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    Review of 'Female genital mutilation – why does it still exist in Africa?'

    Female genital mutilation – why does it still exist in Africa?Crossref
    A good analysis of the underlying causes of FGM
    Average rating:
        Rated 4.5 of 5.
    Level of importance:
        Rated 5 of 5.
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        Rated 4 of 5.
    Level of completeness:
        Rated 4 of 5.
    Level of comprehensibility:
        Rated 4 of 5.
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    Female genital mutilation – why does it still exist in Africa?

    Abstract Female genital mutilation (FGM) includes all procedures that involve partial or total removal of the external female genitalia for non-medical reasons. FGM is practised in many parts of the world – including 28 African countries, some countries in the Middle East and Asia, and some population groups in Central and South America. Its prevalence rates range from 0.6% up to 97.9%, and it has been classified as a violation of human and children’s rights. Consequently, several countries have passed laws against the practice and many international programmes have been implemented to abandon it. Yet, FGM still prevails in many countries. This literature review aimed at identifying the underlying reasons for the perpetuation of FGM, ascertaining forces that foster its promotion and persistence and who is responsible for pushing its continuation. The main goal was to try to understand the underlying causes that make FGM resistant against initiatives and campaigns targeting its elimination. A literature search was carried out using several databases. All sources that approached the topic of FGM were incorporated including literature reviews, systematic reviews, qualitative and quantitative as well as mixed-method studies that described attitudes towards FGM and factors associated with its practice. Different factors that were interlinked could be identified at the individual, interpersonal, organisational/institutional as well as the community/societal level as the underlying causes of the perpetuation for FGM. These factors varied within and between different settings, and include individual characteristics such as parents’ level of education, place of residence, personal beliefs (aesthetics, health benefits, hygiene) about FGM as well as the medicalisation of FGM and the involvement of health care professionals at the institutional level. Cultural factors like gender inequality, social norms and pressure also played an important role. Surprisingly, no evidence that supported religious motives could be found in any of the three monotheistic religions. This review suggests that the reasons behind the performance of FGM differ between and within countries and contexts, but cannot be found in the scriptures even though it is mainly practiced by Muslims. Girls with low education living in small Muslim communities, in rural areas in Africa and whose parents especially the mother had a low educational level, were at increased risk of undergoing FGM. Successful actions to eliminate this practice require a balance between respect of culture and human rights. Practising communities should be involved in each step of every programme. Finally, it is crucial to target the young generations through education, women empowerment and reduction of gender inequality.

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      The authors do a good analysis of the underlying causes of FGM and design a comprehensive model for this analysis.

      Under the introduction and in paragraph 2, the authors mention the traditional excisers as the main circumcisers, however, medicalisation of the procedure has become prevalent in some countries, for example in Egypt 2014, more than 70% of FGM operations were performed by physicians. Authors may like to add thissentence.

      Please consider providing data about the magnitude of FGM inthe world right after the first paragraph of the introduction and before the types. If I remember correctly, the number of circumcised women across the world is around 130-140 million and more than 3 million girls are at risk of being circumcised every year.

      In the socio-ecological model, I did not see much differencebetween the community and society levels, authors may consider combining both.

      Concerning religious leaders under the organizational level,one of the reasons behind the contradictions between what the religious leaders tell people and what the real religion says isthat culture and religion are often mixed in the minds of leaders, authors may like to highlight this point or add it in the discussion.

      I did not see where "Lack of political commitment, lackof laws and regulations, lack of the role of media and lack ofawareness raising" fit into this model. Authors may consider adding another level to the model or discussing it in more detail under the organizational level.

      Under gender norm Ref 34, it mentions FGC while in the wholearticle the term used was FGM, authors may consider changing it.

      Recent literature shows some evidence that the role of men is increasing in decision making regarding FGM, whether for having it or not having it done for their daughters/female relatives. There are also complicated relationships that exist between men's sexual feelings and FGM. The authors may consider highlighting this important point under the gender level or the discussion. There is a referenced article that may help.

      The discussion looks like a summary rather than a discussion, authors may consider enriching it by adding their own input, ideas, and perhaps suggestions and recommendations


      El-Mouelhy, M.T., Johansen, R. Elise. B., Ragab A.R., & Fahmy, A. (2013). Men’s perspectives on the relationship between sexuality and female genital mutilation in Egypt. Sociology Study, 3(2), 104‐113.


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