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      What Works and What Does Not: A Discussion of Popular Approaches for the Abandonment of Female Genital Mutilation

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          Abstract

          The prevalence of Female Genital Mutilation (FGM) is reducing in almost all countries in which it is a traditional practice. There are huge variations between countries and communities though, ranging from no change at all to countries and communities where the practice has been more than halved from one generation to the next. Various interventions implemented over the last 30–40 years are believed to have been instrumental in stimulating this reduction, even though in most cases the decrease in prevalence has been slow. This raises questions about the efficacy of interventions to eliminate FGM and an urgent need to channel the limited resources available, where it can make the most difference in the abandonment of FGM. This paper is intended to contribute to the design of more effective interventions by assessing existing knowledge of what works and what does not and discusses some of the most common approaches that have been evaluated: health risk approaches, conversion of excisers, training of health professionals as change agents, alternative rituals, community-led approaches, public statements, and legal measures.

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          Most cited references53

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            Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries.

            Reliable evidence about the effect of female genital mutilation (FGM) on obstetric outcome is scarce. This study examines the effect of different types of FGM on obstetric outcome. 28 393 women attending for singleton delivery between November, 2001, and March, 2003, at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan were examined before delivery to ascertain whether or not they had undergone FGM, and were classified according to the WHO system: FGM I, removal of the prepuce or clitoris, or both; FGM II, removal of clitoris and labia minora; and FGM III, removal of part or all of the external genitalia with stitching or narrowing of the vaginal opening. Prospective information on demographic, health, and reproductive factors was gathered. Participants and their infants were followed up until maternal discharge from hospital. Compared with women without FGM, the adjusted relative risks of certain obstetric complications were, in women with FGM I, II, and III, respectively: caesarean section 1.03 (95% CI 0.88-1.21), 1.29 (1.09-1.52), 1.31 (1.01-1.70); postpartum haemorrhage 1.03 (0.87-1.21), 1.21 (1.01-1.43), 1.69 (1.34-2.12); extended maternal hospital stay 1.15 (0.97-1.35), 1.51 (1.29-1.76), 1.98 (1.54-2.54); infant resuscitation 1.11 (0.95-1.28), 1.28 (1.10-1.49), 1.66 (1.31-2.10), stillbirth or early neonatal death 1.15 (0.94-1.41), 1.32 (1.08-1.62), 1.55 (1.12-2.16), and low birthweight 0.94 (0.82-1.07), 1.03 (0.89-1.18), 0.91 (0.74-1.11). Parity did not significantly affect these relative risks. FGM is estimated to lead to an extra one to two perinatal deaths per 100 deliveries. Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive FGM.
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                Author and article information

                Journal
                Obstet Gynecol Int
                Obstet Gynecol Int
                OGI
                Obstetrics and Gynecology International
                Hindawi Publishing Corporation
                1687-9589
                1687-9597
                2013
                23 April 2013
                : 2013
                : 348248
                Affiliations
                1Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
                2UNFPA-UNICEF Joint Programme on FGM/C, United Nations Population Fund, 304 East 42nd Street, New York, NY 10017, USA
                3Flinders University, Flinders Prevention, Promotion and Primary Health Care, Southgate Institute South Australia, GPO Box 2100, Adelaide, SA 5001, Australia
                4International Centre for Reproductive Health, De Pintelaan 185 UZP114, 9000 Ghent, Belgium
                Author notes

                Academic Editor: Johanne Sundby

                Article
                10.1155/2013/348248
                3655658
                23737795
                ed6b1823-ebff-4e68-8d05-68bea739ce8d
                Copyright © 2013 R. Elise B. Johansen et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 8 February 2013
                : 18 March 2013
                Categories
                Review Article

                Obstetrics & Gynecology
                Obstetrics & Gynecology

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