Search

Female genital mutilation (FGM) is still a common practice in Sudan. Nine out of ten women have been subjected to this practice. In 2009, a proposed ban on FGM in the National Child Act miserably failed to materialize. In spite of the failure of a national law against FGM, with extensive funding from UNICEF and UNFPA, several of Sudan’s eighteen states have criminalized this harmful traditional practice. This CMI Brief is based on a Sudan Working Paper titled “ Weak law forbidding female genital mutilation in Red Sea State, Sudan ”. The Brief has been published as an article published in open democracy March 2017. One of these states is Red Sea, located in eastern Sudan. Red Sea is known for being extremely conservative when it comes to women’s rights, and FGM is widely practiced. We chose to investigate the criminalization process in Red Sea out of a genuine desire to study a positive example of a state that had managed to introduce a ban on FGM against all odds. Instead, we found a “paper tiger” law that does not protect girls against FGM. While the law is a political compromise cleverly designed to please stakeholders, girls at risk of undergoing FGM remain unprotected. Criminalizing FGM in Sudan FGM includes any procedure involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons. It is a harmful traditional practice, which reflects deep-rooted inequality between the sexes and constitutes an extreme form of discrimination against women. Numerous international and regional human rights treaties and conventions condemn the practice. Eliminating FGM is part of the United Nations sustainable development goal 5 – to achieve gender equality and empower all women and girls. One of this goal’s targets is to “eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation&r

Female Genital Mutilation (FGM) has been identified as one of the most serious human rights violations women are exposed to in many countries, in spite of national and international efforts. The actual implementation of preventive strategies and support of victims faces a number of challenges that can only be addressed by an interdisciplinary approach integrating public health and legal considerations. FGM in the context of women as refugees who left their country to escape FGM has rarely been covered in this context. This article summarizes the most important international standards and initiatives against FGM, highlights the medical, legal, and psychological factors identified so far, and explores the interdisciplinary considerations in changing a country and society to permit safe return of those escaping FGM to third countries and support public health in the country.

Social norms affect almost every aspect of people’s lives, and can be an obstacle to or support economic development. This paper outlines what social norms are and how they work, providing examples from everyday life and from development case studies. Sometimes not much can be done about changing undesirable social norms. In those cases, development economists need to be aware of how the existence of those norms can impact the effects of the policies they advocate. But of particular importance to development economists is the ways in which social norms can be changed, at least under some circumstances. Understanding of social norm change is still patchy at best, but the paper outlines the theoretical underpinnings of change, with empirical evidence from various policies aimed at changing social norms. However, some of those policies raise ethical concerns that would require attention.

This paper presents trends in monetary and nonmonetary dimensions of wellbeing in Ethiopia using data from the Household Consumption and Expenditure and Welfare Monitoring surveys implemented in 2000, 2005, and 2011. The paper provides evidence on changes in overlapping deprivations using a non-index approach to multidimensional poverty. It assesses the performance of various dimensions in education, health, and living standards, taking one indicator at a time. It then examines the overlap between different dimensions of poverty and examines how this has changed over time in Ethiopia and across rural and urban areas. It highlights that although Ethiopia’s multidimensional poverty index is very high, there have been improvements in overlapping deprivations and, as a result, the number of individuals deprived in multiple dimensions has fallen.

Tema rada bila je istraživanje ljudskih prava žena u neliberalnim i liberalnim zemljama. Nastojalo se ukazati na loš položaj ženskih ljudskih prava u tradicionalnim zajednicama gdje pretežito dominiraju stariji muškarci i kulturni običaji poput ženskog genitalnog sakaćenja. Koristeći liberalno-feminističku perspektivu, rad zaključuje po uzoru na Marthu Nussbaum kako ova promjena mora biti internalizirana i raspravlja o legitimnosti nametanja sustava vrijednosti, potencijalnom duplom standardu i legitimnosti međunarodne intervencije u širem smislu. Rad također raspravlja o položaju doseljenika unutar liberalnih demokracija i pokušaj rješavanja njihovih zahtjeva za kulturnim pravima. Predmet istraživanja bio je žensko genitalno sakaćenje kao teška povreda ljudskih prava, koji ukazuje na problematiku nedovoljno jasno specificiranih prava žena unutar međunarodnopravnog okvira i njegove primjene. Glavni zaključci tiču se kako bi liberalizam mogao proširiti svoj kut gledanja i više uvrstiti pitanje kulture u javnom prostoru nasuprot isključivo privatnoj sferi. Zaključak je također kako određena ljudska prava žena moraju biti zadovoljena u svrhu pravednosti te rad djelomično počiva na teorijama pravednosti uz praktične implikacije. Odgovor na istraživačko pitanje glasi kako je ovaj običaj povreda ženskog ljudskog prava na tjelesnu autonomiju, što još uvijek nije uvršteno u Opću deklaraciju o ljudskim pravima., The topic of the paper was the research of women's human rights in iliberal and liberal countries. An effort was made to point out the poor position of women's human rights in traditional communities where older men and cultural customs such as female genital mutilation predominate. Using a liberal-feminist perspective, the paper concludes, following the example of Martha Nussbaum, that this change must be internalized and discusses the legitimacy of imposing a value system, a potential double standard, and the legitimacy of international intervention in a broader sense. The paper also discusses the position of immigrants within liberal democracies and attempts to address their demands for cultural rights. The subject of the research was female genital mutilation as a serious violation of human rights, which points to the problem of insufficiently clearly specified rights of women within the international legal framework and its application. The main conclusions concern how liberalism could broaden its point of view and include more the issue of culture in the public space as opposed to the exclusively private sphere. The conclusion is also that certain human rights of women must be satisfied for the purpose of justice, and the work is partly based on theories of justice with practical implications. The answer to the research question is that this custom is a violation of women's human right to bodily autonomy, which is still not included in the Universal Declaration of Human Rights.

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.

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.

Background In a context of high migration, there are growing numbers of women living in the UK who have experienced female genital mutilation/cutting. Evidence is needed to understand how best to meet their health-care needs and to shape culturally appropriate service delivery. Objectives To undertake two systematic reviews of qualitative evidence to illuminate the experiences, needs, barriers and facilitators around seeking and providing female genital mutilation-/cutting-related health care from the perspectives of (1) women and girls who have experienced female genital mutilation/cutting (review 1) and (2) health professionals (review 2). Review methods The reviews were undertaken separately using a thematic synthesis approach and then combined into an overarching synthesis. Sixteen electronic databases (including grey literature sources) were searched from inception to 31 December 2017 and supplemented by reference list searching. Papers from any Organisation for Economic Co-operation and Development country with any date and in any language were included (Organisation for Economic Co-operation and Development membership was considered a proxy for comparable high-income migrant destination countries). Standardised tools were used for quality appraisal and data extraction. Findings were coded and thematically analysed using NVivo 11 (QSR International, Warrington, UK) software. Confidence in the review findings was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation – Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. All review steps involved two or more reviewers and a team that included community-based and clinical experts. Results Seventy-eight papers (74 distinct studies) met the inclusion criteria for both reviews: 57 papers in review 1 (n = 18 from the UK), 30 papers in review 2 (n = 5 from the UK) and nine papers common to both. Review 1 comprised 17 descriptive themes synthesised into five analytical themes. Women’s health-care experiences related to female genital mutilation/cutting were shaped by silence and stigma, which hindered care-seeking and access to care, especially for non-pregnant women. Across all countries, women reported emotionally distressing and disempowering care experiences. There was limited awareness of specialist service provision. Good care depended on having a trusting relationship with a culturally sensitive and knowledgeable provider. Review 2 comprised 20 descriptive themes synthesised into six analytical themes. Providers from many settings reported feeling uncomfortable talking about female genital mutilation/cutting, lacking sufficient knowledge and struggling with language barriers. This led to missed opportunities for, and suboptimal management of, female genital mutilation-/cutting-related care. More positive experiences/practices were reported in contexts where there was input from specialists and where there were clear processes to address language barriers and to support timely identification, referral and follow-up. Limitations Most studies had an implicit focus on type III female genital mutilation/cutting and on maternity settings, but many studies combined groups or female genital mutilation/cutting types, making it hard to draw conclusions specific to different communities, conditions or contexts. There were no evaluations of service models, there was no research specifically on girls and there was limited evidence on psychological needs. Conclusions The evidence suggests that care and communication around female genital mutilation/cutting can pose significant challenges for women and health-care providers. Appropriate models of service delivery include language support, continuity models, clear care pathways (including for mental health and non-pregnant women), specialist provision and community engagement. Routinisation of female genital mutilation/cutting discussions within different health-care settings may be an important strategy to ensure timely entry into, and appropriate receipt of, female genital mutilation-/cutting-related care. Staff training is an ongoing need. Future work Future research should evaluate the most-effective models of training and of service delivery. Study registration This study is registered as PROSPERO CRD420150300012015 (review 1) and PROSPERO CRD420150300042015 (review 2). Funding The National Institute for Health Research Health Services and Delivery Research programme.

