Estimates of female genital mutilation/cutting in the Netherlands: a comparison between a nationwide survey in midwifery practices and extrapolation-model.

BACKGROUND: Owing to migration, female genital mutilation or cutting (FGM/C) has become a growing concern in host countries in which FGM/C is not familiar. There is a need for reliable estimates of FGM/C prevalence to inform medical and public health policy. We aimed to advance methodology for estimating the prevalence of FGM/C in diaspora by determining the prevalence of FGM/C among women giving birth in the Netherlands. METHODS: Two methods were applied to estimate the prevalence of FGM/C in women giving birth: (I) direct estimation of FGM/C was performed through a nationwide survey of all midwifery practices in the Netherlands and (II) the extrapolation model was adopted for indirect estimation of FGM/C, by applying population-based-survey data on FGM/C in country of origin to migrant women who gave birth in 2018 in the Netherlands. RESULTS: A nationwide survey among primary care midwifery practices that provided care for 57.5% of all deliveries in 2018 in the Netherlands, reported 523 cases of FGM/C, constituting FGM/C prevalence of 0.54%. The indirect estimation of FGM/C in an extrapolation-model resulted in an estimated prevalence of 1.55%. Possible reasons for the difference in FGM/C prevalence between direct- and indirect estimation include that the midwives were not being able to recognize, record or classify FGM/C, referral to an obstetrician before assessing FGM/C status of women and selective responding to the survey. Also, migrants might differ from people in their country of origin in terms of acculturation toward discontinuation of the practice. This may have contributed to the higher indirect-estimation of FGM/C compared to direct estimation of FGM/C. CONCLUSIONS: The current study has provided insight into direct estimation of FGM/C through a survey of midwifery practices in the Netherlands. Evidence based on midwifery practices data can be regarded as a minimum benchmark for actual prevalence among the subpopulation of women who gave birth in a given year.

Female genital mutilation/cutting in Italy: an enhanced estimation for first generation migrant women based on 2016 survey data.

BACKGROUND: Migration flows of women from Female Genital Mutilation/Cutting practicing countries have generated a need for data on women potentially affected by Female Genital Mutilation/Cutting. This paper presents enhanced estimates for foreign-born women and asylum seekers in Italy in 2016, with the aim of supporting resource planning and policy making, and advancing the methodological debate on estimation methods. METHODS: The estimates build on the most recent methodological development in Female Genital Mutilation/Cutting direct and indirect estimation for Female Genital Mutilation/Cutting non-practicing countries. Direct estimation of prevalence was performed for 9 communities using the results of the survey FGM-Prev, held in Italy in 2016. Prevalence for communities not involved in the FGM-Prev survey was estimated using to the 'extrapolation-of-FGM/C countries prevalence data method' with corrections according to the selection hypothesis. RESULTS: It is estimated that 60 to 80 thousand foreign-born women aged 15 and over with Female Genital Mutilation/Cutting are present in Italy in 2016. We also estimated the presence of around 11 to 13 thousand cut women aged 15 and over among asylum seekers to Italy in 2014-2016. Due to the long established presence of female migrants from some practicing communities Female Genital Mutilation/Cutting is emerging as an issue also among women aged 60 and over from selected communities. Female Genital Mutilation/Cutting is an additional source of concern for slightly more than 60% of women seeking asylum. CONCLUSIONS: Reliable estimates on Female Genital Mutilation/Cutting at country level are important for evidence-based policy making and service planning. This study suggests that indirect estimations cannot fully replace direct estimations, even if corrections for migrant socioeconomic selection can be implemented to reduce the bias.

Migrating with Special Needs? Projections of Flows of Migrant Women with Female Genital Mutilation/Cutting Toward Europe 2016-2030.

