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Background: Half of the world's children experience violence every year, but the meaning of violence is not universally agreed. We may therefore risk failing to measure, and address, the acts that matter most to children and adolescents. In this paper, we describe and synthesise evidence on how children and adolescents in sub-Saharan Africa conceptualise different behavioural acts which are deemed violence in childhood under WHO and UN CRC definitions. Methods and findings: We conducted a systematic review of qualitative studies. We searched PsychINFO, CINAHL, Embase, Global Health, Medline and ERIC for all publications released prior to March 2023. 30 papers met inclusion criteria. We synthesised primary data from children and adolescents and drew upon theoretical and contextual interpretations of authors of included studies. Only 12 of more than 45 sub-Saharan African countries were represented with relevant research. Of the 30 included papers, 25 came from three countries: South Africa, Uganda and Ghana. Only 10 of 30 papers reported data from young children (pre-adolescence), and 18 of 30 papers primarily focused on sexual violence. 14 studies used child friendly and/or participatory methods. From this limited evidence, we identified six overarching themes in how children and adolescents conceptualised their experiences of acts internationally recognised as violence: 1) adults abusing or neglecting responsibility; 2) sexual violence from peers, family and community members; 3) violence in established intimate relationships; 4) emotional violence surrounding sex from peers and community members; 5) fighting and beating between peers; 6) street and community dangers. No studies meeting our inclusion criteria specifically examined children or adolescents' conceptualisations of homophobic or transphobic violence; violence against children with disabilities; boys' experiences of sexual violence from male perpetrators; trafficking, modern slavery or conflict; child labour; or female genital mutilation. We found that three dimensions were important in how children and adolescents constructed conceptualisations of violence: their age, relationship to the perpetrator, and the physical location of acts they had experienced. These dimensions were interrelated and gendered. Conclusion: The current limited evidence base suggests children and adolescents' conceptualisations of violence overlapped with, but were also distinct from, the WHO and UNCRC definitions of violence. Currently international survey tools focus on measuring types and frequencies of particular acts and neglect to focus on children's understandings of those acts. Relationship to perpetrator, age of child, physical location are all important in how children conceptualise their experiences of acts internationally recognised as violence, and therefore might be important for their health and social outcomes. Those developing measures should account for these dimensions when developing items for testing. [ABSTRACT FROM AUTHOR]

Since the onset of the Somali civil war in the late 1980s, more than 2 million Somalis have been internally displaced or crossed international borders to seek haven. Yet, research on diasporic Somali women's intergenerational communication about marriage, sex, and female genital cutting (FGC) remains scant. This paper draws from data we collected from 15 women over the age of 45 who were part of a much larger project on refugee women and sexual health and well-being. The analysis centers on how Somali women across the generations recalibrate definitions of family. We analyze the new roles that sisters, aunts, and grandmothers occupy in the lives of younger women, as family dispersal often results in the absence of biological mothers. In the new settlement, the findings showcase both continuity and change in how sex, marriage, and female genital cutting (FGC) are discussed among female family members. Our findings support not only the dynamic nature of family roles that women occupy across generations but also the malleability of cultural practices as families navigate changing cultural, legal, and social norms in their new settlements. [ABSTRACT FROM AUTHOR]

This paper explores FGM-safeguarding in the UK through a decolonial lens. Based on an analysis of the development of law and policy relating to 'Female Genital Mutilation' in the UK alongside data collected in focus groups with people of ethnic Somali heritage living in Bristol, we argue that the current legislation and policies, as well as their delivery, are steeped in colonial Othering. We demonstrate that legislative and policy approaches operate through a gendered and generational binary in which non-White mothers are othered as migrants (regardless of citizenship status) for whom anachronistic culture is deemed determinative, whilst their daughters are claimed as British. In this construction, 'FGM' operates as the symbolic marker that designates un/belonging: the uncircumcised girl is rescuable and claimed as 'one of us', whilst the circumcised mother is considered a mutilated political subject for whom belonging is foreclosed. [ABSTRACT FROM AUTHOR]

In 2015, the international community agreed to end Female Genital Mutilation/Cutting (FGM/C) by 2030. However, the target is unlikely to be met as changes in practice, including medicalized female genital mutilation/cutting (mFGM/C), challenge abandonment strategies. This paper critically reviews the current World Health Organization (WHO) definition of mFGM/C to demonstrate that mFGM/C, as currently defined, lacks detail and clarity, and may serve as an obstacle to the collection of credible, reliable, and comparable data relevant to targeted FGM/C prevention policies and programs. The paper argues that it is necessary to initiate a discussion on the revision of the current WHO definition of mFGM/C, where different components (who-how-where-what) should be taken into account. This is argued by discussing different scenarios that compare the current WHO definition of mFGM/C with the actual practice of FGM/C on the ground. The cases discussed within these scenarios are based on existing published research and the research experience of the authors. The scenarios focus on countries where mFGM/C is prevalent among girls under 18 years, using data from Demographic Health Surveys and/or Multiple Indicator Cluster Surveys, and thus the focus is on the Global South. The paper places its arguments in relation to wider debates concerning female genital cosmetic surgery, male genital circumcision and consent. It calls for more research on these topics to ensure that definitions of FGM/C and mFGM/C reflect the real-world contexts and ensure that the human rights of girls and women are protected. [ABSTRACT FROM AUTHOR]

This paper examines the practice of female genital mutilation (FGM) among the Dawoodi Bohra community in Pakistan. FGM, a non-therapeutic alteration of the female genitalia, is examined through the lenses of religion, culture and health. The Dawoodi Bohra, predominantly based in Karachi, practice FGM as a religious and cultural rite, linking it to notions of purity and social acceptance. Despite global efforts to outlaw and eradicate FGM, it persists, underpinned by deeply held beliefs and the insular nature of the community. The physical and psychological effects of FGM are profound, leading to immediate and long-term complications such as severe pain, infection and psychological trauma. This paper discusses the impact of these practices on women's health and rights, while critiquing the lack of an effective legal framework in Pakistan to combat FGM. In addressing this issue, the paper contributes to the broader discourse on gender-based violence and the rights of women and children in patriarchal societies. [ABSTRACT FROM AUTHOR]

