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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.

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 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.

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 (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.

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.

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.

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.

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.

© 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.

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.

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.

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.

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”.

Current public debate on “female genital mutilation” often renders the impression that it is possible to draw an unambiguous line between acceptable and condemnable practices of female genital cutting. In this paper, the cultural histories of cutting of the female genitalia are presented and discussed. Available historical accounts of female circumcision practices in Africa reflect Western, mainly European, ideas and ideologies at certain points in time. In a sense, these descriptions have more to say about “us” than “them”. Further, the historical descriptions of female circumcision in Africa are intertwined with time-bound notions and cutting practices in Western countries in different epochs. Through retrospective reflections, it is possible to see how current commonsensical standpoints, among them the hegemony of a “zero tolerance” attitude regarding cutting of the female genitalia among Africans, are a product of a recently introduced perspective, and also how this generally accepted perspective may render it more difficult to present multi-faceted ethnographic accounts of lived experiences today.

The terms ‘Female Circumcision’ (FC), ‘FG Cutting’ (FGC) and ‘FG Mutilation’ (FGM) refer to procedures involving the partial or total removal of the external female genitalia for non-medical reasons. In practicing countries, FGC/FC is more widely used, as it is believed to be inoffensive, providing more impartial ways of discussing the practice. Positive beliefs about FC/FGC include virginity, marriage prospects, family reputation, or passage to adulthood. Regardless of terminology, the practice exists in at least 28 African counties, and a few Asian and Middle Eastern countries. In Western society, FGM is considered a breach of human rights, being outlawed in a number of countries. With immigration trends, FGC is now prominent in Western society among practicing communities. While the past decade has seen an increase in studies and recommendations for health-care support related to the physical health consequences of FGM, little is known about the psychological impact and its management. For many girls and women, FGC is a traumatic practice, transforming it to FGM and affecting their mental health. This discussion paper focuses on evidence relating to the mental health consequences of FGM, therapeutic interventions, and the mental health nurse's role in addressing the needs of this group of women.

Background Serious forms of violence against women include Female Genital Mutilation (FGM) and Intimate Partner Violence (IPV). The aim of this study was to determine if FGM is associated with IPV, using data obtained from the Demographic and Health Survey (DHS) 2012 in Ivory Coast. Methods Participants for this study were drawn from the 2011-12 Ivory Coast Demographic and Health Survey (CDHS), a nationally representative sample of 10060 women aged 15 to 49 years. The analysis of this paper is restricted to the sample of women who responded to the FGM and domestic violence modules (N = 5005). Results The lifetime prevalence of physical violence was 24.8%, sexual violence, 5.7%, and emotional violence, 19.0%, and the prevalence of any lifetime IPV was 32.1%. In all, 40.6% reported female genital cutting or mutilation (FGM). Women reporting FGM were two times as likely to experience sexual IPV (AOR: 1.96, CI: 1.29-2.98), while other subtypes of IPV were higher in women reporting FGM but they were not significant. Of the socio-demographic covariates, urban residence and having a primary education were associated with most subtypes of IPV, while being a Muslim seemed protective from any type, sexual and emotional IPV. Having seen the father beating the mother was positively associated with most IPV subtypes, and having been diagnosed with a sexually transmitted infection (STI) in the previous 12 months was associated with physical and sexual IPV. Conclusion Significant rates of FGM and IPV were found among this sample of Ivorian women calling for the need for multiple strategies to reduce FGM and IPV.

