Social disharmony, inauthenticity and patriarchy: an Ubuntu perspective on the practice of female genital mutilation.

Female Genital Mutilation (FGM) is a universal issue which affects girls in Africa, the Middle East, Asia and South America, and immigrant communities in Western Europe, North America, Australia and New Zealand. FGM is a cultural practice in approximately 29 countries in Africa, affecting over 140 million girls. FGM is practiced as a rite of passage, where girls are initiated into womanhood. This practice is promoted as a means for incorporation, thus ascribing personhood, and belonging for girls to their communities. African scholars hold conflicting positions about FGM, with some arguing that it is essential for relational fullness and harmony. While others believe FGM is unjustified because of the health and social risks associated with the practice. We argue, applying sustainable social harmony and Gyekye's views on cultural revitalization, that FGM is morally unjustified and should be prohibited. We believe the claims that FGM fosters harmony, a value of Ubuntu, are fallacious, and this perceived harmony is pretentious and unsustainable. We claim that FGM is inauthentic, unjust and steeped in patriarchal underpinnings that are unsustainable, thus it is a disharmonious practice. Cultural practices that are disharmonious should be refined and pruned and must be dynamic and responsive to current realities.

Women who have undergone female genital mutilation/cutting's perceptions and experiences with healthcare providers in Paris.

Female genital mutilation/cutting (FGM/C) is a health and human rights issue and a dangerous form of gender-based violence. Given migratory flows from the countries in which it is practised, FGM/C concerns a substantial number of women living in Western countries. In this study, we looked at women who had undergone FGM/C experiences with French medical practitioners. We also discussed with them the desirability of screening for, and prevention of, FGM/C in international travel medicine centres. A qualitative approach was used to collect and analyse the data. Focus groups and semi-structured interviews were held with 26 women (24 participants in focus groups and 2 individual interviews). Transcriptions were coded and analysed thematically. All the participants came from sub-Saharan Africa. Their median age was 32.9 years. Persistent silence about FGM/C in the host society following immigration resulted in dissatisfaction with healthcare providers. Participants expected professionals to address the subject of FGM/C, feeling professionals should bring up the subject first so as to put women at ease. International travel medicine centres were discussed by some as a possible means of prevention.

Beyond the Sociocultural Rhetoric: Female Genital Mutilation, Cultural Values and the Symbolic Capital (Honor) of Women and Their Family in Conakry, Guinea-A Focused Ethnography Among "Positive Deviants".

Female genital mutilation (FGM) is justified by sociocultural arguments, including that it guarantees girls'/women's appropriate sexual behavior, thus preserving family honor. We explored the perspectives of Guineans who do not practice FGM ("positive deviants"), as well as of Guineans who still practice FGM but who are supportive of abandoning the practice ("reluctant adherents"). We conducted a "focused ethnographic" study in Conakry, Guinea with a sample of 58 people. Individual semi-structured interviews were undertaken to explore the views and experiences of 18 women and 12 men of different generations who abandoned the practice of FGM. Group interviews with an additional 16 women and 12 men (half of whom were "positive deviants" and the other half "reluctant adherents") validated and enriched the data. Participants consider that FGM has deleterious consequences as it: (1) does not prevent girls or married women from being sexually active outside of marriage; (2) may impair couples' sexual satisfaction, and thus lead to divorce, men's infidelity or polygamy; and (3) may reduce women's ability to have multiple children, because of the increased risk of infertility or obstetric complications. In addition, participants reported that many Guineans fear that the promotion of FGM abandonment is a Western plot to eradicate their culture. We conclude that Guineans who practice and do not practice FGM share the same cultural values about the importance of culturally appropriate sexual behavior, being married, and having many children, which are central sources of honor (symbolic capital) to women and their families. They, however, have opposing views on how to achieve these objectives. Based on our participants' perspectives, the harmful consequences of FGM can potentially sabotage these sources of honor. Recommendations for messages aimed at promoting FGM abandonment are discussed.

Exploring young people's interpretations of female genital mutilation in the UK using a community-based participatory research approach.