ObjectiveTo explore the experiences of accessing and receiving healthcare related to female genital mutilation/cutting (FGM/C) across the life course from the perspective of women and girls who have undergone FGM/C.DesignA systematic review of qualitative research studies using a thematic synthesis approach.MethodsInclusion criteria were qualitative studies (including grey literature) of any design, from Organisation for Economic Co-operation and Development (OECD) countries, of any date and any language. Sixteen electronic databases were searched from inception to December 2017, supplemented by reference list searching. Papers were screened, selected and quality-appraised by two reviewers using established tools from the Joanna Briggs Institute. NVivo software was used to extract study characteristics and code study findings. An inductive thematic synthesis approach was undertaken to identify descriptive themes and interpret these into higher order analytical constructs. Confidence in the review findings was assessed using Grading of Recommendations, Assessment, Development and Evaluations-Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual).ResultsFifty-seven papers (from 55 distinct studies) from 14 different OECD countries were included (50% published within the last 8 years). One-third of studies focused exclusively on maternity care experiences, whereas others covered a range of foci. No studies reported explicitly on girls’ experiences or on experiences of health service-led safeguarding interventions. Only three studies addressed psychological care. The synthesis developed 17 descriptive themes, organised into 5 analytical constructs. These related to communication, access to care, experiences of cultural dissonance/integrity, disempowering care experiences and positive care encounters. The themes illuminate significant challenges to obtaining timely and holistic care (especially for deinfibulation), and highlight different ways in which women may experience care as disrespectful, unsafe and disempowering. Key elements of ‘culturally safe care’ are identified.ConclusionsThis review has highlighted key knowledge gaps, especially around (1) girls’/unmarried women’s experiences and (2) the impact of recent safeguarding interventions. There is an ongoing need for community engagement, service development and staff training.PROSPERO registration numberCRD420150300012015.

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.

Susan Costello School of Global, Urban and Social Studies, RMIT University, Melbourne, VIC, Australia Abstract: 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. Keywords: female genital mutilation, female genital cutting, female circumcision, child protection, risk management&nbsp

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.

This paper aims to focus on migration movements in which women and children suffer violence as consequence of illegal traditions that are considered crimes in host countries. Such violence is specified in endemic practices such as forced marriages as well as child marriages and female genital mutilation/cutting. In this context, the concept of cultural crime arises which does not justify these behaviors. This paper combines human rights, criminal law, culture, education and children protection perspectives., O presente artigo analisa os movimentos migratórios em que mulheres e crianças sofrem violência em decorrência de práticas tradicionais consideradas criminosas pelos países hospedeiros. Essa violência é especificada em práticas endêmicas como casamentos forçados, casamento infantil e mutilação genital feminina. Neste contexto, surge o conceito de crime cultural, o qual não justifica estas condutas. O presente artigo mescla as perspectivas de direitos humanos, direito penal, cultura, educação e proteção de crianças e adolescentes., SEJ-599 Los Nuevos Retos del Derecho en Una Sociedad Globalizada. Derecho 3.0. (DERECHO Y CIENCIA)

This paper starts with a discussion about the symmetrical aspects of circumcision of girls and circumcision of boys. In a brief overview of historical changes in the discourses on circumcision, especially regarding girls, we can see how a conceptual asymmetry was created through the activist claim, introduced in the early 1980s and prominent since then, that one of the phenomena, in whatever form, was to be labelled ‘mutilation’, the other ‘harmless’. The paper will further discuss later developments in the form of an activist movement (the genital integrity movement, intactivists) contending that also boys without decision-making capacity need to have legal protection against non-medical procedures that irreversibly change their genitals. Examples from the academic, medical, and political-legal fields in Europe will demonstrate a general trend in which the symmetries between circumcision of girls and boys are again being brought out, now within a children’s rights perspective.

Female genital mutilation/cutting (FGM/C) is still present in many African countries, as well as a few others. The United Nations has targeted women’s empowerment in terms of both women’s health and gender equality as one of its Sustainable Development Goals. In this paper, we aimed to study the possible link between women’s empowerment and support for the continuation of FGM/C. We used DHS data from seven African countries and considered both the empowerment and FGM/C modules. We selected empowerment variables based on Kabeer’s conceptual framework and used multilevel logistic models to evaluate the putative role of empowerment in support for discontinuing the practice. The multilevel models highlighted the protective effect of education. Other variables, including justification of intimate partner violence (IPV) and having experienced FGM/C, were associated with FGM/C support. The relationship between decision-making and FGM/C support appears complex, while the unmet need for contraception and job conditions do not seem to play a role. Our findings confirm that some aspects of women’s empowerment (education and rejection of IPV) may enhance the discontinuation of FGM/C. However, the relationship between empowerment and support for continuation of FGM/C is complex and should not be treated as self-evident. Thus, using DHS data, we empirically support the UN’s proposal for discontinuing FGM/C through sustaining women’s empowerment.

Introduction Improving healthcare providers’ capacities of prevention and treatment of female genital mutilation (FGM) is important given the fact that 200 million women and girls globally are living with FGM. However, training programs are lacking and often not evaluated. Validated and standardized tools to assess providers’ knowledge, attitude and practice (KAP) regarding FGM are lacking. Therefore, little evidence exists on the impact of training efforts on healthcare providers’ KAP on FGM. The aim of our paper is to systematically review the available published and grey literature on the existing quantitative tools (e.g. scales, questionnaires) measuring healthcare students’ and providers’ KAP on FGM. Main body We systematically reviewed the published and grey literature on any quantitative assessment/measurement/evaluation of KAP of healthcare students and providers about FGM from January 1st, 1995 to July 12th, 2016. Twenty-nine papers met our inclusion criteria. We reviewed 18 full text questionnaires implemented and administered to healthcare professionals (students, nurses, midwives and physicians) in high and low income countries. The questionnaires assessed basic KAP on FGM. Some included personal and cultural beliefs, past clinical experiences, personal awareness of available clinical guidelines and laws, previous training on FGM, training needs, caregiver’s confidence in management of women with FGM, communication and personal perceptions. Identified gaps included the medical, psychological or surgical treatments indicated to improve girls and women’s health; correct diagnosis, recording ad reporting capacities; clitoral reconstruction and psychosexual care of circumcised women. Cultural and personal beliefs on FGM were investigated only in high prevalence countries. Few questionnaires addressed care of children, child protection strategies, treatment of short-term complications, and prevention. Conclusion There is a need for implementation and testing of interventions aimed at improving healthcare professionals’ and students’ capacities of diagnosis, care and prevention of FGM. Designing tools for measuring the outcomes of such interventions is a critical aspect. A unique, reproducible and standardized questionnaire could be created to measure the effect of a particular training program. Such a tool would also allow comparisons between settings, countries and interventions. An ideal tool would test the clinical capacities of providers in managing complications and communicating with clients with FGM as well as changes in KAP.

En este trabajo se hace una revisión bibliográfica acerca de la mutilación genital femenina (MGF) y una de sus complicaciones: la disfunción sexual. El objetivo es refrescar los conocimientos en este tema y poner de manifiesto que es necesaria la realización de estudios de mejor calidad en este campo. A pesar de ser una práctica anecdótica en Occidente, la mutilación genital femenina es una violación de los derechos humanos que tiene una prevalencia altísima a nivel mundial. Además, presenta ciertas complicaciones médicas (infecciosas, obstétricas, urinarias, etc.) que no han de ser desdeñadas por los profesionales sanitarios que atienden a mujeres procedentes de países donde esta práctica es común. El énfasis en la disfunción sexual derivada de esta práctica pretende destacar que también hay que prestar atención a esta complicación, puesto que están demostradas las secuelas que la MGF provoca a nivel de la función sexual femenina, las cuales se miden mediante el Índice de Función Sexual Femenina (FSFI). Por último, se proponen técnicas de desinfibulación y reconstrucción clitoriana., This paper is a review of female genital mutilation (FGM) and one of its complications: sexual dysfunction. The aim is to update the knowledge on this topic and to bring up the fact that further investigation is needed. Although its practice is anecdotal in developed countries, female genital mutilation is a human rights violation and its prevalence is extremely high worldwide. Moreover, FGM is related to several medical complications, such as obstetric, infectious or urinary complications, that clinicians must be aware of when they assist women who come from countries where this practice is common. Our emphasis on sexual dysfunction related to FGM tries to highlight the fact that we must also take care of this complication, which has been proved in several papers and it is usually measured by the Female Sexual Function Index (FSFI). Finally, we present several deinfibulation and clitoral reconstruction techniques.

