Female Genital Mutilation/Cutting in the United States: Updated Estimates of Women and Girls at Risk, 2012

OBJECTIVES:

In 1996, the U.S. Congress passed legislation making female genital mutilation/cutting (FGM/C) illegal in the United States. CDC published the first estimates of the number of women and girls at risk for FGM/C in 1997. Since 2012, various constituencies have again raised concerns about the practice in the United States. We updated an earlier estimate of the number of women and girls in the United States who were at risk for FGM/C or its consequences.

METHODS:

We estimated the number of women and girls who were at risk for undergoing FGM/C or its consequences in 2012 by applying country-specific prevalence of FGM/C to the estimated number of women and girls living in the United States who were born in that country or who lived with a parent born in that country.

RESULTS:

Approximately 513,000 women and girls in the United States were at risk for FGM/C or its consequences in 2012, which was more than three times higher than the earlier estimate, based on 1990 data. The increase in the number of women and girls younger than 18 years of age at risk for FGM/C was more than four times that of previous estimates.

CONCLUSION:

The estimated increase was wholly a result of rapid growth in the number of immigrants from FGM/C-practicing countries living in the United States and not from increases in FGM/C prevalence in those countries. Scientifically valid information regarding whether women or their daughters have actually undergone FGM/C and related information that can contribute to efforts to prevent the practice in the United States and provide needed health services to women who have undergone FGM/C are needed.

Full PDF article at:   http://goo.gl/9DWlht

By:  Goldberg H1, Stupp P1, Okoroh E1, Besera G1, Goodman D1, Danel I1.

• 1Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, GA.
• Public Health Rep. 2016 Mar-Apr;131(2):340-7. 

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The facts you should know about female genital mutilation – video

Via:  http://goo.gl/xEidZM

Estimating the Magnitude of Female Genital Mutilation/Cutting in Norway: An Extrapolation Model

Background

With emphasis on policy implications, the main objective of this study was to estimate the numbers of two main groups affected by FGM/C in Norway: 1) those already subjected to FGM/C and therefore potentially in need for health care and 2) those at risk of FGM/C and consequently the target of preventive and protective measures. Special attention has been paid to type III as it is associated with more severe complications.

Methods

Register data from Statistics Norway (SSB) was combined with population-based survey data on FGM/C in the women/girls’ countries of origin.

Results

As of January 1^st 2013, there were 44,467 first and second-generation female immigrants residing in Norway whose country of origin is one of the 29 countries where FGM/C is well documented. About 40 pct. of these women and girls are estimated to have already been subjected to FGM/C prior to immigration to Norway. Type III is estimated in around 50 pct. of those already subjected to FGM/C. Further, a total of 15,500 girls are identified as potentially at risk, out of which an approximate number of girls ranging between 3000 and 7900 are estimated to be at risk of FGM/C.

Conclusion

Reliable estimates on FGM/C are important for evidence-based policies. The study findings indicate that about 17,300 women and girls in Norway can be in need of health care, in particular the 9100 who are estimated to have type III. Preventive and protective measures are also needed to protect girls at risk (3000 to 7900) from being subjected to FGM/C. Nevertheless, as there are no appropriate tools at the moment that can single these girls out of all who are potentially at risk, all girls in the potentially at risk group (15,500) should be targeted with preventive measures.

Below:  FGM/C Percentage of girls and women already subjected to FGM/C in Norway by country of origin

Below:  Numbers of girls and women subjected to FGM/C type III by most represented countries of origin

Full article at:   http://goo.gl/QFkFuS

By:  Mai M. Ziyada, Marthe Norberg-Schulz, and R. Elise B. Johansen

Norwegian Centre for Violence and Traumatic Stress Studies, P.b. 181 Nydalen, 0409 Oslo, Norway

Samfunnsøkonomisk analyse (Formerly DAMVAD Norge AS), Olavsvei 112, 1450 Nesoddtangen, Norway

Mai M. Ziyada, Email: on.stvkn@adayiz.m.m.

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Countries with Highest Prevalence of Female Genital Mutilation, 2004-15

Via:  https://atlas.qz.com/charts/EyDmnqTtx

Sexual Anatomy and Function in Women With and Without Genital Mutilation

INTRODUCTION:

Female genital mutilation (FGM), the partial or total removal of the external genitalia for non-medical reasons, can affect female sexuality. However, only few studies are available, and these have significant methodologic limitations.