Female genital mutilation/cutting (FGM/C) is a rising issue in western societies as a consequence of international migration. Our paper presents demography-driven projections of female flows with FGM/C from each practicing country to each EU28 member state for the 3 sub-periods 2016-2020, 2021-2025, and 2026-2030, with the aim of supporting resource planning and policy making. According to our projections, the EU28 countries will receive a flow of around 400,000 female migrants between 2016 and 2020, and around 1.3 million female migrants between 2016 and 2030 from FGM/C practicing countries. About one-third of them, corresponding to an estimated 127,000 between 2016 and 2020, and more than 400,000 between 2016 and 2030 will have undergone FGM/C before migration. Among these female flows, slightly more than 20% is expected to be made up of girls aged 0-14. According to the expected age at arrival, 20% of these girls are expected to have already undergone FGM/C, while slightly less than 10% are to be considered potentially at risk of undergoing FGM/C after migration. As the number of women with FGM/C in Europe is expected to rise at quite a fast rate, it is important to act timely by designing targeted interventions and policies at the national and at the European level to assist cut women and protect children. Such measures are particularly compelling in France, Italy, Spain, UK, and Sweden that are expected to be the most affected countries by migration from FGM/C practicing countries.

Estimating the number of foreign women with female genital mutilation/cutting in Italy.

BACKGROUND: Female genital mutilation/cutting (FGM/C), is an emerging topic in Europe as a consequence of the increasing proportion of women migrating from Africa. The prevalence of FGM/C is however unknown in Europe, as there are no country-representative surveys on this topic. The aim of this study is to provide an estimate for Italy for the year 2010. METHODS: This study relies on the results of the First Survey on Women at Risk of FGM/C held in Italy in 2010. This cross-sectional survey involved 1000 migrants from the main FGM/C practicing countries aged 15-49 living in the Italian region of Lombardy. The estimate presented is based on a method combining direct estimates for the communities involved in the survey and indirect estimates for other communities. Indirect estimations were obtained using a refinement of the most general extrapolation-of-country-prevalence-data method. RESULTS: It is estimated that some 57 000 foreign girls and women aged 15-49 with FGM/C were living in Italy in 2010. The Nigerian community is the most affected, with around 20 000 women with FGM/C (35.5% of the total number women affected in Italy), followed by the Egyptian community (around 18 600 women with FGM/C; 32.5%). Another 15% of the women affected are from the Horn of Africa, notably from Ethiopia (3200 women; 5.5%), Eritrea (2800 women; 4.9%) and Somalia (2300 women; 4%). CONCLUSIONS: This study offers an additional methodological advancement by proposing a combination of direct and indirect estimation of FGM/C. The results are crucial information to plan interventions and targeted policies.

Estimates of first-generation women and girls with female genital mutilation in the European Union, Norway and Switzerland.

BACKGROUND: Female genital mutilation (FGM) is the practice of partial or total removal of female genitalia for non-medical reasons. The procedure has no known health benefits but can cause serious immediate and long-term obstetric, gynaecological and sexual health problems. Health workers in Europe are often unaware of the consequences of FGM and lack the knowledge to treat women adequately. OBJECTIVE: Our goal was to estimate the number of first-generation girls and women in the European Union, Norway and Switzerland who have undergone FGM. Before migration from FGM-practicing countries began, FGM was an unknown phenomenon in Europe. METHODS: Secondary analysis of data from the 2011 EU census and extrapolation from age-specific FGM prevalence rates in the immigrants' home countries to these data were used to provide our estimates. Estimates based on census and other demographic data were compared to our results for Belgium. RESULTS: In 2011 over half a million first-generation women and girls in the EU, Norway and Switzerland had undergone FGM before immigration. One in two was living in the UK or France, one in two was born in East-Africa. CONCLUSIONS: For the first time, scientific evidence gives a reliable estimate of the number of first-generation women and girls in Europe coming from countries where FGM is practiced. The use of census data proves reliable for policy makers to guide their actions, e.g., regarding training needs for health workers who might be confronted with women who have undergone FGM, or the need for reconstructive surgery.

Legal Status and Fertility Patterns: Regulation-Induced Disruption Among Previously Undocumented Immigrant Women in Italy.

We explore, using a unique survey dataset containing retrospective information on immigrants' legal status, the relationship between previous irregular experience-from arrival up to the first residence permit achievement-and fertility patterns among non-EU immigrant women in Italy. While competing hypotheses explaining migrants' fertility behaviour have been recurrently offered, there is a substantial lack of knowledge on the role of undocumented experience as a contextual barrier in shaping international migrants' family formation processes. We adopt a life-course approach, employing event history analysis and Poisson regression modelling, to investigate how irregularity among immigrant women intertwines with the timing of the first childbirth and the total number of births occurred in Italy. We find that irregular experience-as a time-dependent process-delays the transition to childbirth post-migration. Furthermore, having experienced irregular status reduces completed fertility, offering few possibilities to catch-up over the life-course with fertility levels of women continuously having the legal status. Findings suggest long-lasting effects of irregular status and the potential disruption of migrant's fertility induced by migration policies, admission systems, and regulation factors. The reduced possibility of legal entry channels and lack of migration policies for planning and managing migration into Italy may thus have an impact on family formation trajectories among international immigrant women.