In this article, I discuss compulsory genital examinations in Swedish African, mainly Somali, girls. The discussion is based on data from 122 police files, including criminal investigations regarding suspected “female genital mutilation” (FGM). A growing body of research in European countries indicates that processes of cultural change are occurring among immigrant communities from areas where traditionally girls are subjected to what is construed as “circumcision”. Many studies show growing opposition to these practices among people who have migrated to Europe, and there is little evidence to support the assertion that large-scale illegal activities are prevalent. Yet there is a dominant discourse stating that FGM is secretively practised on a large scale among some immigrant groups in Europe, and policies encourage the detection of cases to charge in criminal court. I describe the current situation in Sweden and highlight some of the drawbacks of a very harsh, although well-intended, policy to check for FGM in Europe. While the ultimate aim is to protect girls at risk for FGM, current policies have ramifications that are invasive and sometimes even traumatising for the girls involved. This paper offers an empirical example of how politics in western multicultural societies may negatively influence the sexual health and rights of a target group, in this case, girls and young women whose families originate from countries where circumcision of girls is practiced.

Female Genital Cutting, Women’s Health, and Development is part of the World Bank Working Paper series. These papers are published to communicate the results of the Bank’s ongoing research and to stimulate public discussion. This strategy paper provides a comprehensive understanding of the issue of female genital mutilation/cutting—scope, challenges, opportunities, best practices, and how communities, development agencies, and national governments can work together to eliminate the practices on the ground. The World Bank is committed to assisting governments in ending the practice of female genital cutting, as the practice has a direct, negative impact on the health and well-being of women around the world. The recommendations set forth in this paper take advantage of the World Bank’s comparative advantage in dealing with governments. Continued silence perpetuates the practice, thereby undermining women’s productivity. Corte Genital Femenino, Salud de la Mujer y Desarrollo forma parte de la serie de documentos de trabajo del Banco Mundial de Documentación Laboral. Estos documentos son publicados para comunicar los resultados de la investigación en curso y estimular el debate público. Este documento de estrategia proporciona una comprensión sobre la mutilación genital femenina, desafíos, oportunidades, mejores prácticas y cómo las comunidades, las agencias de desarrollo y los gobiernos nacionales pueden trabajar juntos para eliminar las prácticas sobre en este terreno. El Banco Mundial está comprometido a ayudar a los gobiernos en finalizar este tipo de prácticas, referente al corte genital femenino, puesto que estas tienen un impacto directo y negativo sobre la salud y el bienestar de las mujeres de todo el mundo. Las recomendaciones enunciadas en este documento aprovechan las ventajas comparativas del Banco tomando ventaja en el trato con los gobiernos. El silencio continuo perpetúa la práctica, socavando así la productividad de las mujeres.

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.

Background: Global efforts to end female genital mutilation (FGM) have intensified in recent decades because of the rising awareness that such a practice is an act of extreme violence against women and girls. Articles on FGM have been published highlighting the combined efforts of international and non-governmental organizations, governments, as well as religious and civil society groups to end the practice. However, the consequences of this research are not well known, and it seems that the socioeconomic aspects of the practice are underreported.Objective: This review aims to characterize over a 40-year period the scientific output on the consequences of FGM in African countries, the most affected region known for the high prevalence of FGM, and review data on the socioeconomic consequences of the practice.Design: A systematic review of literature was done, looking at the following databases: PubMed, Embase, CINAHL, BDSP, Web of Science, PsycINFO, FRANCIS, Sociological Abstracts, WHOLIS, RERO, and SAPHIR. The analysis was limited to articles concerning the African continent, published in English and French, from January 1, 1972, to December 31, 2011.Results: One hundred ninety-eight articles were reviewed. More than half of the articles were published during the last decade of the study period. The majority of papers were published in biomedical journals (64.1%). Most studies looked at Africa as a region (33.3%). Nigeria was the single country most investigated (19.2%), followed by Egypt (10.6%). Most first authors were affiliated to non-African countries (60.6%): among them 21.2% were US-based, 4% were from African institutions, and 16.2% from Nigeria.The medical and psychological consequences (51.5%) and the prevalence and ethics of the practice (34.4%) were the most frequently investigated topics. The socioeconomic consequences were addressed in a minority of the papers (14.1%): they were classified into direct economic consequences (2.5%), school attendance (1%), marriageability (2%), sexual and marital consequences (3.5%), fertility (2.5%), domestic violence (1%), and discrimination (1.5%).Conclusions: The publication of articles on the consequences of FGM is increasing, but there is little research on the socioeconomic consequences of the practice. More scientific data focusing on this dimension is necessary to strengthen prevention, advocacy, and intervention campaigns.Keywords: female genital mutilation; systematic review; Africa; medical and psychological consequences; prevalence and ethics; socioeconomic consequences(Published: 4 October 2016)Citation: Glob Health Action 2016, 9: 31489 - http://dx.doi.org/10.3402/gha.v9.31489

Background: Over the past few decades Egypt has attempted to limit and control female genital mutilation (FGM). However, these efforts have not succeeded in curbing the practice, which maintains wide popular support and is firmly embedded in local traditions and structures. An attitudinal change is therefore a prerequisite for any successful campaign against FGM. This paper charts the evolution of beliefs that the practice of FGM in Egypt should be stopped. Method: This paper examines trends in opposition to FGM among ever-married women in Egypt between 1995 and 2014, using six waves of the Egypt Demographic and Health Surveys. Results: The results show that the percentage of ever-married women who think the practice of FGM should be stopped rose from 13.9 % in 1995 to 31.3 % in 2014. The central question here is whether this trend exists because new cohorts of young married women are more modern and more opposed to the practice, or because opposition to FGM has spread through multiple segments of society. Our results show that back in 1995 opposition to FGM was concentrated in two groups: non-circumcised women, and wealthy, highly educated urban women. Between 1995 and 2014 opposition to FGM increased considerably among other groups of women. Conclusion: Our results show that the observed increases in opposition to FGM are not caused by younger cohorts of married women who oppose FGM, nor by the expansion of the groups most likely to oppose FGM. Rather, the results imply that the belief that FGM should be stopped spread to all walks of life, although poorly educated rural women remain least likely to oppose FGM.

Female genital mutilation and circumcision (FGM/C) is an expression that describes social and traditional actions performed for the removal of the clitoris and inner lips; labia minora as well as part of the outer lips; labia majora. The research has addressed the effects of this action on women in Ejagham community of the Southwest region of Cameroon. The study focuses on effects revealed during the research, including voices of the women who had undergone FGM/C, excisors recount, violence against women physical, psychological, social, and sexual effects. In traditional African societies, cultural values should be upheld with dignity to humankind. Our traditional practices too, need to give honour to our bodies. Therefore, opinions from different groups within the Ejagham community are revealed in the discussion. More so, the study also found out that FGM/C was a practice performed on the girls and women on the cultural and traditional beliefs that the process signifies a rite of passage from girl to womanhood. The process caused pain and violated the right of the young girls. The findings revealed that there are divided opinions on FGM/C within the community. Custodians of the Ejagham tradition that are in favour of the practice are conflicting with those who are against the practice on medical and human right justifications. These different platforms play a prominent role in the various perceptions held by the people. A significant segment of the Ejagham community, together with some representatives of the international community, NGOs and the government of Cameroon are involved in efforts to bring about change in the community by eliminating the tradition through community-based awareness programs. These programs that are accessible by everybody has empowered people in the community with knowledge on the subject and provided the necessary resources that will help in eliminating the practice. The efforts have initiated a changing climate in the community; however, this does not yet mean that the tradition has been abolished. The paper shall also discuss the traditional and cultural reasons for the practice of FGM in Cameroon. The author will state International instruments, Conventions, the National laws, Action plan that is to eliminate or lead to the abandonment of FGM practices in Cameroon. The paper will conclude with suitable suggestions to eradicate the practice of FGM/C, which is against Human Rights. Keywords: Female Genital Mutilation/Cutting, Human Rights, Ejagham, Community, Cameroon Comments from the Examiner have been included in the thesis Master in Peace and Development WorkABSTRACT Female genital mutilation and circumcision (FGM/C) is an expression that describes social and traditional actions performed for the removal of the clitoris and inner lips; labia minora as well as part of the outer lips; labia majora. The research has addressed the effects of this action on women in Ejagham community of the Southwest region of Cameroon. The study focuses on effects revealed during the research, including voices of the women who had undergone FGM/C, excisors recount, violence against women physical, psychological, social, and sexual effects. In traditional African societies, cultural values should be upheld with dignity to humankind. Our traditional practices too, need to give honour to our bodies. Therefore, opinions from different groups within the Ejagham community are revealed in the discussion. More so, the study also found out that FGM/C was a practice performed on the girls and women on the cultural and traditional beliefs that the process signifies a rite of passage from girl to womanhood. The process caused pain and violated the right of the young girls. The findings revealed that there are divided opinions on FGM/C within the community. Custodians of the Ejagham tradition that are in favour of the practice are conflicting with those who are against the practice on medical and human right justifications. These different platforms play a prominent role in the various perceptions held by the people. A significant segment of the Ejagham community, together with some representatives of the international community, NGOs and the government of Cameroon are involved in efforts to bring about change in the community by eliminating the tradition through community-based awareness programs. These programs that are accessible by everybody has empowered people in the community with knowledge on the subject and provided the necessary resources that will help in eliminating the practice. The efforts have initiated a changing climate in the community; however, this does not yet mean that the tradition has been abolished. The paper shall also discuss the traditional and cultural reasons for the practice of FGM in Cameroon. The author will state International instruments, Conventions, the National laws, Action plan that is to eliminate or lead to the abandonment of FGM practices in Cameroon. The paper will conclude with suitable suggestions to eradicate the practice of FGM/C, which is against Human Rights. Keywords: Female Genital Mutilation/Cutting, Human Rights, Ejagham, Community, Cameroon