In the last two decades, genital transplants have emerged as another type of quality‐of‐life transplants. Successful allogenic transplantations of the uterus, ovary, testicle, and penis have all been reported. Yet, there is no discussion of clitoris transplantation in the medical literature, mass media, and everywhere else I searched. This surgery could be used for cisgender women who have a clitoral injury or disease or who have undergone female genital cutting. I examine the gender norms regarding sexuality and reproduction to show how they shape surgical advancements. My point in this paper is not to take a normative position on status of current genital transplantations. Rather, I highlight that their existence is due, at least in part, because they align with dominant gender norms: penis and testicle transplantations reinforce the importance of men's virility and the existence of "normal" male genitalia, whereas uterus and ovary transplantations uphold the conflation of women and reproduction and the strong valuing of women's fertility. That medical advances reflect cultural values is not a new claim. What is new in this paper is the discussion of how sexism norms—regarding the invisibility of the clitoris and the devaluing of women's sexual pleasure— has engendered various types of genital transplants, but not clitoris transplantation. [ABSTRACT FROM AUTHOR]

Background: The Women's Health Needs Study (WHNS) collected information on the health characteristics, needs, and experiences, including female genital mutilation (FGM) experiences, attitudes, and beliefs, of women aged 18 to 49 years who were born, or whose mothers were born, in a country where FGM is prevalent living in the US. The purpose of this paper is to describe the WHNS design, methods, strengths and limitations, as well as select demographic and health-related characteristics of participants. Methods: We conducted a cross-sectional survey from November 2020 –June 2021 in four US metropolitan areas, using a hybrid venue-based sampling (VBS) and respondent-driven sampling (RDS) approach to identify women for recruitment. Results: Of 1,132 participants, 395 were recruited via VBS and 737 RDS. Most were born, or their mothers were born, in either a West African country (Burkina Faso, Guinea, Mali, Mauritania, Sierra Leone, The Gambia) (39.0%) or Ethiopia (30.7%). More than a third were aged 30–39 years (37.5%) with a majority who immigrated at ages ≥13 years (86.6%) and had lived in the United States for ≥5 years (68.9%). Medicaid was the top health insurer (52.5%), followed by private health insurance (30.5%); 17% of participants had no insurance. Nearly half of women reported 1–2 healthcare visits within the past 12 months (47.7%). One in seven did not get needed health care due to cost (14.8%). Over half have ever used contraception (52.1%) to delay or avoid pregnancy and 76.9% had their last pelvic and/or Papanicolaou (pap) exam within the past 3 years. More than half experienced FGM (55.0%). Nearly all women believed that FGM should be stopped (92.0%). Conclusion: The VBS/RDS approach enabled recruitment of a diverse study population. WHNS advances research related to the health characteristics, needs, and experiences of women living in the US from countries where FGM is prevalent. [ABSTRACT FROM AUTHOR]

The article provides information related to medical research for women's health in the U.S. The use of angiotensin-converting-enzyme inhibitors during pregnancy was prohibited by medical specialist because of the associated increased risk of fetopathy. The World Health Organization has collaborated a prospective study regarding the effect of female genital mutilation on obstetric outcome. A study regarding the examination of gender effects on peak exercise oxygen consumption, the implications for cardiac transplantation and the survival health failure patients.

This paper presents and critically interrogates a comprehensive 7Ps framework for analysing and addressing gender-based violence. It takes the UN and the Council of Europe's models as points of departure and develops the framework beyond the current state of the art, explains its different components, and offers reflections on its use in the practice of gender-based violence research. The UN 3P model, encompassing prevention, protection, and prosecution, later developed by the Council of Europe's Istanbul Convention into a 4P model, comprising prevention, protection, prosecution, and integrated policies, has since been revisited, elaborated upon, and expanded in work focusing on gender-based violence in particular domains, such as female genital mutilation or gender-based violence in sport. To study gender-based violence in academia, the comprehensive 7Ps analytical framework has been deployed to interrogate the policies in place at national and institutional levels, including sexual harassment. Based on empirical data and conceptual analysis in the EU project UniSAFE: Gender-based violence and institutional responses: Building a knowledge base and operational tools to make universities and research organisations safe (2021–2024), the paper argues that the refined 7Ps model, comprising Prevalence, Prevention, Protection, Prosecution of offenders (and disciplinary measures), Provision of services, Partnerships between actors, and Policies specifically addressing the issue, allows for a more encompassing approach, in turn allowing a more fine-grained understanding of variations and explanations for success (or lack thereof) in terms of outcomes. [ABSTRACT FROM AUTHOR]

To achieve Sustainable Development Goal 5 for gender equality by 2030, it is crucial for health and development professionals and governmental officials to understand how legal systems empower or oppress populations on the basis of gender worldwide, including opportunities and challenges of statutory provisions created by legal pluralism. Using Ethiopia as a case study, this paper examines how local laws applied in Sharia and Customary Dispute Resolution courts impact gender equality and the health of women and girls inspite of the inculcation of human rights statutes into national legislation, including the Constitution. We identify several key issues with the substantive law and its enforcement. First, laws which have been instituted at the national level to improve gender equally have been poorly enforced at the local level. Second, there is a sustained enforcement of laws that oppress women and that protect male perpetrators of gender-based violations. Third, local courts limit female representation and uphold patriarchy. To improve the health of women and girls, stakeholders must take into consideration the ways in which legal systems uphold harmful gender norms and obstruct and/or advance progress towards equal representation, opportunities, and constitutionally-mandated protections for all. [ABSTRACT FROM AUTHOR]

This paper analyses the barriers to the recognition of gender-based persecution as grounds for asylum. It focuses on Spain and examines the rulings of Spanish courts on applications based on various types of gender violence between 2009 and 2019 and looks at the theoretical propositions of "the politics of silence". The paper proposes that these barriers can be attributed to the interweaving of androcentric and colonial frameworks that produce arbitrary representations of non-European women and their cultures. It also highlights the paradoxical way authorities deploy culturalisation strategies around female genital mutilation and forced marriage, treating them as "exotic" violence, in contrast to the strategies of invisibilisation and silence used with other types of gender-based violence, such as "intimate violence". [ABSTRACT FROM AUTHOR]

Background: Female genital mutilation (FGM) is a cultural practice with numerous negative health consequences. Due to migration from countries where FGM is prevalent into high-income countries, there is increased awareness within non-practising communities, with emphasis on FGM's illegal nature and the negative impacts on women. It is therefore vital for health professionals to be knowledgeable to provide adequate patient care. Aim: This review aimed to synthesise literature to report the understanding and experiences of health professionals caring for females affected by FGM in high-income countries. Methods: A systematic search was conducted on three databases: Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). Inclusion and exclusion criteria were applied to select the papers. Findings from included papers were synthesised using thematic synthesis. Findings: Eight articles met the criteria. Four themes were generated: FGM knowledge, training, attitudes and caring for FGM patients. Conclusion: Health professionals' knowledge and experiences of FGM tend to be varied. This review highlights the need of training for health professionals in high-income countries to strengthen their FGM knowledge. [ABSTRACT FROM AUTHOR]

