Effectiveness of health education as an intervention designed to prevent female genital mutilation/cutting (FGM/C): a systematic review.
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ABSTRACT: 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.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.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.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.
Project description:Background: Female genital mutilation (FGM) occurs mainly in Africa, parts of the Arabian Peninsula and parts of Asia. It is commonly associated with acute complications as well as diverse late/delayed complications. One of the most common of these late complications is progressively enlarging painless cysts of the vulva. Case Report: An 8-year-old girl from Eritrea presented to our paediatric emergency department with a progressively enlarging mass of the vulva. She had undergone a clitoridectomy and partial removal of the labia minora as an infant in Eritrea. We performed surgical excision of the cyst and reconstruction of the labia. Histology showed a traumatic squamous epithelial inclusion cyst of the vulva. Conclusion: Epithelial or dermoid cysts of the vulva following FGM are extremely rare. Symptoms often require surgical intervention. Through increasing migration, more girls and female youths with FGM are likely to present to practices and hospitals in Germany. Thus increased knowledge and awareness of the medical complications of FGM and their treatment will be necessary in years to come.
Project description:BackgroundFemale genital mutilation/cutting (FGM/C) is a common practice in developing countries, including the UAE, and presents a major health problem.MethodsA questionnaire-based cross-sectional study was conducted among 1035 participants: 831 (80.3%) females and 204 (19.7%) males.ResultsThe number of women with FGM/C was 344; hence the prevalence of FGM/C in our study was 41.4%. Type I was the most prevalent (62.8%), followed by Type II (16.6%) and Type III (5%). FGM/C was less prevalent among educated and employed women (p-value <?0.001) and was mostly performed during infancy and childhood. Among the participants, 13.7% reported that their daughters had undergone FGM/C, with Type I being the most common, and 25% of them planned to have their future daughters undergo Type I FGM/C. While FGM/C was mostly performed by ritual circumcisers (74.4%), in 25 and 36.7% of the cases, it was performed by health professionals and in the clinic setting, respectively. About 69% of the participants considered FGM/C a custom, 72.8% were against the practice, and only 17.4% believed in its legality. Complications occurred in 30% of cases. The type of FGM/C was associated with the occurrence of complications: bleeding, difficulties in sexual life, and delivery-related problems (p-value <?0.05). One-fifth of the male participants expressed plans to circumcise future daughters (p-value <?0.001).ConclusionFGM/C remains a prevalent practice in the UAE and has a negative association with the general health of Emirati women. The lack of clear legislation to criminalize this practice is a problem to be addressed. In this context, national-level educational and legal strategies should be a priority.
Project description:BackgroundThe real prevalence and incidence of women living with or at risk of female genital mutilation/cutting (FGM/C) is unknown in Switzerland and many parts of Europe, as there are no representative surveys similar to DHS or MICS for European countries. Indirect estimates are commonly used to estimate the number of women with FGM/C in high-income countries, but may not reflect the actual FGM/C prevalence among migrants. Direct measures may provide more accurate estimates that could guide policy- and clinical decision-making. Swiss hospital data may provide a sample of patients that can be used to describe the prevalence of FGM/C in Swiss hospitals. Our study assesses the number of inpatient women and girls in Swiss university hospitals from countries with high FGM/C prevalence, and of inpatients with a coded diagnosis of FGM/C.MethodsWe conducted an exploratory descriptive study in Switzerland to assess the number of women and girls admitted to Swiss university hospitals between 2016 and 2018 from 30 FGM/C practicing countries, as well as inpatients with a coded diagnosis of FGM/C using anonymized data. We calculated indirect estimates for inpatient women and girls living with or at risk of FGM/C and compared them with the number of inpatients with a coded diagnosis of FGM/C.Results8720 women and girls from FGM/C practicing countries were admitted. 207 patients had a coded diagnosis of FGM/C, including 7 with a nationality outside the 30 targeted countries, corresponding to an overall prevalence of 2.3% (95%CI, 2.0-2.6). The number of FGM/C cases by hospital was significantly different across years (P < 0.001), with a higher proportion of cases collected in Geneva, Switzerland.ConclusionsThe comparison between indirect estimates of inpatients with or at risk of FGM/C and the low number of FGM/C cases coded, suggests low recording and coding capacities of FGM/C. The capacity of coding primary and secondary diagnosis of FGM/C in Swiss university hospitals seems low. Protocol number: 2018-01851: SwissEthics Committee, Canton of Geneva, Switzerland.