AIM:

To understand the impact of FGM on the anatomy of the clitoris and bulbs using magnetic resonance imaging and on sexuality using psychometric instruments and to study whether differences in anatomy after FGM correlate with differences in sexual function, desire, and body image.

METHODS:

A cross-sectional study on sexual function and sexual anatomy was performed in women with and without FGM. Fifteen women with FGM involving cutting of the clitoris and 15 uncut women as a control group matched by age and parity were prospectively recruited. Participants underwent pelvic magnetic resonance imaging with vaginal opacification by ultrasound gel and completed validated questionnaires on desire (Sexual Desire Inventory), body image (Questionnaire d'Image Corporelle [Body Image Satisfaction Scale]), and sexual function (Female Sexual Function Index).

MAIN OUTCOME MEASURES:

Primary outcomes were clitoral and bulbar measurements on magnetic resonance images. Secondary outcomes were sexual function, desire, and body image scores.

RESULTS:

Women with FGM did not have significantly decreased clitoral glans width and body length but did have significantly smaller volume of the clitoris plus bulbs. They scored significantly lower on sexual function and desire than women without FGM. They did not score lower on Female Sexual Function Index sub-scores for orgasm, desire, and satisfaction and on the Questionnaire d'Image Corporelle but did report significantly more dyspareunia. A larger total volume of clitoris and bulbs did not correlate with higher Female Sexual Function Index and Sexual Desire Inventory scores in women with FGM compared with uncut women who had larger total volume that correlated with higher scores.

CONCLUSION:

Women with FGM have sexual erectile tissues for sexual arousal, orgasm, and pleasure. Women with sexual dysfunction should be appropriately counseled and treated.

Below:  Vulvar appearance of (A) a woman without female genital mutilation (arrow = glans of clitoris) and (B) a woman with female genital mutilation type IIb (arrow = palpable clitoral stump hidden under the scar). Panel C shows a corresponding sagittal proton density-weighted fat-saturated magnetic resonance image of the woman without female genital mutilation. Depicted are the clitoral crus (white arrowhead), bulb (black arrowhead), intact clitoral glans (short black arrow), ultrasound gel in the distal vagina (black spherical mark), and symphysis pubis (long black arrow). Panel D shows a T2-weighted magnetic resonance image of the woman with female genital mutilation. The distal part of the clitoral body (white arrows) is covered by the scar. The clitoris is not in direct contact with the ultrasound gel in the distal vagina (black spherical mark). Also depicted is the symphysis pubis (white arrowheads)

Full article at:   http://goo.gl/f4D99t

By:  Abdulcadir J1, Botsikas D2, Bolmont M3, Bilancioni A4, Djema DA5, Bianchi Demicheli F4, Yaron M4, Petignat P4.

• 1Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland. Electronic address: jasmine.abdulcadir@hcuge.ch.
• 2Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland; Division of Radiology, Department of Imaging, Geneva University Hospitals, Geneva, Switzerland.
• 3Faculty of Psychology and Educational Science, University of Geneva, Geneva, Switzerland.
• 4Department of Obstetrics and Gynecology, Geneva University Hospitals, Geneva, Switzerland.
• 5Division of Radiology, Department of Imaging, Geneva University Hospitals, Geneva, Switzerland. 
• J Sex Med. 2016 Jan 27. pii: S1743-6095(15)00058-2. doi: 10.1016/j.jsxm.2015.12.023.

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Female Genital Mutilation/Cutting: Risk Management and Strategies for Social Workers and Health Care Professionals

Female genital mutilation/cutting (FGM/C) is a traditional practice originating in Africa. Its worst forms cause irreparable harm to girls and women and have no medical justification. Based on a literature review of global responses to FGM/C and conversations with Australian women who migrated from FGM/C practicing countries, this paper provides some background on FGM/C and its epidemiology, outlining its prevalence, types, and health risks and complications for women and girls. It discusses risk-prevention strategies, first, for health practitioners in identifying, screening, and supporting women affected by FGM/C and, second, for welfare and social workers and health care professionals to identify, work with, and prevent girls from being cut. Consistent with international trends in addressing the risks of FGM/C, the paper suggests practice responses for coordinated responses between professionals, communities from practicing countries, and governments of different countries.