Female Genital Mutilation is a heinous crime committed against women and often goes unreported. It is commonly a practice that involves cutting, pricking, removing, and sometimes sewing up external female genitalia for non-medical reasons. It is described as gender-based violence and is most common globally. This practice is based on illogical and irrational justification and hence it is the need of the hour to eradicate the menace by bringing beneficial legislation in India. This paper is aimed at developing a holistic approach on the part of not only the political heads of the nation but it makes a humble attempt to imbibe a sense of belongingness as a whole., {"references":["India's dark Secret: Female Genital Mutilation, Oct. 2020, 22, 9:30 pm. https://you. Tube/MKXXVilKCwc, Female Genital Mutilation- an international legal perspective, International Bar Association the voice of legal profession, Oct. 2020, 22, 10:30 pm www.ibanet.org Vol.3, Kalita Mallika, A case study on the victims of Domestic violence in Assam with special reference to Educated Women, E-ISSN No: 2454-9916, Issue:5, May 2017, Oct. 2020, 22, 11:40 pm https://www.academia.edu It is the procedure that involves partial or complete removal of the external female genitalia another injuryury to the female genital organs for cultural or non-medical reasons. FGM and the Law Around the World, 19th June 2019, Oct. 2020, 22, 1:30 am. https://www.unfpa.org/resources/female-genital-mutilation-fgm, The Law and the FGM, An overview of 28 African Countries, September 2018, Thomson Reuters Foundation This means a partial or total removal of the clitoris and in rarest of rare cases only the prepuce. It is the partial or total removal of the clitoris and the labia minora, (the inner folds of the vulva) with or without excision of the labia majora (the outer folds of skin of the vulva). It means narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositing the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoris. Id Supra note 4 -\"These Countries include Benin, Burkino Faso, Central African Republic, Chad, Cote d' Ivoire, Democratic Republic of Congo, Djibouti, Egypt, Ethiopia, Eritrea, Gambia, Ghana, Guinea, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Tago, Zambia and Uganda\". FGM And the Law Around the World- Equality Now, Oct. 2020, 30, 8:30 pm https://www.equalitynow.org African Countries urged to toughen laws on female genital mutilation- Reuters, Nov. 2020, 01, 7:15 pm. https://www.reuters.com Ebah Emmanuel, Female Genital Mutilation (FGM): A Deadly Degrading Painful Practice, Divine Spark Publication, ASIN:BO16QYF6SE, 30th No, 2015 The Act states that any person found guilty of an offense under this Act shall be liable to a maximum penalty of a fine or imprisonment up to fourteen years or both. Female Genital Mutilation legislation in UK, Bawso, Nov. 2020, 01, 9:30 pm. https://bawso.org.uk>uploads Female Genital Mutilation- RANZCOG, Nov. 2020, 01, 12:00 am. https://www.ranzcog.edu.au> Supra note 14 Legislation on Female Genital Mutilation in the United States, Nov. 2020, 03, 5:15 pm. https://www.reproductiverights.org> India's Darkk Secret: Female Genital Mutilation, Hindustan Times Supra note 9 Supra note 4 Anuj Garg V Hotel Association of India and Others, 6 De, 2007 Supreme Court questions practice of female genital mutilation- Times of India, Nov. 2020, 03, 6:45 pm. https://m.timesofindia.com/India/supreme-court-questions-practice-of-female-genital-mutilation/amp Id -\"The short-term health effects are excessive bleeding, swelling and inflammation in the genital area, infection, urinary problems and in some extreme cases, even death. The long-term consequences include chronic genital infection, recurring urinary tract infection, painful sexual intercourse, complications during pregnancy, labor and delivery of the child, perinatal risks and debilitating psychological effects like post-traumatic stress disorder and depression\"."]}

According to each society’s condition the ethical attitude of the individual may be colored by the attitude of the society. It is therefore not surprising to find what is ethical in one society might not be ethical in another. Female Genital Cutting, as an example, is seen in some societies as a must and something good for the whole community in general and for girls in particular, while in others, it is seen as mutilation and violation of human rights. The practice of female genital cutting is a complex issue that ties the traditional gender roles, superstition, local concepts on health and sexuality, as well as several other social relations. Worldwide, an estimated 130 million girls and women have undergone FGC. The current paper examines medicalization of female genital cutting from ethical point of view. The paper discusses the issue in the following themes: definition of the practice, the justifications of the practice, the complications and lastly the ethical reflections. The paper argues that laws that prohibit the practice would not work, without wide socio-cultural change; any effort to eradicate the practice would not succeed De acuerdo a las condiciones sociales la actitud ética del individuo puede ser matizada por la actitud de la sociedad. Por lo tanto no es sorprendente encontrar, que algo que es ético en una sociedad no lo sea para otra sociedad. La mutilación genital femenina, es un ejemplo de esto, ésta mutilación es vista en algunas sociedades como lo debido y algo bueno para toda la comunidad en general y para las niñas en particular; mientras que en otras sociedades, esto es visto como mutilación y violación de los derechos humanos. Esta práctica, es un aspecto complejo que ata los roles tradicionales de género, la superstición, los conceptos locales en cuanto a sexualidad, salud, así como otras relaciones sociales. En el mundo se tiene un estimado de 130 millones de niñas y mujeres que han sido sometidas a la mutilación genital femenina (FGC) El presente artículo examina la medicalización de ésta práctica, desde un punto de vista ético. Este documento discute el tópico en los siguientes temas : definición de la práctica, justificación de la misma, sus complicaciones y finalmente las reflexiones éticas. Este artículo argumenta que las leyes que prohiben esta práctica no funcionarían sin un amplio cambio sociocultural; cualquier esfuerzo para erradicar dicha práctica no será exitoso