BACKGROUND: Female genital mutilation (FGM) is a deeply-rooted cultural practice mainly undertaken in Africa, the Middle East and Asian countries. Evidence to date suggests that although first-generation migrants to the West are abandoning FGM, the custom continues in some places, albeit in small numbers. This study examined how young people living in FGM affected communities in the United Kingdom (UK), interpreted and explained FGM. METHODS: A community-based participatory research (CBPR) approach was used to recruit and train nine young people aged 15-18 as co-researchers. These comprised eight females and one male from second-generation FGM affected communities, living in Bristol. The co-researchers then undertook focus groups and semi-structured interviews with twenty participants aged 13-15 living in Bristol, Cardiff and Milton Keynes. The qualitative data from the training workshops, interviews and focus groups were collected and analysed using thematic analysis. RESULTS: There were conflicting views among participants. Some perceived FGM as a historical tradition that was of very little, if any, relevance to them. In contrast, others perceived that the more archaic, cultural interpretation of FGM, more commonly shared by older generations, had been supplanted by a new form of FGM, which they believed to be a safe procedure, made so by the availability of highly-trained, qualified doctors and better equipment in the UK. Participants spoke of challenges encountered when attempting to raise the issue of FGM with parents. Nevertheless, they acknowledged that- being born and raised in the UK - enabled them to talk openly and to challenge others. CONCLUSION: Future strategies to address and prevent FGM in the UK will require a public health approach that is holistic, intersectional and empowering. Such measures should be relevant to young people born and raised in the UK who interpret FGM differently to previous first-generation migrant relatives and communities. Tackling FGM requires a shift away from a principal preoccupation with harm reduction and criminalisation towards collaboration and active dialogue with communities, in positive and productive ways that acknowledge and engage issues of identity, race, gender, and generation, enabling people affected by FGM to take control of their health and well-being.

Beyond will: the empowerment conditions needed to abandon female genital mutilation in Conakry (Guinea), a focused ethnography.

BACKGROUND: Female genital mutilation (FGM) can give rise to immediate and long-term health problems for girls/women. Numerous studies have identified the sociocultural determinants of this tradition, but so far, in a national context where FGM is highly practiced, virtually none have focused on people refusing to have their daughters cut. We therefore aimed to understand the sociocultural dynamics underlying the non-practice of FGM in Guinea, a country which has one of the most prevalent rates of this practice in the world. This research explored the demographic and sociocultural profiles of Guineans who do not practice FGM, as well as their non-practice experience in a context of high FGM prevalence and social pressure. METHODS: We used a "focused ethnography" methodology and conducted semi-structured individual interviews with 30 women and men from different generations (young adults, parents, grandparents) living in Conakry, Guinea. RESULTS: We found that participants 1) do not disclose their non-practicing status in the same way, and 2) have different experiences with social pressure. A typology was created to describe participants as per their various profiles and experiences, which we named as: 1) the "activists", 2) the "discrete", 3) the "courageous", 4) the "strategists". DISCUSSION: Wanting to stop practicing FGM is not enough. The main empowering conditions allowing people to enact their decision not to have their daughters undergo FGM are: benefiting from social support (positive social capital), or being financially independent from the traditional solidarity network (sufficient economic capital). We therefore recommend finding ways to increase women's/families' empowerment to enact their decision not to practice FGM, mainly by: 1) providing them with new sources of social support, and 2) supporting them to gain more financial independence, including through schooling and improved access to better-paid employment. CONCLUSIONS: This study was the first to explore the experience of people who do not practice FGM in a context of high FGM prevalence and social pressure. The results and recommendations of this research can inform strategies for FGM abandonment and therefore contribute to improving or developing intervention strategies that promote the health and well-being of girls and women.