Countries grouped according to prevalence, types I, II, and III and laws against FGM/C

Categories	Prevalence of girls and women of reproductive age who report having been cut, and Type of FGC/M	Countries	Countries with laws against FGM/C
1. Very high prevalence countries, almost universal	Over 80% of girls and women of reproductive age reported having been cut, 30% Type III	Somalia (98%), Guinea (96%), Djibouti (93%), Egypt (91%). Eritrea (89%), Mali (89%), Sierra Leone (88%), Sudan (88%).	Djibouti, Egypt. Eritrea, Guinea, Somalia, Sudan.
2. Moderately high prevalence countries	Between 51% and 80% of girls and women cut, predominantly Types I and II	Gambia (76%), Burkina Faso (76%), Ethiopia (74%), Mauritania (69%), Liberia (66%).	Burkina Faso, Ethiopia, Mauritania.
3. Moderately low prevalence countries	Between 26% and 50% of girls and women cut, predominantly Types I and II	Guinea Bissau (50%), Chad (44%), Cote D’Ivoire (38%), Kenya (27%), Nigeria (27%), Senegal (26%).	Chad, Cote D’Ivoire, Kenya, Senegal, Guinea Bissau, Nigeria.
4. Low prevalence	Between 10 and 25%, predominantly Types I and II	Central African Republic (24%), Yemen (23%), United Republic of Tanzania (15%), Benin (13%).	Central African Republic, Benin, United Republic of Tanzania.
5. Very low prevalence	Below 10%	Iraq (8%), Ghana (4%), Togo (4%), Niger (2%), Cameroon (1%), Uganda (1%).	Ghana, Niger, Togo.

Notes: Data from UNICEF 2013,4 and Macfarlane and Dorkenoo.15

Abbreviation: FGM/C, female genital mutilation/cutting.

Full article at:   http://goo.gl/h2My9U

By:  Susan Costello

School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, Australia

Correspondence: Susan Costello, School of Global, Urban and Social Studies, RMIT University, 360 Swanston Street, Melbourne 3001, VIC, Australia, Email ua.ude.timr@olletsoc.nasus

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Cultural Change After Migration: Circumcision of Girls in Western Migrant Communities

This paper reviews the current knowledge on cultural change after migration in the practice of female circumcision, also named genital cutting or mutilation. Explorative studies show trends of radical change of this practice, especially the most extensive form of its kind (type III or the 'Pharaonic' type). The widespread interpretation that Islam would require circumcision of girls is questioned when, for example, Somalis meet other Muslim migrants, such as Arab Muslims, who do not circumcise their daughters. 

The few criminal court cases for circumcision of girls that have taken place in Western countries corroborate the conclusion that substantial change in the practice has occurred among migrants. In this literature review, an absence of reports is identified from healthcare providers who have witnessed circumcision after migration. Concurrently, a substantial knowledge exists on how to take care of already circumcised women and girls, and there is a system of recommendations in place regarding best practices for prevention. There is a great potential for healthcare providers to encourage this development towards general abandonment of circumcision of girls. The challenge for the future is how to incorporate culturally sensitive efforts of prevention on the one hand, and the examination of suspicious cases of illegal circumcision on the other. 

We recommend using - in a cautious way - the existing routines for identifying child abuse in general. Experiences from African contexts show that failure to generate significant change of the harmful practices/tradition may be due to the lack of multidisciplinary collaboration in different sectors of the society. 

In Western societies, the tendency toward abandonment of the practice could be reinforced by professionals who work toward better inclusion of men and women originally from countries where circumcision is practised.

Full article at:  http://goo.gl/D1Ql8A

By:  Johnsdotter S1, Essén B2.

• 1Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden. Electronic address: sara.johnsdotter@mah.se.
• 2Department of Women's and Children's Health/IMCH, Uppsala University, University Hospital, 751 85 Uppsala, Sweden. 

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Eradicating Female Genital Mutilation & Cutting in Tanzania: An Observational Study

Background

Female genital mutilation and cutting (FGM/C) has long been practiced in various parts of the world. The practice is still prevalent in 29 countries on the African continent despite decades of campaigning to eradicate it. The approaches for eradication have been multi-pronged, including but not limited to, health risk campaigns teaching about the health consequences for the girls and the women, recruitment of change agents from within the communities and the enforcement of legal mechanisms.

The purpose of this study was to analyse the impact of an 18 month long campaign to eradicate or reduce FGM/C in a rural predominantly Masai community.