Razvijanje odgovora na genitalno sakaćenje žena i djevojčica te implementacija predmetnih propisa složen su izazov koji ima multikulturalni kontekst. Riječ je o osobito osjetljivom problemu u kojem su kulturna obilježja kontroverzna i stoje na putu već prihvaćenim standardima ljudskih prava. Kritički osvrti na ovu pojavu uključuju i interpretacije genitalnog sakaćenja kao sredstva društvene kontrole nad ženama u društvima koja su izrazito patrijarhalna i patrilinearna. Predmet ovog rada jesu pojavni oblici, etiološki razlozi, medicinske i psihološke posljedice za žrtvu te pravna regulacija sakaćenja ženskih spolnih organa u svijetu i u Republici Hrvatskoj. Aktualnost problematici priskrbile su dvije činjenice: da je Kaznenim zakonom uvedena zabrana genitalnog sakaćenja kroz novo kazneno djelo te da nije bilo radova na ovu temu u hrvatskoj kaznenopravnoj literaturi. U tu se svrhu istražuje kategorizacija radnji obavljanja genitalnog sakaćenja, navode dosad uočene medicinske posljedice ovakve prakse, izlažu predmetne kaznenopravne regulacije mnogih zemalja u svijetu te na kraju raspravlja o prikladnom odgovoru na ovaj fenomen unutar hrvatskog Kaznenog zakona i predlažu promjene glede postojeće inkriminacije., Evoking a response to genital mutilation on women and girls and implementing applicable laws and regulations are complex challenges with a multicultural background. It is a particularly sensitive issue with controversial cultural features standing in the way to existing human rights standards. Critical reviews of this phenomenon refer to interpretation of female genital mutilation as a means of social control over women in societies that are highly patriarchal and patrilineal. The paper deals with manifestations, etiology, medical and psychological consequences for the victims as well as with legal regulations of female genital mutilation worldwide and in the Republic of Croatia. There are two facts that contributed to the contemporariness of the issue: firstly, the Criminal Code has introduced a definition of a new criminal offense to prohibit female genital mutilation and secondly, the fact that Croatian criminal legal theory has not dealt with this topic so far. For this purpose, the paper researches on categorization of genital mutilation act, states medical consequences of such practices, presents regulations within criminal law in different countries, and in the end discusses the appropriate response to this phenomenon in the Croatian Criminal Code as well as suggests changes regarding existing incrimination., Die Schaffung rechtlicher Antworten auf die Verstümmelung von Geschlechtsorganen der Frauen und Mädchen und die Anwendung von betreffenden Vorschriften stellen eine komplexe Herausforderung mit einem multikulturellen Kontext dar. Es handelt sich um ein besonders empfindliches Problem mit kontroversen kulturellen Merkamalen, die im Wege der Implementation von längst angenommenen menschenrechtlichen Normen und Standards stehen. Kritischer Rückblick auf diese Erscheinung beeinschließt auch eine Interpretation der Verstümmelung von weiblichen Geschlechtsorganen als Mittel der Gesellschaftskontrolle über die Frauen in den ausdrücklich patriarchalen und patrilinearen Gesellschaften. Gegenstand der Untersuchung in dieser Arbeit stellen die Erscheinungsformen, ethiologische Gründe, medizinische und psychologische Folgen für die Opfer und die rechtliche Regelung der Verstümmelung von weiblichen Geschlechtsorganen in der Welt und in der Republik Kroatien. Die Aktualität dieser Problematik ist zweien Tatsachen zu verdanken: dass das Verbot der Verstümmelung von Geschlechtsorganen als eine neue Stratfat durch das Strafgesetz eingeführt wurde, und dass bis jetzt keine Arbeiten zu diesem Thema in kroatischer strafrechtlicher Literatur veröffentlicht wurden. Zum oben angführten Zweck wird die Kategorisierung der Verstümmelung von Geschlechtsorganen untersucht, die bis jetzt beobachteten medizinischen Folgen dieser Praxis angeführt, die betreffende strafrechtliche Regelung in vielen Ländern der Welt dargestellt, und schließlich die Angemessenheit der Antworten auf dieses Phänomen im kroatischen Strafgesetz erörtert und Änderungen bezüglich der vorhandenen Inkriminierung vorgeschlagen.

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.

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

Purpose of Review Based on the discussions of a symposium co-organized by the Université Libre de Bruxelles (ULB) and the University of Lausanne (UNIL) in Brussels in 2019, this paper critically reflects upon the zero-tolerance strategy on “Female Genital Mutilation” (FGM) and its socio-political, legal and moral repercussions. We ask whether the strategy is effective given the empirical challenges highlighted during the symposium, and also whether it is credible. Recent Findings The anti-FGM zero-tolerance policy, first launched in 2003, aims to eliminate all types of “female genital mutilation” worldwide. The FGM definition of the World Health Organization condemns all forms of genital cutting (FGC) on the basis that they are harmful and degrading to women and infringe upon their rights to physical integrity. Yet, the zero-tolerance policy only applies to traditional and customary forms of genital cutting and not to cosmetic alterations of the female genitalia. Recent publications have shown that various popular forms of cosmetic genital surgery remove the same tissue as some forms of “FGM”. In response to the zero-tolerance policy, national laws banning traditional forms of FGC are enforced and increasingly scrutinize the performance of FGC as well as non-invasive rituals that are culturally meaningful to migrants. At the same time, cosmetic procedures such as labiaplasty have become more popular than ever before and are increasingly performed on adolescents. Summary This review shows that the socio-legal and ethical inconsistencies between “FGM” and cosmetic genital modification pose concrete dilemmas for professionals in the field that need to be addressed and researched., info:eu-repo/semantics/published

Okaleczanie żeńskich genitaliów (ang. female genital mutilation, FGM) to zbiorcze określenie dotyczące praktyk usuwania lub uszkadzania w inny sposób niektórych lub wszystkich zewnętrznych narządów płciowych kobiet. Praktyki tego typu są w części społeczności przeprowadzane powszechnie na dziewczynkach poniżej piętnastego roku życia, pomimo istnienia przeciwskazań medycznych. Obrzezanie chłopców jest w wielu aspektach podobne do okaleczania żeńskich genitaliów : osoby poddawane najczęściej tym zabiegom są bardzo młode, można również wskazać na pewne podobieństwa dotyczące symboliki tych procedur. Ponadto, obrzezanie chłopców również niesie za sobą ryzyko krzywdy, zwłaszcza w wypadku ewentualnych błędów medycznych przy jego wykonywaniu. FGM jest w zachodnim świecie zwalczane, obrzezanie chłopców - dopuszczane. W tekście rozważane jest, czy dopuszczalne byłoby podejście kompromisowe do kwestii FGM, w postaci tzw. kompromisu z Seattle. Female genital cutting includes procedures which remove or cause injury to some or all women’s external genital organs. There are a lot of medical risks involved with many of its forms - nevertheless, in some societies it is mainstream practice, carried out mostly on girls younger than fifteen years of age. There are some similarities between female genital cutting and male circumcision : young age of people who are being subjected to those procedures, and - to some extend - symbolic meaning and risk of harm. Female genital cutting is strictly banned in Western countries, while male circumcision is accepted. It indicates on how biased the Western view is when it comes to evaluating the practice of male circumcision. In this paper, it is considered if it would be acceptable to make compromise in the case of female genital cutting in the form of so-called Seattle compromise. There are convincing arguments to stop those practices altogether, no matter what sex children are, but it needs to be taken into consideration that change will not happen overnight. This is why the situation calls for a compromise solution. When we consider medically unnecessary genital cutting, same standards should be applied to minor cases of FGC as well as to male circumcision. At the same time it needs to be assured that all pro- cedures which result in negative medical consequences or in a serious risk of such are completely banned.

Research Question (RQ): FGM represents a global concern as 63 million more girls could be subjected to FGM by 2050. It is a deeply embedded cultural tradition that holds a symbolic meaning in numerous communities and is practiced in rural and urban areas. Purpose: The objective of this paper was to review the current literature on female genital mutilation consequences, to describe and critically assess the theoretical and methodological approaches to treatment options and to describe and assess different methods that aim to stop or reduce the continuation od FGM. Method: We carried out a literature review of articles published in the last 10 years. Included articles studied consequences following FGM, treatment options and different methods to stop or reduce the continuation of FGM. Literature search was conducted on the following databases PubMed, PEDro, Cochrane database, CINAHL and Medline. Results: Globally the prevalence is declining, as many actions from legal to community based programmes are being proposed. There are many known consequences that can be divided in to two groups: short and long term. Treatment options are t well documented in the literature, but published studies are of poor quality. Nevertheless there are many treatment options and guidelines on how to treat women with FGM. Organization: Health care professional should be well informed and sensitive to properly treat women with FGM. They should also inform women about possible consequences and legal aspects. Society: Society should be informed about this procedure and should encourage open communication within the society, especially between men and women. Originality: This article offers a new and recent prospective of FGM, consequences and treatment options as well as what we can do to stop this practice. Limitations / further research: Limitations of this review include the risk of bias, because it is not possible to identify and retrieve all studies. Future research should be of better quality and should focus especially on treatment options.

The Republic of Serbia has ratified the Council of Europe Convention on preventing and combating violence against women and domestic violence (Istanbul Convention). As a result, the female genital mutilation offence was entered into the Criminal Code of the Republic of Serbia in 2016 by way of accepting the obligations thereof. In this paper, the author analyzes the characteristics of the said criminal offence and points to certain weaknesses, with the aim of improving the existing regulations.