Studies have shown a possible link between women achieving some degree of economic independence through empowerment and a decline in gender-based violence (GBV). However, inadequate funding has been a major challenge in developing economies, while foreign aid has been seen as an alternative funding source. Foreign aid for promoting women's rights and gender equality is improving in African countries. Yet, according to official statistics, the frequency of GBV in Africa is among the highest in the world. Given this, this paper examines the impact of women's aid and institutional quality on factors that can reduce GBV using both cross-sectional autoregressive lags to investigate short- and long-run implications and the Panel Vector Correction Model to examine the shock effect of aid on other variables. Also, the mediating role of institutional quality and women's aid are considered. The metrics used for the factors that reduce GBV are female children out of school, the secondary school gender parity index, the genital mutilation prevalence rate, and the metrics for institutional quality are the rules of law and government effectiveness. The implications from the findings show that enhancing the legal structure is very important in Africa, given the low coefficient values to reduce discrimination against the right to education; more should be done to increase the enrolment of female students through the maximisation of women's aid in order to achieve the short- and long-term objectives of reducing gender violence. The findings also show that the rule of law significantly aids in the reduction of female genital mutilation in the short and long run; government effectiveness is insignificant. Also, they show that women's aid also reduces female genital mutilation, albeit at a low rate. The results of this study call for strong enhanced government support and funding to end the practice of female genital mutilation and discrimination against female education in the short and long run. [ABSTRACT FROM AUTHOR]

The UN has stated its aim to eliminate 'Female Genital Mutilation' by 2030. In adherence to this, many countries have introduced or enhanced legislative and policy measures aimed at prevention through surveillance and punishment. In the European context, while protecting young girls from harm is the notional purpose of such measures, political and media debates have often been framed within nation-building rhetoric: across Europe 'FGM' has become the de rigour signifier of the vilified migrant/Muslim Other. This paper explores the impact of FGM-safeguarding measures in relation to citizenship and belonging for people of Somali heritage living in Bristol, England. It contributes to the incipient critical scholarship concerned with the powerful but blinkered hegemonic narrative pedalled by the UN and the policy turn within Europe towards prevention-through-criminalisation. Further, it advances debates on the conundrum of inclusive citizenship considering how a policy intervention which was initiated with widespread support among affected groups and undertaken on an anti-racist platform, resulted in stigmatisation and racism. Using Anderson's (Us and Them? The Dangerous Politics of Immigration Control. Oxford: OUP) framework of citizenship as a 'community of value', the paper also contributes to the growing body of work on how citizenship is experienced and the symbiotic and interdependent relationship between status, rights and identity. [ABSTRACT FROM AUTHOR]

This article assesses the legality of Female Genital Piercing (FGP), which refers to the piercing of female genitalia to adorn it with jewellery, for decoration or sexual enhancement. The position in the UK is uncertain because the World Health Organisation regards piercing as a form of FGM, which is a criminal offence in all parts of the UK. After analysing the stance adopted by the international community, the paper examines the legislation that criminalises FGM and considers whether FGP could fall within its scope. The paper concludes that female genital piercings could constitute FGM in limited circumstances, but even then, it may not be in the public interest to initiate a criminal prosecution. This lack of certainty is problematic for professional piercers who would welcome legislation providing an express exemption for genital piercings performed on consenting adult women. [ABSTRACT FROM AUTHOR]

This paper contributes to decolonising global health and development by exposing how coloniality in knowledge production informs dominant approaches to shifting social norms underpinning female genital mutilation/cutting (FGM/C) and child marriage. Major organisations in this field demonstrate systemic grandmother-exclusionary bias, namely sidelining grandmothers as change agents compared to adolescent girls, women of reproductive age, men and boys, and religious leaders. Grandmother-exclusionary bias stems from two assumptions: grandmothers do not influence FGM/C or child marriage; grandmothers only exert harmful influence and cannot change their views. These assumptions reflect Eurocentric constructions of modernity, and limited understanding of cultural contexts where seniority confers authority on female elders in relation to sexual and reproductive health (SRH). Grandmother-exclusionary bias goes against evidence that grandmothers wield authority over these practices; insights from meta-evaluations and systems/socioecological approaches that social norms change requires engaging people who wield authority over those norms; and proof that grandmothers can lead change if engaged respectfully. Instead, I present the 'grandmother-inclusive' Girls Holistic Development programme in Senegal, developed by the non-governmental organisation The Grandmother Project, as a decolonial option. It uses cultural renewal and participatory intergenerational dialogue to support grandmothers in shifting SRH-related norms and healing the damage Western modernity has inflicted on their communities. [ABSTRACT FROM AUTHOR]

Growing numbers of women are showing interest in clitoral reconstructive surgery after 'Female Genital Mutilation'. The safety and success of reconstructive surgery, however, has not clearly been established and due to lack of evidence the World Health Organization does not recommend it. Based on anthropological research among patients who requested surgery at the Brussels specialist clinic between 2017 and 2020, this paper looks at two cases of women who actually enjoy sex and experience pleasure but request the procedure to become 'whole again' after stigmatising experiences with health-care professionals, sexual partners or gossip among African migrant communities. An ethnographic approach was used including indepth interviews and participant observation during reception appointments, gynecological consultations, sexology and psychotherapy sessions. Despite limited evidence on the safety of the surgical intervention, surgery is often perceived as the ultimate remedy for the 'missing' clitoris. Such beliefs are nourished by predominant discourses of cut women as 'sexually mutilated'. Following Butler, this article elicits how discursive practices on the physiological sex of a woman can shape her gender identity as a complete or incomplete person. We also examine what it was that changed the patients' mind about the surgery in the process of re-building their confidence through sexology therapy and psychotherapy. [ABSTRACT FROM AUTHOR]

