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      Transforming social norms to end FGM in the EU: an evaluation of the REPLACE Approach

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          Abstract

          Background

          Despite numerous campaigns and interventions to end female genital mutilation (FGM), the practice persists across the world, including the European Union (EU). Previous interventions have focused mainly on awareness raising and legislation aimed at criminalizing the practice. Limited evidence exists on the effectiveness of interventions due in part to the lack of systematic evaluation of projects. This paper presents an evaluation of the REPLACE Approach, which is a new methodology for tackling FGM based on community-based behaviour change and intervention evaluation.

          Methods

          We developed, trialed and evaluated the REPLACE Approach through extensive engagement with eight FGM affected African diaspora communities in five EU countries. We employed qualitative and quantitative tools to obtain data to inform the development, implementation and evaluation of the Approach. These included community-based participatory action research, questionnaires and community readiness assessments. The research took place between 2010 and 2016.

          Results

          Findings suggested that the Approach has the capability for building the capacities of FGM affected communities to overturn social norms that perpetuate the practice. We observed that community-based action research is a useful methodology for collecting data in FGM intervention settings as it allows for effective community engagement to identify, educate and motivate influential community members to challenge the practice, as well as obtaining useful information on the beliefs and norms that shape the practice. We also found that community readiness assessments, pre and post intervention, were useful for tailoring interventions appropriately and for evaluating changes in attitudes and behaviour that may have resulted from the interventions.

          Conclusion

          This evaluation has demonstrated that the REPLACE Approach has the potential, over time, to bring about changes in norms and attitudes associated with FGM. Its strengths lay in the engagement with influential community members, in building the capacity and motivation of community members to undertake change, in recognising contextual differences in the barriers and enablers of FGM practice and in tailoring interventions to local community readiness to change, and then evaluating interventions to re-inform implementation. The next steps would therefore be to implement the Approach over a longer time frame to assess if it results in measurable change in behaviour.

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          Most cited references17

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          Community readiness: Research to practice

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            Using social norms theory for health promotion in low-income countries

            Summary Social norms can greatly influence people’s health-related choices and behaviours. In the last few years, scholars and practitioners working in low- and mid-income countries (LMIC) have increasingly been trying to harness the influence of social norms to improve people’s health globally. However, the literature informing social norm interventions in LMIC lacks a framework to understand how norms interact with other factors that sustain harmful practices and behaviours. This gap has led to short-sighted interventions that target social norms exclusively without a wider awareness of how other institutional, material, individual and social factors affect the harmful practice. Emphasizing norms to the exclusion of other factors might ultimately discredit norms-based strategies, not because they are flawed but because they alone are not sufficient to shift behaviour. In this paper, we share a framework (already adopted by some practitioners) that locates norm-based strategies within the wider array of factors that must be considered when designing prevention programmes in LMIC.
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              Dynamics of change in the practice of female genital cutting in Senegambia: testing predictions of social convention theory.

              Recent reviews of intervention efforts aimed at ending female genital cutting (FGC) have concluded that progress to date has been slow, and call for more efficient programs informed by theories on behavior change. Social convention theory, first proposed by Mackie (1996), posits that in the context of extreme resource inequality, FGC emerged as a means of securing a better marriage by signaling fidelity, and subsequently spread to become a prerequisite for marriage for all women. Change is predicted to result from coordinated abandonment in intermarrying groups so as to preserve a marriage market for uncircumcised girls. While this theory fits well with many general observations of FGC, there have been few attempts to systematically test the theory. We use data from a three year mixed-method study of behavior change that began in 2004 in Senegal and The Gambia to explicitly test predictions generated by social convention theory. Analyses of 300 in-depth interviews, 28 focus group discussions, and survey data from 1220 women show that FGC is most often only indirectly related to marriageability via concerns over preserving virginity. Instead we find strong evidence for an alternative convention, namely a peer convention. We propose that being circumcised serves as a signal to other circumcised women that a girl or woman has been trained to respect the authority of her circumcised elders and is worthy of inclusion in their social network. In this manner, FGC facilitates the accumulation of social capital by younger women and of power and prestige by elder women. Based on this new evidence and reinterpretation of social convention theory, we suggest that interventions aimed at eliminating FGC should target women's social networks, which are intergenerational, and include both men and women. Our findings support Mackie's assertion that expectations regarding FGC are interdependent; change must therefore be coordinated among interconnected members of social networks. Published by Elsevier Ltd.

                Author and article information

                Contributors
                h.barrett@coventry.ac.uk
                hsx536@coventry.ac.uk
                Yussif.Alhassan@lstmed.ac.uk
                Els.Leye@UGent.be
                Journal
                Reprod Health
                Reprod Health
                Reproductive Health
                BioMed Central (London )
                1742-4755
                18 March 2020
                18 March 2020
                2020
                : 17
                : 40
                Affiliations
                [1 ]ISNI 0000000106754565, GRID grid.8096.7, Development Geography, Centre for Trust, Peace and Social Relations, , Coventry University, Priory Street, ; Coventry, CV1 5FB UK
                [2 ]ISNI 0000000106754565, GRID grid.8096.7, Health Psychology Applied to Public Health, Centre for Advances in Behavioural Science, , Coventry University, ; Priory Street, Coventry, CV1 5FB UK
                [3 ]ISNI 0000 0004 1936 9764, GRID grid.48004.38, Department of International Public Health, , Liverpool School of Tropical Medicine, Pembroke Place, ; Liverpool, L3 5QA UK
                [4 ]ISNI 0000 0001 2069 7798, GRID grid.5342.0, Global Health and Gender Related Practices, , Ghent University, International Centre for Reproductive Health, ; C. Heymanslaan 10, 9000 Ghent, Belgium
                Author information
                http://orcid.org/0000-0002-5474-0077
                Article
                879
                10.1186/s12978-020-0879-2
                7079414
                32183828
                2b0e2669-c409-46ef-a98b-fd127b58572c
                © The Author(s). 2020

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 13 January 2019
                : 6 February 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000897, Directorate-General for Justice;
                Award ID: JUST/2012/DAP/AG/3273
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2020

                Obstetrics & Gynecology
                female genital mutilation,replace approach,community-based research,behaviour change intervention,social norm change,evaluation,african diaspora,community readiness to change,com-b

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