Prevention Of Female Genital Mutilation Research Articles

Cluster randomised trial of a health system strengthening approach applying person-centred communication for the prevention of female genital mutilation in Guinea, Kenya and Somalia

IntroductionThere is limited evidence on effective health systems interventions for preventing female genital mutilation (FGM). This study tested a two-level intervention package at primary care applying person-centred communication (PCC) for...

"All you Gain is Pain and Sorrow": Facilitators and Barriers to the Prevention of Female Genital Mutilation in High-income Countries.

Female genital mutilation (FGM) is a harmful practice that has long-lasting negative impacts on the physical and psychological health of victims. Deemed a global concern, this practice persists in high-income countries (HIC) among certain migrant communities. Given the deleterious effects of the practice, we conducted an updated systematic review of the facilitators and barriers associated with the prevention of FGM in HIC. A systematic review of published qualitative studies of FGM in HIC was conducted from 2012 to 2022. The search resulted in 276 studies. Of these, the majority were from low- and middle-income countries (LMIC) and excluded. A total of 14 studies were deemed fit for inclusion and none were excluded during quality appraisal. Relevant data were extracted from the studies and thematically analyzed to identify prevalent themes. A total of 12 themes were identified and the majority reflected barriers to the prevention of FGM including beliefs about female virtue, beliefs about social sanctions, and the preservation of culture, among others. Facilitators to the prevention of FGM were fewer and included memory and trauma from experiencing FGM, knowledge and awareness of the female anatomy, and legislative protection from FGM due to migration. A few themes, such as religious beliefs, acted as both facilitators and barriers. Findings highlight the importance of shared cultural and social threads among FGM practicing communities in HIC. Interventions can use these findings to guide the development of sociocultural strategies centered on community-level prevention and reduction of FGM in HIC.

Evaluating the long-term impact of large-scale trainings: an exposure based cross-sectional study on female genital mutilation-related knowledge, attitudes and practices among Sudanese midwives in Khartoum State

ObjectivesTo examine the long-term impact of large-scale training targeting midwives in a setting where they are the main female genital mutilation (FGM) practitioners. We hypothesised that trained midwives would have...

“Nurses and health professionals facing female genital mutilation: a qualitative study “

BackgroundTransnational migratory movements make Spain a country with a very diverse population, including women and girls from countries where Female Genital Mutilation (FGM) is practiced. Given this reality, we set out to carry out a qualitative study to identify the knowledge, attitudes and skills of health professionals regarding FGM.MethodQualitative study with a content analysis approach. Forty-seven health professionals with the profiles of Nursing, Family Medicine, Pediatrics, Midwifery and Gynecology and Obstetrics were purposively selected. Data were collected through semi-structured in-depth interviews and focus groups. The qualitative content analysis approach was used for data analysis. The study was conducted in the years 2019 and 2022.ResultsAlthough most professionals are aware of the current legislation on FGM in Spain, only a few of them are aware of the existence of the FGM prevention protocol in Castilla-La Mancha. This lack of knowledge together with the perception that FGM belongs to the private sphere of women, contributes to the loss of opportunities to identify and prevent FGM.ConclusionHealth professionals’ training, especially midwives and pediatricians, is essential to the identification and action against Female Genital Mutilation.

National and international programmatic perspective on facilitators and barriers for Sudan’s health sector response on female genital mutilation (2016–2018): a qualitative study

ObjectivesTo explore the facilitators and barriers that affected the design and implementation of the first 3 years of Sudan’s largest health programme on female genital mutilation (FGM).DesignWe used a qualitative...

Knowledge and attitudes among nurses and midwives in Cyprus and Kenya regarding Female Genital Mutilation (FGM): A comparative study

It is estimated that 200 million girls/women are living with Female Genital Mutilation (FGM). FGM is a violation of human rights. It has detrimental effects on girls/women's physical and psychological health. Nurses and midwives have an essential role in the management and prevention of FGM. The aim of this paper is to investigate the knowledge and attitudes of nurses and midwives in Cyprus and Kenya regarding FGM.A quantitative methodology was applied with the use of an online survey. The sample consisted of 231 Kenyan and Cyprus nurses and midwives.Most of the participants reported being aware of the issue of FGM. It seems that no protocols exist in managing FGM complications.Although participants have some knowledge regarding FGM, results revealed the need for further training. They underlined the need for adoption or development of protocols at workplace. Some participants seemed to be skeptical regarding the medicalization of FGM.

