Exploring the latest evidence to end Female Genital Mutilation/Cutting

4 October 2018

Reflections on the 2016 Report of the UN Secretary-General

In 2016, the Evidence to End FGM/C: Research to Help Girls and Women Thrive consortium—a UKAID-funded research programme led by the Population Council, provided evidence on female genital mutilation/cutting (FGM/C) in preparation for the 2016 UN Secretary-General’s report on “Intensifying global efforts for the elimination of female genital mutilations”. This report, which addressed aspects like root causes of FGM/C that were missing in previous years, was submitted for consideration to the 71st Session of the UN General Assembly. Much of the consortium’s evidence and recommendations were then successfully adopted in the 2016 resolution.  

As world leaders recently gathered for the 73rd session of the General Assembly, this resolution was again up for review. In the two years since it was submitted, our consortium has continued to build a clear picture of FGM/C and a solid understanding of the wider impacts of the practice. This work includes identifying which abandonment interventions are working, where, and why. This latest convening provides an opportunity to reflect on where we have been, what we are continuing to learn, achievements, and what challenges remain. More importantly, this moment also allows us to pause and consider how this new evidence should guide our way forward in the campaign to end FGM/C.

  1. Improving measurement of FGM/C prevalence and trends remains the key to shaping interventions.

Data on the prevalence of FGM/C from Demographic Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICs) have been critical in advancing efforts that support the abandonment of the practice. This data shows us that, globally, there has been significant change in the prevalence of FGM/C in some countries. However, national averages of FGM/C hide localised and ethnic hotspots within countries where the practice persists.

To better identify these hotspots, we are using more robust statistical analysis methods to account for the geographical location and ethnic affiliation of survey participants. For example, a recently-completed analysis of DHS data from Kenya provides a rich and detailed picture of when, where, and how FGM/C has been carried out in the country, and we are applying these same methods to analyse data from Nigeria and Senegal. In addition, we are further situating our analysis in the context of economic, social, and regional disparities to better understand the differences in FGM/C continuation and abandonment.

Evidence from our studies shows that programmes that aim to end FGM/C must recognise and respond to local variations in attitudes towards abandonment at the individual, household, and community levels. These programmes can be more effective with better understanding of how to engage individual and community values and norms that can both uphold or stop the practice of FGM/C.

  1. A greater understanding of context drives greater impact.

For interventions to be contextually appropriate and most effective, it is critical to understand the power dynamics and social factors, including gender roles, which influence decision-making. For example, study findings suggest that in communities in Senegambia, older women are the most open to changes around the tradition of FGM/C. As the custodians of tradition and a strong desire to maintain the well-being and identity of girls in their families, they are more willing than younger women to consider new approaches, assuring continuity in tradition and cultural identity through openness to change. These findings demonstrate how programmes that consider how gender roles are culturally sanctioned and assess power and authority in communities provide the opportunity to support actions that may influence shifts, decisions, and ultimately, abandonment.

Findings also show that FGM/C may be a prerequisite for early/child marriage.  FGM/C and early/child marriage often occur in the same places and among the same subgroups, driven by the same social norms and traditions that aim to ensure girls’ social and economic security. As the dynamics of both practices vary greatly by country, interventions addressing them must consider the unique local drivers of each practice and may need to be paired with activities that promote education and socioeconomic empowerment to be effective.

  1. Responding to cut women and girls' needs requires evidence on sexual and psychological consequences.

Our research on the health impacts of FGM/C demonstrates a need to better understand women’s psychosexual experiences with FGM/C. FGM/C can cause changes in external female genitalia and expose women and girls to immediate and long-term physical, sexual, and psychological consequences. However, the lack of valid and reliable measures of sexual health and well-being hinders efforts to characterise the impacts of FGM/C for women and girls. Our review of studies underscores the need to develop contextually-appropriate measures that factor in cross-cultural aspects and a wider range of key dimensions of sexual health and well-being of women who have undergone FGM/C.

  1. We must question assumptions about culture to identify shifts in the practice of FGM/C.

As we continue to document who performs FGM/C, how it is performed, and where it takes place, we are finding that individuals, households, and communities are adopting changes to manage the consequences of adverse health outcomes and criminalisation of the practice of FGM/C. In Somaliland, for example, there is transition in cut severity rather than a move towards the abandonment of the practice, attributed to awareness generation and sensitisation by health care workers and religious leaders.

We have also found that the medicalisation of FGM/C is normalising the practice, as the health care providers who now perform it are respected members of these communities. Though WHO guidelines on the clinical management of health complications from FGM/C exist, we now need the development of relevant curricula and training for health providers to respond to this shift in practice. Such education should address FGM/C – related complications, legal and human rights issues, and a consensus on the role of health professionals in the management and prevention of the practice.

  1. Intervention programmes need strong monitoring and evaluation systems to improve design, implementation, and impact.

Our current research has helped to identify the additional, ongoing evidence needed to assess what works to support abandonment of FGM/C. Social marketing campaigns (SMCs), for example, are widely used in abandonment efforts. Our study findings from Egypt and Sudan on SMCs show that effective campaigns require multiple and diverse audience engagement, aligned around a clear, shared road map, to enhance reach and impact.

Although a diversity of abandonment interventions are being implemented, many lack robust systems for monitoring and evaluation (M&E). Increasing resource allocation for M&E, strengthening knowledge management for collective work by diverse stakeholders, and building the expertise necessary for data generation and use can make FGM/C interventions more responsive and effective. Implementation research, as part of programme implementation, could also measure programme effectiveness and inform programme design on a range of interventions.

Taking a moment to reflect on this latest body of knowledge while nations gather to discuss the world’s most pressing issues is important. However, it is more critical that this evidence is not only considered but ultimately used to inform programmes and interventions that support the global campaign to end FGM/C. It is only with evidence-based solutions that real change can happen.

Jacinta Muteshi-Strachan

Project Director, FGM/C Research Program, Population Council

Jacinta Muteshi-Strachan is a renowned expert in gender equality, women’s rights, and reproductive health with experience as a researcher, programme manager, and advisor. She provides leadership and oversight to the Population Council-led research consortium on female genital mutilation/cutting (FGM/C).

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