The psychological impact of Female Genital Mutilation/Cutting (FGM/C) on girls/women’s mental health: a narrative literature review

Mulongo, Peggy; Martin, Caroline J. Hollins; McAndrew, Sue

doi:10.1080/02646838.2014.949641

Cited by 60 publications

(56 citation statements)

References 34 publications

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“…We note that postponing the circumcision does not alleviate individuals from associated complications. Studies of female circumcision among adolescents consistently report major physical, psychological, and sociological complications following the surgery (168, 169). …”

Section: Implications Of the Hypothesismentioning

confidence: 99%

A “Wear and Tear” Hypothesis to Explain Sudden Infant Death Syndrome

Elhaik

2016

Front. Neurol.

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Sudden infant death syndrome (SIDS) is the leading cause of death among USA infants under 1 year of age accounting for ~2,700 deaths per year. Although formally SIDS dates back at least 2,000 years and was even mentioned in the Hebrew Bible (Kings 3:19), its etiology remains unexplained prompting the CDC to initiate a sudden unexpected infant death case registry in 2010. Due to their total dependence, the ability of the infant to allostatically regulate stressors and stress responses shaped by genetic and environmental factors is severely constrained. We propose that SIDS is the result of cumulative painful, stressful, or traumatic exposures that begin in utero and tax neonatal regulatory systems incompatible with allostasis. We also identify several putative biochemical mechanisms involved in SIDS. We argue that the important characteristics of SIDS, namely male predominance (60:40), the significantly different SIDS rate among USA Hispanics (80% lower) compared to whites, 50% of cases occurring between 7.6 and 17.6 weeks after birth with only 10% after 24.7 weeks, and seasonal variation with most cases occurring during winter, are all associated with common environmental stressors, such as neonatal circumcision and seasonal illnesses. We predict that neonatal circumcision is associated with hypersensitivity to pain and decreased heart rate variability, which increase the risk for SIDS. We also predict that neonatal male circumcision will account for the SIDS gender bias and that groups that practice high male circumcision rates, such as USA whites, will have higher SIDS rates compared to groups with lower circumcision rates. SIDS rates will also be higher in USA states where Medicaid covers circumcision and lower among people that do not practice neonatal circumcision and/or cannot afford to pay for circumcision. We last predict that winter-born premature infants who are circumcised will be at higher risk of SIDS compared to infants who experienced fewer nociceptive exposures. All these predictions are testable experimentally using animal models or cohort studies in humans. Our hypothesis provides new insights into novel risk factors for SIDS that can reduce its risk by modifying current infant care practices to reduce nociceptive exposures.

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Section: Implications Of the Hypothesismentioning

confidence: 99%

A “Wear and Tear” Hypothesis to Explain Sudden Infant Death Syndrome

Elhaik

2016

Front. Neurol.

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“…In the long term, FGM can also give rise to reproductive health problems, such as dyspareunia (difficulty having sexual intercourse), complications during childbirth and even neonatal death, particularly among women who have been infibulated [6, 7]. Moreover, psychological health problems such as anxiety, depression and post-traumatic stress disorder are associated with this practice [8, 9]. Furthermore, some girls and women do not survive the complications of FGM such as haemorrhage, infections (e.g., tetanus) and obstructed labour [2, 10, 11].…”

Section: Introductionmentioning

confidence: 99%

Understanding the motivations of health-care providers in performing female genital mutilation: an integrative review of the literature

2017

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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.

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“…Whilst many articles reference the concept of 'emotional and psychological' difficulties, (Mulongo, Martin, & McAndrew, 2014) this is rarely substantiated with empirical evidence and studies that do exist tend to apply a western Post Traumatic Stress Disorder (PTSD) framework to responses of survivors. This fits poorly with the local cosmologies, norms, and values within which survivors make sense of their experiences (Boyden & Gibbs, 1997;Liebling-Kalifani, 2010;Levine, 1999;Wessells, 1999).…”

Section: Introductionmentioning

confidence: 99%