While enormous and growing sums of money are spent each year in genital cosmetic surgeries, ritual female genital interventions increasingly meet strong political and social opposition. Which interpretative models have been adopted to define some interventions as “cosmetic” and the others as “criminal”? Is there a colonialist attitude implicit in banning ritual female genital interventions? This appear to be the case after a joint examination of the health risks associated with the breast implant, the symbolic meanings of the ritual interventions, the strategic reinvention of traditional practices, and the use of the binomy health/pathology as a “controlling process”. This paper challenges the assumption that who is exposed to the plastic surgeon’s scalpel enjoys freedom and autonomy in an oppression-free society, while who is subjected to the ritual knife is a passive victim of traditional patriarchal societies.Mientras se gastan cifras enormes y cada año crecientes en intervenciones quirúrgicas que modifican los órganos sexuales, las intervenciones rituales sobre los genitales femeninos encuentran una oposición política y social cada vez más fuerte. ¿Cuáles son los modelos interpretativos adoptados para definir como estéticas a unas y criminales a las otras? ¿Existe una actitud colonialista implícita en la condena de las intervenciones rituales sobre los genitales femeninos? Este parece ser el caso cuando se examinan conjuntamente los daños para la salud derivados del implante mamario, los significados simbólicos de las intervenciones rituales, la reinvención estratégica de las prácticas tradicionales y el uso del binomio salud/patología como “proceso de control”. Este artículo propone cuestionar la idea de que quien se somete al bisturí del cirujano plástico disfruta de libertad y autonomía en una sociedad libre de opresión, mientras que quien se expone al cuchillo ritual es víctima pasiva de las sociedades patriarcales tradicionales.

Special Series on Social Norms and Harmful Practices Female Genital Mutilation/Cutting (FGM/C) is still a widespread practice in Ethiopia, although important declines in prevalence rates can be observed in some areas of the country. Attitudes towards the practice have drastically changed, evidenced by the fact that overall support for FGM/C has declined and younger mothers are less likely than older mothers to have their daughters cut. This paper provides an analysis of the social dynamics of change in four geographic locations with different ethnic populations in Ethiopia, where interventions were undertaken to support the abandonment of FGM/C and other harmful practices. Each experience used community conversation and dialogue as a tool to promote the abandonment process, although their overall strategies and impact differed. The four experiences together provide a greater understanding of the process of change within communities and the role played by key actors within and outside the community. The study demonstrates that by addressing FGM/C within a human rights context, community members are able to consider not cutting as a possible alternative to the existing convention of cutting. The human rights perspective also encourages reflection on gender roles, generating interest and dialogue about other social practices that harm women and girls, such as marriage by abduction and early marriage.

The aim of this paper is to analyse the phenomenon of the making of reactive cultural identities in a particular and sensitive case: the female genital mutilation (FGM) in an African context. This case is framed in the debate between feminism and multiculturalism and in the controversies about the feminist transnational interventions to defend women’s human rights. Alice Walker, the Afro-American writer and activist promoted an international campaign against FGM that was strongly contested by African activists. There has been a main criticism against sensationalism in the media that reduces Africa as alterity to a barbarian and uncivilised rite. We try to analyse all this in relation to the need of promoting an intercultural feminist ethics in order to fostering the process of empowerment of local women. Contexts and means are relevant if we try, first, to eradicate cultural practices that damage women’s lives and rights and, also, to consolidate a transnational and intercultural feminism. El objetivo de este artículo, en el contexto del debate entre feminismo y multiculturalismo, es analizar el fenómeno de identidades culturales reactivas que ha operado en el caso de la interpelada práctica de la mutilación genital femenina en algunos enclaves africanos. Para ello seguiremos la peripecia de Alice Walker, la escritora y activista afroamericana, en su denuncia de esta dañina práctica cultural que atenta contra los derechos a la integridad corporal y psíquica de las mujeres. Queremos dejar de lado el sensacionalismo con que suele ser tratado en muchos medios de opinión este asunto y que contribuye a construir la alteridad de lo africano como mera barbarie y carencia de civilización. Tratamos, aquí, de analizar lo anterior en relación a la necesidad de ir construyendo una ética intercultural feminista que promueva el empoderamiento de las mujeres locales. Los contextos y los medios de intervención son relevantes para el empeño de erradicar eficazmente las prácticas culturales que violan los derechos de las mujeres al tiempo que se consolida un feminismo transnacional e intercultural.