RéSUMé: CONTEXTE: Les mutilations génitales féminines (MGF) peuvent nuire à la santé des filles/femmes. Plusieurs études ont identifié les déterminants socioculturels de cette tradition, or aucune n'a focalisé sur des personnes vivant dans un contexte où les MGF sont hautement pratiquées et qui refusent de faire exciser leurs filles. En Guinée, la prévalence des MGF est très élevée et la pression sociale pour faire exciser les filles est forte. Cette recherche a donc exploré les profils démographiques et socioculturels, et l'expérience de Guinéens qui ne pratiquent pas les MGF. MéTHODES: Nous avons utilisé une méthodologie « d'ethnographie focalisée ¼, et mené des entretiens individuels semi-structurés avec 30 femmes et hommes de différentes générations (jeunes adultes, parents, grands-parents) vivant à Conakry, en Guinée. RéSULTATS: Nous avons constaté que les participants 1) ne divulguent pas tous leur statut de non-pratique, et 2) ont différentes expériences de pression sociale. Nous avons créé une typologie pour les décrire selon leurs différents profils et expériences, et les avons surnommés ainsi: 1) « activistes ¼, 2) « discrets ¼, 3) « courageux ¼, 4) « stratèges ¼. DISCUSSION: Vouloir abandonner la pratique des MGF ne suffit pas. Les principales conditions permettant aux participants de mettre en oeuvre leur décision de ne pas faire exciser leurs filles sont: bénéficier de soutien social (capital social positif), ou être financièrement indépendant du réseau de solidarité traditionnel (capital économique suffisant). Nous recommandons donc de trouver des moyens pour accroître l'autonomisation des femmes/familles pour qu'elles puissent mettre en œuvre leur décision de ne pas faire exciser leurs filles, principalement en les soutenant pour accéder à 1) du soutien social, et 2) l'indépendance financière, y compris par la scolarisation et l'accès à des emplois mieux rémunérés. CONCLUSIONS: Cette étude a été la première à explorer l'expérience de personnes qui ne pratiquent pas les MGF dans un contexte de forte prévalence des MGF et de pression sociale. Les résultats et recommandations de cette recherche peuvent éclairer les stratégies d'abandon des MGF et ainsi contribuer à améliorer ou à développer des stratégies d'intervention qui favorisent la santé et le bien-être des filles/femmes.

Female Genital Mutilation in Ethiopia's Afar Region: Patterning, Drivers, and Decision-Making.

PURPOSE: To explore the patterning, practices, and drivers of female genital mutilation (FGM) in Ethiopia's Afar region. METHODS: This article draws on mixed-methods research conducted in 2022 in 18 rural communities in three districts of Ethiopia's Afar region. Survey data were collected from 1,022 adolescents and their caregivers. Qualitative interviews were conducted with approximately 270 adults and adolescents. RESULTS: The survey found that FGM remains practically universal (97% of sampled adolescent girls), and infibulation remains the norm (87% of girls). Most adolescent girls and caregivers reported that FGM is required by religion and should continue. When queried about the main reason for FGM, however, most cited culture rather than religion. Female caregivers and adolescent girls were more likely to report that FGM has benefits than risks; the reverse was true for male caregivers. Qualitative evidence suggests that even girls who are not reported as infibulated generally, and that the social benefits of FGM--especially regarding controlling girls' sexuality and facilitating their marriageability--are perceived to outweigh health risks. Where there are shifts in type of FGM, it is largely due to efforts of religious leaders who preach against infibulation and for "milder" types--and the growing scope of fathers to input into mothers' FGM decision-making and advocate for less invasive types. DISCUSSION: Eliminating FGM requires focusing on contexts where the practice is most invasive and progress is not yet visible. Given complex intrahousehold and intragenerational dynamics, this will necessitate engaging whole communities with sustained multipronged approaches to shift social norms.

Strengthening woman-centred care for pregnant women with female genital mutilation in Australia: a qualitative muti-method study.

Woman-centred care is a collaborative approach to care management, where the woman and her health provider recognise one another's expertise and interact based on mutual respect to provide adequate information and individualised care. However, woman-centred care has not been fully achieved, particularly for women who have experienced female genital mutilation in high-income countries. A lack of clear guidelines defining how to implement woman-centred care may negatively impact care provision. This study sought to explore the quality of point-of-care experiences and needs of pregnant women with female genital mutilation in Australia to identify elements of woman-centred care important to women and how woman-centred care can be strengthened during consultations with health professionals. This multi-method qualitative study comprised two phases. In phase one, we conducted interviews with women with female genital mutilation to explore their positive experiences during their last pregnancy, and in phase two, a workshop was held where the findings were presented and discussed to develop recommendations for guidelines to support woman-centred care. The findings of the first phase were presented under three distinct categories of principles, enablers, and activities following a framework from the literature. In phase two, narrative storytelling allowed women to share their stories of care, their preferences, and how they believe health providers could better support them. Their stories were recorded visually. This study highlights the importance of a comprehensive approach to woman-centred care involving experts, clinicians, community members, and women in designing education, tools, and guidelines.

