The Female Genital Mutilation/Cutting Experience in Somali Women: Their Wishes, Knowledge and Attitude

Do Attitude, Awareness and Intention to Perform Female Genital Mutilation or Cutting for Their Daughters of Women Healthcare Providers Differ from Mothers in Somalia?

Aim

This study aimed to determine whether there were differences in attitude, awareness, and intention to perform female genital mutilation or cutting for their daughters in the future between female healthcare providers and mothers.

Methods

A comparative cross-sectional study design was used.

Results

A total of 508 women were included in the study. Of the participants, 68.7% (n = 349) were mothers (Group I) who visited the hospital and 31.3% (n = 159) were women healthcare professionals (Group II) [27% (n = 137) nurses and 4.3% (n = 22) doctors]. It was found that 8 (1.6%) of the participants did not have FGM/C and the FGM/C ratio was lower in group II (95%) than in group I (100%) (p < 0.001). In group I, 99.7% (n = 299) of the participants and 30.6% (n = 19) of those in group II reported intending to perform FGM for their daughters in the future (p < 0.001). The reasons for FGM/C most cited by participants were a traditional rite of passage into womanhood (78%), religious requirement (69.3%), and preservation of their virginity until marriage (59.3%). "Stop FGM" was given as a message on FGM/C by 60% of the participants (n = 79) who answered (n = 127, 100%) to open-ended questions.

Conclusion

The results of this study show that female health professionals with higher education and monthly income had less positive perception of their FGM/C and less intention to allow their daughters to undergo FGM/C.

Determinants of Disagreement with Female Genital Mutilation Among Mothers

Aim

Female genital mutilation (FGM) is widely practiced in Somalia. Limited data are available on the attitude of the Somalia community regarding FGM. The present study aimed to explore the attitude of mothers toward the practice of FGM.

Methods

A cross-sectional study was conducted from March to July 2021 among mothers attending outpatient clinics at a tertiary referral hospital in Mogadishu, Somalia.

Results

A total of 247 participants were included, 65.2% of whom believed this practice should be continued. The most cited reason reported regarding FGM was a requirement for religion (90.7%). About 73.9% of mothers stated that the most cited reason reported regarding the abandonment of FGM was health complications. About 59.8% of the study participants thought that FGM could be stopped through education. The results revealed that women who graduated from primary school (OR: 2.21; 95% CI: 1.090-4.51), who had no social media account (OR: 2.305; 95% CI: 1.147-4.633), and women who were circumcised by a traditional birth attendant (OR: 4.55; 95% CI: 1.57-13.22) were more likely to think that FGM should be continued compare with their counterparts.

Conclusions

We found that mothers who were less educated, had no social account and those circumcised by a traditional birth attendant had more positive attitudes toward FGM.

The global prevalence of female genital mutilation/cutting: A systematic review and meta-analysis of national, regional, facility, and school-based studies

BACKGROUND

Female genital mutilation/cutting (FGM/C) is a nonmedical procedure entailing the modification of the external female genitalia. A description of the prevalence and distribution of FGM/C allows the tracking of progress toward ending FGM/C by 2030 (Sustainable Development Goal (SDG): target 5.3). This systematic review aimed to examine FGM/C prevalence and types, by World Health Organization (WHO) region and country.

METHODS AND FINDINGS

A systematic search using Medical Subject Headings (MeSH) and keywords from 2009 to March 24, 2022 was undertaken in MEDLINE, PubMED, PsycINFO, Web of Science, and Embase to identify studies presenting FGM/C prevalence. Abstract and full-text screening, quality assessment, and data extraction were undertaken by 2 reviewers. Only nationally representative studies were included in the meta-analysis. Pooled FGM/C prevalence was estimated by random-effects meta-analysis using generalized linear mixed models (GLMMs). FGM/C prevalence with 95% confidence intervals (CIs), prediction intervals (PIs), and FGM/C type were presented separately by women aged 15 to 49 years and girls aged 0 to 14 years. A total of 163 studies met the inclusion criteria and 30 were included in the meta-analysis, of which 23 were from the WHO African Region (AFR), 6 from the Eastern Mediterranean Region (EMR), and 1 from the South East Asian Region (SEAR). These studies included data from 406,068 women across 30 countries and 296,267 girls across 25 countries; the pooled prevalence estimate of FGM/C among women aged 15 to 49 years was 36.9% (95% CI: 19.6% to 58.3%; PI: 0.4% to 99.0%), and 8.27% (95% CI: 3.7% to 17.3%; PI: 0.1% to 89.3%) among girls aged 0 to 14 years. Among included countries, this gave a total estimated prevalence of 84,650,032 women (95% CI: 45,009,041 to 133,834,224) and 13,734,845 girls with FGM/C (95% CI: 6,211,405 to 28,731,901). Somalia had the highest FGM/C prevalence among women (99.2%), and Mali had the highest among girls (72.7%). The most common type of FGM/C among women was "flesh removed" (Type I or II) in 19 countries. Among girls, "not sewn closed" (Type I, II, or IV) and "flesh removed" (Type I or II) were the most common types in 8 countries, respectively. Among repeated nationally representative studies, FGM/C decreased for both women and girls in 26 countries. The main limitation of the study methodology is that estimates were based on available published data, which may not reflect the actual global prevalence of FGM/C.

