Printed in the United Kingdom. To access this publication online visit www.replacefgm2.eu Reproduction is authorised provided the source is acknowledged. Grant (2013-15). Consequently, the REPLACE Approach has been tried and tested across five different EU member states, and five different migrant populations. It is flexible and tailored, and importantly, makes use of the assets and skills that lie within communities to help them bring about change for themselves. ISBN: 978184600062The REPLACE Toolkit and the accompanying REPLACE Community Handbook provide a 'how to' guide for community members affected by FGM, and community leaders and organisations working with them to bring about an end to FGM in the EU. The Toolkit provides detailed yet easily digestible 'tools', set around a simple five-point 'cyclic framework for social norm transformation' for supporting and empowering communities to bring about change from within. The Community Handbook presents this information in a brief and functional form, to help community members 'pick up and run' with the REPLACE Approach. 4The REPLACE Approach addresses many of the criticisms levied at current efforts to bring about an end to FGM in the EU. It does this in an accessible way, by incorporating interdisciplinary strategies and drawing on the strengths of all the partners and communities involved in its development. The team are to be commended on this bold step forward in working together to end FGM in the EU. This Toolkit presents the REPLACE Approach which has been developed with the goal of ending FGM in the EU. It is a bottom-up approach that empowers communities and puts them at the centre of social norm transformation using behavioural change theory. It is thus aimed at those within FGM affected communities or those working with these communities, whose goal is to end FGM in the EU. It is also relevant to policy makers who aim to end FGM; since the success of the REPLACE Approach is enhanced by political support. Neena Gill, West Midlands MEP 5 Table of ContentsEXECUTIVE List of Tables ContextThe exact number of women and girls living with FGM in Europe is not known (EIGE, 2013;Leye, et al, 2014). However, in 2009 the European Parliament (EP) estimated that up to half a million women living in Europe had been subjected to FGM with a further 180,000 women and girls at risk of being subjected to the practice every year (EP, 2009). This data has been extrapolated from the prevalence data in countries of origin and the number of women from those countries living in the EU. The UNHCR (2013) suggests that those EU countries with the highest numbers of girls and women who have survived or are at risk of FGM are:France, Italy, Sweden, the UK, Belgium, Germany and the Netherlands.The very limited data available on FGM in the EU does not differentiate the type of FGM being experienced. It is assumed that the type of FGM performed in home countries will be performed by migrants from that country when they relocate to a host country in the EU. This 10 assumption may no...
Background: Despite numerous campaigns and interventions to end female genital mutilation (FGM), the practice persists across the world, including the European Union (EU). Previous interventions have focused mainly on awareness raising and legislation aimed at criminalizing the practice. Limited evidence exists on the effectiveness of interventions due in part to the lack of systematic evaluation of projects. This paper presents an evaluation of the REPLACE Approach, which is a new methodology for tackling FGM based on community-based behaviour change and intervention evaluation. Methods: We developed, trialed and evaluated the REPLACE Approach through extensive engagement with eight FGM affected African diaspora communities in five EU countries. We employed qualitative and quantitative tools to obtain data to inform the development, implementation and evaluation of the Approach. These included communitybased participatory action research, questionnaires and community readiness assessments. The research took place between 2010 and 2016. Results: Findings suggested that the Approach has the capability for building the capacities of FGM affected communities to overturn social norms that perpetuate the practice. We observed that community-based action research is a useful methodology for collecting data in FGM intervention settings as it allows for effective community engagement to identify, educate and motivate influential community members to challenge the practice, as well as obtaining useful information on the beliefs and norms that shape the practice. We also found that community readiness assessments, pre and post intervention, were useful for tailoring interventions appropriately and for evaluating changes in attitudes and behaviour that may have resulted from the interventions.Conclusion: This evaluation has demonstrated that the REPLACE Approach has the potential, over time, to bring about changes in norms and attitudes associated with FGM. Its strengths lay in the engagement with influential community members, in building the capacity and motivation of community members to undertake change, in recognising contextual differences in the barriers and enablers of FGM practice and in tailoring interventions to local community readiness to change, and then evaluating interventions to re-inform implementation. The next steps would therefore be to implement the Approach over a longer time frame to assess if it results in measurable change in behaviour.
Purpose – Despite numerous studies on FGM, little is known about belief systems that support FGM in the EU. The purpose of this paper is to explore the dynamic nature of belief systems and enforcement mechanisms that perpetuate FGM among three African migrant communities in the EU. Design/methodology/approach – This paper is based on data collected through community-based participatory action research in three communities: Eritrean and Ethiopian community in Palermo, Italy; Guinea Bissauan community in Lisbon, Portugal; and Senegalese and Gambian community in Banyoles, Spain. A total of 24 FGDs and 70 in-depth narrative interviews were conducted for the research. Findings – The research finds that belief systems supporting the practice of FGM among African migrants in the European diaspora are similar to those in their home countries. Beliefs structured around religion, sexuality, decency, marriage and socialisation are particularly significant in perpetuating FGM in the study migrant communities. These are enforced through sanctions and social expectations from the migrants’ home and host communities. Research limitations/implications – Members of the migrant communities that were the focus of this research are ethnically diverse; therefore it is possible that differences in the practice of and views on FGM by various ethnicities may have been masked. Also, due to close linkages between the migrants and their home countries it was hard to delineate beliefs that are specific to the host countries. In addition, it was difficult to assess the level of education of the migrants and how this may have impacted on their beliefs due to their contrasting and inconsistent educational backgrounds. Originality/value – This paper provides evidence to show that the practice of FGM among migrants in the EU is driven by both social norms and individual (parent) behaviour and therefore there is a need for interventions to focus on individual behaviour change and social norm transformation techniques. It also suggests that beliefs around FGM have remained socially significant among migrants despite their exposure to European culture because such beliefs are used to promote the moral standards of girls, marriageability of women, respectability of families, and the assertion of cultural and religious identity in the migrants’ new environment. The paper further underscores the role of migrants’ European context as well as the home country in strengthening beliefs that perpetuate FGM in the EU.
Background: In the era of rapid dolutegravir rollout, concerns about neural tube defects have complicated the health systems response among women of childbearing potential. This qualitative study, which was nested within the DolPHIN-2 clinical trial, examined the current and future health system opportunities and challenges associated with the transition to dolutegravir-based regimen as first line antiretroviral therapy among women of childbearing potential in South Africa and Uganda. Method: Semi-structured in-depth interviews with members of antiretroviral therapy guideline development groups and affiliates were conducted. Thirty-one participants were purposively selected for the study, including senior officials from the Ministry of Health and National Drug Regulatory Authority in Uganda and South Africa as well as health-sector development partners, activists, researchers and health workers. A thematic approach was used to analyse the data. Findings: Despite differences in health system contexts, several common challenges and opportunities were identified with the transition among women of childbearing potential in South Africa and Uganda. In both contexts national stakeholders identified challenges with ensuring gender equity in roll out due to the potential teratogenicity of dolutegravir, paucity of data on dolutegravir use in pregnancy, potential stock out of effective contraceptives, poorly integrated contraception services, and limited pharmacovigilance in pregnancy. Participants identified opportunities that could be harnessed to accelerate the transition, including high stakeholder interest and commitment to transition, national approval and licensure of a generic tenofovir/lamivudine/dolutegravir regimen, availability of a network of antiretroviral therapy providers, and strong desire among women for newer and more tolerable regimens.
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