Abstract Given the conventional wisdom that poverty and associated income shocks are the fundamental causes of child labour, from a policy perspective, there is a perception that social safety net programmes can play a vital role in reducing child labour. While there is extensive evidence that shows the prevalence of child labour is low among beneficiaries of conditional cash transfer programmes, the impact of workfare programs on child labour has been rarely investigated in the economics literature. This paper addresses the issue by evaluating the impact of the public works component of the Productive Safety Net Programme implemented in Ethiopia in 2005. The programme aims to help poor households to build assets and develop resilience to shocks through employment in public projects. Results from child fixed effects estimations show that children in programme beneficiary households are significantly less likely than their counterparts in non‐beneficiary households to be involved in child labour. The findings suggest that, if well targeted, even safety net programmes that do not primarily target child outcomes can be useful in addressing child labour problems.
Female genital mutilation (FGM) is any process that injures or removes part or all of the external female genital organs for non-medical reasons. FGM is a growing public health concern in the UK because of an increase in migration from countries where it is widely practised. Education on FGM for nurses is key to supporting women who have undergone the practice, as well as safeguarding girls and women who are at risk. Nurses must understand the history and culture of FGM as well as the long-term health complications to be able to support affected women both professionally and sensitively.
Over 513,000 girls and women in the United States are at risk or are victims of female genital mutilation/cutting.1 Female genital mutilation/cutting is defined as partial or complete excision of external genitalia or injury to the genital organs for nonmedical reasons.2 A scoping review of surgical interventions for female genital mutilation/cutting–related morbidity confirmed that the majority of female genital mutilation/cutting care is delivered by obstetrics and gynecology providers.3 However, procedures such as clitoral reconstruction, scar excision, neuroma treatment, and functional and aesthetic reconstruction fall within the scope and expertise of plastic surgeons.4 To assess familiarity with female genital mutilation/cutting, a 33-question survey was deployed to 3628 members of the American Society of Plastic Surgeons. Three-hundred sixty-three members responded (10 percent response rate). Most respondents were cis male (n = 224, 61.7 percent), White (n = 280, 77.1 percent), and born in the United States (n = 300, 82.6 percent). Respondents consisted of 217 attending physicians (59.8 percent) and 123 trainees (33.8 percent). Respondents were similar to nonresponders and the general American Society of Plastic Surgeons membership. A similar survey was deployed to 5000 obstetrics and gynecology physicians through the American College of Obstetricians and Gynecologists, with a 9.8 percent response rate (n = 491). Eighty percent of plastic surgery respondents (n = 285) reported no prior education or training on female genital mutilation/cutting, 84.5 percent were unfamiliar with the World Health Organization classification system of female genital mutilation/cutting, and 88.4 percent were uncertain of existing clinical management guidelines at hospital, national, or international levels (Table 1). Female genital mutilation/cutting has been formally banned in the United States since 1996; yet, 19 states do not currently have legislation in place criminalizing female genital mutilation/cutting.5 The most commonly selected location of where female genital mutilation/cutting is practiced was Africa (n = 324, 89.3 percent); it can be practiced in any country where communities from endemic areas are living.6 Respondents believed cultural tradition (n = 284, 78.2 percent), control of women’s sexuality (n = 258, 71.1 percent), and religion (n = 250, 68.9 percent) were reasons why it is performed. All listed immediate and chronic physical risks were selected at similar frequency. Most respondents (n = 196, 54.0 percent) indicated that female genital mutilation/cutting can occur repeatedly through a woman’s childhood and adult life; while it is usually performed before age 15, it can be performed at any age.7 Table 1. - Knowledge and Training Related to Female Genital Mutilation/Cutting According to Plastic Surgery Respondents Survey Item Response All Respondents Total no. of respondents 363 Have you