The age-old tradition of Female Genital Cutting (FGC), most commonly known as Female Genital Mutilation (FGM), is a coming-of-age ritual practiced in some countries in Africa, the Middle East, Asia, and Latin America. It is also practiced in the immigrant communities that migrate from these regions to Western countries. There are a multitude of physical and mental health issues associated with FGC, including chronic infections, infertility, anxiety and depression, complications during childbirth, and death. In 1985, the United Kingdom criminalized the practice of FGC in order to eliminate it. However, evidence suggests that criminalization has been ineffective and that immigrant communities continue to practice FGC without proper medical training and equipment. This paper proposes that replacing criminalization with harm reduction programs will allow policy makers to obtain accurate data on FGC in the UK in order to inform the development of future programs that will ultimately eradicate the practice., Columbia Social Work Review, Vol 13 No 1 (2015)

PurposeThe overall goal of the Saleema Initiative in Sudan is to promote long-term abandonment of female genital mutilation and cutting (FGM) through a contribution to changing social norms, attitudes, and intentions related to the practice. The initiative aims to create positive cultural associations with a girl remaining uncut, a new social norm. Saleema hypothesizes that branding the alternative to FGM (abandonment) will promote social norms change. In 2014, the lead author designed a monitoring and evaluation framework for Saleema in partnership with UNICEF, the National Council for Child Welfare (NCCW), and local organizations.MethodsThe Saleema evaluation aimed to evaluate the effectiveness of the campaign in reducing pro-FGM social norms. A quasi-experimental design controlled for dosage of campaign messages delivered across the 18 states in Sudan to measure a dose-response effect. We operationalized social norms through a 4-item scale validated in previous research.ResultsThis paper reports on quantitative evaluation findings based on data gathered in from 2015-2017 and focuses on the dose-response relationship between Saleema exposure and changes in FGM social norms. We found that self-reported exposure was associated with reduced pro-FGM social norms (coeff. = -0.329, p < .001). Additionally, higher doses of Saleema, measured through an exogenous measure of campaign event exposure from an independent monitoring system was associated with reduced pro-FGM social norms (coeff. = -0.146, p < .001).ConclusionsSaleema was effective in reducing pro-FGM social norms. It is a promising strategy and findings contribute to the growing literature on social norms approaches to behavior change.

Trabajo fin de grado en Enfermería, Introducción: La mutilación genital femenina es todo procedimiento que, de forma intencional y por motivos no médicos, altera o lesiona los órganos genitales femeninos. No tiene ningún beneficio, pero si muchas posibles complicaciones a corto, medio y largo plazo, cuya gravedad depende del tipo de mutilación practicada afectando tanto al nivel físico como psicosocial de las mujeres y niñas que la sufren. Su prevalencia, trayectoria histórica y legislación son importantes aspectos a conocer. Objetivo: Analizar el papel de la enfermera en la detección y tratamiento de la mutilación genital femenina. Metodología: Revisión narrativa llevada a cabo tras realizar búsquedas tanto en las bases de datos de ciencias de la salud Pubmed, Scielo, Cuiden, Cinahl, Cochrane Plus, Dialnet y Enferteca, como en las instituciones gubernamentales y no gubernamentales desde el año 2014 al 2019. Resultados: Se seleccionaron 25 artículos y 5 documentos institucionales que recogían información acerca del ritual, razones que sustentan la práctica tanto de la población general como del personal sanitario que la realiza, factores de riesgo que entran en juego, nivel competencial de las enfermeras españolas y líneas de intervención recomendadas. Conclusiones: La enfermera cuenta con una posición privilegiada para ser parte fundamental del problema, pero para ello se precisa de un nivel de competencia con el que no cuenta actualmente. Es necesaria la formación que permita a este colectivo empoderarse para poder empoderar a todas las mujeres y niñas sobre las que recae el peso de esta práctica tan cruel e injusta que se sustenta sobre la defensa de la tradición por el mero hecho de serlo y sobre una estructura social que tan solo tiene en cuenta el valor reproductivo de la mujer y que por tanto controla todas sus otras esferas de desarrollo., Introduction: Female genital mutilation includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. It has no health benefits, but so many complications in the short, medium and long term, whose severity depends on the type of mutilation performed afecting both the physical and psychosocial level of the women and girls who suffer it. Its prevalence and its historycal and legislative trajectories are important issues to know. Objetive: Analyzing nurses’ role in the detection and treatment of female genital mutilation. Methodology: Narrative research carried out by looking on both health science data bases Pubmed, Scielo, Cuiden, Cinahl, Cochrane Plus, Dialnet and Enferteca, as well as governmental and non-governmental institutions since 2014 to 2019. Results: 25 articles and 5 institutional papers were selected which contained information about the ritual, reasons to support it by population and health care practitioners, associated risk factors, competence level of Spanish nurses and recommended lines of intervention. Conclusions: Nurses have a priviledged position to be a fundamental part of the problem, but this requires a competence level that they do not have currently. Training is necessary to enable this colective group to empower itself to be able to empower all of these women and girls who bear the burden of this cruel and unfair practice, that is based on the defense of the tradition by the mere fact of being it and on a social structure that only takes into account the reproductive value of women and, therefore, controls all them other areas of development.

BackgroundThe 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.MethodsIn 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.ResultsWe 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%).ConclusionsSwedish 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.

Introduction\ud \ud As a result of global migration, health professionals in destination countries are increasingly being called upon to provide care for women and girls who have experienced female genital mutilation/cutting (FGM/C). There is considerable evidence to suggest that their care experiences are sub-optimal. This systematic review sought to illuminate possible reasons for this by exploring the views, experiences, barriers and facilitators to providing FGM-related healthcare in high income countries, from health professionals’ perspectives.\ud \ud \ud \ud Methods\ud \ud Sixteen electronic databases/resources were searched from inception to December 2017, supplemented by reference list searching and suggestions from experts. Inclusion criteria were: qualitative studies (including grey literature) of any design, any cadre of health worker, from OECD countries, of any date and any language. Two reviewers undertook screening, selection, quality appraisal and data extraction using tools from the Joanna Briggs Institute (JBI). Synthesis involved an inductive thematic approach to identify descriptive themes and interpret these into higher order analytical constructs. Confidence in the review findings was assessed using GRADE-CERQual. The review protocol was registered with PROSPERO (CRD420150300042015).\ud \ud \ud \ud Results\ud \ud Thirty papers (representing 28 distinct studies) from nine different countries were included. The majority of studies focused on maternity contexts. No studies specifically examined health professionals’ role in FGM/C prevention/safeguarding. There were 20 descriptive themes summarised into six analytical themes that highlighted factors perceived to influence care: knowledge and training, communication, cultural (mis)understandings, identification of FGM/C, clinical management practices and service configuration. Together, these inter-linked themes illuminate the ways in which confidence, communication and competence at provider level and the existence and enactment of pathways, protocols and specialist support at service/system level facilitate or hinder care.\ud \ud \ud \ud Conclusions\ud \ud FGM/C is a complex and culturally shaped phenomenon. In order to work effectively across cultural divides, there is a need for provider training, clear guidelines, care pathways and specialist FGM/C centres to support mainstream services.

Female genital mutilation (FGM) is a cultural practice common in many Islamic societies. It involves the deliberate, non-therapeutic physical modification of young girls’ genitalia. FGM can take several forms, ranging from less damaging incisions to actual removal of genitalia and narrowing or even closing of the vagina. While often thought to be required by religion, FGM both predates and has no basis in the Koran. Rather, it is a cultural tradition, motivated by a patriarchal social desire to control female bodies to ensure virginity at marriage (preserving family honour), and to prevent infidelity by limiting sexual desire. In the USA and Australia in 2010, peak medical bodies considered endorsing the medical administration of a ‘lesser’ form of FGM. The basis for this was pragmatic: it would be preferable to satisfy patients’ desire for FGM in medically-controlled conditions, rather than have these patients seek it, possibly in more severe forms, under less safe conditions. While arguments favouring medically-administered FGM were soon overcome, the prospect of endorsing FGM illuminated the issue in these two Western countries and beyond. This paper will review the nature of FGM, its physical and psychological health consequences, and Australian laws prohibiting FGM. Then, it will scan recent developments in Africa, where FGM has been made illegal by a growing number of nations and by the Protocol to the African Charter on Human and Peoples’ Rights 2003 (the Maputo Protocol), but is still proving difficult to eradicate. Finally, based on arguments derived from theories of rights, health evidence, and the historical and religious contexts, this paper will ask whether an absolute human right against FGM can be developed.

