This study examines the effectiveness of anti-Female Genital Mutilation (FGM) laws in reducing the prevalence of FGM across 19 countries. We compile a new database on national anti-FGM legislation detailing the specific provisions. Using all available DHS and MICS data, we compare girls at risk of FGM before and after the law within the same region and same ethnic group using a staggered difference-in-differences approach. Our main results show that anti-FGM laws significantly reduce FGM rates by an average of 5 percentage points. The effect is three times larger for girls born after the law's enactment and in countries with a stronger rule of law. The magnitude of the impact increases with the pre-ban prevalence of FGM, but we observe the largest relative reductions in areas where FGM concerned about 30\% of the female population before the reform. Further results reveal welfare enhancing implications of banning FGM in terms of increased schooling. This work provides a novel contribution on the capacity of laws to effectively influence behaviors, offering important insights for the design of policies aimed at eliminating harmful practices and promoting gender equality.
Migration has resulted in specialist community public health nurses (SCPHN), specifically SCPHN school nurses, encountering female genital mutilation (FGM) more commonly in practice, requiring them to upskill to offer support and raise awareness ( Robinson, 2011 ). A policy was critically analysed, and a literature review conducted, to identify evidence-based strategies to enable the SCPHNSN to effectively raise FGM awareness to school-aged pupils. The findings highlighted three themes – Education, cultural influence and community leader and FGM survivor engagement, which translated into practice as a SCPHNSN-led FGM education project ( Diop and Askew, 2009 , Adeniran et al. 2015 , Galukande et al. 2015 , Raible et al. 2017 , Connelly et al. 2018 , Johnson et al. 2018 ). A project such as this would enable the SCPHNSN to raise pupil awareness, increase knowledge of support services, achieving practice decline over time.
BACKGROUND: Female genital mutilation (FGM) is a harmful cultural practice that is predominantly documented in Africa, but also occurs in other parts of the world. Due to migration, women who have undergone FGM can also be found in the European Union (EU). Due to a lack of systematic representative surveys on the topic in EU, the prevalence of FGM and the number of women and children subjected to the practice remains unknown. However, information on the magnitude of the problem in the EU is necessary for policy makers to design and track preventive measures and to determine resource allocation. METHODS: Between March 2015 and May 2015, we performed a situation analysis consisting of a critical interpretive synthesis and SWOT-analysis of available at the time peer reviewed and grey literature document on national prevalence studies on FGM in the EU. Studies estimating the prevalence of FGM and the number of girls and women subjected to the practice in the EU were mapped to analyse their methodologies and identify their Strengths, Weakness, Opportunities and Threats (SWOT). Distinction was made between direct and indirect estimation methods. RESULTS: Thirteen publications matched the prioritized inclusion criteria. The situation analysis showed that both direct and indirect methodologies were used to estimate FGM prevalence and the number of girls and women subjected to FGM in the EU. The SWOT-analysis indicated that due to the large variations in the targeted population and the available secondary information in EU Member States, one single estimation method is not applicable in all Member States. CONCLUSIONS: We suggest a twofold method for estimating the number of girls and women who have undergone FGM in the EU. For countries with a low expected prevalence of women who have undergone FGM, the indirect method will provide a good enough estimation of the FGM prevalence. The extrapolation-of-FGM-countries-prevalence-data-method, based on the documented FGM prevalence numbers in DHS and MICS surveys, can be used for indirect estimations of girls and women subjected to FGM in the EU. For countries with a high expected prevalence of FGM in the EU Member State, we recommend to combine both a direct estimation method (e.g. in the form of a survey conducted in the target population) and an indirect estimation method and to use a sample design as developed by the FGM-PREV project. The choice for a direct or indirect method will ultimately depend on available financial means and the purpose for the estimation.
Lotte De Schrijver, Luk Van Baelen, Nina Van Eekert et al.
Female Genital Mutilation has been described by the U.N. as a ‘critical human rights issue’ and as a consequence, several jurisdictions, including England and Wales, have enacted specific legislation to combat the practice. This paper considers FGM from a human rights standpoint and analyses the law in England and Wales in the light of this. Although arguments have been presented to support the continuance of the practice, the opposing arguments are more compelling, particularly in relation to child victims. The law in England and Wales reflects this perspective, adopting a strong universalist human rights approach to FGM. The stance initially taken i.e. to criminalise FGM, was criticised because the law was not utilised and in response, civil protection measures were introduced. This paper concludes that the latter have been more useful than the criminal provisions and impact private and family life to a lesser degree than other civil law alternatives. But whether they will continue to be effective, following the Court of Appeal judgment in Re X which set aside a global travel ban because it violated the right to private and family life and had not been fully justified, remains to be seen.
