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Background: Owing to migration, female genital mutilation or cutting (FGM/C) has become a growing concern in host countries in which FGM/C is not familiar. There is a need for reliable estimates of FGM/C prevalence to inform medical and public health policy. We aimed to advance methodology for estimating the prevalence of FGM/C in diaspora by determining the prevalence of FGM/C among women giving birth in the Netherlands., Methods: Two methods were applied to estimate the prevalence of FGM/C in women giving birth: (I) direct estimation of FGM/C was performed through a nationwide survey of all midwifery practices in the Netherlands and (II) the extrapolation model was adopted for indirect estimation of FGM/C, by applying population-based-survey data on FGM/C in country of origin to migrant women who gave birth in 2018 in the Netherlands., Results: A nationwide survey among primary care midwifery practices that provided care for 57.5% of all deliveries in 2018 in the Netherlands, reported 523 cases of FGM/C, constituting FGM/C prevalence of 0.54%. The indirect estimation of FGM/C in an extrapolation-model resulted in an estimated prevalence of 1.55%. Possible reasons for the difference in FGM/C prevalence between direct- and indirect estimation include that the midwives were not being able to recognize, record or classify FGM/C, referral to an obstetrician before assessing FGM/C status of women and selective responding to the survey. Also, migrants might differ from people in their country of origin in terms of acculturation toward discontinuation of the practice. This may have contributed to the higher indirect-estimation of FGM/C compared to direct estimation of FGM/C., Conclusions: The current study has provided insight into direct estimation of FGM/C through a survey of midwifery practices in the Netherlands. Evidence based on midwifery practices data can be regarded as a minimum benchmark for actual prevalence among the subpopulation of women who gave birth in a given year.

Objectives: The aim of the study was (I) to estimate the prevalence of Female Genital Mutilation/Cutting (FGM/C) and distribution of types of FGM/C among migrant girls and women in the Netherlands, and (II) to estimate the number of migrant girls at risk of being cut in the immediate future., Methods: National population-based survey data regarding FGM/C prevalence were applied to female migrants in the Netherlands who migrated from 29 countries with available nationally representative data on FGM/C., Results: As of January 1st 2018, there were 95,588 female migrants residing in the Netherlands, originating from 29 countries with available nationally representative data on FGM/C. Our findings suggest that about 41,000 women had undergone FGM/C, of which 37% had Type III (infibulation). In total 4,190 girls are estimated to be at risk of FGM/C in the next 20 years, of whom 394 were first-generation girls., Conclusion: These findings show the urgency to develop appropriate strategies and policies to prevent FGM/C, to protect girls and women at risk of the practice, and to provide adequate services and support for those affected by FGM/C in the Netherlands., Competing Interests: The authors declare no competing interest. Author AM owns Middelburg Human Rights Law Consultancy, but has no financial nor other competing interest in this manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: Migration flows of women from Female Genital Mutilation/Cutting practicing countries have generated a need for data on women potentially affected by Female Genital Mutilation/Cutting. This paper presents enhanced estimates for foreign-born women and asylum seekers in Italy in 2016, with the aim of supporting resource planning and policy making, and advancing the methodological debate on estimation methods., Methods: The estimates build on the most recent methodological development in Female Genital Mutilation/Cutting direct and indirect estimation for Female Genital Mutilation/Cutting non-practicing countries. Direct estimation of prevalence was performed for 9 communities using the results of the survey FGM-Prev, held in Italy in 2016. Prevalence for communities not involved in the FGM-Prev survey was estimated using to the 'extrapolation-of-FGM/C countries prevalence data method' with corrections according to the selection hypothesis., Results: It is estimated that 60 to 80 thousand foreign-born women aged 15 and over with Female Genital Mutilation/Cutting are present in Italy in 2016. We also estimated the presence of around 11 to 13 thousand cut women aged 15 and over among asylum seekers to Italy in 2014-2016. Due to the long established presence of female migrants from some practicing communities Female Genital Mutilation/Cutting is emerging as an issue also among women aged 60 and over from selected communities. Female Genital Mutilation/Cutting is an additional source of concern for slightly more than 60% of women seeking asylum., Conclusions: Reliable estimates on Female Genital Mutilation/Cutting at country level are important for evidence-based policy making and service planning. This study suggests that indirect estimations cannot fully replace direct estimations, even if corrections for migrant socioeconomic selection can be implemented to reduce the bias.

Background: Female genital mutilation/cutting (FGM/C), is an emerging topic in Europe as a consequence of the increasing proportion of women migrating from Africa. The prevalence of FGM/C is however unknown in Europe, as there are no country-representative surveys on this topic. The aim of this study is to provide an estimate for Italy for the year 2010., Methods: This study relies on the results of the First Survey on Women at Risk of FGM/C held in Italy in 2010. This cross-sectional survey involved 1000 migrants from the main FGM/C practicing countries aged 15-49 living in the Italian region of Lombardy. The estimate presented is based on a method combining direct estimates for the communities involved in the survey and indirect estimates for other communities. Indirect estimations were obtained using a refinement of the most general extrapolation-of-country-prevalence-data method., Results: It is estimated that some 57 000 foreign girls and women aged 15-49 with FGM/C were living in Italy in 2010. The Nigerian community is the most affected, with around 20 000 women with FGM/C (35.5% of the total number women affected in Italy), followed by the Egyptian community (around 18 600 women with FGM/C; 32.5%). Another 15% of the women affected are from the Horn of Africa, notably from Ethiopia (3200 women; 5.5%), Eritrea (2800 women; 4.9%) and Somalia (2300 women; 4%)., Conclusions: This study offers an additional methodological advancement by proposing a combination of direct and indirect estimation of FGM/C. The results are crucial information to plan interventions and targeted policies., (© The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)