Influence of Female Genital Mutilation/Cutting on Health Morbidity, Health Service Utilization and Satisfaction with Care among Somali Women and Teenage Girls in the United States

Johnson‐Agbakwu, Crista; Fox, Kathleen A.; Banke-Thomas, Aduragbemi; Michlig, Georgia J.

doi:10.1007/s40615-022-01266-x

Cited by 7 publications

(7 citation statements)

References 31 publications

(47 reference statements)

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“…Among study designs that can estimate prevalence, the prevalence ranged from 0.32% of women attending midwifery clinics in the Netherlands [103] to 47.8% of Kurdish and Somali women in Finland [104] (Table B in S3 Appendix). Type III was the most common type in 11 studies [105][106][107][108][109][110][111][112][113][114][115], followed by Type II in 5 studies [116][117][118][119][120], Type I (6 studies) [121][122][123][124][125][126], Types I and II (3 studies) [127][128][129], and Type IV (2 studies) [130,131] (Table C…”

Section: Studies On Migrant Populationsmentioning

confidence: 99%

The global prevalence of female genital mutilation/cutting: A systematic review and meta-analysis of national, regional, facility, and school-based studies

et al. 2022

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Background Female genital mutilation/cutting (FGM/C) is a nonmedical procedure entailing the modification of the external female genitalia. A description of the prevalence and distribution of FGM/C allows the tracking of progress toward ending FGM/C by 2030 (Sustainable Development Goal (SDG): target 5.3). This systematic review aimed to examine FGM/C prevalence and types, by World Health Organization (WHO) region and country. Methods and findings A systematic search using Medical Subject Headings (MeSH) and keywords from 2009 to March 24, 2022 was undertaken in MEDLINE, PubMED, PsycINFO, Web of Science, and Embase to identify studies presenting FGM/C prevalence. Abstract and full-text screening, quality assessment, and data extraction were undertaken by 2 reviewers. Only nationally representative studies were included in the meta-analysis. Pooled FGM/C prevalence was estimated by random-effects meta-analysis using generalized linear mixed models (GLMMs). FGM/C prevalence with 95% confidence intervals (CIs), prediction intervals (PIs), and FGM/C type were presented separately by women aged 15 to 49 years and girls aged 0 to 14 years. A total of 163 studies met the inclusion criteria and 30 were included in the meta-analysis, of which 23 were from the WHO African Region (AFR), 6 from the Eastern Mediterranean Region (EMR), and 1 from the South East Asian Region (SEAR). These studies included data from 406,068 women across 30 countries and 296,267 girls across 25 countries; the pooled prevalence estimate of FGM/C among women aged 15 to 49 years was 36.9% (95% CI: 19.6% to 58.3%; PI: 0.4% to 99.0%), and 8.27% (95% CI: 3.7% to 17.3%; PI: 0.1% to 89.3%) among girls aged 0 to 14 years. Among included countries, this gave a total estimated prevalence of 84,650,032 women (95% CI: 45,009,041 to 133,834,224) and 13,734,845 girls with FGM/C (95% CI: 6,211,405 to 28,731,901). Somalia had the highest FGM/C prevalence among women (99.2%), and Mali had the highest among girls (72.7%). The most common type of FGM/C among women was “flesh removed” (Type I or II) in 19 countries. Among girls, “not sewn closed” (Type I, II, or IV) and “flesh removed” (Type I or II) were the most common types in 8 countries, respectively. Among repeated nationally representative studies, FGM/C decreased for both women and girls in 26 countries. The main limitation of the study methodology is that estimates were based on available published data, which may not reflect the actual global prevalence of FGM/C. Conclusions In this study, we observed large variation in FGM/C prevalence between countries, and the prevalence appears to be declining in many countries, which is encouraging as it minimizes physical and physiological harm for a future generation of women. This prevalence estimate is lower than the actual global prevalence of FGM/C due to data gaps, noncomparable denominators, and unavailable surveys. Yet, considerable policy and community-level interventions are required in many countries to meet the SDG target 5.3. Trial registration Registration: CRD42020186937.