Around 200 million women and girls worldwide are affected by female genital mutilation/cutting (FGM/C). FGM/C is a procedure that harms or alters the external female genitals for non-medical reasons, and is usually performed on children. Often, this procedure leads to severe consequences for the women’s physical and mental health. In a cross-sectional sample of 112 women seeking medical counseling, physical and mental health characteristics associated with FGM/C were examined and possible predictors for the development of post-traumatic stress disorder (PTSD) in women affected by FGM/C were identified. A total of 55.4% (n = 66) of the women reported symptom levels of probable PTSD. Predictors for higher PTSD symptomology were an older age at the time of the FGM/C procedure, feelings of guilt and the centrality of the event in the woman’s life. Thus, cognitive–emotional processing was found to play an important role in the emergence of PTSD in women suffering from FGM/C. However, interventions taking into consideration these characteristics are mostly lacking and need to be investigated further in the context of FGM/C.
Nele Wulfes, Uwe von Fritschen, Cornelia Strunz et al.
BACKGROUND: Female Genital Mutilation/Cutting (FGM/C) is a harmful practice that violates the human rights of women and girls. Despite global efforts to restrict the practice, there have been few reports on major positive changes to the problem. Health education interventions have been successful in preventing various health conditions and promoting service use. They have also been regarded as promising interventions for preventing FGM/C. The objective of this systematic review is to synthesise findings of studies about effectiveness of health education as an intervention to prevent FGM/C. METHODS: The electronic databases searched were MEDLINE, EMBASE, Cochrane library, Web of Science, Psych INFO, CINAHL and ASSIA. Our search included papers published in the English language without date limits. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). A predesigned data recording form was used to extract data from the included studies which were summarised by comparing similar themes. RESULTS: Twelve out of 359 individual studies met our inclusion criteria. Seven studies were quantitative, three were qualitative and two used mixed methods. Six studies tested before and after the interventions, four studies assessed the effectiveness of previous interventions used by different research teams and two studies endorsed the intervention. Four main factors emerged and were associated with facilitating or hindering the effectiveness of health education interventions: sociodemographic factors; socioeconomic factors; traditions and beliefs; and intervention strategy, structure and delivery. CONCLUSIONS: It is vital to target factors associated with facilitating or hindering the effectiveness of health education for FGM/C. This increases the possibility of effective, collective change in behaviour and attitude which leads to the sustainable prevention of FGM/C and ultimately the improved reproductive health and well-being of individuals and communities.
Susan Waigwa, Lucy Doos, Caroline Bradbury‐Jones et al.
BACKGROUND: Female genital mutilation (FGM) is a harmful practice prevalent in 35 countries, mainly in Africa, as well as in some Middle Eastern countries and a few Asian countries. FGM comprises all procedures that involve partial or complete resection of, or other injury to, external female genitalia for non-medical reasons. The practice of FGM has spread to Western countries due to migration. The European Institute for Gender Equality recommend that FGM be combatted by nationally coordinated efforts through implementation of national action plans, guidelines for professionals as well as comprehensive research in the field. FGM was outlawed in Denmark 2003, but no national actions plan has been implemented. Instead, the task of combatting FGM is currently under the responsibility of local governments in the form of the 98 municipalities. The aim of this study is to investigate the Danish municipalities' efforts to prevent FGM on the local level, and whether these initiatives are in accordance with international recommendations and standards. METHODS: All 98 Danish municipalities were invited to respond to a questionnaire regarding FGM in their respective municipalities. The inclusion process and questionnaire was designed after a pilot study, which included 29 municipalities. The questionnaire consisted of four overall areas of focus: "action plan", "registration", "information material" and "preventive initiatives". Demographic data were gathered from the 2017 census by Statistics Denmark. Risk countries were defined as countries with a tradition for FGM, identified from the 2016 UNICEF definition. RESULTS: A total of 67 municipalities participated in the study. At the time of census, 1.8% of the Danish population was immigrants with origins in risk countries. A total of 10.4% of the responding municipalities indicated to have implemented a specific action plan against FGM. A total of 7,5% had implemented specific preventive initiatives against FGM. Registration of reported FGM cases were indicated to be performed in 73.1% of the responding municipalities; however, only 17.9% stated to perform registration of FGM specifically as such, and not as general child abuse. CONCLUSIONS: Our study shows that the current situation of FGM registration and prevention being under local administrative responsibility in the 98 Danish municipalities has led to a severe lack of coordinated public initiative against FGM.