There is inadequate information on the practice of female genital mutilation (FGM) in the UK, and there are often myths and perceptions within communities that influence the effectiveness of prevention programmes. This means it is difficult to address the trends and changes in the practice in the UK. To this end, FORWARD undertook novel and innovative research using the Participatory Ethnographic and Evaluative Research (PEER) method to explore the views of women from Eritrea, Sudan, Somalia and Ethiopia that live in London and Bristol (two UK cities). Women-s views, taken from PEER interviews, reflected reasons for continued practice of FGM: marriageability, the harnessing and control of female sexuality, and upholding traditions from their countries of origin. It was also clear that the main supporters of the practice were believed to be older women within families and communities. Women described the impact FGM was having on their lives as isolating. And although it was clearly considered a private and personal matter, they developed a real sense of connection with their peers within the research process. The women were overwhelmingly positive about combating the practice, although they believed it would probably take a while before it ends completely. They also made concrete recommendations on how to improve support services for women affected by FGM: Training for professionals (particularly in healthcare), increased engagement with, and outreach to, communities, culturally appropriate materials and information made available and accessible to communities, and more consequent implementation of legislation. Finally, the women asked for more empathy and understanding, particularly from health professionals. Rather than presenting FGM as a completely alien and inconceivable practice, it may help for those looking into these women-s lives and working with them to understand the social and economic context in which the practice takes place., {"references":["E. Dorkenoo, L. Morison, and A. MacFarlane. A Statistical Study to\nEstimate the Prevalence of Female Genital Mutilation in England and\nWales. FORWARD in collaboration with London School of Hygiene and\nTropical Medicine and the Department of Midwifery at City University.\n2007. Funded by the UK Department of Health.","Eliminating","WHO, UNICEF, UNAIDS, UNIFEM and others. Female genital\nmutilation: An interagency statement. 2008. Available at\nhttp://www.who.int/reproductivehealth/\npublications/fgm/fgm_statement_2008.pdf.","S. Johnsdotter. Female Genital Cutting among immigrants in European\ncountries: Are risk estimations reasonable? Conference Paper. 2004.","S. Johnsdotter & B. Essén. Sexual Health among Young Somali Women\nin Sweden: Living With Conflicting Culturally Determined Sexual\nIdeologies. 2004.","N. Price & K. Hawkins. Researching sexual and reproductive behaviour:\na peer ethnographic approach. Social Science & Medicine. 2002. 55:\n1325-1336.","Chapter 1 of the ÔÇÿWestminster Primary Care Trust Public Health Annual\nReport 2004/2005- which can be found at http://www.westminsterpct.\nnhs.uk/pdfs/phar0405_chapter1.pdf.","http://www.bristol.gov.uk/ccm/navigation/council-anddemocracy/\nstatistics-and-census-information/.","Ismail L & Home A. Waiting for the Sun to Rise. An introductory paper\nexamining the health effects and social implications of khat use for\nBristol-s Somali community. Research commissioned by Bristol-s\nÔÇÿCommunity at Heart-. 2005. Available at\nhttp://www.bristol.gov.uk/ccm/cmsservice/\nstream/asset/?asset_id=29371083."]}

According to each society's condition the ethical attitude of the individual may be colored by the attitude of the society. It is therefore not surprising to find what is ethical in one society might not be ethical in another. Female Genital Cutting, as an example, is seen in some societies as a must and something good for the whole community in general and for girls in particular, while in others, it is seen as mutilation and violation of human rights. The practice of female genital cutting is a complex issue that ties the traditional gender roles, superstition, local concepts on health and sexuality, as well as several other social relations. Worldwide, an estimated 130 million girls and women have undergone FGC. The current paper examines medicalization of female genital cutting from ethical point of view. The paper discusses the issue in the following themes: definition of the practice, the justifications of the practice, the complications and lastly the ethical reflections. The paper argues that laws that prohibit the practice would not work, without wide socio-cultural change; any effort to eradicate the practice would not succeed. De acuerdo a las condiciones sociales la actitud ética del individuo puede ser matizada por la actitud de la sociedad. Por lo tanto no es sorprendente encontrar, que algo que es ético en una sociedad no lo sea para otra sociedad. La mutilación genital femenina, es un ejemplo de esto, ésta mutilación es vista en algunas sociedades como lo debido y algo bueno para toda la comunidad en general y para las niñas en particular; mientras que en otras sociedades, esto es visto como mutilación y violación de los derechos humanos. Esta práctica, es un aspecto complejo que ata los roles tradicionales de género, la superstición, los conceptos locales en cuanto a sexualidad, salud, así como otras relaciones sociales. En el mundo se tiene un estimado de 130 millones de niñas y mujeres que han sido sometidas a la mutilación genital femenina (FGC) El presente artículo examina la medicalización de ésta práctica, desde un punto de vista ético. Este documento discute el tópico en los siguientes temas : definición de la práctica, justificación de la misma, sus complicaciones y finalmente las reflexiones éticas. Este artículo argumenta que las leyes que prohiben esta práctica no funcionarían sin un amplio cambio sociocultural; cualquier esfuerzo para erradicar dicha práctica no será exitoso.

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.

© 2020 The Author(s) Female genital mutilation/cutting FGM/C is the process of removing part or all of the female external genitalia. Twenty-nine countries are known to be FGM/C prevalent. The prevalent countries are mostly in Sub Saharan Africa, Middle East, and Asia. FGM/C prevalence countries have total high fertility rate (TFR), high maternal mortality ratio (MMR), low female life expectancy (LEF) and high birth rate (BR). This paper extracted the TFR, MMR, LEF, and BR of FGM/C prevalent countries from each metric's comprehensive databases. Correlation analysis was used to find links between FGM/C and the four health metrics. There is a significant negative correlation between TFR and the duo of LEF and BR, which implies that having more children reduces women's life expectancy and FGM/C prevalent countries. The average TFR, MMR, LEF and BR for the 29 countries are 4.44 children, 517.24 deaths per 10,000, 63.03 years, and 33.83 per 1000 population. Behavioral change and maternal education are recommended to change the religious and cultural view of female sexuality and reduce FGM/C prevalence.

Background Female Genital Mutilation/Cutting (FGM/C) is a harmful practice that violates the human rights of women and girls. Despite global efforts to restrict the practice, there have been few reports on major positive changes to the problem. Health education interventions have been successful in preventing various health conditions and promoting service use. They have also been regarded as promising interventions for preventing FGM/C. The objective of this systematic review is to synthesise findings of studies about effectiveness of health education as an intervention to prevent FGM/C. Methods The electronic databases searched were MEDLINE, EMBASE, Cochrane library, Web of Science, Psych INFO, CINAHL and ASSIA. Our search included papers published in the English language without date limits. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). A predesigned data recording form was used to extract data from the included studies which were summarised by comparing similar themes. Results Twelve out of 359 individual studies met our inclusion criteria. Seven studies were quantitative, three were qualitative and two used mixed methods. Six studies tested before and after the interventions, four studies assessed the effectiveness of previous interventions used by different research teams and two studies endorsed the intervention. Four main factors emerged and were associated with facilitating or hindering the effectiveness of health education interventions: sociodemographic factors; socioeconomic factors; traditions and beliefs; and intervention strategy, structure and delivery. Conclusions It is vital to target factors associated with facilitating or hindering the effectiveness of health education for FGM/C. This increases the possibility of effective, collective change in behaviour and attitude which leads to the sustainable prevention of FGM/C and ultimately the improved reproductive health and well-being of individuals and communities. Electronic supplementary material The online version of this article (10.1186/s12978-018-0503-x) contains supplementary material, which is available to authorized users.

Two hundred million girls and women in the world are estimated to have undergone female genital mutilation (FGM), and another 15 million girls are at risk of experiencing it by 2020 in high prevalence countries (UNICEF, 2016. Female genital mutilation/cutting: a global concern. 2016). Despite decades of concerted efforts to eradicate or abandon the practice, and the increased need for clear guidance on the treatment and care of women who have undergone FGM, present efforts have not yet been able to effectively curb the number of women and girls subjected to this practice (UNICEF. Female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change. 2013), nor are they sufficient to respond to health needs of millions of women and girls living with FGM. International efforts to address FGM have thus far focused primarily on preventing the practice, with less attention to treating associated health complications, caring for survivors, and engaging health care providers as key stakeholders. Recognizing this imperative, WHO developed guidelines on management of health complications of FGM. In this paper, based on foundational research for the development of WHO’s guidelines, we situate the practice of FGM as a rights violation in the context of international and national policy and efforts, and explore the role of health providers in upholding health-related human rights of women at girls who are survivors, or who are at risk. Findings are based on a literature review of relevant international human rights treaties and UN Treaty Monitoring Bodies.

This paper critically investigates the criminalization of female genital mutilation/cutting (FGM/C) in Red Sea, a state with one of the highest prevalence rates of FGM/C in Sudan (where 89% of females have undergone the procedure). Infibulation, also called “pharaonic circumcision” or “kushabi,” is the most severe type of FGM/C is widely practiced in Red Sea, especially among conservative tribal groups such as the Beja tribe and its subgroups Hadendawa and Beni Amer. These tribal groups played a key role in keeping criminalization of FGM/C out of the Red Sea State Child Act of 2007. Although the act was revised in 2011 to address FGM/C, it does so only weakly and does not clearly prohibit the most severe types of FGM/C. In essence, conservative political forces in Red Sea have been able to shape the legislative process.

