The Female Genital Mutilation (FGM) - migration matrix: The case of the Arab League Region.

The movement of people from and to countries and regions with different Female Genital Mutilation (FGM) prevalence and practices and the implications for the elimination of FGM are under researched. In this article, we intend to examine the factors that support or deter Female Genital Mutilation (FGM) in the context of internal, regional and international migration in and from countries in the Arab League Region. We selected the Arab League Region as the focus of this article as it contains countries with some of the highest FGM adult prevalence rates in the world, as well as countries where FGM is not traditionally performed. It is also a region with high levels of population mobility including internal, regional and international flows of migration. The region thus provides a case study, which can help elucidate other geographical migration-FGM contexts.

The Saleema initiative in Sudan to abandon female genital mutilation: Outcomes and dose response effects.

PURPOSE: The overall goal of the Saleema Initiative in Sudan is to promote long-term abandonment of female genital mutilation and cutting (FGM) through a contribution to changing social norms, attitudes, and intentions related to the practice. The initiative aims to create positive cultural associations with a girl remaining uncut, a new social norm. Saleema hypothesizes that branding the alternative to FGM (abandonment) will promote social norms change. In 2014, the lead author designed a monitoring and evaluation framework for Saleema in partnership with UNICEF, the National Council for Child Welfare (NCCW), and local organizations. METHODS: The Saleema evaluation aimed to evaluate the effectiveness of the campaign in reducing pro-FGM social norms. A quasi-experimental design controlled for dosage of campaign messages delivered across the 18 states in Sudan to measure a dose-response effect. We operationalized social norms through a 4-item scale validated in previous research. RESULTS: This paper reports on quantitative evaluation findings based on data gathered in from 2015-2017 and focuses on the dose-response relationship between Saleema exposure and changes in FGM social norms. We found that self-reported exposure was associated with reduced pro-FGM social norms (coeff. = -0.329, p < .001). Additionally, higher doses of Saleema, measured through an exogenous measure of campaign event exposure from an independent monitoring system was associated with reduced pro-FGM social norms (coeff. = -0.146, p < .001). CONCLUSIONS: Saleema was effective in reducing pro-FGM social norms. It is a promising strategy and findings contribute to the growing literature on social norms approaches to behavior change.

Shifts in FGM/C practice in Sudan: communities' perspectives and drivers.

BACKGROUND: Although Sudan has one of the highest prevalence of female genital mutilation or cutting (FGM/C), there have been shifts in e practice. These shifts include a reduction in the prevalence among younger age cohorts, changes in the types of FGM/C, an increase in medicalization, and changes in age of the practice. The drivers of these shifts are not well understood. METHOD: Qualitative data drawn from a larger study in Khartoum and Gedaref States, Family and Midwife individual interviews and focus group discussions. Analysis and categorization within a Social Norms theoretical framework. RESULTS: Major findings confirmed shifts in the type FGM/C (presumably from infibulation to non-infibulating types) and increasing medicalization in the studied communities. These shifts were reported to be driven by social, professional and religious norms. CONCLUSION: Changes in FGM practice in Sudan include drivers which will not facilitate abandonment of the practice instead lead to normalization of FGM/C. Yet professionalisation of Midwives including their oath to stop FGM/C has potential to facilitate abandonment rapidly if developed with other Sudan health professionals.

Inclusion and human rights in health policies: comparative and benchmarking analysis of 51 policies from Malawi, Sudan, South Africa and Namibia.

While many health services strive to be equitable, accessible and inclusive, peoples' right to health often goes unrealized, particularly among vulnerable groups. The extent to which health policies explicitly seek to achieve such goals sets the policy context in which services are delivered and evaluated. An analytical framework was developed--EquiFrame--to evaluate 1) the extent to which 21 Core Concepts of human rights were addressed in policy documents, and 2) coverage of 12 Vulnerable Groups who might benefit from such policies. Using this framework, analysis of 51 policies across Malawi, Namibia, South Africa and Sudan, confirmed the relevance of all Core Concepts and Vulnerable Groups. Further, our analysis highlighted some very strong policies, serious shortcomings in others as well as country-specific patterns. If social inclusion and human rights do not underpin policy formation, it is unlikely they will be inculcated in service delivery. EquiFrame facilitates policy analysis and benchmarking, and provides a means for evaluating policy revision and development.

Up the garden path and over the edge: where might health-seeking behaviour take us?

The concept of health-seeking behaviour continues to permeate the development literature, and this paper reviews the main approaches. However, it also suggests that health-seeking behaviour is a somewhat over-utilized and under-theorized tool. Although it remains a valid tool for rapid appraisal of a particular issue at a particular time, it is of little use as it stands to explore the wider relationship between populations and health systems development. If we wish to move the debate into new and more fruitful arenas, we need to develop a tool for understanding how populations engage with health systems, rather than using health-seeking behaviour as a tool for describing how individuals engage with services. The paper suggests one way in which we might start to frame the debate, using reflexive communities and social capital as key theoretical and analytical concepts.