What Works and What Does Not: A Discussion of Popular Approaches for the Abandonment of Female Genital Mutilation

Abstract

The prevalence of Female Genital Mutilation (FGM) is reducing in almost all countries in which it is a traditional practice. There are huge variations between countries and communities though, ranging from no change at all to countries and communities where the practice has been more than halved from one generation to the next. Various interventions implemented over the last 30–40 years are believed to have been instrumental in stimulating this reduction, even though in most cases the decrease in prevalence has been slow. This raises questions about the efficacy of interventions to eliminate FGM and an urgent need to channel the limited resources available, where it can make the most difference in the abandonment of FGM. This paper is intended to contribute to the design of more effective interventions by assessing existing knowledge of what works and what does not and discusses some of the most common approaches that have been evaluated: health risk approaches, conversion of excisers, training of health professionals as change agents, alternative rituals, community-led approaches, public statements, and legal measures.

Evidence to inform education, training and supportive work environments for midwives involved in the care of women with female genital mutilation: A review of global experience

“…Moreover there is no synthesis of current research to inform the design of midwifery education programs or supportive workplace practice in both LMIC and HIC settings. Reviews to date have focused on nursing care (Terry & Harris, 2013), health professional training in Africa (Berg & Denison, 2012;Berg & Denison, 2013), or have provided a broad discussion of peer reviewed and grey literature on health professional training (Johansen et al, 2013). To address the gap in the literature, we undertook a review of the peer reviewed literature to examine the experiences and needs of midwives in LMIC and HIC to endeavour to provide more insight for educators and policy makers.…”

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

“…In 37 the fifteen years that followed, programmes aimed at reducing FGM emphasised the health risks of the practice, as this was felt to be the most acceptable and sensitive way to challenge the problem. Whilst a human rights approach has now been introduced to tackle FGM (see Section 1.6) raising awareness of the health impacts of FGM amongst practicing communities continues to be the preferred tool used to end FGM (Johansen et al, 2013).…”

“…In 37 the fifteen years that followed, programmes aimed at reducing FGM emphasised the health risks of the practice, as this was felt to be the most acceptable and sensitive way to challenge the problem. Whilst a human rights approach has now been introduced to tackle FGM (see Section 1.6) raising awareness of the health impacts of FGM amongst practicing communities continues to be the preferred tool used to end FGM (Johansen et al, 2013).The effectiveness of stressing the health impacts of FGM in order to end the practice in the EU is being questioned by many researchers and interventionists (Johansen et al, 2013).REPLACE suggests that the reason that this 'health approach' has had limited success in ending FGM is because it does not treat FGM as a social norm, with different communities having different belief systems and being at different stages of readiness to end the practice.Whilst raising awareness of the health impacts of FGM, the approach does not provide communities and individuals with the necessary tools to challenge the social norm which supports FGM enabling behavioural change to occur. …”

The need for an evidence-informed, multi-sectoral and community participatory action framework to address the practice of female genital mutilation in Sri Lanka

“…Lessons from other countries have shown that successful programs against female genital mutilation require long-term commitment to induce/support behaviour change at community level and capacitate enforcement mechanisms through communities of practice across health, education and law enforcement sectors [16][17][18][19][20]. The close tethering of the practice to ethnic and religious communities in Sri Lanka warrants a careful calibration of actors, where evidence-based and community participatory approach is needed.…”

“…Evidence from other countries have shown that efforts to curb female genital mutilation relies on the strength of community advocates, legal experts, researchers, clinicians and administrators working at local, regional and national levels [16][17][18]. First and foremost, this requires courage on the part of us, the medical professionals.…”