Addressing Female Genital Mutilation During a Humanitarian Crisis
Literature Review
Systematic Review: This form consists of an overview of existing evidence pertinent to a clearly formulated research questions, which uses pre-specified and standardized methods to identify and critically appraise relevant research, and to collect, report, and analyze data from the studies that are included in the review. The goal is to deliberately document, critically evaluate, and summarize scientifically all of the research about a clearly defined research problem. Typically, it focuses on a very specific empirical question, often posed in a cause-and-effect form, such as “To what extent does A contribute to B?”
An overview of the subject and issue
- Background on Female Genital Mutilation (FGM)
Female genital mutilation (FGM) refers to all procedures involving partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons (WHO, 2010). The World health organization defines four main types of FGM that are described as
- Context: The need to explore the humanitarian context of FGM
Humanitarian crises increase the risk of gender-based violence (GBV) (Wirtz et al., 2018; Stark et al., 2011; UNICEF). The needs and rights of girls and women at risk of or affected by FGM are often neglected in humanitarian responses (Jennings et al., 2019; 28 Too Many, 2014). While humanitarian crises often increase girls’ and women’s vulnerability and marginalisation, they may also present opportunities for disrupting harmful social norms and practices. As an example, during the Ebola virus outbreak in 2014, in Sierra Leone, response to the pandemic included a presidential ban on FGM which resulted in a reduction in the practice (Bjälkander et al, 2016). Before the pandemic, FGM was near universal in Sierra Leone with 89.6 percent of girls and women having undergone FGM (2013 DHS). However, once the Ebola pandemic was over in 2015, FGM returned (Schwartz, 2019). The experience in Sierra Leone points to the need to think about the humanitarian-development nexus including post-crisis planning to sustain positive trends gained related to harmful practices.
Methods
The methodology for this literature review includes a systematic review of qualitative and quantitative based peer-reviewed journal articles and grey literature. Databases explored includes MEDLINE, CINHAL, and EBSCO. An additional internet search was performed using Google Scholar, ProQuest, and Science Direct to extract reliable academic literature, journals and reference lists. The medical subject heading (MeSH) terms used when performing the search were “female genital mutilation”, “female genital cutting”, “female circumcision”, and “harmful practices” combined with secondary keywords related to the humanitarian development context of public health crisis, emergencies, pandemic/epidemic, and Ebola. Reviews, Qualitative Studies, Cohort Studies, Case-Control Studies, Randomised Controlled Trials and Cross-Sectional Studies were included.
Division of works under review into themes or categories [e.g. works that support a particular position, those against, and those offering alternative approaches entirely],
Sexual violence and gender inequality
Among the ten studies, two addresses female genital mutilation practice in humanitarian settings from sexual violence and gender inequality perspective. The study by Vu et al. (2014) seeks to determine the prevalence of sexual violence among women in refugee camps that have a complex humanitarian crisis. The results from the study indicate that one in every five refugee women in complex humanitarian settings undergo sexual and gender-based violence. The study identifies female genital mutilation as one of the overarching forms of violence and articulates the need to have long-term strategies and interventions for improving identification as well as management of FGM survivors in complex settings. Denney, Gordon & Ibrahim (2015) focus on approaches for managing FGM as one type of gender violence after Ebola in Sierra Leone. The study establishes constant campaigns and mobilizations as sustainable long term post-Ebola gender violence management approaches.
Cultural beliefs and ethnicity
Five studies focused on the relationship between cultural practices and female genital mutilation. O’Brien & Tolosa (2016) study focuses on the effect of the Ebola epidemic in West Africa on multi-violence against all women age groups. The study articulates that the vulnerable nature of women in developing countries is reflected in cultural practices such as female genital mutilation and early marriages. The study concludes that the prevalence of harmful practices such as FGM increase during humanitarian crises and necessities well-rounded interventions. Devi (2018) study identifies female circumcision as a traditional rite of passage that has been ingressed in the West African culture and will continue to prevail from one humanitarian crisis to the other. Bjälkander et al. (2016) article elucidate that female circumcision is viewed as a transition into a secret women’s society known as the Bondo Society. However, during the Ebola epidemic in Sierra Leone, paramount chiefs who serve to protect the community traditions played a major role in enacting laws against FGM to minimize the risk of Ebola transmission.
Morgan (2015) attempts to identify post-Ebola strategies that are garnering positive impact to the people. The article identifies community educational workshops as one good approach that can give long-term solutions. Notably, these educational workshops should target both women and men and tailored to community prescriptions. Jennings et al. (2019) indicate that majority of the evidence on programmatic interventions in complex settings have comprehensively focused on other aspects and left out cultural practices such as FGM. The study recommends adequate quantification of FGM prevalence in humanitarian settings such as refugee camps. Mitike & Deressa (2009) study reveals a high prevalence of FGM among Somali refugees in Ethiopia. The study indicates significant support and acceptance of the practice in the refugee camps particularly due to the tenets of the Somali ethnic group.