received any kind of education or training on FGM/C? Yes 62 (17.3) No 285 (79.6) Uncertain 11 (3.1) Are you familiar with the WHO classification system for FGM/C (types I, II, III, IV)? Yes 29 (8.5) No 289 (84.8) Uncertain 23 (6.7) Where is FGM/C practiced? Africa 324 (89.3) Europe 125 (34.4) Asia 188 (51.8) Australia/Oceania 88 (24.2) North America 112 (30.9) South America 103 (28.4) Why is FGM/C performed? Religious reasons 250 (68.9) To control women’s sexuality 258 (71.1) To ensure virginity before marriage and fidelity in marriage 168 (46.3) Hygiene 39 (10.7) Cultural tradition 284 (78.2) Punishment 111 (30.6) Uncertain 46 (12.7) Immediate physical risks associated with FGM/C include: Hemorrhage 300 (82.6) Hemorrhagic, neurogenic, or septic shock 280 (77.1) Genital and reproductive tract infections 313 (86.2) Urinary tract infections 290 (79.9) Acute urinary retention 251 (69.1) Dysuria 269 (74.1) Damage to urethra 306 (84.3) Death 251 (69.1) Other 11 (3.0) Long-term risks associated with FGM/C include: Chronic wounds 292 (80.4) Chronic vulvar and clitoral pain 317 (87.3) Sexual dysfunction 323 (89.0) Urethral fistulas and strictures 307 (84.6) Recurrent UTIs 287 (79.1) Complicated deliveries: cesarean delivery, postpartum hemorrhage, episiotomy, labor dystocia, obstetrical tears/lacerations, extended maternal hospital stay, infant resuscitation at delivery 284 (78.2) Mental illness: depression, PTSD, anxiety 312 (86.0) Other 3 (0.8) FGM/C can occur: Once in childhood 112 (30.9) Several times in childhood 73 (20.1) Repeatedly throughout a woman’s childhood and adult life 196 (54.0) Uncertain 96 (26.4) Are you aware of any existing guidelines regarding clinical management and/or legal requirements for FGM/C at the following levels? In the hospital(s) where I practice 2 (0.6) At the national level 9 (2.5) At the international level 16 (4.4) Uncertain 321 (88.4) Are you interested in knowing more about FGM/C? Yes 192 (59.3) No 68 (21.0) Uncertain 64 (19.8) What form of education or training would you find helpful on this topic? Assigned reading 8 (2.5) Guest speaker who has FGM/C or is expert in FGM/C 72 (22.8) I would not find any form of education or training helpful on this topic 34 (10.8) Lecture 37 (11.7) Lecture series 26 (8.2) Online modules 102 (32.3) Other (please describe) 6 (1.9) Self-directed learning 31 (9.8) FGM/C, female genital mutilation/cutting; WHO, World Health Organization; UTIs, urinary tract infections; PTSD, posttraumatic stress disorder. Two-hundred ninety-one respondents (87.7 percent) had never treated a patient with female genital mutilation/cutting. A large majority (81.5 percent) believed that plastic surgeons have a role in female genital mutilation/cutting care, and 56.2 percent believed they have a role in advocacy for laws to prevent the practice. Nearly 60 percent were interested in learning more. Obstetrics and gynecology physicians were significantly more likely than plastic surgeons to have received female genital mutilation/cutting education [n = 204 (41.6 percent) versus n = 62 (17.3 percent), p < 0.001], be familiar with female genital mutilation/cutting classification [n = 181 (36.9 percent) versus n = 29 (8.5 percent), p < 0.001], and have had encounters with female genital mutilation/cutting patients [n = 114 (23.4 percent) versus n = 256 (79.0 percent), p < 0.001 for no encounter]. Our results highlight an important knowledge gap of the epidemiology and practice of female genital mutilation/cutting, screening and diagnosis, and pertinent regulations. Online learning platforms, such as the American Society of Plastic Surgeons Education Network and virtual grand rounds, were the preferred methods for learning about this topic. Plastic surgeons possess the technical expertise to treat the diverse, chronic sequelae of female genital mutilation/cutting. There are opportunities for multidisciplinary collaboration and referral clinics, particularly with obstetrics and gynecology colleagues. With increased awareness and education, we can improve the quality of life for women and girls living with female genital mutilation/cutting. ACKNOWLEDGMENTS The authors would like to acknowledge Christopher Simmons, an analyst from the American Society of Plastic Surgeons, for his assistance with deploying the survey. DISCLOSURE The authors have no significant conflicts of interest or financial interests in relation to the content of this article. The Buehler Center for Health Policy and Economics in Northwestern’s Feinberg School of Medicine funded this study in part. Dr. Chappell performed this research during a funded research year sponsored by the Institute for Global Health at Northwestern University.
