BackgroundFemale genital mutilation (FGM) is a traditional harmful practice that can cause severe physical and psychological damages to girls and women. Increasingly, trained health-care providers carry out the practice at the request of families. It is important to understand the motivations of providers in order to reduce the medicalization of FGM. This integrative review identifies, appraises and summarizes qualitative and quantitative literature exploring the factors that are associated with the medicalization of FGM and/or re-infibulation.MethodsLiterature searches were conducted in PubMed, CINAHL and grey literature databases. Hand searches of identified studies were also examined. The “CASP Qualitative Research Checklist” and the “STROBE Statement” were used to assess the methodological quality of the qualitative and quantitative studies respectively. A total of 354 articles were reviewed for inclusion.ResultsFourteen (14) studies, conducted in countries where FGM is largely practiced as well as in countries hosting migrants from these regions, were included. The main findings about the motivations of health-care providers to practice FGM were: (1) the belief that performing FGM would be less harmful for girls or women than the procedure being performed by a traditional practitioner (the so-called “harm reduction” perspective); (2) the belief that the practice was justified for cultural reasons; (3) the financial gains of performing the procedure; (4) responding to requests of the community or feeling pressured by the community to perform FGM. The main reasons given by health-care providers for not performing FGM were that they (1) are concerned about the risks that FGM can cause for girls’ and women’s health; (2) are preoccupied by the legal sanctions that might result from performing FGM; and (3) consider FGM to be a “bad practice”.ConclusionThe findings of this review can inform public health program planners, policy makers and researchers to adapt or create strategies to end medicalization of FGM in countries with high prevalence of this practice, as well as in countries hosting immigrants from these regions. Given the methodological limitations in the included studies, it is clear that more robust in-depth qualitative studies are needed, in order to better tackle the complexity of this phenomenon and contribute to eradicating FGM throughout the world.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-017-0306-5) contains supplementary material, which is available to authorized users.

Background Female genital mutilation (FGM) can give rise to immediate and long-term health problems for girls/women. Numerous studies have identified the sociocultural determinants of this tradition, but so far, in a national context where FGM is highly practiced, virtually none have focused on people refusing to have their daughters cut. We therefore aimed to understand the sociocultural dynamics underlying the non-practice of FGM in Guinea, a country which has one of the most prevalent rates of this practice in the world. This research explored the demographic and sociocultural profiles of Guineans who do not practice FGM, as well as their non-practice experience in a context of high FGM prevalence and social pressure. Methods We used a “focused ethnography” methodology and conducted semi-structured individual interviews with 30 women and men from different generations (young adults, parents, grandparents) living in Conakry, Guinea. Results We found that participants 1) do not disclose their non-practicing status in the same way, and 2) have different experiences with social pressure. A typology was created to describe participants as per their various profiles and experiences, which we named as: 1) the “activists”, 2) the “discrete”, 3) the “courageous”, 4) the “strategists”. Discussion Wanting to stop practicing FGM is not enough. The main empowering conditions allowing people to enact their decision not to have their daughters undergo FGM are: benefiting from social support (positive social capital), or being financially independent from the traditional solidarity network (sufficient economic capital). We therefore recommend finding ways to increase women’s/families’ empowerment to enact their decision not to practice FGM, mainly by: 1) providing them with new sources of social support, and 2) supporting them to gain more financial independence, including through schooling and improved access to better-paid employment. Conclusions This study was the first to explore the experience of people who do not practice FGM in a context of high FGM prevalence and social pressure. The results and recommendations of this research can inform strategies for FGM abandonment and therefore contribute to improving or developing intervention strategies that promote the health and well-being of girls and women.

BackgroundThe use of modern contraceptive methods among adolescents and youth is a public health priority to prevent unwanted pregnancies. To our knowledge, no study has ever explored and documented the promoting factors for contraceptive use among urban adolescents and youth in Guinea. The objective of this study was to explore the personal, community, and health system factors that promote the use of contraceptive methods among urban adolescents and youth in Guinea. MethodsWe conducted a qualitative exploratory and descriptive study with adolescents and youth aged 15 to 24 living in Conakry, Guinea. Data were collected through twenty-six individual in-depth interviews, and 10 group interviews with an additional eighty individuals, for a total of 106 participants. The investigation was conducted from June to October 2019. Both individual and group interviews were audio-recorded, and the verbatims were afterwards transcribed. Data was analyzed using the “thematic analysis” method (deductive and inductive approaches).ResultsThe personal factors favoring contraceptive use among adolescents and youth pertained to perceived benefits of the methods, knowledge of the family planning service channels, means to afford the cost of the method, and spouse/sexual partner approval. The community factors included peer suggestions about contraceptive methods, and socio-cultural beliefs about the method. The health system factors referred to access to free contraceptive methods, availability of methods, clinical competence and attitude of the health care provider to advise or administer methods, and proximity of family planning services to users’ place of residence. ConclusionsThis research shows that many adolescents and youth living in Conakry are sexually active and want to avoid unwanted pregnancy by using modern, traditional or cultural contraceptive methods. Access to free or affordable methods, discretion of method use, proximity and availability of methods, and suggestions of methods by peers are factors that motivate adolescents and youth to use contraception. This knowledge can inform policies and programs to improve the use of effective contraceptive methods by adolescents and youth living in Conakry, Guinea, and ultimately contribute to the optimal sexual and reproductive health of this population.

ObjectivesTo explore communities’ perceptions about COVID-19 in the context of the ANRS COV33 Coverage-Africa clinical trial evaluating the efficacy of treatments in preventing clinical worsening of COVID-19.DesignDescriptive qualitative study using semistructured in-depth individual interviews conducted by telephone in French and Soussou between May and September 2021. Data were transcribed, translated in French when applicable and analysed with the thematic analysis method.SettingThe eight neighbourhoods most affected by COVID-19 in Conakry’s urban context, capital of Guinea.Participants4 community leaders acting as key informants—providing insights regarding population’s opinions—and six community members, who were exposed to an information session conducted as part of Coverage-Africa.ResultsAccording to participants, community members have heterogeneous viewpoints about COVID-19: it exists and is dangerous; it is benign (‘bad cold’); or it is fictitious (eg, government conspiracy). The fear of stigmatisation and social isolation of those sick or cured of COVID-19 was largely reported by participants, with illustrations of distressing situations for the victims. To avoid stigma, many patients seem to adopt strategies of discretion (eg, lying/hiding about the disease). Although community attitudes were reported to have evolved since the beginning of the epidemic, stigma remained a pervasive concern for many people.ConclusionsCommunity perceptions about COVID-19 in Conakry may be partly explained by the Guinean context of Ebola history and of sociopolitical tensions. Stigmatisation of COVID+ people seems to be aimed at protecting others against contamination. However, social avoidance can greatly affect the morale of stigmatised people, especially in collectivist cultures like Guinea. Further investigating stigma, including its role on seeking COVID-19 screening and treatment services, and its consequences on mental health among affected/exposed people, would contribute to identifying improved prevention and care interventions in preparation for future health threats, and to promoting participation in health research.Trial registration numberNCT04920838(Pre-results stage).