Background: In 2020, the number of displaced people worldwide reached 41.3 million (IOM, 2020). Among them, are many migrants and refugees at risk of sexual and gender‐based violence (SGBV). Healthcare providers have a key role to play in identifying migrant victims/survivors of violence. Objectives: This paper seeks to assess STIs prevalence, sexual health and sexual violence among third country nationals (TCNs) attending the GUC in Malta. Methods: This is a mixed methods study carried out at the Genitourinary Clinic (GUC), which is the only public sexual health clinic in Malta. Demographic data, sexual history and diagnoses of patients attending the GUC between January 2018 and December 2019 were collected and retrospectively analysed. A SGBV risk assessment was performed through a semi‐structured questionnaire. Results: In the 24‐month study period, a total of 12 654 patients accessed the GUC in Malta. Demographic data were collected on age, gender, nationality, marital status and sexual orientation. 16.4% (n = 2064) of these were extra‐European migrants, predominantly male. 80 different nationalities were recorded, with the 5 most common being Nigerian, Filipino, Libyan, Syrian and Brazilian. The average age was 32.6 years. Over 110 sex workers were visited at the GUC in the study period – 20 were foreign, primarily from China. The presence of a 'massage parlour owner' during consultation, lack of control over passports and other factors were identified as warning signs of trafficking. 5 cases of sexual violence and forced prostitution involving girls from Sub‐Saharan Africa and, in 2 cases, boys recently arrived in Malta by boat, were encountered. 6 African women accessing the service exhibited a type of female genital mutilation (FGM). Conclusions: Migration, sexual health and SGBV overlap in important ways. Further research and training in SGBV and migration in the healthcare setting and awareness‐raising about existing services among the migrant population are required. [ABSTRACT FROM AUTHOR]

Rosling et al's book Factfulness aims to inspire people to use strong supporting facts in their decision‐making, with 10 rules of thumb to fight dramatic instincts. In this paper, the Factfulness framework is applied to female genital cutting (FGC), in order to identify possible biases and promote evidence‐based thinking in studies on FGC, clinical guidelines on management of FGC, and interventions aimed at abolishing FGC. The Factfulness framework helps to acknowledge that FGC is not a uniform practice and helps address that variability. This framework also highlights the importance of multidisciplinarity to understand causalities of the FGC issue, which the authors argue is essential. This paper highlights the fact that FGC is a dynamic practice, with changes in the practice that are ongoing, and that those changes are different in different contexts. The "zero tolerance" discourses on FGC fail to acknowledge this. Factfulness encourages us to be more critical of methodologies used in the area of FGC, for example when estimating girls at risk of FGC in migration contexts. Factfulness provides the tools to calculate risks rather than judgments based on fear. This may help limit stigmatization of women with FGC and to allocate resources to health problems of migrant women based on real risks. The framework also calls for more research and production of less biased facts in the field of FGC, in order to improve interventions aimed at abolishing FGC, and clinical guidelines for the treatment of FGC. Factfulness is a useful and structured foundation for reflection over constructs, biases and disputes surrounding FGC, and can help improve the quality of future evidence‐based interventions and education that address the actual needs of women with FGC and girls at risk of FGC. [ABSTRACT FROM AUTHOR]

The paper explores the roles of men in the continuation/abandonment of female genital mutilation (FGM) in a migrant minority community in Sweden. The aim is to contribute to the under-researched area of men's attitudes towards and experiences of FGM, using frameworks on engaging men, feminist theories on men and masculinity, and intersectionality. It is based on an inductive qualitative design for data collection, including a focus group discussion with 13 male Somali migrants in Sweden. The analysis shows a window of opportunity for involving minority migrant men in prevention and to challenge a minority migrant gender regime. The ambivalent attitudes expressed are based on a will to reflect on roles, a desire to adjust to conflicting social norms and institutional rules, and an interest in the legal, health and medical consequences of FGM. The paper concludes that successful interventions and involvement need to consider local activism, gendered dynamics, masculinities and empowerment; attempts to eradicate FGM will be more successful if they empower women and men. [ABSTRACT FROM AUTHOR]

This paper explores the rites of passage rituals as the loci of health outcomes. It highlights how religiously sanctioned practices play a central role in healthcare in defiance of the perceived private and public dichotomy that dominates the modern secular mindset. Highlighted in the chapter are African rites of passage, specifically breast "ironing", female genital mutilation/cutting (FGM/C), and child marriage. Drawing from findings of a survey of 50 respondents, the chapter illustrates how these practices exemplify how rituals invoke health concerns in Africa and amongst Africans in the diaspora. The elevation of scientific knowledge and the privatization and categorization of religious knowledge as non-scientific in the mid-19th century resulted in the separation of the cure for the physical body from the spiritual factors, thus eliciting statements like "medicine is secular" and "religion is sacred and private." In reality, however, medicine and religion have been interwoven for centuries and ancient holistic paradigms of healthcare have been present in many cultures even as society has modernized. [ABSTRACT FROM AUTHOR]

Somali and Sudanese transnational discourses on female genital cutting (FGC) center on a shift from infibulation to sunna circumcision, a change perceived to reduce health risks and accommodate religious teaching, yet this shift is far less extensive and substantial than its typical portrayal suggests. Based on data from interviews and focus group discussions with 95 migrants of Somali and Sudanese origin, in this paper, I explore these migrants' discourses of change and how and why they seem blurred and contradictory. Most participants described the ongoing abandonment of infibulation and uptake of sunna circumcision in terms of civilization, modernization and transition toward a more correct Islam; however, their perceptions of the anatomical extents and religious and cultural meanings of sunna circumcision appeared blurred and contradictory. We suggest that these blurred and contradictory perceptions of sunna circumcision enable the study's participants to maneuver in a context of opposing and changing social norms regarding FGC. [ABSTRACT FROM AUTHOR]

• A tipping point in the rate of cutting does not exist in every community. • Some communities have a stable rate of female genital cutting between 0 and 1. • The existence of a tipping point determines which policies will be effective. • Develops novel method to construct community distribution of household preferences. • This method can also be used to understand other social behaviors. More than 200 million women alive today have undergone female genital cutting (FGC). Despite the associated negative health outcomes, the practice has persisted for generations. The prevailing theory of FGC persistence is that FGC is a social coordination norm, which implies that if a sufficient number of community members agree to abandon FGC, a tipping point is reached and the rate of FGC will fall to zero. Recent empirical evidence is inconsistent with this theory. This paper formalizes an alternative theoretical explanation in which households have heterogeneous thresholds—i.e. the rate of FGC in their community at which the household switches from practicing to not practicing FGC. This threshold heterogeneity removes the certainty that a tipping point exists and introduces the possibility of a stable internal equilibrium in the rate of FGC in a community. Using a dataset of more than 27,000 women born across 4.5 decades in Burkina Faso, I use a novel technique to construct community-level distributions of household thresholds. These distributions show that some communities in Burkina Faso have tipping points while some have a stable internal equilibrium. I find suggestive, but statistically insignificant, evidence that communities with a larger share of educated women, higher poverty rates, and lower population density are more likely to have a tipping point. Additionally, the empirical method developed in this paper has applications to the evolution of other social phenomena such as technology adoption, voting behavior, and racial segregation. [ABSTRACT FROM AUTHOR]