Reconstructive and Aesthetic Surgeries on the Female Genitalia. Guideline of the DGGG, DGPRÄC, OEGGG and SGGG (S2k-Level, AWMF Registry No. 009/019, May 2022).

Aim This official guideline was coordinated and published by the German Society for Gynaecology and Obstetrics (DGGG), the German Society for Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC), the Austrian Society for Gynaecology and Obstetrics (OEGGG), and the Swiss Society for Gynaecology and Obstetrics (SGGG). The guideline aims to provide a consensus-based overview of reconstructive and aesthetic surgeries on female genitalia based on an evaluation of the relevant literature. Methods This S2k-guideline was developed by representative members from different medical professions on behalf of the guidelines commission of the DGGG, DGPRÄC, OEGGG and SGGG using a structured consensus process. Recommendations Statements and recommendations on the epidemiology, aetiology, classification, symptoms, diagnosis, and treatment of acquired changes of the external genitalia are presented and special situations are discussed.

Abandoning female genital mutilation/cutting (FGMC) is an emerging but costly parental investment strategy in rural Ethiopia.

Female genital mutilation or cutting (FGMC) has profound consequences for an estimated 200 million women world-wide, yet affected communities often resist efforts to end the practice. Marriage market dynamics have been proposed as key to this resistance, because where FGMC is normative, parents are motivated to cut their daughters to improve their marriage prospects. Some economists have also argued that financial gain, through bride wealth payments, incentivises parents to cut daughter's at time of marriage. Bride wealth, however, does not necessarily equal net economic return, confounding efforts to test this assumption. Here we use detailed data on the financial value of all exchanges at marriage from Ethiopian Arsi Oromo agropastoralists to assess their association with FGMC. We also explore the idea that parents must replace FGMC with other forms of investment (e.g., education) when cutting practices are rejected. Multivariate multilevel Bayesian models were run using data from the first marriages of 358 women to assess the association between FGMC status and education and marriage-related outcomes: bride wealth payments, dowry costs, and age at marriage. Being cut is associated with lower dowry costs and earlier age at marriage but does not predict bride wealth paid by the groom's family. School attendance is associated with higher bride wealth, particularly for women with four or more years of education, and with later age at marriage. These findings indicate that bride wealth payments do not maintain FGMC among the Arsi Oromo. While we find a relative economic loss for parents from FGMC abandonment through higher value dowry gifts, this may be traded-off against the health benefits to uncut daughters. These findings point to the emergence of new norms, whereby Arsi Oromo parents reject cutting for their daughters and prefer their daughters-in-law to be educated.

Variations in the Prevalence of Female Genital Mutilation Among Reproductive-aged Women in Nigeria Across Three Generations.

