecological, plastic surgery, psychosexual consulting may be recommended to provide person-centered care.

Experiences of young women who underwent female genital mutilation/cutting.

To describe the FGM/C experiences of young women living in Nigeria. Globally, several activities have been targeted at ending female genital mutilation/cutting (FGM/C). However, the practice is ongoing, especially in countries such as Nigeria, which is reported to be having a population boom. Therefore, there is a need to investigate the FGM/C experiences of young women in such countries so that efforts towards ending it can be accelerated using evidence-based, community-led interventions. A qualitative descriptive design. The study took place in two states of south-eastern Nigeria with a high prevalence of FGM/C. The snowball sampling method was used to recruit 22 women, aged 20-40, who had undergone FGM/C. Participant's experiences were explored through semi-structured interviews, and the qualitative content analysis was used for data analysis. The consolidated checklist for reporting of qualitative studies guided the reporting of this study. Three themes and seven subthemes emerged from the data. The themes were as follows: cultural issues, life as a circumcised woman and the future with FGM/C. Half of the participants could not recall their experiences on the day of their circumcision, as they were circumcised at infancy. However, those who were older when circumcised experienced it as a painful, traumatic experience forced upon them. Some of the participants experienced sexual and childbirth problems due to this procedure, and this was of great concern to them. Female genital mutilation/cutting was a traumatic experience forced on the participants. They felt helpless as they could not choose and had to do the "right thing." Despite the trauma and complications caused by the cutting, some still supported the continuation of the practice. Understanding the experiences of genitally mutilated women could assist healthcare practitioners in rendering quality, and contextualised services to these women.

Sahiyo Stories: Shattering the Silence on Female Genital Mutilation/Cutting.

Sahiyo Stories brought together women from across the United States to create personalized digital stories narrating the experience of undergoing female genital mutilation/cutting (FGM/C). FGM/C continues because people believe that if a girl does not undergo it, she will not grow up to be a "good woman." For centuries, then, women have been afraid to speak about FGM/C for fear of ostracization from their communities, getting loved ones in trouble, and other reasons. Sahiyo Stories shatters this silence and the digital stories collection is woven together by a united sentiment to protect future generations of girls from this harm.

Female Genital Self-Image in Women With and Without Female Genital Mutilation/Cutting in Jeddah, Saudi Arabia.

IntroductionThe consequences of female genital mutilation/cutting (FGM/C) on female genital self-image are not known.AimTo assess whether women with and without FGM/C differed with regard to female genital self-image.MethodsA survey was administered to a group of women attending the King Abdulaziz University Hospital obstetrics and gynecology clinic from December 2016 to August 2017. 963 consecutive adult women seen at the clinic completed the survey.Main outcome measuresThe main outcome measure of this study was female genital self-image being assessed with the female genital self-image scale (FGSIS).ResultsOne-fifth (18.2%) of the women self-reported having undergone FGM/C as young girls. Women with FGM/C had a similar FGSIS score as women with no FGM/C (21.3 ± 4.6, n = 175 vs 21.6 ± 4.8, n = 756, analysis of variance, P = .37). In multivariate regression analysis, only level of education remained independently associated with the FGSIS score. Women with some university education had a greater mean FGSIS score than women with no university education (22.1 ± 4.49, n = 564 vs 20.8 ± 5.03, n = 399, P < .0001).ConclusionsWomen with and without FGM/C in a Saudi Arabian clinic generally had a similarly positive genital self-image. Only level of education was independently associated with the FGSIS score.Rouzi AA, Berg RC, Alamoudi R, et al. Female Genital Self-Image in Women With and Without Female Genital Mutilation/Cutting in Jeddah, Saudi Arabia. Sex Med 2020;8:752–756.

Evaluation of etiology, characteristics, and treatment of patients with vesicovaginal fistula observed in rural Africa

ObjectiveIn this study, we aimed to evaluate the etiology, characteristics, and treatment of patients with diagnosis of vesicovaginal fistula (VVF) due to labor in rural Africa following surgery in a hospital with western standards according to the current literature. MethodsIn this retrospective large case series, 56 patients undergoing surgery due to prediagnosis of VVF and then followed-up regularly in Nyala-Sudan Turkey Training and Research Hospital between December 2018 and February 2019 were evaluated. The information related to the ages, mode, and the number of deliveries, previous histories of fistula repair surgery, postoperative success and complication rates were gathered. ResultsThe absence of urine from the vagina during the examination with methylene blue was defined as success. The overall success rate was 84.3 %. The vaginal route was most commonly preferred for fistula repair surgery and its success rate and efficiency were found to be higher. In addition, a low complication rate was observed as 3.9 %. A higher rate of association was observed between Female Genital Mutilation/Cutting (FMG/C) and fistula. Especially FGM/C type 3 was frequently seen with a rate of 61.7 %. This type of FGM/C was observed in all patients undergoing reoperation. The main causes of recurrence of fistula were vaginal delivery within 6 months of repair or presence of multiple fistulas at diagnosis. ConclusionsThe surgery and follow-up process should be individualized after this examination based on the condition, clinical picture of the patient and surgeon’s experience. Additionally worldwide steps should be taken to prevent FGM/C as it is associated with many undesired outcomes including VVF.