Human rights language has become a common method of internationally denouncing violent, discriminatory or otherwise harmful practices, notably by framing them as reprehensible violations of those fundamental rights we obtain by virtue of being human. While often effective, such women's rights discourse becomes delicate when used to challenge practices, which are of important cultural significance to the communities in which they are practiced. This paper analyses human rights language to challenge the gender disparity in access to health care and in overall health outcomes in certain countries where such disparities are influenced by important cultural values and practices. This paper will provide selected examples of machismo and marianismo discourses in certain Latin American countries on the one hand and of female genital cutting/excision (FGC/E) in practicing countries, both of which exposed to women's rights language, notably for causing violations of women's right to health. In essence, a reflective exercise is provided here with the argument that framing such discourses and practices as women's rights violations. Calling for their abandonment have shown that it may not only be ineffective nor at times appropriate, it also risks delegitimizing associated discourses, norms and practices thereby enhancing criticisms of the women's rights movement rather than adopting its principles. A sensitive community-based collaborative approach aimed at understanding and building cultural discourses to one, which promotes women's capabilities and health, is proposed as a more effective means at bridging cultural and gender gaps. [ABSTRACT FROM AUTHOR]

Female Genital Mutilation has been described by the U.N. as a 'critical human rights issue' and as a consequence, several jurisdictions, including England and Wales, have enacted specific legislation to combat the practice. This paper considers FGM from a human rights standpoint and analyses the law in England and Wales in the light of this. Although arguments have been presented to support the continuance of the practice, the opposing arguments are more compelling, particularly in relation to child victims. The law in England and Wales reflects this perspective, adopting a strong universalist human rights approach to FGM. The stance initially taken i.e. to criminalise FGM, was criticised because the law was not utilised and in response, civil protection measures were introduced. This paper concludes that the latter have been more useful than the criminal provisions and impact private and family life to a lesser degree than other civil law alternatives. But whether they will continue to be effective, following the Court of Appeal judgment in Re X which set aside a global travel ban because it violated the right to private and family life and had not been fully justified, remains to be seen. [ABSTRACT FROM AUTHOR]

This paper discusses an aspect of empowerment in relation to the central human capabilities for women with FGM/C in the diaspora. Many women who have undergone the practice of FGM/C come from societies where gender inequalities and gender-based discrimination between men and women persist, which compromises their capabilities, and many find themselves in vulnerable positions in their relationships with men, at work and in their everyday-life. The participants in this study however appeared somehow to have been empowered through certain health-promoting activities where they exercised agency in the western social context, they reside in. This paper examines the empowerment gained by the migrant women with FGM/C after participating in health-promoting activities. We compared this form of empowerment to the reinforcement of their capabilities according to Nussbaum's central human capabilities. Drawing on Nussbaum's list as a starting point we explore the relationship between capabilities and empowerment. We found that some central human capabilities appeared to be reinforced through health-promoting activities, whereas issues relating to asylum seeking became a determinant of empowerment in the women's own terms. Although the activities aimed to empower women, the participants themselves felt that they would only truly be empowered if they obtained full citizenship. [ABSTRACT FROM AUTHOR]

Drawing from qualitative research with female asylum seekers in Scotland who had claimed asylum to protect their daughters from female genital cutting (FGC), this article examines the workings of the culture of disbelief during asylum interviews. In this article I illustrate how the treatment of FGC-related asylum claims is informed by the convergence of hostile environment, gender and refugee stereotypes and the dominant representations of FGC. I argue that at the collision of anti-immigration and anti-FGC discourses, asylum seeking women are confronted with conflicting expectations whereby they are simultaneously expected to reinforce the constructions of themselves as victims of 'backward' cultural practices, and to narrate their vulnerability beyond cultural terms in order to meet the criteria for asylum outlined in the Refugee Convention. This paper illuminates the multiple strategies asylum interviewers employ to undermine women's lived experiences of persecution, revealing the contradictions in how interviewers simultaneously question the threat of FGC, women's inability to resist these practices and women's own experiences of being subject to FGC. Through this, I problematise the assumptions that FGC as an 'extreme' form of gender-based violence would offer an exception to refugee women's persistent struggles in being recognised as victims of persecution. [ABSTRACT FROM AUTHOR]

Background: Although Female Genital Mutilation/Cutting (FGM/C) is internationally considered a harmful practice, it is increasingly being medicalized allegedly to reduce its negative health effects, and is thus suggested as a harm reduction strategy in response to these perceived health risks. In many countries where FGM/C is traditionally practiced, the prevalence rates of medicalization are increasing, and in countries of migration, such as the United Kingdom, the United States of America or Sweden, court cases or the repeated issuing of statements in favor of presumed minimal forms of FGM/C to replace more invasive forms, has raised the debate between the medical harm reduction arguments and the human rights approach. Main body: The purpose of this paper is to discuss the arguments associated with the medicalization of FGM/C, a trend that could undermine the achievement of Sustainable Development Goal 5.3. The paper uses four country case studies, Egypt, Indonesia, Kenya and UK, to discuss the reasons for engaging in medicalized forms of FGM/C, or not, and explores the ongoing public discourse in those countries concerning harm reduction versus human rights, and the contradiction between medical ethics, national criminal justice systems and international conventions. The discussion is structured around four key hotly contested ethical dilemmas. Firstly, that the WHO definition of medicalized FGM/C is too narrow allowing medicalized FGM to be justified by many healthcare professionals as a form of harm reduction which contradicts the medical oath of do no harm. Secondly, that medicalized FGM/C is a human rights abuse with lifelong consequences, no matter who performs it. Thirdly, that health care professionals who perform medicalized FGM/C are sustaining cultural norms that they themselves support and are also gaining financially. Fourthly, the contradiction between protecting traditional cultural rights in legal constitutions versus human rights legislation, which criminalizes FGM/C. Conclusion: More research needs to be done in order to understand the complexities that are facilitating the medicalization of FGM/C as well as how policy strategies can be strengthened to have a greater de-medicalization impact. Tackling medicalization of FGM/C will accelerate the achievement of the Sustainable Development Goal of ending FGM by 2030. [ABSTRACT FROM AUTHOR]