Key Factors, Drivers and Gatekeepers of Female Genital Mutilation in Ethiopia: A Meta-synthesis of National and Regional Studies

Female Genital Mutilation (FGM) is a harmful practice that consists of all procedures involving partial or total removal of the female external genitalia or other injuries to the female genital organs for non-medical reasons. This meta-synthesis aimed to identify and describe key factors, drivers, and gatekeepers of FGM practices in Ethiopia and was conducted using systematic searches in electronic databases (PubMed, PsycINFO, and Google Scholar) and grey literature published from 2012 to 2021. The main factors and drivers of FGM practices were cultural and traditional practices including marriageability and religious obligations. Other drivers were poor enforcement of laws against the practice including medicalization of FGM practice. The key gatekeepers included traditional birth attendants who were also mostly female circumcisers; mothers, grandmothers, and older women who were reported as major promoters, circumcisers, and key decision makers on the practice. Religious leaders and health workers also played pivotal role in the prevention of FGM as trusted source of information dissemination. It is therefore important that Programme and policy strategies to eliminate the practice are tailored to the local context, not only addressing these factors and drivers but involving the gatekeepers.

Effect of COVID-19 pandemic on female sexual function in women with female genital mutilation

We aimed to evaluate the impact of the COVID-19 pandemic on female sexual function in women with female genital mutilation (FGM) in Somalia. This cross-sectional study was conducted on women with FGM attending the gynaecologic outpatient clinic of our hospital, between March and June 2021, using a validated Female Sexual Function Index (FSFI) questionnaire with a physical examination based on FGM typing. Those women who refused to participate, those with mental illness, uncontrolled systemic disease, drug, alcohol, or khat addiction, pregnant, genital prolapse, gynaecological or urological cancer, previous pelvic surgery, premature ovarian failure, genital skin diseases, drug use that affects sexual function and those with or suspected of having COVID-19 infection were excluded. A total of 201 sexually active women enrolled, with a mean age of 29 (14–55) years. Comparison of FSFI scores and the COVID-19 pandemic, a statistically significant worsening in the mean FSFI scores and all its domains (p<.001, for each). All of the domains of the FSFI were determined higher before and during the pandemic except pain. There is a decline in female sexual functioning during the COVID-19 outbreak in women with FGM. FGM is a major public health concern necessitating urgent response in Somalia. Impact statement What is already known on this subject? As it stands, there is a body of research on sexual behaviour during COVID-19 pandemic, but a lack of conclusive evidence. However, our knowledge of the sexual function of women with FGM during the COVID-19 pandemic is largely based on very limited data. What do the results of this study add? There is a decline in female sexual functioning during COVID-19 pandemic in women with female genital mutilation in Somalia. What are the implications of these findings for clinical practice and/or further research? FGM is a major public health problem necessitating urgent response worldwide. There is an urgent need to implement FGM prevention programmes and raise public awareness in order to eradicate this harmful practice.

Involving the health sector in the prevention and care of female genital mutilation: results from formative research in Guinea

BackgroundDespite efforts to reduce the burden of female genital mutilation (FGM) in Guinea, the practice remains prevalent, and health care providers are increasingly being implicated in its medicalization. This formative study was conducted to understand the factors that facilitate or impede the health sector in providing FGM prevention and care services to inform the development of health sector-based interventions.MethodsBetween April and May 2018, a mixed methods formative study was carried out using a rapid assessment methodology in three regions of Guinea—Faranah, Labe and Conakry. A structured questionnaire was completed by one hundred and fifty health care providers of different cadres and 37 semi-structured interviews were conducted with health care providers, women seeking services at public health clinics and key stakeholders, including health systems managers, heads of professional associations and schools of nursing, midwifery, and medicine as well as representatives of the Ministry of Health. Eleven focus group discussions were conducted with female and male community members.ResultsThis study revealed health systems factors, attitudinal factors held by health care providers, and other factors, that may not only promote FGM medicalization but also impede a comprehensive health sector response. Our findings confirm that there is currently no standardized pre-service training on how to assess, document and manage complications of FGM nor are there interventions to promote the prevention of the practice within the health sector. This research also demonstrates the deeply held beliefs of health care providers and community members that perpetuate this practice, and which need to be addressed as part of a health sector approach to FGM prevention.ConclusionAs integral members of FGM practicing communities, health care providers understand community beliefs and norms, making them potential change agents. The health sector can support them by incorporating FGM content into their clinical training, ensuring accountability to legal and policy standards, and promoting FGM abandonment as part of a multi-sectoral approach. The findings from this formative research have informed the development of a health sector intervention that is being field tested as part of a multi-country implementation research study in Guinea, Kenya, and Somalia.

