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Female genital mutilation in Sierra Leone: who are the decision makers?

Afr J Reprod Health. 2012 Dec;16(4):119-31.FREE

Female genital mutilation in Sierra Leone: who are the decision makers?

Bjälkander O, Leigh B, Harman G, Bergström S, Almroth L.

Division of Global Health, Department of Public Health, Karolinska Institute, Stockholm, Sweden. owolabi.bjalkander@ki.se

ABSTRACT

The objectives of this study were to identify decision makers for FGM and determine whether medicalization takes place in Sierra Leone. Structured interviews were conducted with 310 randomly selected girls between 10 and 20 years in Bombali and Port Loko Districts in Northern Sierra Leone. The average age of the girls in this sample was 14 years, 61% had undergone FGM at an average age of 7.7 years (range 1-18). Generally, decisions to perform FGM were made by women, but father was mentioned as the one who decided by 28% of the respondents. The traditional excisors (Soweis) performed 80% of all operations, health professionals 13%, and traditional birth attendants 6%. Men may play a more important role in the decision making process in relation to FGM than previously known. Authorities and health professionals’ associations need to consider how to prevent further medicalization of the practice.

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Dynamics of change in the practice of female genital cutting in Senegambia: testing predictions of social convention theory.

Soc Sci Med. 2011 Oct;73(8):1275-83. Epub 2011 Aug 26.

Dynamics of change in the practice of female genital cutting in Senegambia: testing predictions of social convention theory.

Shell-Duncan B, Wander K, Hernlund Y, Moreau A.

University of Washington, Department of Anthropology, Box 353100, Seattle, WA 98195-3100, United States. bsd@u.washington.edu

ABSTRACT

Recent reviews of intervention efforts aimed at ending female genital cutting (FGC) have concluded that progress to date has been slow, and call for more efficient programs informed by theories on behavior change. Social convention theory, first proposed by Mackie (1996), posits that in the context of extreme resource inequality, FGC emerged as a means of securing a better marriage by signaling fidelity, and subsequently spread to become a prerequisite for marriage for all women. Change is predicted to result from coordinated abandonment in intermarrying groups so as to preserve a marriage market for uncircumcised girls. While this theory fits well with many general observations of FGC, there have
been few attempts to systematically test the theory. We use data from a three year mixed-method study of behavior change that began in 2004 in Senegal and The Gambia to explicitly test predictions generated by social convention theory.
Analyses of 300 in-depth interviews, 28 focus group discussions, and survey data from 1220 women show that FGC is most often only indirectly related to marriageability via concerns over preserving virginity. Instead we find strong evidence for an alternative convention, namely a peer convention. We propose that being circumcised serves as a signal to other circumcised women that a girl or woman has been trained to respect the authority of her circumcised elders and is  worthy of inclusion in their social network. In this manner, FGC facilitates the  accumulation of social capital by younger women and of power and prestige by elder women. Based on this new evidence and reinterpretation of social convention
theory, we suggest that interventions aimed at eliminating FGC should target women’s social networks, which are intergenerational, and include both men and women. Our findings support Mackie’s assertion that expectations regarding FGC are interdependent; change must therefore be coordinated among interconnected members of social networks.

Published by Elsevier Ltd.

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Building community-based participatory research partnerships with a Somali refugee community.

Am J Prev Med. 2009 Dec;37(6 Suppl 1):S230-6.

Building community-based participatory research partnerships with a Somali refugee community.

Johnson CE, Ali SA, Shipp MP.

Department of Obstetrics and Gynecology, Maricopa Integrated Health System, Southwest Interdisciplinary Research Center, Arizona State University, 411 N. Central Avenue, Phoenix AZ 85004, USA. Crista.Johnson@asu.edu

BACKGROUND: The U.S. has become home to growing numbers of immigrants and refugees from countries where the traditional practice of female genital cutting (FGC) is prevalent. These women under-utilize reproductive health care, and challenge healthcare providers in providing culturally appropriate care. PURPOSE: This study examined Somali immigrant women’s experiences with the U.S. healthcare system, exploring how attitudes, perceptions, and cultural values, such as FGC, influence their use of reproductive health care. METHODS: A mixed-method community-based participatory research (CBPR) collaboration with a Somali refugee community was conducted from 2005 to 2008 incorporating surveys, semi-structured focus groups, and individual interviews. Providers caring for this community were also interviewed to gain their perspectives and experiences. RESULTS: The process of establishing a partnership with a Somali community is described wherein the challenges, successes, and lessons learned in the process of conducting CBPR are examined. Challenges obtaining informed consent, language barriers, and reliance on FGC self-report were surmounted through mobilization of community social networks, trust-building, and the use of a video-elicitation device. The community partnership collaborated around shared goals of voicing unique healthcare concerns of the community to inform the development of interventional programs to improve culturally-competent care. CONCLUSIONS: Community-based participatory research using mixed-methods is critical to facilitating trust-building and engaging community members as active participants in every phase of the research process, enabling the rigorous and ethical conduct of research with refugee communities.

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