While diaspora communities have become more critical of Female Genital Cutting (FGC), there are also trends of continuity. To explore the interplay between continuity and change, I designed a study among Somali migrants in Norway. A team of six Somali research assistants collected data from 72 male and female research participants between 16 and 57 years of age through in-depth interviews and focus group discussions. The aim of the study was to gather knowledge that could improve interventions among migrant populations. The study findings indicate that the experience of FGC as a practice in transition implies that people have to maneuver between different and partly contradictory social norms. The paper first discusses the contradiction between a strong negative attitude toward FGC and very low engagement. The lack of engagement is explained by the increased privatization of FGC and insecurities due to the transition and disempowerment with regard to challenging the FGC practices of relatives based in countries of origin. Second, the paper explores the contradiction between perceptions of FGC as a disappearing practice and the recognition of trends of continuation. Trends of continuation include those related to perceptions of risk during travel to countries of origin, resistance to defibulation, support for sunna circumcision and insecurities regarding the significance of FGC for marriageability. Thus, despite an almost universally negative attitude toward FGC in the form of infibulation, ongoing changes can, to some extent, hamper further change. This suggests that to ensure further progress in the abandonment of the practice, these complex and interconnected expectations must be addressed. [ABSTRACT FROM AUTHOR]

This is a review paper that focuses on Egypt as a case study, to challenge existing discourses about the practice of female circumcision in the twenty-first century. It contributes to the current academic discourse relevant to the practice by underscoring the structural, cultural and historical factors influencing its persistence today. Highlighting the various social and structural enablers preventing its eradication, this paper aims to shed light on the reasons why forms of gender-based violence such as female circumcision continue to exist in our modern-day societies and households. [ABSTRACT FROM AUTHOR]

Background: Increasing numbers of childbearing women with a history of female genital mutilation (FGM) are accessing maternity services in high‐income countries across the world. For many of these women, their first contact with the health services in their host country is when they are pregnant. While the clinical consequences of certain categories of FGM are well documented, how high‐risk maternity services — designed to mitigate the obstetric consequences of FGM — impact upon women's experience of childbearing is less clear. Methods: Using a meta‐synthesis approach, this paper synthesizes 12 qualitative research papers, conducted in 5 high‐income countries, to explore how migrant women with a history of FGM experience maternity care in their host countries. Results: One over‐arching theme and four discrete subthemes of migrant women's experience of the maternity services in their host country were identified: feelings of alienation; fatalism and divine providence, positive and negative feelings about maternity care, different understandings of the birthing process, and feelings about FGM. Conclusions: The findings illustrate that migrant women with a history of FGM frequently encounter negative attitudes when accessing the maternity services in their host countries. Women's experiences suggest a concerning absence of sensitive and empathetic care; a more woman‐centered approach is recommended. [ABSTRACT FROM AUTHOR]

Background: Female genital mutilation (FGM) is a cultural practice defined as the partial or total removal of the external female genitalia for nontherapeutic indications. Due to changing patterns of migration, clinicians in high‐income countries are seeing more women from countries where the practice is prevalent. This review aims to understand the sociocultural and health needs of these women and identify opportunities to improve the quality of maternity care for women with FGM. Methods: We undertook a systematic review and meta‐synthesis of peer‐reviewed primary qualitative research to explore the experience and needs of migrant women with FGM receiving maternity care. A structured search of nine databases was undertaken, screened papers appraised, and a thematic analysis undertaken on data extracted from the findings and discussion sections of included papers. Results: Sixteen peer‐reviewed studies were included in the systematic review. Four major themes were revealed: Living with fear, stigma, and anxiety; Feelings of vulnerability, distrust, and discrimination; Dealing with past and present ways of life after resettlement; and Seeking support and involvement in health care. Conclusions: The findings suggest that future actions for improving maternity care quality should be focused on woman‐centered practice, demonstrating cultural safety and developing mutual trust between a woman and her care providers. Meaningful consultation with women affected by FGM in high‐income settings requires cultural sensitivity and acknowledgment of their specific circumstances. This can be achieved by engaging women affected by FGM in service design to provide quality care and ensure woman‐focused policy is developed and implemented. [ABSTRACT FROM AUTHOR]

Introduction: historically, programs aimed at making communities abolish female genital mutilation or cutting (FGM/C) consisted mainly of awareness campaigns on sexual reproductive health and rights and the enforcement of newly implemented laws. These types of programs or interventions appear to be only partially effective and sometimes yield unintended results, such as actually strengthening commitment to FGM/C or transforming it into a secret practice. A newer approach to change that is intended to account for the cultural meanings ascribed to FGM/C are alternative rites of passage (ARP). Amref Health Africa started adopting this approach in 2007. Since then, by a trial-and-error process lessons have been learned, that will be reflected upon in this paper. Methods: desk research was conducted on organizational data regarding all Amref Health Africa's efforts to end FGM/C. Ninety-four in-depth formal interviews were held with members from Maasai and Samburu communities in Kenya targeted through maximum variation sampling. And participant observation of significative events as well as daily pastimes took place during school holiday season at the end of 2016. Furthermore extensive informal talks were held with project donors, activists, journalists, members of other nongovernmental organizations, members of community services organizations, local government officials, high-ranking Dutch and US diplomats and senior members of the Anti-Female Genital Mutilation Board, which is part of the Kenyan Ministry of Public Service, Youth and Gender Affairs. On the basis of these data a framework on different positions on FGM/C was developed and published in early 2018. By reviewing the data again from a particular change management and public health perspective, by peer-debriefing within a multi-disciplinary research team and by explicating the lessons learned this paper adds to an overview that is of crucial importance to practitioners working to end FGM/C. Results: risk of exclusion, perceived loss of cultural identity, changing meanings ascribed to cultural practices, lack of precise knowledge about subjective (sexual) experience and negative stereotyping are reasons not to adhere to anti-FGM/C programs. Areas of concern are the role confusion with following-up on policing, perceived outsider interference and the intended prolonging of the transition phase into womanhood not being explicated and embedded with ARP. Aspects to enhance to lever change more effectively are education and school curriculum development, male involvement, new stylization of love relationships, monitoring and evaluation and inclusive aspects of religion. Conclusion: changing a culturally embedded practice such as FGM/C is inherently complex. Because the cultural meanings ascribed to this practice are also evolving, any intervention that is effective at present might become superfluous in the future. A holy grail approach to change simply does not exist. Change needs to be levered in a variety of ways while working on the alignment of all these efforts by regular and thorough quantitative and qualitative assessments of effects and side-effects and reflections on lessons learned. [ABSTRACT FROM AUTHOR]