Project description:ObjectivesThe objective of this study was to determine whether female genital mutilation/cutting (FGM/C) exists in Jeddah, Saudi Arabia.DesignA cross-sectional study.SettingKing Abdulaziz University Hospital, Jeddah, Saudi Arabia.ParticipantsBetween December 2016 and August 2017, women attending the obstetrics and gynaecology clinics were asked to participate in a cross-sectional survey. This included questions on demographics, FGM/C status and type and attitudes towards the practice.ResultsIn a convenience sample of 963 women aged 18 to 75 years, 175 (18.2%) had undergone FGM/C. Compared with women without FGM/C, women with FGM/C were older, married, non-Saudi and had a lower monthly income. Thirty-seven (21.1%) women had had FGM/C with some cutting of body parts (type I or II), 11 (6.3%) with suturing (type III), 46 (26.3%) with no cutting of body parts (type IV) and 81 (46.3%) did not know their type of FGM/C. There was also a significant association between nationality and age at which FGM/C was performed, with Saudi women undergoing the procedure earlier than Egyptian, Somali, Yemeni and Sudanese women.ConclusionsFGM/C is prevalent in Jeddah, Saudi Arabia, among immigrant women from other countries, and it is practised among Saudi women. Further research is needed to determine its prevalence.
Project description:Introductionunderstanding women's attitudes towards female genital mutilation is an important step towards eliminating this practice. We used the 2016 Ethiopia Demographic and Health Survey (EDHS) data set to examine the relationship between wealth index, and previous history of circumcision on women's opinions whether female genital mutilation (FGM) should be continued or stopped in Ethiopia.MethodsData from 6984 women aged 15-49 years were extracted from the 2016 Ethiopia EDHS data set. Multivariable logistic regression analysis was performed to analyse the data.ResultIn this study, women with a higher level of education and wealth index were more likely to support the cessation of FGM. However, circumcised women (AOR: 0.22; 95% CI: 0.15-0.32), women from the Afar region (AOR: 0.34; 95% CI: 0.22-0.50), Somali region (AOR: 0.42; 95% CI: 0.27-0.65), and Dire Dawa region (AOR: 0.51; 95% CI: 0.32-0.83) were less likely to support discontinuation of FGM.ConclusionThe present study revealed that wealth index, education level, history of circumcision, and regional variation are associated with women's attitude towards discontinuation of the practice of FGM in Ethiopia. Empowering women in terms of socioeconomic status and education can change attitudes and might help prevent female genital mutilation in the future. Furthermore, interventions targeting FGM practices should focus on regional variance in order to have a meaningful impact on reducing this harmful cultural practice in Ethiopia.
Project description:BackgroundWe updated the indirect estimates for women and girls living with Female Genital Mutilation Cutting (FGM/C) in Switzerland, using data from the Swiss Federal Statistical Office of migrant women and girls born in one of the 30 high-prevalence FGM/C countries that are currently living in Switzerland.MethodsWe used Yoder and Van Baelen's "Extrapolation of FGM/C Countries' Prevalence Data" method, where we applied DHS and MICS prevalence figures from the 30 countries where FGM/C is practiced, and applied them to the immigrant women and girls living in Switzerland from the same 30 countries.ResultsIn 2010, the estimated number of women and girls living with or at risk of FGM/C in Switzerland was 9059, whereas in 2018, we estimated that 21,706 women and girls were living with or at risk of FGM/C.ConclusionOver the past decade, there have been significant increases in the number of estimated women and girls living with or at risk of FGM/C in Switzerland due to the increase in the total number of women and girls originally coming form the countries where the practice of FGM/C is traditional.
Project description:Nontherapeutic female genital modifications can cause short- and long-term consequences. Caregivers should promote women's self knowledge on genitals' anatomy and physiology, and psychophysical and sexual health. They should also inform on possible negative consequences of vulvar nontherapeutic alterations requested and avoid the medicalization of female genital mutilation.
