Considerations on the use and interpretation of survey data on FGM/C

This technical brief was written as an addendum to the trends presented in the “State of-Art-Synthesis of Female Genital Mutilation/Cutting: What Do We Know Now?” published in October 2016. This brief describes important sources of reliable data that have been generated in recent years, to provide accurate information on FGM/C practices and attitudes. The majority of these data are derived from cross-sectional survey research, and the brief notes the strengths and limitations of this research approach which should be borne in mind when using and interpreting these data. Table 1 summarizes nationally representative data on FGM/C available from a number of population-based surveys. Table 2 provides a summary of the key findings reviewed in the original document, and assesses the degree of confidence we have in these findings based on the available data and methodological issues outlined in this addendum

Female genital mutilation/cutting in Kenya: Is change taking place? Descriptive statistics from four waves of Demographic and Health Surveys

Nationally representative survey data on female genital mutilation/cutting (FGM/C) in Kenya are available from four waves of Demographic and Health Surveys. These survey data provide a rich and detailed picture of when, where, and how FGM/C has been carried out, and trends in changes in the practice. National prevalence data from successive waves of surveys show a steady decrease in the prevalence of FGM/C among women aged 15–49. While the data reported here are descriptive, they provide useful insights on the progress of FGM/C abandonment at national and subnational levels. These findings are useful for policymakers in steering discussions on policies, but also for guiding where to target interventions especially given the large ethnic and religious diversity. Findings also highlight where there are large numbers of women living with FGM/C who may be in need of specialized health services

Reference guide for data collection: Qualitative social network interviews

The purpose of this document is to guide researchers who plan to use qualitative social network methods drawing on our experiences implementing a qualitative study entitled, “The End of Female Genital Mutilation/Cutting in Senegal: Tracing Social Networks, Investigating the Role of Gender and Intergenerational Influence.” Qualitative fieldwork was carried out in two contrasting settings in Senegal: 1) a region with a low prevalence of female genital mutilation/cutting (FGM/C) characterized by ethnic heterogeneity, and 2) a region with a high prevalence of FGM/C characterized by relative ethnic homogeneity. The goal of this research was to investigate the ways in which social interactions and social influence vary along dimensions including gender, class, and generation, and how they influence the dynamics of decisionmaking regarding FGM/C

Tracing change in female genital mutilation/cutting: Shifting norms and practices among communities in Narok and Kisii counties, Kenya

In Kenya, there has been a steady and marked decline in the prevalence of female genital mutilation/cutting (FGM/C) but there is great variance in the prevalence of FGM/C across the country, with prevalence remaining high among certain ethnic groups such as Somali, Samburu, Kisii, and the Maasai. The objectives of this study were: 1) to explore whether and how unprogrammed factors or programmed FGM/C interventions (alternative rites of passage, legal and policy measures, religious-oriented approaches, promotion of girls’ education, intergenerational dialogues, use of rescue centers, and other undocumented approaches) influence community values deliberation in Narok and Kisii counties; 2) to assess what changes in FGM/C norms and practices have occurred in Narok and Kisii counties, and identify factors motivating these changes; and 3) to identify barriers to FGM/C abandonment in these key “hot spots,” and assess how, in light of empirical findings and theoretical models of behavior, intervention efforts might be optimized and coordinated to accelerate abandonment. The study clearly shows that norms and practices of FGM/C are not static even in these study areas. While there might not be widespread abandonment yet, people are reassessing norms and traditions in light of the current social climate. These changes may provide a useful starting point for intervention programs that seek to create dialogue and critical reflection on the practice of FGM/C in an effort to accelerate its abandonment

Tracing change in female genital mutilation/cutting through social networks: An intersectional analysis of the influence of gender, generation, status, and structural inequality

Policies and programs designed to eliminate female genital mutilation/cutting (FGM/C) in Senegal have been implemented over several decades, but the practice has been surprisingly tenacious. Strategies for accelerating abandonment have been informed by theories of change, and social norms theory, in particular, has become a prominent framework for understanding behavior change dynamics. FGM/C is held in place by interdependent normative expectations: what one family chooses to do is linked to expectations of others and reinforced through social sanctions. Hence, a key strategy for promoting behavior change rests on coordinating change in norms and behavior among people who interact with one another. While progress has been made in developing methods for identifying social norms linked to FGM/C, much less is known about how to identify the relevant “people who interact.” This study identifies the social norms surrounding the practice of FGM/C in two regions in Senegal, and investigates the social networks in which these norms are embedded. The aim is to produce evidence to inform the design of targeted network interventions that can optimize behavior change and accelerate abandonment of FGM/C

Exploring the nature and extent of normative change in FGM/C in Somaliland

More than 200 million girls and women alive today have undergone FGM/C across 30 countries in Africa, Asia, and the Middle East. While most affected countries have adopted legal frameworks prohibiting FGM/C, these have been varyingly effective in preventing the practice or significantly accelerating its abandonment. The success of programmatic interventions to address FGM/C has also been variable. One possible reason for the limited success of these initiatives is the neglect of the collectively held social norms underpinning the practice’s continuation. This study, conducted in 30 villages in Somaliland, aimed to investigate: 1) if the norms associated with FGM/C are consistent with a social coordination norm; 2) which norms—if any—are associated with different stages of readiness to change; 3) how, to what extent, and by whom the norms and practices are being contested or altered; and 4) if the stages of readiness to change are associated with gender, location (rural/urban), and generational differences

Health sector involvement in the management of female genital mutilation/cutting in 30 countries

Background: For the last decades, the international community has emphasised the importance of a multisectoral approach to tackle female genital mutilation (FGM/C). While considerable improvement concerning legislations and community involvement is reported, little is known about the involvement of the health sector. Method: A mixed methods approach was employed to map the involvement of the health sector in the management of FGM/C both in countries where FGM/C is a traditional practice (countries of origin), and countries where FGM/C is practiced mainly by migrant populations (countries of migration). Data was collected in 2016 using a pilot-tested questionnaire from 30 countries (11 countries of origin and 19 countries of migration). In 2017, interviews were conducted to check for data accuracy and to request relevant explanations. Qualitative data was used to elucidate the quantitative data. Results: A total of 24 countries had a policy on FGM/C, of which 19 had assigned coordination bodies and 20 had partially or fully implemented the plans. Nevertheless, allocation of funding and incorporation of monitoring and evaluation systems was lacking in 11 and 13 of these countries respectively. The level of the health sectors' involvement varied considerably across and within countries. Systematic training of healthcare providers (HCP) was more prevalent in countries of origin, whereas involvement of HCP in the prevention of FGM/C was more prevalent in countries of migration. Most countries reported to forbid HCP from conducting FGM/C on both minors and adults, but not consistently forbidding re-infibulation. Availability of healthcare services for girls and women with FGM/C related complications also varied between countries dependent on the type of services. Deinfibulation was available in almost all countries, while clitoral reconstruction and psychological and sexual counselling were available predominantly in countries of migration and then in less than half the countries. Finally, systematic recording of FGM/C in medical records was completely lacking in countries of origin and very limited in countries of migration. Conclusion: Substantial progress has been made in the involvement of the health sector in both the treatment and prevention of FGM/C. Still, there are several areas in need for improvement, particularly monitoring and evaluatio