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.
Carolyne Njue, Jamlick Karumbi, Tammary C. Esho et al.
OBJECTIVES: This study aimed to identify associated factors for postpartum depression (PPD) among women with female genital mutilation (FGM) in Somalia. METHODS: This was a cross-sectional study conducted between February and May 2021 in Somalia Mogadishu-Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia. Mothers with any known chronic disease, or psychiatric disorders and who refused to participate were excluded from the study. The cutoff point for depression was defined as ≥13 points according to the Edinburgh Postnatal Depression Scale. RESULTS: = .002). Education level, place of residence, occupational status, number of children, type of FGM, and the presence of perineal tear did not differ significantly between depressed and non-depressed groups. CONCLUSIONS: Women with FGM had increased depressive symptoms in the early postpartum period in Somalia. In addition, women who had lower income had higher PPD scores than their counterparts. Further studies are needed to develop a deeper understanding of the relationships between FGM and PPD and its causes.
Objective background: This was a retrospective study of the clinical and therapeutic aspects of urological complications of female genital mutilation in the urology department of Bamako’s Gabriel Touré University Hospital. Methods: Our study took place from 2002 to 2017 in the urology department of the Gabriel Touré University Hospital in Bamako and concerned cases of complications of female genital mutilation. Our study included all girls or women presenting with urinary disorders related to complications of genital mutilation and received in urological consultation and surgical management. Results: The average age of our patients was 2.5 years, with extremes ranging from 3 months to 35 years. The oldest patient had presented with dystocia during both deliveries. Acute urine retention (n = 7) was the most frequent reason for consultation. Other signs included urinary incontinence, pollakiuria and burning. Physical examination revealed clitoridectomy and abrasion of the labia minora in 13 patients. Type III of the WHO classification of female genital mutilation was the most frequent and corresponded to infibulation.
Mamadou Tidiani Coulibaly, Issa Amadou, Maimouna Traore et al.
Female genital mutilation/cutting (FGM/C) threatens the health and well-being of girls in a variety of ways. Some experts have suggested that human immunodeficiency virus (HIV) may be among the practice’s adverse health outcomes. They theorize that because women with FGM/C risk genital trauma and bleeding during intercourse, their chances of acquiring HIV from an infected male partner are increased. While evidence that FGM/C increases susceptibility to HIV could bolster FGM/C eradication efforts, this connection has received limited research attention. This brief highlights the Evidence to End FGM/C program’s findings on the current state of evidence on the association between FGM/C and HIV, including the quality of the existing research and recommendations for further investigation.
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.
Amend the Children Act 1989 to provide that certain proceedings under Part 1 of Schedule 2 to the Female Genital Mutilation Act 2003 are family proceedings.
PURPOSE: The overall goal of the Saleema Initiative in Sudan is to promote long-term abandonment of female genital mutilation and cutting (FGM) through a contribution to changing social norms, attitudes, and intentions related to the practice. The initiative aims to create positive cultural associations with a girl remaining uncut, a new social norm. Saleema hypothesizes that branding the alternative to FGM (abandonment) will promote social norms change. In 2014, the lead author designed a monitoring and evaluation framework for Saleema in partnership with UNICEF, the National Council for Child Welfare (NCCW), and local organizations. METHODS: The Saleema evaluation aimed to evaluate the effectiveness of the campaign in reducing pro-FGM social norms. A quasi-experimental design controlled for dosage of campaign messages delivered across the 18 states in Sudan to measure a dose-response effect. We operationalized social norms through a 4-item scale validated in previous research. RESULTS: This paper reports on quantitative evaluation findings based on data gathered in from 2015-2017 and focuses on the dose-response relationship between Saleema exposure and changes in FGM social norms. We found that self-reported exposure was associated with reduced pro-FGM social norms (coeff. = -0.329, p < .001). Additionally, higher doses of Saleema, measured through an exogenous measure of campaign event exposure from an independent monitoring system was associated with reduced pro-FGM social norms (coeff. = -0.146, p < .001). CONCLUSIONS: Saleema was effective in reducing pro-FGM social norms. It is a promising strategy and findings contribute to the growing literature on social norms approaches to behavior change.
William Douglas Evans, Cody Donahue, Jeremy Williams Snider et al.