Background and Objective: Female genital mutilation (FGM) is widespread mainly in low and middle-income countries. Nigeria is one of the countries with the highest prevalence of FGM, accounting for about one of every four cases globally. The purpose of this study was to determine the prevalence of FGM among three generations in Abuja, the federal capital city of Nigeria. Methods: This is a cross-sectional study among women of reproductive age (15-49 years) within two area councils of Abuja (Bwari and Abuja Municipal) and Nyanya suburban district adjoining the federal capital territory in Nigeria. The respondents are pregnant women attending antenatal care at four selected health facilities. Data were collected using Google Forms and were analyzed with SPSS for Windows version 25. Results: This study comprised data from 634 females (who had an average age of 33±6.0 years) from four major healthcare facilities in Abuja. The most common age group was 30 - 34 years (29.2%). The prevalence of FGM in the first generation (37.7%) was significantly higher than in the second (28.5%) and the third generations (8.7%) (p<0.01). The prevalence of FGM in the second generation was also significantly higher than in the third (p<0.01). The predictors of women circumcising their daughters include primary/no-education AOR 1.48 (95% CI: 0.41-5.31; p<0.05), being a traditionalist 4.94 (95% CI: 0.29-84.56; p<0.05), or Muslim 2.27 (95% CI: 0.94-5.49; p<0.05), respondent's mother being circumcised 1.69 (95% CI: 0.26-10.85, p<0.05) or mother's circumcision unknown 5.41 (95% CI: 0.78-37.34; p<0.05), respondents being circumcised 54.71 (95% CI: 0.78-37.34; p<0.001), culture 2.48 (95% CI: 1.00-6.19; p<0.05), and ignorance of adverse psycho-social/emotional effects of FGM 4.39 (95% CI: 1.46-13.17; p<0.05). Conclusion and Global Health Implications: Although there is a decline in FGM prevalence from the first generation to the third generation in Nigeria, the current prevalence of 8.7% remains a public health concern. Nigerian women's ongoing experience of FGM requires both individual and stakeholders' involvement to eradicate health-related problems such as tissue damage, infection, scarring, infertility, and pains during sexual intercourse, urination, and menstruation.

"I Can't Blame Mum": A Qualitative Exploration of Relational Dynamics in Women With Female Genital Mutilation (FGM) in the United Kingdom.

Female genital mutilation (FGM) is conceptualized as an interpersonal act, commonly initiated by mothers. This study investigates relational dynamics among adult women who experienced FGM in childhood and have since migrated to the United Kingdom. A qualitative research design was employed, using semi-structured interviews and interpretative phenomenological analysis (IPA) with nine women. Three superordinate themes emerged: (a) "The 'who to blame?' conflict: Preserving goodness in parents"; (b) "Better or worse? Positioning the self in relation to others"; and (c) "Regaining power: Righting the wrongs." Implications for understanding the relational consequences of FGM and the discontinuation of its intergenerational transmission are considered.

Understanding the Experiences and Needs of Migrant Women Affected by Female Genital Mutilation Using Maternity Services in Australia.

Female genital mutilation (FGM) is a cultural practice defined as the partial or total removal of the external female genitalia for non-therapeutic reasons. Changing patterns of migration in Australia and other high-income countries has meant that maternity care providers and health systems are caring for more pregnant women affected by this practice. The aim of the study was to identify strategies to inform culturally safe and quality woman-centred maternity care for women affected by FGM who have migrated to Australia. An Appreciative Inquiry approach was used to engage women with FGM. We conducted 23 semi-structured interviews and three focus group discussions. There were four themes identified: (1) appreciating the best in their experiences; (2) achieving their dreams; (3) planning together; and (4) acting, modifying, improving and sustaining. Women could articulate their health and cultural needs, but they were not engaged in all aspects of their maternity care or considered active partners. Partnering and involving women in the design and delivery of their maternity care would improve quality care. A conceptual model, underpinned by women's cultural values and physical, emotional needs, is presented as a framework to guide maternity services.

The State of Adolescent Sexual and Reproductive Health.

In the 25 years since the 1994 International Conference on Population and Development, significant progress has been made in adolescent sexual and reproductive health and rights (ASRHR). Trend analysis of key ASRHR indicators at global, national, and subnational levels indicates that adolescent girls today are more likely to marry later, delay their first sexual experience, and delay their first childbirth, compared with 25 years ago; they are also more likely to use contraceptives. Despite overall progress, however, unequal progress in many ASRHR outcomes is evident both within and between countries, and in some locations, the state of adolescents' lives has worsened. Population growth in countries with some of the worst shortfalls in ASRHR mean that declining rates, of child marriage, for example, coexist with higher absolute numbers of girls affected, compared with 25 years ago. Emerging trends that warrant closer attention include increasing rates of ovarian and breast cancer among adolescent girls and sharp increases in the proportion of adolescents who are overweight or obese, which has long-term health implications.

