Peer-reviewed article
Preventing female genital mutilation in high income countries: a systematic review of the evidence
Carolyne Njue, Jamlick Karumbi, Tammary C. Esho, Nesrin Varol, Angela J Dawson ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined evidence on strategies to prevent female genital mutilation (FGM) in high-income countries, focusing on interventions used in migrant communities. The review identified 11 studies describing prevention activities including legislation, community outreach, healthcare professional training, and engagement with community champions. Most evaluations measured only short-term changes in attitudes and knowledge rather than long-term health or social outcomes. The authors conclude that FGM prevention requires multifaceted approaches but that rigorous longitudinal evaluation is needed to provide stronger evidence of effectiveness.
Key points
- High-income countries have implemented legislative action, bureaucratic interventions, health persuasion, community outreach, and healthcare professional training as FGM prevention strategies
- Most studies are process evaluations measuring short-term outcomes such as changes in attitude, knowledge and confidence or audits of practices
- There is limited evaluative research on empowerment-oriented preventative activities involving affected women and girls
- FGM prevention requires multifaceted responses encompassing socio-economic factors, education, health services and community mobilisation
- Investment in rigorous longitudinal evaluation of FGM prevention efforts is needed to guide future decision-making
Limitations
The review does not provide details on the specific content or intensity of individual interventions, making it difficult to compare approaches. The review focuses on high-income countries and may not capture evidence from countries with higher FGM prevalence where prevention strategies may differ.
Abstract
BACKGROUND: Female genital mutilation (FGM) is prevalent in communities of migration. Given the harmful effects of the practice and its illegal status in many countries, there have been concerted primary, secondary and tertiary prevention efforts to protect girls from FGM. However, there is paucity of evidence concerning useful strategies and approaches to prevent FGM and improve the health and social outcomes of affected women and girls. METHODS: We analysed peer-reviewed and grey literature to extract the evidence for FGM prevention interventions from a public health perspective in high income countries by a systematic search of bibliographic databases and websites using appropriate keywords. Identified publications were screened against selection criteria, following the PRISMA guidelines. We examined the characteristics of prevention interventions, including their programmatic approaches and strategies, target audiences and evaluation findings using an apriori template. FINDINGS: Eleven documents included in this review described primary and secondary prevention activities. High income countries have given attention to legislative action, bureaucratic interventions to address social injustice and protect those at risk of FGM, alongside prevention activities that favour health persuasion, foster engagement with the local community through outreach and the involvement of community champions, healthcare professional training and capacity strengthening. Study types are largely process evaluations that include measures of short-term outcomes (pre- and post-changes in attitude, knowledge and confidence or audits of practices). There is a dearth of evaluative research focused on empowerment-oriented preventative activities that involve individual women and girls who are affected by FGM. Beattie's framework provides a useful way of articulating negotiated and authoritative prevention actions required to address FGM at national and local levels. CONCLUSION: FGM is a complex and deeply rooted sociocultural issue that requires a multifaceted response that encompasses socio-economic, physical and environmental factors, education and learning, health services and facilities, and community mobilisation activities. Investment in the rigorous longitudinal evaluation of FGM health prevention efforts are needed to provide strong evidence of impact to guide future decision making. A national evidence-based framework would bring logic, clarity, comprehension, evidence and economically more effective response for current and future prevention interventions addressing FGM in high income countries.