Archives Blog Original research

Meaning-making of female genital cutting: children’s perception and acquired knowledge of the ritual.

Int J Womens Health. 2013 Apr 15;5:165-75. doi: 10.2147/IJWH.S40447. Print 2013.FREE

Meaning-making of female genital cutting: children’s perception and acquired knowledge of the ritual.

Schultz JH, Lien IL.

Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway.


How do girls who have undergone female genital cutting understand the ritual? This study provides an analysis of the learning process and knowledge acquired in their meaning-making process. Eighteen participants were interviewed in qualitative indepth interviews. Women in Norway, mostly with Somali or Gambian backgrounds, were asked about their experiences of circumcision. Two different strategies were used to prepare girls for circumcision, ie, one involving giving some information and the other keeping the ritual a secret. Findings indicate that these two approaches affected the girls’ meaning-making differently, but both strategies seemed to lead to the same educational outcome. The learning process is carefully monitored and regulated but is brought to a halt, stopping short of critical reflexive thinking. The knowledge tends to be deeply internalized, embodied, and morally embraced. The meaning-making process is discussed by analyzing the use of metaphors and narratives. Given that the educational outcome is characterized by limited knowledge without critical reflection, behavior change programs to end female genital cutting should identify and implement educational stimuli that are likely to promote critical reflexive thinking.

This article can be accessed in this LINK

Archives Blog News

Time will tell.

J R Soc Med. 2008 Dec;101(12):609-10. doi: 10.1258/jrsm.2008.08k031. FREE

Time will tell.

Starin D.

University College London Gower Street, London, UK.


…Young girls walk along the paths carrying even younger children on their backs and small bundles of fire wood on their heads, practising for their future roles. Up here in the now-green rainy season fields, it is very clear that women are women and girls are women in waiting. And like their mothers and grandmothers and aunts and older sisters and 140 million other girls and women worldwide, most of these young girls will be circumcised. Because no formal studies have been done, it is difficult to estimate how many females in The Gambia have been circumcised. Rough estimates run from 68% to 93%.

This letter can be accessed for free in this LINK

Agenda Blog Cultural

Exhibition: A Future Without FGM

An exhibition organized by Wassu Gambia Kafo. More information HERE


Archives Blog Original research

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.


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.

This article can be purchased in this LINK

Archives Blog Original research

Are there “stages of change” in the practice of female genital cutting?: Qualitative research findings from Senegal and The Gambia.

Afr J Reprod Health. 2006 Aug;10(2):57-71.

Are there “stages of change” in the practice of female genital cutting?: Qualitative research findings from Senegal and The Gambia.

Shell-Duncan B, Herniund Y.

Department of Anthropology, University of Washington, Box 353100 Seattle, WA 98195-3100, USA.


In recent years there has been growing interest in developing theoretical models for understanding behaviour change with respect to the practice of female genital cutting (FGC). Drawing on extensive qualitative data collected in Senegal and The Gambia, the research reported here explores whether and how theoretical models of stages of behaviour change can be applied to FGC. Our findings suggest that individual readiness to change the practice of FGC is most dearly seen as operating along a continuum, and that broad stages of change characterise regions or segments of this continuum. Stages identified by previous researchers for other “problems behaviours” such as smoking inadequately describe readiness to change FGC since this decision is often a collective rather than individual one. The data reveal that the concept of stage of change is a complex construct that simultaneously captures behaviour, motivation, and features of the environment in which the decision is being made. Consequently stages identified in this research reflect the multidimensional nature of readiness to change the practice of FGC. Limitations of stage of change models as applied to FGC include the fact that they do not capture important aspects of the dynamics of negotiation between decision-makers, and do not reflect the shifting nature of opinions of individuals or the constellation of decision-makers. Nonetheless, we suggest the application of stage of change theory may provide a useful means of describing readiness for change of individual decisions-makers and at an aggregate level, patterns of readiness for change in a community. How this construct can be employed in quantitative population research requires further investigation.

There is no link to view this article online.

Original research

Strengthening the emergency healthcare system for mothers and children in The Gambia.

Reprod Health. 2010 Aug 18;7:21.

Strengthening the emergency healthcare system for mothers and children in The Gambia.

Cole-Ceesay R, Cherian M, Sonko A, Shivute N, Cham M, Davis M, Fatty F, Wieteska S, Baro M, Watson D, Phillips B, Macdonald R, Hayden B, Southall D.

Head Office, Maternal and Childhealth Advocacy International (MCAI), Conway Chambers, 83 Derby Rd, Nottingham NG1 5BB, UK.