Küresel bir sorun olarak kadın sünneti üzerine YouTube videolarının bir analizi

Objective: Female genital mutilation is the removal of female genital organs for non-medical reasons, which is widely practiced worldwide. Female genital mutilation is a dark subject for the scientific world since it is often practiced in closed societies. In this study, we aimed to evaluate the role of YouTube videos in the prevention of female genital mutilation. Material and Methods: In this cross-sectional study, an internet search was conducted on YouTube.com on May 1, 2021, using the keywords «female genital mutilation» and «female circumcision» on a web browser with a clear cache and latest updates. Search results were evaluated in terms of the demographic characteristics of uploaders and the quality and reliability of the videos. Results: Most of the videos were shared by women. The videos shared by women and healthcare professionals were higher quality and more reliable compared to videos uploaded by men and religious personnel. Conclusion: YouTube.com videos may be beneficial for the prevention of female genital mutilation, but more attention should be paid to this issue, particularly by healthcare professionals, and more reliable videos with the higher quality should be shared. Keywords: Circumcision, female, genitalia.

A hybrid, effectiveness-implementation research study protocol targeting antenatal care providers to provide female genital mutilation prevention and care services in Guinea, Kenya and Somalia

BackgroundIn settings with high prevalence of female genital mutilation (FGM), the health sector could play a bigger role in its prevention and care of women and girls who have undergone this harmful practice. However, ministries of health lack clear policies, strategic plans or dedicated funding to implement anti-FGM interventions. Along with limited relevant knowledge and skills to prevent the practice of FGM and care for girls and women living with FGM, health providers have limited interpersonal communication skills and self-efficacy, while some may have supportive attitudes towards FGM and its medicalization. We propose to test the effectiveness of a health system strengthening intervention that includes training antenatal care (ANC) providers on person-centred communication (PCC) for FGM prevention.MethodsThis will be a two-level, hybrid, effectiveness-implementation research study using a cluster randomized trial design in Guinea, Kenya and Somalia conducted over a 6 months period. In each country, within pre-selected regions/counties, 60 ANC clinics will be randomized to intervention and control arms. At baseline, all clinics will receive the level one intervention involving provision of FGM-related clinical guidelines and handbook as well as anti-FGM policies and posters. At month 3, intervention clinics will receive the level two intervention comprising of a training for ANC providers on PCC to challenge their FGM-related attitudes and build their communication skills to effectively provide FGM prevention counselling. A process evaluation will be conducted to understand ‘how’ and ‘why’ the intervention package achieves intended results. Multi-level regression modelling will be used for quantitative data analysis while qualitative data will be assessed using thematic content analysis to determine the effectiveness, feasibility and acceptability of the different intervention levels.DiscussionThe proposed study will strengthen the knowledge base regarding how to effectively involve health providers in FGM prevention and care.Trial registrationTrial registration and date: PACTR201906696419769 (June 3rd, 2019).

Cost and impact of scaling up female genital mutilation prevention and care programs: Estimated resource requirements and impact on incidence and prevalence.