The aim of this article is to assess whether Female Genital Cosmetic Surgery (FGCS), which refers to procedures which change the structure and appearance of healthy female genitalia for non-medical reasons, violates the Female Genital Mutilation Act 2003, in the light of CPS guidance issued in 2019 and literature regarding the motivations of women seeking FGCS and its effectiveness. The paper concludes that FGCS does , prima facie, constitute FGM and argues that the medical exception contained in the legislation should seldom be available – but based on CPS guidance, a criminal prosecution will rarely be in the public interest. The article ends by asserting that the distinction drawn in practice (if not in law) between the treatment of western and non-western women is problematic, not only because it is discriminatory, but because tolerating FGCS may serve to legitimise FGM and result in the circumvention of the FGM Act 2003. [ABSTRACT FROM AUTHOR]

Introduction: The practice of female genital mutilation (FGM/C) in traditional African societies is grounded in traditions of patriarchy that subjugate women. It is widely assumed that approaches to eradicating the practice must therefore focus on women's empowerment and changing gender roles. Methods: This paper presents findings from a qualitative study of the FGM/C beliefs and opinions of men and women in Kassena-Nankana District of northern Ghana. Data are analyzed from 22 focus group panels of young women, young men, reproductive age women, and male social leaders. Results: The social systemic influences on FGM/C decision-making are complex. Men represent exogenous sources of social influence on FGM/C decisions through their gender roles in the patriarchal system. As such, their FGM/C decision influence is more prominent for uncircumcised brides at the time of marriage than for FGM/C decisions concerning unmarried adolescents. Women in extended family compounds are relatively prominent as immediate sources of influence on FGM/C decision-making for both brides and adolescents. Circumcised women are the main source of social support for the practice, which they exercise through peer pressure in concert with co-wives. Junior wives entering a polygynous marriage or a large extended family are particularly vulnerable to this pressure. Men are less influential and more open to suggestions of eliminating the practice of FGM/C than women. Conclusion: Findings attest to the need for social research on ways to involve men in the promotion of FGM/C abandonment, building on their apparent openness to social change. Investigation is also needed on ways to marshal women's social networks for offsetting their extended family familial roles in sustaining FGM/C practices. [ABSTRACT FROM AUTHOR]

Female genital mutilation (FGM) is defined by the World Health Organization to include: ‘procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons’. It is a practice that affects many females in England and Wales and as a result, specific legislation has been introduced to tackle it. This paper explores the development of the criminal and civil law relating to FGM in England and Wales. It discusses the advantages and disadvantages of the approaches adopted and considers whether they are effective. The paper concludes that the creation of a specific criminal offence has proved to be ineffectual; that the introduction of civil FGM protection orders is a more appropriate and effective means of combatting the practice and that legal measures need to be supplemented by non-legal interventions. [ABSTRACT FROM PUBLISHER]

Rapid immigration from countries that practice female genital mutilation/cutting (FGM/C) has introduced new populations requiring culturally sensitive health care. Clinicians play an important role in providing documentation and expert testimony for women seeking asylum on the basis on FGM/C. The intent of this paper is to provide instruction to providers aiming to evaluate an individual seeking asylum based on FGM/C. This document provides guidance about the three primary parts of evaluation: the interview, exam, and report. Other goals of investigation include preventing and ending suffering, compensation, and psychological or physical rehabilitation. [ABSTRACT FROM AUTHOR]

Performing female genital mutilation (FGM) is prohibited within the UK by the FGM Act of 2003. A mandatory reporting duty for FGM requires regulated health and social care professionals and teachers in England and Wales to report known cases of FGM in under 18-year-olds to the police. An application to the court for an FGM protection order (FGMPO) can be made to keep individual women and girls safe from FGM. This paper reveals the significant disconnect between the number of FGMPO applications and known recorded cases of FGM. The introduction of FGMPOs requires critical exploration as there is insufficient evidence to show that FGMPOs are effective in protecting women and girls from FGM. It is therefore unclear what impact, if any, FGMPOs are having upon the protection of women and girls at risk of FGM. The barriers to the implementation of FGMPOs and possible solutions are discussed. [ABSTRACT FROM AUTHOR]

Introduction: An estimated of 500,000 women and girls in the European Union (EU) have undergone female genital mutilation (FGM), with a further 180,000 at risk every year. Meeting the needs of these women and girls demands multidisciplinary action. This paper presents the United to End Female Genital Mutilation (UEFGM) knowledge platform, which is part of an EU-funded project. The platform is designed as a practice tool to improve the knowledge and skills of professionals who are likely to come into contact with women and girls affected by FGM.Method: Literature review was applied in regard to FGM along with expert validation process for the development of the modules particularly the e-learning section, expert and stakeholders' meetings for the other pillars of the Platform.Results: Three pillars were developed in the Platform: a) e-learning, b) country specific focus and c) live-knowledge discussion forum. The Platform explores related knowledge, skills, good practices, shared knowledge among professionals. UEFGM serves professionals and public as well in EU and worldwide.Conclusion: UEFGM comprises e-learning with a country-specific focus and a live discussion forum in which knowledge is shared between professionals worldwide. UEFGM discusses FGM and all related matters in a culturally- and gender-sensitive manner. It is a unique multidisciplinary and multilingual educational resource that has been found useful in everyday practice. [ABSTRACT FROM AUTHOR]

Background Female genital mutilation (FGM) is commonly practiced in sub-Saharan Africa and results in adverse pregnancy outcomes among affected women. This paper assessed the prevalence and effects of FGM on pregnancy outcomes in a rural Ghanaian setting. Methods We analyzed 9306 delivery records between 2003 and 2013 from the Navrongo War Memorial Hospital. Multivariable logistic regression analyses were used to determine the effects of FGM on pregnancy outcomes such as stillbirth, birth weight, postpartum haemorrhage, caesarean and instrumental delivery. We also assessed differences in the duration of stay in the hospital by FGM status. Results A greater proportion of mothers with FGM (24.7%) were older than 35 years compared with those without FGM (7.6%). FGM declined progressively from 28.4% in 2003 to 0.6% in 2013. Mothers with FGM were nearly twice as likely to have caesarean delivery (adjusted odds ratios = 1.85 with 95%CI [1.72, 1.99]) and stillbirths (1.60 [1.21, 2.11]) compared with those without. Similarly, they had a 4-fold increased risk of post-partum haemorrhage (4.69 [3.74, 5.88]) and more than 2-fold risk lacerations/episiotomy (2.57 [1.86, 3.21]) during delivery. Average duration of stay in the hospital was higher for mothers with FGM from 2003 to 2007. Conclusions Despite significant decline in prevalence of FGM, adverse obstetric outcomes are still high among affected women. Increased public health education of circumcised women on these outcomes would help improve institutional deliveries and heighten awareness and prompt clinical decisions among healthcare workers. Further scale-up of community level interventions are required to completely eliminate FGM. [ABSTRACT FROM AUTHOR]