ABSTRACT: A system to improve the management of emergencies during pregnancy, childbirth, infancy and childhood in a region of The Gambia (Brikama) with a population of approximately 250,000 has been developed.This was accomplished through formal partnership between the Gambian Ministry of Health, the World Health Organisation, Maternal Childhealth Advocacy International and the Advanced Life Support Group.Since October 2006, the hospital in Brikama has been renovated and equipped and more efficiently provided with emergency medicines. An emergency ambulance service now links the community with the hospital through a mobile telephone system. Health professionals from community to hospital have been trained in obstetric, neonatal and paediatric emergency management using skills’ based education. The programme was evaluated in log books detailing individual resuscitations and by external assessment.The hospital now has constant water and electricity, a functioning operating theatre and emergency room; the maternity unit and children’s wards have better emergency equipment and there is a more reliable supply of oxygen and emergency drugs, including misoprostol (for treating post partum haemorrhage) and magnesium sulphate (for severe pre-eclampsia). There is also a blood transfusion service.Countrywide, 217 doctors, nurses, and midwives have undergone accredited training in the provision of emergency maternal, newborn and child care, including for major trauma. 33 have received additional education through Generic Instructor Courses and 15 have reached full instructor status. 83 Traditional Birth Attendants and 48 Village Health Workers have been trained in the recognition and initial management of emergencies, including resuscitation of the newborn. Eleven and ten nurses underwent training in peri-operative nursing and anaesthetics respectively, to address the acute shortage required for emergency Caesarean section.Between May 2007 and March 2010, 109 patients, mostly pregnant mothers, were stabilised and transported to hospital by the new emergency ambulance service.293 resuscitation attempts were documented in personal logbooks.A sustainable system for better managing emergencies has been established and is helping to negate the main obstacle impeding progress: the country’s lack of available trained medical and nursing staff. However, insufficient attention was paid to improving staff morale and accommodation representing significant failings of the programme.

This article can be accessed in this LINK.

Original research

Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care.

Reprod Health. 2005 May 4;2(1):3.

Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care.

Cham M, Sundby J, Vangen S.

Institute of Community Medicine, Faculty of Medicine, University of Oslo, Norway.


BACKGROUND: Maternal mortality is the vital indicator with the greatest disparity between developed and developing countries. The challenging nature of measuring maternal mortality has made it necessary to perform an action-oriented means of gathering information on where, how and why deaths are occurring; what kinds of action are needed and have been taken. A maternal death review is an in-depth investigation of the causes and circumstances surrounding maternal deaths. The objectives of the present study were to describe the socio-cultural and health service factors associated with maternal deaths in rural Gambia.

METHODS: We reviewed the cases of 42 maternal deaths of women who actually tried to reach or have reached health care services. A verbal autopsy technique was applied for 32 of the cases. Key people who had witnessed any stage during the process leading to death were interviewed. Health care staff who participated in the provision of care to the deceased was also interviewed. All interviews were tape recorded and analyzed by using a grounded theory approach. The standard WHO definition of maternal deaths was used.

RESULTS: The length of time in delay within each phase of the model was estimated from the moment the woman, her family or health care providers realized that there was a complication until the decision to seeking or implementing care was made. The following items evolved as important: underestimation of the severity of the complication, bad experience with the health care system, delay in reaching an appropriate medical facility, lack of transportation, prolonged transportation, seeking care at more than one medical facility and delay in receiving prompt and appropriate care after reaching the hospital.

CONCLUSION: Women do seek access to care for obstetric emergencies, but because of a variety of problems encountered, appropriate care is often delayed. Disorganized health care with lack of prompt response to emergencies is a major factor contributing to a continued high mortality rate.

This article can be accessed in this LINK.

Blog Original research

The burden of reproductive-organ disease in rural women in The Gambia, West Africa.

Lancet. 2001 Apr 14;357(9263):1161-7.

The burden of reproductive-organ disease in rural women in The Gambia, West Africa.

Walraven G, Scherf C, West B, Ekpo G, Paine K, Coleman R, Bailey R, Morison L.

Medical Research Council Laboratories, Farafenni Field Station, PO Box 273, The, Banjul, Gambia.


BACKGROUND: Data on the epidemiology of reproductive-organ morbidity are needed to guide effective interventions, to set health-care priorities, and to target future research. This study aimed to find out the prevalence of reproductive-organ disease in a sample of rural Gambian women.

METHODS: A questionnaire on reproductive health was administered by fieldworkers to women aged 15-54 years living in a rural area under demographic surveillance. A female gynaecologist questioned and examined the women (including speculum and bimanual pelvic examinations). Vaginal swabs were taken to test for Trichomonas vaginalis, Candida albicans, and bacterial vaginosis, cervical smears for cytology, cervical swabs for Chlamydia trachomatis PCR and Neisseria gonorrhoeae culture, and venous blood for haemoglobin, HIV, herpes simplex virus 2, and syphilis serology.