PurposeSDG 5.3 targets include eliminating harmful practices such as Female Genital Mutilation (FGM). Limited information is available about levels of investment needed and realistic estimates of potential incidence change. In this work, we estimate the cost and impact of FGM programs in 31 high burden countries.MethodsThis analysis combines program data, secondary data analysis, and population-level costing methods to estimate cost and impact of high and moderate scaleup of FGM programs between 2020 and 2030. Cost per person or community reached was multiplied by populations to estimate costs, and regression analysis was used to estimate new incidence rates, which were applied to populations to estimate cases averted.ResultsReaching the high-coverage targets for 31 countries by 2030 would require an investment of US$ 3.3 billion. This scenario would avert more than 24 million cases of FGM, at an average cost of US$ 134 per case averted. A moderate-coverage scenario would cost US$ 1.6 billion and avert more than 12 million cases of FGM. However, average cost per case averted hides substantial variation based on country dynamics. The most cost-effective investment would be in countries with limited historic change in FGM incidence, with the average cost per case averted between US$ 3 and US$ 90. The next most effective would be those with high approval for FGM, but a preexisting trend downward, where cost per case averted is estimated at around US$ 240.InterpretationThis analysis shows that although data on FGM is limited, we can draw useful findings from population-level surveys and program data to guide resource mobilization and program planning.

Minority migrant men’s attitudes toward female genital mutilation: Developing strategies to engage men

This article explores minority migrant men's attitudes towards female genital mutilation (FGM), and how these attitudes can be used to develop strategies to engage men in the eradication of FGM. Based on interviews and focus group discussions, the article finds that men's attitudes can be enabling, disabling or neutral: the identification of and variations between these need to be taken into account when developing strategies to engage men in the eradication of FGM. There is currently a window of opportunity for involving minority migrant men in the prevention of FGM and in the challenging of a minority migrant gender regime.

An Evaluation of Community-Based Interventions Used on the Prevention of Female Genital Mutilation in West African Countries

The traditional practice called Female Genital Mutilation has been recorded in several countries in Africa and in other regions around the world. Female Genital Mutilation is regarded as a major Public Health burden due to the extensive health risks associated with the procedure and community-based interventions has been prescribed to eliminate the practice. This paper presents a review of published literature about community-based interventions carried out to prevent Female Genital Mutilation in West Africa between the years 2000-2013. A literature search was conducted for papers published between the years 2000 - 2013. Papers were reviewed if they reported a positive change in knowledge, attitude and behaviour towards FGM. Twenty papers met the inclusion criteria. A total of eight types of methods were identified: Advocacy Campaigns, Health Education, Sensitization Workshops, Community dialogue, Media campaigns (radio, newspaper, film shows, information posters) counselling, role plays and Skills training. This study identified that these interventions utilised health promotion models such as the behaviour change, client-centred/empowerment, social change and most commonly the educationalmodel. None of the interventions were based on the medicalmodel of health promotion. Hence, it seems an incorporation of the medical and educational models of health promotion could result in a greater impact in community-based interventions to prevent FGM.

Insights from outside BJOG

Insights from outside BJOG

The prevention of female genital mutilation in England: what can be done?

Female genital mutilation (FGM) is a global public health issue. Women in the UK are at risk of FGM and its adverse health consequences but little is known about its practice. Since 1985 it has been a criminal offence to perform FGM in the UK and further legislation has tightened the law but FGM continues. Four community researchers from the Kenyan, Nigerian, Somalian and Sudanese communities in Oxford conducted focus groups and interviews with 53 people to understand the communities' beliefs about how best to prevent FGM. Participants believed that the current UK legislation alone was not sufficient to tackle FGM and might in fact be counterproductive by alienating communities through its perceived imposition. They felt that there had been insufficient consultation with affected communities, awareness raising and education about the legislation. Community-led solutions were the most effective way to tackle FGM. FGM adversely affects communities globally. In the UK, researchers from affected communities gathered data demonstrating the feasibility and importance of involving communities in FGM prevention work. Further research is needed to understand how best to prevent FGM in affected communities and, very importantly, to examine the impact of the UK legislation relating to FGM.