Gro Møller Christoffersen, Peter James Bruhn, Rosanna de Neergaard et al.
AIMS AND OBJECTIVES: This study aimed to describe and understand the lived experiences and opinions of sub-Saharan women living in Spain in relation to female genital mutilation. BACKGROUND: Female genital mutilation is a bloody procedure with serious consequences for the health of women and girls. Understanding mutilated women's lived experiences plays a crucial role in the management of health consequences and could help healthcare professionals to provide assistance to these women. DESIGN: A descriptive phenomenological study was carried out. The COREQ checklist was followed as guidance to write the manuscript. METHODS: A total of 12 in-depth interviews were conducted. Interviews were recorded, transcribed and analysed using ATLAS.ti 9.0. RESULTS: Two themes with four subthemes were identified from the data analysis: 1) 'The traumatic experience of female circumcision' with the subthemes 'Female mutilation is a physical and psychological torture procedure' and 'recognising and coping with negative emotions'; 2) 'The fight for the eradication of female genital mutilation' which contains the subthemes 'the need for a real sociocultural change at the origin' and '"I want to be the last": Personal development leads to sociocultural change'. CONCLUSIONS: Female genital mutilation was experienced by women as a very aggressive and traumatic event. It causes considerable negative emotions that last over time. Although there is a tendency to reject the practice, in women's countries of origin, there is social pressure for girls to be mutilated. RELEVANCE TO CLINICAL PRACTICE: Caring for women who have suffered from female genital mutilation requires awareness of the traumatic experience they underwent when they were girls. Healthcare professionals play a crucial role in eradicating female genital mutilation. Apart from education, preventive measures may include specific recommendations when girls are travelling to the country of origin and participatory action research.
José Manuel Martínez‐Linares, Olga María López‐Entrambasaguas, Isabel María Fernández‐Medina et al.
OBJECTIVE: To describe the presentation and management of children with suspected or confirmed female genital mutilation (FGM) referred to a specialist paediatric clinic. METHODS: Data collected included referral source, age, ethnicity, circumstances of FGM and clinical findings in accordance with the WHO FGM classification. RESULTS: Between September 2014 and January 2019, 148 children attended the clinic of whom 55 (37.2%) had confirmed FGM. Police or social care referred 112 (76%) children. The proportion of looked-after children (LAC) was significantly higher in the group with confirmed FGM (17/55, 31%) compared with children where FGM was not confirmed (5/93, 5%). In almost all children where FGM was confirmed, FGM was initially disclosed by the child or family (53/55, 96%) and of these 48/55 (87%) underwent FGM prior to UK entry. The remaining seven cases were British children, potentially meeting legal criteria under the FGM Act, and one resulted in a successful prosecution. CONCLUSIONS: The number of children with FGM was significantly lower than expected based on UK prevalence estimates. Most children had undergone FGM prior to UK entry, and the majority of cases were initially disclosed by the child or family themselves. These results reflect the lack of large-scale proof of the practice of FGM in the UK and are consistent with growing evidence of the abandonment of FGM among communities after migration.
Sakaria Ali, Roshnee Patel, Alice Jane Armitage et al.
Campaigns to prohibit the use of corporal punishment against children receive only a fraction of the interest and support that is elicited by campaigns to eliminate ‘child slavery’, even though the latter is said to be defined primarily by the use of violence to control children. This article draws on research with young Ghanaian men and women who, as children, experienced what antislavery NGOs describe as ‘child slavery’ to show that the kind of violent control they were subjected to as supposed ‘child slaves’ was neither qualitatively different from, nor more extreme than, the kinds of violent control they experienced in other contexts, especially the home. The article questions the selective focus on violence in ‘child slavery’ in abolitionist campaigns, arguing that it reflects and reproduces patriarchal, racialised, and colonial thinking about childhood, dependency, and legitimate authority, including the idea that some adults have the right to violently control children.
