Interventions to reduce the prevalence of female genital mutilation/cutting in African countries

Abstract

This Campbell systematic review examines the empirical research on the effectiveness of female genital mutilation/cutting (‘FGM/C’) interventions to reduce the occurrence of FGM/C practices in the 28 African countries that carry out FGM/C practices. The review also examines the empirical research on contextual factors that may help explain the effectiveness, or lack thereof, of such interventions. It summarises findings from 8 effectiveness studies and 27 context studies conducted in seven different African countries: Burkina Faso, Egypt, Ethiopia, Somalia/Kenya, Mali, Nigeria and Senegal. Interventions to encourage the abandonment of FGM/C have positive effects on attitudes, but no effect was found on the practice of FGM/C itself. The lack of effects may be due to weak study design, including small samples, and high heterogeneity among the included studies. The main factors that supported FGM/C were tradition, religion, and reduction of women's sexual desire. The main factors that hindered FGM/C were medical complications and prevention of sexual satisfaction. Key messages This systematic review aimed to answer the following research questions: 1.What is the effectiveness of interventions designed to reduce the prevalence of female genital mutilation/cutting (FGM/C) compared to no or other active intervention? 2.How do factors related to the continuance and discontinuance of FGM/C help explain the effectiveness of interventions designed to reduce the prevalence of FGM/C? We used an integrative evidence approach, whereby analyses of effectiveness data and context data were completed in separate streams, but where we in the final step integrated the results from the two sets of data in a realist synthesis approach. We included eight effectiveness studies (research question 1). All employed a controlled before‐and‐after study design. The quality assessment resulted in a final decision of weak study quality for all eight studies, which involved 7,042 participants residing in seven different African countries: Burkina Faso, Egypt, Ethiopia, Somalia/Kenya, Mali, Nigeria, and Senegal. We could perform four meta‐analyses but there was doubt about the validity of all results. The results showed that the effectiveness of the included interventions was limited, although they pointed to potential advantageous developments, such as positive changes in attitudes and knowledge regarding FGM/C, as a result of the FGM/C abandonment interventions. We included 27 context studies (research question 2) from the countries where an effectiveness study had taken place (we did not identify any studies from Ethiopia). The synthesis of context studies showed that the factors related to the continuance and discontinuance of FGM/C varied across contexts, but the main factors that supported FGM/C were tradition, religion, and reduction of women's sexual desire. The main factors that hindered FGM/C were medical complications and prevention of sexual satisfaction. Our ability to conclude regarding both the question of effectiveness of FGM/C ...

The REPLACE* Approach: Supporting Communities to end FGM in the EU. A Toolkit

“…Two recent systematic reviews by Berg, Denison and colleagues have identified a total of just eight evaluations of interventions that included before and after assessments and a control or comparator group (Berg et al, 2009;Berg & Denison, 2013). None of these evaluations assessed interventions delivered in a European context.…”

How to do a good systematic review of effects in international development: a tool kit

“…The results of the search should be clearly documented (Moher et al 2009). Figure 1 presents an example search flow from a review on interventions to reduce incidence of female genital mutilation and cutting (Berg and Denison 2012). A typical review goes from several thousand or so papers identified in the initial search (often many more in social science literature), to just a couple of hundred for which an abstract or full-text screening review is conducted, and then a dozen or less included effectiveness studies.…”

“…And this evidence is thin in studies that are included because of rigorous impact evaluation designs. Hence, there is a need to turn to evidence in the other studies excluded at that final stage, as shown in the additional context studies included in Berg and Denison (2012). However, there is not yet agreement as to what constitutes credible evidence to allow additional studies to be included for this purpose (see Snilstveit 2012).…”

“…Examples of consolidated theory-based systematic reviews include Waddington and Snilstveit (2009) on water and sanitation, King et al (2011) on community-driven development and Lassi et al (2012) on community health. Berg and Denison (2012) also draw on theory to synthesise both quantitative and qualitative evidence on interventions to prevent female genital mutilation and cutting in Africa. Finally, the external validity of primary studies themselves can be assessed, and incorporated into the analysis.…”

Hacia una educación basada en la evidencia

“…Sin embargo, si se considera el total de revisiones hechas sobre temas que atañen a la educación en colaboración con otros grupos, la cifra asciende a 91 revisiones sistemáticas publicadas, sobre temas tan diversos como la importancia del involucramiento de las familias en el logro académico de los estudiantes (Nye, Schwartz y Turner, 2006;Spier et al, 2013), o la efectividad de los programas de intervención sobre el acoso escolar (Farrington y Ttofi, 2009;Ttofi, Loeber, Lösel, y Farrington, 2012), la violencia (Petrosino, Guckenburg, y Fronius, 2013) o el abuso sexual (Zwi et al, 2007), entre otras. Muchas de las revisiones tratan sobre temas en extremo específicos, como pueden ser la efectividad de los programas educativos para la reducción de la prevalencia de la mutilación genital femenina en paí-ses africanos (Berg y Denison, 2012), o de los programas para disminuir el embarazo en adolescentes (Scher, Maynard, y Stagner, 2006) o de los programas de bolsa de empleo para personas con desórdenes del espectro autista (Westbrook, Fong, Nye, Williams, Wendt y Cortopassi, 2013).…”