The Political, Research, Programmatic, and Social Responses to Adolescent Sexual and Reproductive Health and Rights in the 25 Years Since the International Conference on Population and Development.

Among the ground-breaking achievements of the International Conference on Population and Development (ICPD) was its call to place adolescent sexual and reproductive health (ASRH) on global health and development agendas. This article reviews progress made in low- and middle-income countries in the 25 years since the ICPD in six areas central to ASRH-adolescent pregnancy, HIV, child marriage, violence against women and girls, female genital mutilation, and menstrual hygiene and health. It also examines the ICPD's contribution to the progress made. The article presents epidemiologic levels and trends; political, research, programmatic and social responses; and factors that helped or hindered progress. To do so, it draws on research evidence and programmatic experience and the expertise and experiences of a wide number of individuals, including youth leaders, in numerous countries and organizations. Overall, looking across the six health topics over a 25-year trajectory, there has been great progress at the global and regional levels in putting adolescent health, and especially adolescent sexual and reproductive health and rights, higher on the agenda, raising investment in this area, building the epidemiologic and evidence-base, and setting norms to guide investment and action. At the national level, too, there has been progress in formulating laws and policies, developing strategies and programs and executing them, and engaging communities and societies in moving the agenda forward. Still, progress has been uneven across issues and geography. Furthermore, it has raced ahead sometimes and has stalled at others. The ICPD's Plan of Action contributed to the progress made in ASRH not just because of its bold call in 1994 but also because it provided a springboard for advocacy, investment, action, and research that remains important to this day.

Female genital mutilation in the UK- where are we, where do we go next? Involving communities in setting the research agenda.

BACKGROUND: Female Genital Mutilation (FGM) is all practices involving cutting, alteration or injury to the female genitalia for non-medical reasons. It is a form of violence against women and children, with no benefits and many harms. In 2014, the UK Government committed to working to eliminate FGM. Steps taken towards this aim included creation of educational and safeguarding resources for professionals, and legislative changes including a mandatory reporting duty for professionals in England and Wales (where if a girl under 18 discloses or is found on examination to have FGM then the professional is mandated to report this to the police), and an FGM Enhanced Dataset applicable to NHS organisations in England requiring the submission of personal data about women and girls who have had FGM to NHS Digital. To date, compliance with dataset returns from primary care services have been low. This report describes using patient and public involvement (PPI) to identify research and service priorities to support communities affected by FGM. METHODS: We held a series of PPI events (4 focus groups, and a multi-agency seminar) in 2015-2016, following the introduction of these legislative changes, speaking to community members, and professionals involved in their care. We asked participants to consider what they identified as research, knowledge and service priorities to support communities affected by FGM. RESULTS: The impact of these legislative and reporting requirements on the trust needed for community members to seek to consult health services was identified as important for further research. Priorities for service development were holistic services, that met a woman's needs throughout her lifecourse. Participants emphasised the importance of understanding how to listen, involve and utilise community voices in developing education for professionals, designing services, and developing policy. CONCLUSIONS: There was a desire for change to develop from within affected communities; any learning and resources need to be co-created and constructed in such a way that they can be effectively shared between women, communities, and professionals. Questions remain about how to define community consultation, how to recognise when it was adequate, and how to hear beyond community activists to hear a wider range of voices.

Female genital mutilation and male involvement: Insights of men and women in two counties in Kenya

This qualitative study, conducted in Meru and Kajiado counties in Kenya, explored the perceptions and attitudes of men and women regarding male involvement in FGM in order to inform the design of male involvement strategies in FGM abandonment. We used focus group discussions to collect the data which was then subjected to thematic analysis. Three main themes emerged from the data: i) culture and the role of men; ii) perceived awareness and knowledge of FGM among men, and iii) credible and customised education and engagement. The study found widespread agreement on the importance of male involvement in FGM abandonment. Culture played an important role in determining the extent of involvement, or lack thereof. We conclude that while culture needs to be respected it ought to be challenged to avoid the continued harm to girls. The potential of men as a collective to bring about change was evident, and policy makers and NGOs should utilise the power of male collectives to support efforts to abandon FGM