Addressing female genital mutilation in Europe: a scoping review of approaches to participation, prevention, protection, and provision of services

BackgroundPublic and policy attention to female genital mutilation (FGM) in diaspora communities has increased in Europe, but research remains limited and misinformation abounds. As a first step to addressing these issues, this study explored FGM prevention and response interventions in Europe, using a scoping literature review and key informant interviews.MethodsA scoping study design was selected, using Arksey and O’Malley’s six-stage scoping framework to review identified sources. Key informant interviews were used to inform and add depth to literature findings. Findings were summarised thematically, guided by the Scottish Government’s ‘4Ps’ framework for tackling violence against women (i.e. participation, prevention, protection, providing services).ResultsSeventy literature sources, of 1095 screened, plus 16 individual and 3 group interview sources were included. Several countries have developed promising interventions supporting FGM resistance and recovery. However, gaps remain including community participation, professional knowledge and linkages, and evaluation of approaches.ConclusionsThis scoping review is an initial attempt to describe available primary evidence on European initiatives responding to FGM. Further research is required to determine whether interventions are effective, while policy and practice development must be shaped and driven by the experiences, needs, and views of affected communities.

The Opinion and Role of Men in Female Circumcision in Khartoum State in 2015-2016

Background: Study on female genital mutilation (FGM), review and contrasting points of view on the subject of men between supporters and opponents and their role in the spread of this phenomenon or control based on their opinion and also the opinion of religions, especially the Islamic religion, medicine and the law on The benefits and the damage that results from behind this phenomenon and then in the presence of customs and traditions in the regions where they are located. Objectives: The study was aimed to study the opinion and role of men in female circumcision in Khartoum state (2015-2016). Methods: In Khartoum state between 2015 and 2016 by descriptive, cross-sectional study, men between 20 to 60 years were enrolled. Men’s attitudes, beliefs, and behaviors were explored in regards to FGM, as well as their ideas about FGM prevention and abandonment. Results: The result 150 cases from Khartoum states revealed 89.6% who refused this idea and most important factor to determine the role and opinion is level of education. But still the major role stayed for women specially mothers, and most of them said we had a role against this idea by 65.4% and 67.4% they known the opinion of Islamic religious. Conclusion: The men had a major role in the female circumcision. The level of education of men was one of the most important indicators.

Interventions for healthcare providers to improve treatment and prevention of female genital mutilation: a systematic review.

BackgroundStudies on healthcare providers’ awareness, knowledge and attitudes regarding female genital mutilation (FGM) have shown a lack of awareness of the prevalence, diagnosis, and management of FGM. Our objective was to systematically review the literature on interventions improving healthcare providers’ capacities of prevention and treatment of FGM.MethodsSystematic review of the published and grey literature on interventions aimed at improving healthcare providers’ capacities of prevention and treatment of FGM (1995–2015). Outcomes observed were knowledge and attitudes about FGM, medicalization, and prevention.ResultsOnly two studies met our inclusion criteria. They reported on educational interventions aimed at increasing caregivers’ knowledge on FGM. One was conducted with 59 providers, in Mali; the other one with 11 certified nurse-midwives in the United States. The studies report basic statistics regarding the improvement of healthcare professionals’ knowledge, attitude on FGM and medicalization of the practice. Neither conducted multivariable analysis nor evaluated the training effects on the quality of the care offered, the clinical outcomes and the satisfaction of women attended, and prevention.ConclusionAs health care providers are essential in prevention and treatment of FGM, developing effective interventions is crucial.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1674-1) contains supplementary material, which is available to authorized users.

The role of men in abandonment of female genital mutilation: a systematic review.

BackgroundMen in their roles as fathers, husbands, community and religious leaders may play a pivotal part in the continuation of female genital mutilation (FGM). However, the research on their views of FGM and their potential role in its abandonment are not well described.MethodsWe undertook a systematic review of all publications between 2004 and 2014 that explored men’s attitudes, beliefs, and behaviours in regards to FGM, as well as their ideas about FGM prevention and abandonment.ResultsWe included twenty peer-reviewed articles from 15 countries in the analysis. Analysis revealed ambiguity of men’s wishes in regards to the continuation of FGM. Many men wished to abandon this practice because of the physical and psychosexual complications to both women and men. Social obligation and the silent culture between the sexes were posited as major obstacles for change. Support for abandonment was influenced by notions of social obligation, religion, education, ethnicity, urban living, migration, and understanding of the negative sequelae of FGM. The strongest influence was education.ConclusionThe level of education of men was one of the most important indicators for men’s support for abandonment of FGM. Social obligation and the lack of dialogue between men and women were two key issues that men acknowledged as barriers to abandonment. Advocacy by men and collaboration between men and women’s health and community programs may be important steps forward in the abandonment process.