Methods

An observational study involving mixed methods, quantitative and qualitative was conducted in Arusha region, Tanzania. A household survey, key informant interviews, focus group discussions, school children's group discussions and project document reviews for both baseline and endline assessments were used. Same tools were used for both baseline and endline assessements. Comparison of baseline and endline findings and conclusions were drawn.

Results

The prevalence of self reported FGM/C at endline was 69.2 %. However, physical obstetric examination of women in labour revealed a prevalence of over 95 % FGM/C among women in labour.

Those in favour of FGM/C eradication were 88 %. Nearly a third of the 100 FGM practitioners had denounced the practice; they also formed a peer group that met regularly comparing baseline and endline. Knowledge about FGM/C health risks increased from 16 to 30 % (p < 0.001). The practice is currently done secretly to an uncertain extent.

Conclusion

This multifaceted educational campaign achieved moderate success in increasing knowledge of the health risks and changing attitudes despite a short period of intervention. However, its effectiveness in reducing FGM/C prevalence was uncertain.

Below:  Illustrating project interventions, activities and selected outcomes

Full article at:   http://goo.gl/JgKqGG

By:  Moses Galukande^1*, Joseph Kamara², Violet Ndabwire³, Elisabeth Leistey³, Cecilia Valla²and Sam Luboga¹

¹Department of Surgery, Makerere University College of Health Sciences, Mulago Hill Road, Kampala, Uganda

²World Vision Australia, Melbourne, Australia

³World Vision Tanzania, Arusha, Tanzania

 

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The Role of Men in Abandonment of Female Genital Mutilation: A Systematic Review

Men in their roles as fathers, husbands, community and religious leaders may play a pivotal part in the continuation of female genital mutilation (FGM). However, the research on their views of FGM and their potential role in its abandonment are not well described.

We undertook a systematic review of all publications between 2004 and 2014 that explored men’s attitudes, beliefs, and behaviours in regards to FGM, as well as their ideas about FGM prevention and abandonment.

We included twenty peer-reviewed articles from 15 countries in the analysis. Analysis revealed ambiguity of men’s wishes in regards to the continuation of FGM. Many men wished to abandon this practice because of the physical and psychosexual complications to both women and men. Social obligation and the silent culture between the sexes were posited as major obstacles for change. Support for abandonment was influenced by notions of social obligation, religion, education, ethnicity, urban living, migration, and understanding of the negative sequelae of FGM. The strongest influence was education.

The level of education of men was one of the most important indicators for men’s support for abandonment of FGM. Social obligation and the lack of dialogue between men and women were two key issues that men acknowledged as barriers to abandonment. Advocacy by men and collaboration between men and women’s health and community programs may be important steps forward in the abandonment process.

  

Full article at: http://goo.gl/KjdzZ0

By:

Nesrin Varol^1*, Sabera Turkmani², Kirsten Black¹, John Hall³ and Angela Dawson²

¹Sydney Medical School, Discipline of Obstetrics and Gynaecology, University of Sydney, Sydney 2006, NSW, Australia

²Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia

³Centre for Clinical Epidemiology & Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia

  

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“A Somali Girl is Muslim and Does Not Have Premarital Sex. Is Vaccination Really Necessary?” A Qualitative Study into the Perceptions of Somali Women in the Netherlands About the Prevention of Cervical Cancer

Below:  The health belief model

In this study, we have identified perceived barriers to the use of preventive measures across three major themes: (1) Somali women and preventive healthcare; (2) Language, knowledge, and negotiating decisions; and (3) Sexual standards, culture, and religion. Many issues have been identified across these themes, e.g., distrust of the Dutch health care system or being embarrassed to get Pap smears due to Female Genital Mutilation (FGM) and having a Dutch, male practitioner; or a perceived low susceptibility to HPV and cancer because of the religious norms that prohibit sex before marriage.

Current measures in the Netherlands to prevent women from developing cervical cancer hardly reach Somali women because these women perceive these kinds of preventative measures as not personally relevant. Dutch education strategies about cervical cancer deviate from ways of exchanging information within the Somali community.

Teachers can provide culturally sensitive information to young Somali women in schools. For Somali mothers, oral education (e.g., poetry or theater) about the Dutch health care system and men’s roles in HPV transmission may be useful.

An intersectional approach, grounded in the Health Belief Model (HBM), is recommended to promote equal access to preventive health care for Somali women.

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