Project description:While Female Genital Mutilation/Cutting (FGM/C) continues to garner global attention, FGM/C-affected migrant communities, who are often racialized minorities in the U.S., face additional challenges which may impact their physical and mental health and well-being. It has been proposed that an overly narrow focus on the female genitalia or FGM/C status alone, while ignoring the wider social experiences and perceptions of affected migrant women, will result in incomplete or misleading conclusions about the relationship between FGM/C and migrant women's health. A cross-sectional study was conducted across two waves of Somali and Somali Bantu women living in the United States, (n = 879 [wave 1], n = 654 [wave 2]). Socio-demographics, self-reported FGM/C status, perceived psychological distress, and self-reported FGM/C-related health morbidity was examined against self-reported experiences of everyday discrimination and perceived psychosocial support. In statistical models including age and educational attainment as potentially confounding socio-demographic variables, as well as self-reported FGM/C status, self-reported discrimination, and perceived psychosocial support, self-reported discrimination was the variable most strongly associated with poor physical health and psychological distress (i.e., FGM/C-related health morbidity and psychological distress), with greater perceived psychosocial support negatively associated with psychological distress, when controlling for all the other variables in the model. FGM/C status was not significantly associated with either outcome. Discrimination, more frequently reported among 'No FGM/C' (i.e., genitally intact or unmodified) women, was most frequently perceived as linked to religion and ethnicity. Our findings are consistent with views that discrimination drives negative outcomes. In this population, discrimination may include the 'quadruple jeopardy' of intersecting relationships among gender, race, religion, and migration status. We find that self-reported experiences of discrimination-and not FGM/C status per se-is associated with adverse physical and mental health consequences in our sample drawn from Somali migrant communities living in the United States, and that social support may help to mitigate these consequences. Our findings thus reinforce calls to better contextualize the relationship between FGM/C and measures of health and well-being among Somali women in the United States (regardless of their FGM/C status), taking psychosocial factors more centrally into account.Clinical Trials.Gov ID no. NCT03249649, Study ID no. 5252. Public website: https://clinicaltrials.gov/ct2/show/NCT03249649.
Project description:BACKGROUND:The 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 is known about where in Africa the declines in prevalence have been fastest and whether changes in prevalence differ by women's socioeconomic status. METHODS:We use data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys for 23 African countries, collected between 2002 and 2016, and covering 293?170 women. We reconstruct long-term cohort trends in FGM/C prevalence spanning 35 years, for women born between 1965 and 1999. We compute absolute and relative changes in FGM/C prevalence and differentials in prevalence by women's education and urban-rural residence. We examine whether socioeconomic differences in FGM/C are converging or diverging. FINDINGS:FGM/C prevalence has declined fastest (in relative terms) in countries with lower initial prevalence, and more slowly in countries with higher initial prevalence. Although better-educated women and those living in urban areas tend to have lower prevalence, in some countries the opposite pattern is observed. Socioeconomic differentials in FGM/C have grown in the majority of countries, particularly in countries with moderate-to-higher overall prevalence. CONCLUSIONS:The documented relationship between absolute and relative FGM/C prevalence rates suggests that in settings with higher initial prevalence, FGM/C practice is likely to be more entrenched and to change more slowly. There is substantial variation between countries in socioeconomic differentials in prevalence and their changes over time. As countries change from higher to lower overall prevalence, socioeconomic inequalities in FGM/C are increasing.
Project description:(1) Background: Female genital mutilation/cutting (FGM/C) is associated with physical and psychological complications. However, there is scarce literature on how women with FGM/C respond to treatment interventions. (2) Methods: In the present pilot longitudinal study, we assessed changes in general psychopathology (Symptom Check List-90-R), sexual functioning and distress (Female Sexual Function Index, Female Sexual Distress Scale-Revised, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) female sexual dysfunction criteria), body image (Body Shape Questionnaire), and sexual body image (Female Genital Self-Image Scale) in a sample of n = 15 women with FGM/C before and after reconstructive surgery. (3) Results: Sexual distress was significantly improved following surgery. We also observed an improvement in general psychopathology and genital self-image. However, sexual function was not improved. (4) Conclusions: These results provide evidence for the benefits of reconstructive surgery on sexual distress in women with FGM/C. The impact of surgery on sexual function cannot be conclusively evaluated.