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Section: Studies On Migrant Populationsmentioning

confidence: 99%

The global prevalence of female genital mutilation/cutting: A systematic review and meta-analysis of national, regional, facility, and school-based studies

et al. 2022

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“…partnerships with the Somali community had been cultivated, nurtured, and sustained for nearly 10 years prior to the present CBPR engagement, wherein the community had already been engaged in meaningful community dialogue and educational outreach on FGM/C [30,[33][34][35][36]. Furthermore, health services for FGM/C-affected women and girls had been provided by the first author, who also possessed over 20 years of experience working directly with FGM/C-affected communities and who also delivered cultural sensitivity training to health care providers on engaging with and addressing the unique health care needs of FGM/Caffected communities.…”

Section: Methodsmentioning

confidence: 99%

“…Informed consent was obtained from all participants, and adolescents aged 15-18 required parental permission (i.e., "proxy consent") and youth assent. Respondent Driven Sampling (RDS) was used during the initial month of data collection only, after which time dynamic geopolitical shifts in U.S. policy towards migrants created fears within the Somali community concerning study participation, necessitating a shift towards snowball sampling to optimize recruitment [30,33,37,38]. Among the women in wave 1 (n = 879), 654 women were matched in wave 2.…”

Section: Methodsmentioning

confidence: 99%

Health outcomes and female genital mutilation/cutting: how much is due to the cutting itself?

et al. 2023

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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

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“…Prevalence within these migrant populations ranged from 0.32% (of a sample of 145,492) [104] to 99% (of a sample of 191) [105] (S8 Results: S14 Table ). Type II [106][107][108][109][110][111][112][113][114] and Type III [104,105,[115][116][117][118][119][120] were most common in 9 studies each, followed by Type I (8 studies) [121][122][123][124][125][126][127][128], and Type IV (three studies) [129][130][131] (S7 Results: S15 Table ).…”

Section: Studies On Migrant Populationsmentioning

confidence: 99%

“…Prevalence within these migrant populations ranged from 0.32% (of a sample of 145,492) [104] to 99% (of a sample of 191) [105] (S8 Results, S14 Table ). Type III [104][105][106][107][108][109][110][111][112][113] was the most common type in 10 studies, followed by Type II in 9 studies [114][115][116][117][118][119][120][121][122],…”

Section: Studies On Migrant Populationsmentioning

confidence: 99%

The global prevalence of female genital mutilation/cutting: A systematic review and meta-analysis of national, regional, facility and school-based studies

Farouki

El-Dirani

Abdulrahim

et al. 2022

Preprint

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Background: Female Genital Mutilation/Cutting (FGM/C) is a non-medical procedure entailing the modification of the external female genitalia. The Sustainable Development Goals aim to end FGM/C by 2030. This systematic review aimed to examine FGM/C prevalence and types, by World Health Organization (WHO) region and country. Methods and Findings: A systematic search using MeSH headings and keywords from inception to March 2, 2020 was undertaken in MEDLINE, PsycINFO, Web of Science, and Embase to identify studies presenting FGM/C prevalence. Abstract and full-text screening, quality assessment, and data extraction were undertaken by two reviewers. Only nationally representative studies were included in the meta-analysis. Pooled FGM/C prevalence was estimated by meta-analysis using random effects models. FGM/C prevalence and types were presented separately by women aged 15-49 and girls aged 0-14. 3,205 articles were identified. 135 met the inclusion criteria and 28 were included in the meta-analysis. Across 27 countries, the pooled prevalence estimate of FGM/C in women aged 15-49 was 40% (95% CI: 26-55%; I2 =100%), and 15% (95% CI: 10-21%; I2 =100%) in girls aged 0-14 across 34 countries. The country with the highest FGM/C prevalence in women was Guinea (97%) and the lowest, Uganda (0.3%). The highest prevalence in girls was in Mali (77%), and the lowest in Ghana (0%). The most common category of FGM/C was flesh removed at 69% (women) and 70% (girls). Limitations include that studies had heterogeneous terminology and relied on recall. Conclusions: There is large variation in FGM/C prevalence, and the lower prevalence in the current generation of girls is encouraging. However, considerable policy and community-level interventions are required to meet the SDG. Future research should consider collecting data on the 15-19 age group in order to accurately assess generational differences in FGM prevalence. The study protocol is available: https://osf.io/ema9j/.

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Influence of Female Genital Mutilation/Cutting on Health Morbidity, Health Service Utilization and Satisfaction with Care among Somali Women and Teenage Girls in the United States

Cited by 7 publications

References 31 publications

The global prevalence of female genital mutilation/cutting: A systematic review and meta-analysis of national, regional, facility, and school-based studies

The global prevalence of female genital mutilation/cutting: A systematic review and meta-analysis of national, regional, facility, and school-based studies

Health outcomes and female genital mutilation/cutting: how much is due to the cutting itself?

The global prevalence of female genital mutilation/cutting: A systematic review and meta-analysis of national, regional, facility and school-based studies

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