The present paper focuses on the tradition of women’s circumsicion in the African tribe of Olinkan in Alice Walker’s Possesing the Secret of Joy. The Olinkans are asked by the white settlers to stop women’s mutilation, but Olinkan men continue this custom stealthily to ensure their patriarchial dominance. This novel is a complicated juxtaposition of two different types of oppression: one by White male colonizers over an African native land, and the other one by the native Olinkan men over native women. In this juxtaposition women and land are both victims exploited and manipulated by men, no matter Black or White. This novel is also seen as a fertile ground to analyze the dual domination of both nature and women by the Olinkan men and White colonizers who are both trying to impose their androcentric rules that are created to dominate women and land, respectively.

Female genital mutilation (FGM) refers to all procedures involving removing parts or all of the external female genitalia for non-medical reasons. As a result of migration and asylum seeking from conflict and wars, FGM has become a transnational issue, affecting more than 200 million girls and women worldwide. It is a form of gender-based violence, a health and policy issue, and violates many human rights laws. FGM has serious physical, psychological, sexual, and reproductive consequences to girls and women. As FGM has a complex socio-cultural imperative, an understanding of the driving forces of this harmful practice is key to helping communities abandon it and to providing education to all stakeholders involved from the level of the community, to healthcare professionals, teachers, civil rights, law and policy makers, migration and law enforcement organisations. FGM is on the decline, and many communities do want it to end. Addressing the human rights priorities of communities and providing them power over their own development processes are key to helping them abandon this practice. In this thesis, I address two questions. The first one is, “How do we strengthen the response of the healthcare system in Australia to best care for women and girls with FGM?” The second one is, “Focusing on the socio-cultural imperatives of FGM, how could we change our path in the global abandonment program to help communities stop this harmful practice?” My review of the literature on this topic has shown that two of the main reasons that FGM continues to be practised are pressure of social obligation in communities and lack of discourse in the public arena between men and women. In the first systematic review conducted on the topic I have highlighted the ambiguity of men’s wishes in regards to the continuation of FGM. In general, men wished to abandon it because of the physical and psychosexual complications to both women and men. Education of men was found to be the most important indicator for men’s support for abandonment. Australia is home to many women and girls from countries where FGM is practised. My thesis shows that two to three percent of women, who gave birth in a metropolitan Australian hospital, had FGM. This is the first available data on prevalence of women with FGM in Australia. My analysis also showed that women who received specialised FGM care had similar obstetric and neonatal outcomes to women without FGM. An extension of such services would further alleviate the burden among affected women and reduce healthcare costs for the Government. Accurate data collection on prevalence and complications of FGM is needed in Australia to appropriately allocate funding and develop such services. The literature and my thesis provide evidence that healthcare professionals (HCP) in countries of prevalence and those of migration, including Australia, lack knowledge on and training in the management of women with FGM. Midwives expressed a lack of confidence in clinical knowledge, skills, and data collection, as well as cultural competence in caring for women with FGM. Doctors acknowledged barriers to effective care stemming from uncoordinated care, unclear professional responsibilities, and communication difficulties. There is a need for improved education and training, supportive supervision, and evidence-based best-practice clinical guidelines and policies to address knowledge gaps and provide better management of and prevention of FGM in children. Informed by the research presented in this thesis, I developed an e-learning module for HCP in Australia to improve their knowledge on the medical, cultural, legal, and advocacy aspects. The Australian Government has addressed violence against women as an important area of focus and has been implementing a 12-year National Plan to reduce violence against women and their children 2010 – 2022. In the final paper in this thesis I propose that HCP, teachers, welfare officers, child protection officers, and government and non-government organisations involved in prevention programs on FGM, need to form a network of experts within this national framework to develop, implement and evaluate national policy and guidelines on healthcare provision, protection of girls, and prevention of FGM. The abandonment process may be accelerated through a global collaboration between governments and organisations involved in FGM programs. I have been involved in the establishment of the Africa Centre for the abandonment of FGM (ACCAF) in Kenya in 2012. A similar centre is planned in the Asia Pacific region in a country of FGM prevalence, which would collaborate with ACCAF and its partners to share research and expertise. It is my hope that the research presented in this thesis will support the work of these centres and hasten the abandonment of FGM.

ObjectiveThe WHO reports that female genital mutilation/cutting (FGM/C) is an ancient cultural practice prevalent in many countries. FGM/C has been reported among women resident in Australia. Our paper provides the first description of FGM/C in Australian children.DesignCross-sectional survey conducted in April–June 2014.SettingPaediatricians and other child health specialists recruited through the Australian Paediatric Surveillance Unit were asked to report children aged ParticipantsOf 1311 eligible paediatricians/child health specialists, 1003 (76.5%) responded.ResultsTwenty-three (2.3%) respondents had seen 59 children with FGM/C and provided detailed data for 31. Most (89.7%) were identified during refugee screening and were born in Africa. Three (10.3%) were born in Australia: two had FGM/C in Australia and one in Indonesia. All parents were born overseas, mainly Africa (98.1%). Ten children had WHO FGM/C type I, five type II, five type III and six type IV. Complications in eight children included recurrent genitourinary infections, menstrual, sexual, fertility and psychological problems. Nineteen children (82.6%) were referred to obstetrics/gynaecology: 16 (69.9%) to social work and 13 (56.5%) to child protection.ConclusionsThis study confirms that FGM/C is seen in paediatric clinical practice within Australia. Paediatricians need cultural awareness, education and resources to help them identify children with FGM/C and/or at risk of FGM/C, to enable appropriate referral and counselling of children, families and communities to assist in the prevention of this practice.

Female genital mutilation (FGM) is still a common practice in many countries in Africa and the Middle East. Understanding the determinants of FGM can lead to more active interventions to prevent this harmful practice. The goal of this study is to explore factors associated with FGM behavior among Iranian mothers and their daughters. Based on Ajzen's theory of planned behavior, we examined the predictive value of attitudes, subjective norms, perceived behavioral control and several socio-demographic variables in relation to mothers' intentions to mutilate their daughters. A paper-and-pencil survey was conducted among 300 mothers (mean age = 33.20, SD = 9.09) who had at least one daughter and who lived in Ravansar, a county in Kermanshah Province in Iran. Structural equation modeling was used to investigate the relationships among the study variables. Our results indicate that attitude is the strongest predictor of mothers' intentions to allow their daughters to undergo FGM, followed by subjective norms. Compared to younger mothers, older mothers have more positive attitudes toward FGM, perceive themselves as having more control over their behavior and demonstrate a greater intention to allow their daughter to undergo FGM. Furthermore, we found that less educated mothers and mothers living in rural areas had more positive attitudes toward FGM and feel more social pressure to allow FGM. The model accounts for 93 percent of the variance in the mothers' intentions to allow their daughters to undergo FGM. Intervention programs that want to decrease FGM might focus primarily on converting mothers' neutral or positive feelings toward FGM into negative attitudes and on alleviating the perceived social pressure to mutilate one's daughter. Based on our findings, we provide recommendations about how to curtail mothers' intentions to allow their daughters to undergo FGM.

El fenómeno migratorio ha dado paso a un tipo de sociedad abierta que permite un enriquecimiento mutuo pero, a su vez, origina tensiones que surgen de la confrontación entre las costumbres y tradiciones de un pueblo y las reglas de convivencia de otra sociedad. Esta colisión se pone de manifiesto especialmente en el tema de la mutilación genital femenina, práctica que obedece a la observancia de una norma cultural en unos casos, religiosa en otros, concebida como signo de identidad, cuando no de género. En este trabajo analizamos la situación de esta realidad en nuestro país, el marco jurídico que sirve de referencia, así como las propuestas para su erradicación, teniendo en cuenta la jurisprudencia española a partir del cuestionado principio de justicia universal. Migration brings about an open type of society which allows for mutual enrichment, but, in turn, is not without tensions that arise as a result of the confrontation between the customs and traditions of a people and the rules of coexistence of another. This collision is especially evident in the subject of female genital mutilation, a practice that reflects the observance of cultural norm in some cases, and religious in other cases, which are a sign of identity or of gender. This paper studies this issue in our country, its legal frame of reference as well as proposals for its eradication, considering the Spanish case law starting from the contested principle of universal justice. Trabajo realizado en el marco del Proyecto de Investigación I+D DER2013-42261-P, del Programa Estatal de Fomento de la Investigación Científica y Técnica de Excelencia, bajo el título “Solidaridad, participación y convivencia en la diversidad”.