CONCLUSIONS

In this study, we observed large variation in FGM/C prevalence between countries, and the prevalence appears to be declining in many countries, which is encouraging as it minimizes physical and physiological harm for a future generation of women. This prevalence estimate is lower than the actual global prevalence of FGM/C due to data gaps, noncomparable denominators, and unavailable surveys. Yet, considerable policy and community-level interventions are required in many countries to meet the SDG target 5.3.

TRIAL REGISTRATION

Registration: CRD42020186937.

The Perception of African Immigrant Women Living in Spain Regarding the Persistence of FGM

Approximately 200 million women and girls have undergone female genital mutilation (FGM) worldwide. Migration has spread the practice of FGM around the world, thus making it a global public health issue. The objective of this descriptive qualitative study was to explore the perceptions of Sub-Saharan immigrant women in Spain in relation to the causes of the persistence of FGM. In-depth interviews were carried out with 13 female FGM survivors of African origin, followed by inductive data analysis using ATLAS.ti software. Two main themes emerged from the analysis: (1) A family ritual symbolic of purification and (2) a system of false beliefs and deception in favour of FGM. The FGM survivors living in Europe are aware that FGM is a practice that violates human rights yet persists due to a system of false beliefs rooted in family traditions and deception that hides the reality of FGM from young girls or forces them to undergo the practice. The ritualistic nature of FGM and the threat of social exclusion faced by women who have not had it performed on them contributes to its persistence nowadays.

Twelve tips for incorporating migrant and ethnic minorities in the medical curriculum and healthcare

Migrant and ethnic communities face several challenges within healthcare systems as patients, physicians and medical students. For health inequalities to be addressed, changes need to be made within our healthcare systems, starting from how the medical curriculum is taught to prospective clinicians. In this article, we present twelve ways to challenge the difficulties migrant and ethnic minorities face in healthcare by incorporating patient, physician and medical student factors into the medical school curriculum and healthcare, in a hope to change outcomes for our widely diverse population of patients and colleagues.

Female Genital Mutilation Consequences and Healthcare Received among Migrant Women: A Phenomenological Qualitative Study

European healthcare systems are increasingly being challenged to respond to female genital mutilation (FGM). This study explores the FGM experiences of migrant women coming from FGM-practicing countries residing in a European host country. A qualitative phenomenological study was carried out and 23 participants were included. Data were collected through 18 face-to-face open-ended interviews and a focus group and were analysed using Giorgi’s four-step phenomenological approach. Three main themes were derived: “FGM consequences”, “healthcare received” and “tackling FGM”. Participants highlighted obstetric, gynaecological and genitourinary consequences such as haemorrhages, perineal tears, caesarean delivery, risk of infection, dysmenorrhea, urinary tract infections and dysuria; consequences for sexuality, mainly, dyspareunia, loss of sexual interest and decreased quality of sexual intercourse; and psychological consequences such as loss of self-esteem, feelings of humiliation and fear of social and familial rejection. Women perceived a profound lack of knowledge about FGM from health providers and a lack of sensitive and empathetic care. Some women perceived threatening and disproportionate attitudes and reported negative experiences. Participants highlighted the importance of educating, raising awareness and improving prevention and detection strategies. The findings disclose the need to improve training and institutional plans to address structural and attitudinal barriers to health equity across migrant families in their host countries.

A New Concept for Central Wedge Resection in Labiaplasty

OBJECTIVE

The aim of the study was to develop a new concept for central wedge resection to improve surgical results. Currently, the most common postoperative complications of the regular central wedge (RV) resection technique are wound dehiscence and scar contracture.

METHODS

A case-control study was applied to randomly divide 119 patients with labia minora hypertrophy deformities into 2 groups: new central wedge (NV) (n = 57) and RV (n = 62). All patients underwent the corresponding corrective surgery to repair the deformity. During the NV procedure, we changed the direction of the scalpel to form 2 inclined sections and sutured these sections together to achieve nonparallel closure lines. The patients in the 2 groups were followed up at 1 and 6 months postoperatively. We described the details of this method and evaluated the treatment outcomes of the 2 groups.

RESULTS

Patient age, labia minora width, and procedure time were not significantly different between the 2 groups (p > 0.05). However, the visual analog scale (VAS) scores in the 2 groups were significantly different (p < 0.05). Two patients in the NV group were somewhat dissatisfied because of lymphoedema and asymmetry; 6 patients in the RV group expressed dissatisfaction with scarring, healing complications, and asymmetry. A minor corrective operation was performed for asymmetry, and the dehiscence healed spontaneously. The patient with edema is still being followed up.

CONCLUSION

The surgical method we introduced was indicated to be a simple and effective procedure that avoided wound dehiscence and scar contracture, which are common with the regular approach.