Skewed Sex Ratios at Birth in Italian Migrant Populations: Evidence from a Longitudinal Register 1999-2017.

Many studies in different settings have suggested that migrants from countries with skewed sex ratios at birth tend to adjust the sex of their offspring to ensure the birth of at least one male child. Enlarging the scope of existing research, the present study explores the phenomenon by studying the sex ratio at birth and sex selection at birth among migrants in Italy, focussing on birth order and the sex of the previous child. We perform a descriptive analysis of SRB by birth order (first, second and third), sex of the previous children, inter-birth interval and citizenship of the child. We analyse data from the Longitudinal register on reproductive histories from 1999 to 2017 (ISTAT). Results show significantly higher values of SRB for third births among Indian and Chinese communities when the first and second births are girls. A skewed SRB is also present among Indian babies born after a female firstborn. A more detailed analysis of SRBs for immigrants from China and India, by the sex of the previous children and inter-birth interval between second and third birth, did not indicate significant changes in SRB when the inter-birth interval is longer. Our study provides evidence for policymaking. However, further research is needed to address the causes of sex selection among immigrant communities. Efforts to alter gender norms and reduce son preference within communities are required to tackle gender discrimination against second-generation girls.

Who Wants to Become Italian? A Study of Interest in Naturalisation among Foreign Migrants in Italy.

Since the early 1990s, Italy, along with other countries situated at Europe's periphery, has become an attractive destination for migrants due to its lax regulation of migration and its job market. Despite its restrictive naturalisation laws, an increasing number of migrants are becoming eligible for Italian citizenship, which has led to a growing number of naturalisations in recent years. Existing research exploring naturalisation and its determinants has found migrants' ability to attain citizenship strongly depends on their interest in becoming a member of the host state, requirements (as defined by the host country), and their capacity to overcome various constraints such as the costs involved in the naturalisation process. However, few empirical studies have focused on immigrants' interest in naturalisation. To fill this gap, we analyse migrants' interest in naturalisation and how it correlates to their eligibility. This paper relies on the most recent data on interest in naturalisation from the 2018 and 2019 waves of the Regional Observatory for Integration and Multiethnicity of Lombardy (Italy). The results show that not all migrants are interested in naturalisation after assessing its perceived costs and benefits, thus confirming an instrumental approach to citizenship. Interest is mostly related to the legislation and conditions in the country of origin. Moreover, the relationship between eligibility and interest is highly dependent on civil stratification, and eligibility is not directly associated with interest. Supplementary Information: The online version contains supplementary material available at 10.1007/s10680-022-09639-y.

The prevalence and risk of Female Genital Mutilation/Cutting among migrant women and girls in the Netherlands: An extrapolation method.

OBJECTIVES: The aim of the study was (I) to estimate the prevalence of Female Genital Mutilation/Cutting (FGM/C) and distribution of types of FGM/C among migrant girls and women in the Netherlands, and (II) to estimate the number of migrant girls at risk of being cut in the immediate future. METHODS: National population-based survey data regarding FGM/C prevalence were applied to female migrants in the Netherlands who migrated from 29 countries with available nationally representative data on FGM/C. RESULTS: As of January 1st 2018, there were 95,588 female migrants residing in the Netherlands, originating from 29 countries with available nationally representative data on FGM/C. Our findings suggest that about 41,000 women had undergone FGM/C, of which 37% had Type III (infibulation). In total 4,190 girls are estimated to be at risk of FGM/C in the next 20 years, of whom 394 were first-generation girls. CONCLUSION: These findings show the urgency to develop appropriate strategies and policies to prevent FGM/C, to protect girls and women at risk of the practice, and to provide adequate services and support for those affected by FGM/C in the Netherlands.