Factors promoting and hindering the practice of female genital mutilation/cutting (FGM/C)

Abstract

Background: In November 2008, the Norwegian Knowledge Centre for Violence and Traumatic Stress Studies (NKVTS) commissioned the Norwegian Knowledge Centre for the Health Services (NOKC) to conduct a systematic review about the factors promoting and hindering female genital mutilation/cutting (FGM/C), from the viewpoints of stakeholders residing in Western countries. The review would answer the question: What are the factors promoting and hindering the practice of FGM/C, as expressed by stakeholders residing in Western countries?

Methods: We searched systematically for relevant literature in international scientific databases, in databases of international organisations that are engaged in aspects related to FGM/C, and in reference lists of relevant reviews and included studies. Additionally, we communicated with professionals working with FGM/C related issues. We selected studies according to pre-specified criteria, appraised the methodological quality using checklists, and summarized the study level results in tables before performing an integrative evidence synthesis. Our conclusions were summed in a conceptual model.

Results: We included and summarized results from 25 studies, of which 16 were qualitative investigations, eight were quantitative studies, and one was a mixed-methods study. There were three stakeholders groups: exiled members from communities where FGM/C is practiced, health workers, and government officials. The results of these stakeholders' perceptions showed that the continuance of FGM/C is largely attributable to six factors: cultural tradition, the interconnected factors sexual morals and marriageability, religion, health benefits, and male sexual enjoyment. Factors perceived as hindering its continuance included health consequences, that it is not a religious requirement, that it is illegal, and that host society discourses reject FGM/C.

Conclusion: Our results show that an intricate web of cultural, social, religious, and medical pretexts for FGM/C exists. However, more research is needed to understand the totality and interconnectedness of factors promoting and hindering FGM/C among exiled members of practicing communities.

*********************************************NORSK Bakgrunn: Kjønnslemlestelse innebærer at hele eller deler av de eksterne kvinnelige kjønnsorganene fjernes eller skades av ikke-terapeutiske grunner. Kjønnslemlestelse praktiseres i mer enn 28 land i Afrika og i noen land i Midtøsten og Asia. Det ser ut til at kjønnslemlestelse noen ganger forekommer i immigrantsamfunn i vestlige land, som Norge, Storbritannia, Sveits og Sverige. Kjønnslemlestelse fører ofte til helseplager som alvorlige smerter, blødninger, sjokk, infeksjoner og vanskeligheter ved urinering og avføring. Kjønnslemleste er anerkjent som en praksis som krenker menneskerettigheter.

Oppdrag Nasjonalt kunnskapssenter for helsetjenesten har gått systematisk gjennom forskning om faktorer som fremmer og forhindrer kjønnslemlestelse, i følge interessegrupper bosatt i vestlige land. Interessegruppene var immigranter som opprinnelig kom fra et land hvor kjønnslemlestelse praktiseres, helsepersonell og ansatte i offentlig virksomhet.

Hovedfunn Resultater av interessegruppenes synspunkter viste at det hovedsakelig var seks faktorer som fremmet og fire faktorer som forhindret kjønnslemlestelse:

* Faktorer som fremmet kjønnslemlestelse var kulturell tradisjon, seksuell moral, gifteverdi, religion, helsegevinst og seksuell nytelse for menn * Faktorer som forhindret kjønnslemlestelse var helsefarer, at kjønnslemlestelse ikke er et religiøst krav, at det er lovstridig og at diskusjonen om kjønnslemlestelse i vestlige land er negativ overfor denne praksisen * Det er behov for ytterligere forskning for å forstå helheten og hvordan faktorer som underbygger hverandre er innbyrdes forbundet