FINDINGS: 1348 (72.0%) of 1871 eligible women took part. Reproductive-organ symptoms were more likely to be reported to the gynaecologist (52.7% of women) than to the fieldworker (26.5%). Menstrual problems, abnormal vaginal discharge, and vaginal itching were the most commonly reported symptoms. A minority of women said they had sought health care for their symptoms. The frequencies of reproductive-organ morbidity were high: menstrual dysfunction 34.1% (95% CI 29.6-39.1), infertility 9.8% (8.2-11.6), reproductive-tract infections 47.3% (43.7-51.0), pelvic tenderness 9.8% ((7.0-13.5), cervical dysplasia 6.7% (5.2-8.4), masses 15.9% (12.5-20.1), and childbirth-related damage to pelvic structures 46.1% (40.1-52.3). 948 (70.3%) women had at least one reproductive-organ disorder.

INTERPRETATION: For these rural women, whose lives depend heavily on their reproductive function, reproductive-organ disease is a large burden. In inadequately resourced rural areas, with poor education, heavy agricultural and domestic labour, and limited access to quality health care, many women are not able to attain and maintain reproductive health and wellbeing.

This article can be accessed in this LINK.

Archives Blog Original research

The long-term reproductive health consequences of female genital cutting in rural Gambia: a community-based survey

Trop Med Int Health. 2001 Aug; 6(8): 643-653

The long-term reproductive health consequences of female genital cutting in rural Gambia: a community-based survey

Morison L, Scherf C, Ekpo G, Paine K, West B, Coleman R, Walraven G


This paper examines the association between traditional practices of female genital cutting (FGC) and adult women’s reproductive morbidity in rural Gambia. In 1999, we conducted a cross-sectional community survey of 1348 women aged 15–54 years, to estimate the prevalence of reproductive morbidity on the basis of women’s reports, a gynaecological examination and laboratory analysis of specimens. Descriptive statistics and logistic regression were used to compare the prevalence of each morbidity between cut and uncut women adjusting for possible confounders. A total of 1157 women consented to gynaecological examination and 58% had signs of genital cutting. There was a high level of agreement between reported circumcision status and that found on examination (97% agreement). The majority of operations consisted of clitoridectomy and excision of the labia minora (WHO classification type II) and were performed between the ages of 4 and 7 years. The practice of genital cutting was highly associated with ethnic group for two of the three main ethnic groups, making the effects of ethnic group and cutting difficult to distinguish. Women who had undergone FGC had a significantly higher prevalence of bacterial vaginosis (BV) [adjusted odds ratio (OR)=1.66; 95% confidence interval (CI) 1.25–2.18] and a substantially higher prevalence of herpes simplex virus 2 (HSV2) [adjusted OR=4.71; 95% CI 3.46–6.42]. The higher prevalence of HSV2 suggests that cut women may be at increased risk of HIV infection. Commonly cited negative consequences of FGC such as damage to the perineum or anus, vulval tumours (such as Bartholin’s cysts and excessive keloid formation), painful sex, infertility, prolapse and other reproductive tract infections (RTIs) were not significantly more common in cut women. The relationship between FGC and long-term reproductive morbidity remains unclear, especially in settings where type II cutting predominates. Efforts to eradicate the practice should incorporate a human rights approach rather than rely solely on the damaging health consequences.

Archives Blog Original research

Health consequences of female genital mutilation/cutting in the Gambia, evidence into action.

Reprod Health. 2011 Oct 3;8:26.

Health consequences of female genital mutilation/cutting in the Gambia, evidence into action.

Kaplan A, Hechavarría S, Martín M, Bonhoure I.

Cátedra de Transferencia del Conocimiento/Parc de Recerca UAB-Santander, Departamento de Antropología Social y Cultural, Universitat Autònoma de Barcelona, Barcelona, Spain.



Female Genital Mutilation/Cutting (FGM/C) is a harmful traditional practice with severe health complications, deeply rooted in many Sub-Saharan African countries. In The Gambia, the prevalence of FGM/C is 78.3% in women aged between 15 and 49 years. The objective of this study is to perform a first evaluation of the magnitude of the health consequences of FGM/C in The Gambia.


Data were collected on types of FGM/C and health consequences of each type of FGM/C from 871 female patients who consulted for any problem requiring a medical gynaecologic examination and who had undergone FGM/C in The Gambia.


The prevalence of patients with different types of FGM/C were: type I, 66.2%; type II, 26.3%; and type III, 7.5%. Complications due to FGM/C were found in 299 of the 871 patients (34.3%). Even type I, the form of FGM/C of least anatomical extent, presented complications in 1 of 5 girls and women examined.


This study shows that FGM/C is still practiced in all the six regions of The Gambia, the most common form being type I, followed by type II. All forms of FGM/C, including type I, produce significantly high percentages of complications, especially infections.

This article is open source in LINK