Female Genital Mutilation/Cutting (FGM/C) has risen up the global advocacy agenda and is recognized as an important child-safeguarding issue. The topic crystallizes key debates in my module, Culture and Development in Africa, and enables Geography undergraduates to explore complex intersections of childhood, gender, sexuality, and ethnicity in diverse African communities. In this paper, in light of in my efforts to teach for social transformation, I reflect on the inquiry-based learning approach I adopt and on its potential benefits. Conscious of postcolonial feminist critiques of processes of racialized "Othering", I discuss dilemmas about how to frame FGM/C and support students' critical engagement with the conflicting, sometimes confusing, discourses of cultural relativism and universal human rights. I seek to foster independent learning and research skills using a "real world" NGO assignment. Qualitative feedback suggests students develop more in-depth subject-knowledge, reflections on the ethics of "development", changes in self-theories and gain important skilful practices that may enhance their employability. Linking my teaching to my work with a charity tackling FGM/C has enabled co-learners to regard this as both a cultural practice that affects "distant others", and as a form of gender-based heteronormative violence and child abuse that has resonance in the local community. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Despite long-term efforts to encourage abandonment of female genital mutilation/cutting (FGMC), the practice remains widespread globally. FGMC is situated in specific social and historical contexts, and both prevalence and rates of decline vary widely across practicing countries. However, cross-national comparative research on the determinants of FGMC is sparse. This paper adds to the limited body of rigorous, theoretically grounded quantitative studies of FGMC and takes a step toward advancing cross-national comparative research. We apply an integrated theoretical framework that brings together norms-based and gender-based explanations of community-level influences on FGMC. We test this framework in four francophone West African countries, drawing on comparable nationally representative data from the Demographic and Health Surveys in Burkina Faso (2010), Côte d'Ivoire (2011-2012), Guinea (2012), and Mali (2012-2013). Results show that community-level FGMC norms and community-level gendered opportunities are associated with girls' risk of FGMC, but that the direct and moderating associations vary qualitatively across countries. Our findings highlight the contribution of context-specific social and institutional processes to the decline or persistence of FGMC. [ABSTRACT FROM AUTHOR]

Female genital mutilation/cutting is a multifaceted, culturally entrenched issue. In response to the United States Conference of Catholic Bishops' resources dealing with the issue of FGM/C, this paper explores what resources sexual ethics can provide Catholic hospitals facing this issue, specifically with regards to the request for reinfibulation (the restoration of infibulation, also called FGM Type III). FGM/C ought not to be treated as a univocal medical practice; rather, in natural law evaluations of the act, the practice of reinfibulation ought to be separately acknowledged. Reinfibulation cannot be properly considered a mutilation in the same way that other types of FGM/C are. Thus reinfibulation should be performed in Catholic hospitals for those women who request it, as part of delivering culturally competent care, justifiable through the principle of material cooperation. [ABSTRACT FROM AUTHOR]

Background: Maternal and Child health remains at the core of global health priorities transcending the Millennium Development Goals into the current era of Sustainable Development Goals. Most low and middle-income countries including Ghana are yet to achieve the required levels of reduction in child and maternal mortality. This paper analysed the trends and the associated risk factors of stillbirths in a district hospital located in an impoverished and remote region of Ghana. Methods: Retrospective hospital maternal records on all deliveries conducted in the Navrongo War Memorial hospital from 2003–2013 were retrieved and analysed. Descriptive and inferential statistics were used to summarise trends in stillbirths while the generalized linear estimation logistic regression is used to determine socio-demographic, maternal and neonatal factors associated with stillbirths. Results: A total of 16,670 deliveries were analysed over the study period. Stillbirth rate was 3.4% of all births. There was an overall decline in stillbirth rate over the study period as stillbirths declined from 4.2% in 2003 to 2.1% in 2013. Female neonates were less likely to be stillborn (Adjusted Odds ratio = 0.62 and 95%CI [0.46, 0.84]; p = 0.002) compared to male neonates; neonates with low birth weight (4.02 [2.92, 5.53]) and extreme low birth weight (18.9 [10.9, 32.4]) were at a higher risk of still birth (p<0.001). Mothers who had undergone Female Genital Mutilation had 47% (1.47 [1.04, 2.09]) increase odds of having a stillbirth compared to non FGM mothers (p = 0.031). Mothers giving birth for the first time also had a 40% increase odds of having a stillbirth compared to those who had more than one previous births (p = 0.037). Conclusion: Despite the modest reduction in stillbirth rates over the study period, it is evident from the results that stillbirth rate is still relatively high. Primiparous women and preterm deliveries leading to low birth weight are identified factors that result in increased stillbirths. Efforts aimed at impacting on stillbirths should include the elimination of outmoded cultural practices such as FGM. [ABSTRACT FROM AUTHOR]

Background: The aim of this paper was to investigate correlations between Somali Swedish own attitudes towards female genital cutting (FGC) and their perceptions about other Swedish Somalis attitudes. Methods: In 2015, a cross-sectional study was conducted in four Swedish municipalities with 648 Somali men and women. To assess the level of agreement between the participants' approval of FGC and their perceptions about approval among other Swedish Somalis, Bangdiwala's B-statistic and Welch's t-test were used. Results: We found a substantial agreement between an individual's own approval of FGC and their perceived approval of FGC among most other Swedish Somali men (B-statistic = 0.85) and women (B-statistic = 0.76). However, we also found a tendency for participants to report that other Swedish Somalis–and especially other Swedish Somali women–approved of FGC, while they themselves did not. Perceived percentage of Somali girls being circumcised in Sweden was significantly higher among Swedish Somalis who said they wanted tissue to be removed on their own daughter (mean 23%, 95% CI: 18.3–27.9) compared to those who said they opposed removal of tissue on their own daughter (mean 8%, 95% CI: 6.4–9.1). The majority of Swedish Somali men (92%) stated a preference to marry someone without FGC or with pricking, which was also the view of most of the Swedish Somali women (90%). Conclusions: Swedish Somalis motivation to continue or discontinue with the practice of FGC may be influenced by perceptions of what other Swedish Somalis prefer. How FGC is being portrayed, in for example media reports, could therefore have an impact on attitudes towards FGC. [ABSTRACT FROM AUTHOR]