Attitudes and Perceptions
Two studies focused on attitudes and perceptions. Varol et al. (2015) study reveal men in Sierra Leone did not and do not support past Ebola FGM. However, the results of the study indicate that men are unable to channel their concerns. Devi (2018) shows that a low number of men would wish FGM to continue in Sierra Leone after what happened during the Ebola epidemic.
An explanation of how each work is similar to and how it varies from the others,
The majority of the selected studies are similar as they present related findings. The two studies that address FGM in complex settings in relation to sexual violence and gender inequality arrive at the same conclusion that the prevalence of FGM is high in humanitarian settings and there is a need to expand the current approaches for future interests. Although the five articles that focused on cultural practices have shared findings and conclusions, there are a few notable variations. All five studies acknowledge that female genital mutilation is a form of cultural practice and there is a need to devise long term intervention. However, not all of the studies go ahead to point possible interventions including studies by O’Brien & Tolosa, Mitike & Deressa (2009), and Devi (2018). Lastly, the two on attitudes and perceptions share the same findings that men want to see the end of FGM.
Conclusions as to which pieces are best considered in their argument, are most convincing of their opinions and make the greatest contribution to the understanding and development of their area of research
Three studies make the greatest contribution to the understanding of the execution of female genital mutilation in humanitarian settings. Jennings et al, (2019) use current literature to show how the victims and survivors of FGM are forgotten during humanitarian crises. It is clear from the study that the majority of the focus has been directed to the prevention of HIV/STIs, unintended pregnancies, and maternal deaths during humanitarian crises. Similarly, Jennings et al. (2019) point out clearly the need to place more focus on FGM programmatic interventions. Mitike & Deressa (2009) cross-sectional study proves that ethnicity prevails and will continue to affect people until issues are addressed. O’Brien & Tolosa (2016) study addresses the area of research head-on as the whole study is based on the effect of the Ebola epidemic in West Africa on violence against gender violence such as FGM.
Gap analysis
There is limited literature on female genital mutilation during humanitarian crises. Young people especially, women are a key population in complex settings, and yet there is minimal literature on the evaluation of sexual as well as reproductive interventions. More so, the social stigma associated with FGM during the humanitarian crisis deters the survivors from reporting their traumatic experiences, an area that has scanty literature evidence. Another important consideration is that future research should address the best ways for accessing the affected populations considering the sensitive nature of humanitarian settings. Lastly, there is limited research on aspects that have led to the continued prevalence of FGM before, during, and after complex emergencies.
References
28 Too Many. (2014). The Impact of Emergency Situations on Female Genital Mutilation. Retrieved from https://www.28toomany.org/static/media/uploads/Training%20Research%20and%20Resources/the_impact_of_emergency_situations_on_fgm.pdf
Bjälkander, O., Nordenstedt, H., Brolin, K., & Ekström, A. M. (2016). FGM in the time of Ebola—carpe opportunitatem. The Lancet Global Health, 4(7), e447-e448.
Denney, L., Gordon, R., & Ibrahim, A. (2015). Teenage Pregnancy after Ebola in Sierra Leone.’. London: Overseas Development Institute.
Devi, S. (2018). FGM in Sierra Leone. The Lancet, 391(10119), 415.
Jennings, L., George, A. S., Jacobs, T., Blanchet, K., & Singh, N. S. (2019). A forgotten group during humanitarian crises: a systematic review of sexual and reproductive health interventions for young people including adolescents in humanitarian settings. Conflict and health, 13(1), 57.
Jennings, L., George, A.S., Jacobs, T. et al (2019). A forgotten group during humanitarian crises: a systematic review of sexual and reproductive health interventions for young people including adolescents in humanitarian settings. Confl Health 13, 57. https://doi.org/10.1186/s13031-019-0240-y
Mitike, G., & Deressa, W. (2009). Prevalence and associated factors of female genital mutilation among Somali refugees in eastern Ethiopia: a cross-sectional study. BMC public health, 9(1), 264.
Morgan, J. (2015). Working towards an end to FGM. The Lancet, 385(9971), 843-844.
O’Brien, M., & Tolosa, M. X. (2016). The effect of the 2014 West Africa Ebola virus disease epidemic on multi-level violence against women. International Journal of Human Rights in Healthcare.
Schwartz D.A. (2019). The Ebola Epidemic Halted Female Genital Cutting in Sierra Leone: Temporarily. In: Schwartz D., Anoko J., Abramowitz S. (eds) Pregnant in the Time of Ebola. Global Maternal and Child Health (Medical, Anthropological, and Public Health Perspectives). Springer, Cham. http://doi-org-443.webvpn.fjmu.edu.cn/10.1007/978-3-319-97637-2_30
Stark, L., & Ager, A. (2011). A Systematic Review of Prevalence Studies of Gender-Based Violence in Complex Emergencies. Trauma, Violence, & Abuse, 12(3), 127–134. https://doi.org/10.1177/1524838011404252
UNICEF (2016). The UNICEF Multi-country Gender-based Violence in Emergencies Programme Evaluation. Retrieved from https://www.unicef.org/evaldatabase/files/Full_report_with_cover_UNICEF_Multi-country_GBViE_Evaluation(1).pdf
Varol, N., Turkmani, S., Black, K., Hall, J., & Dawson, A. (2015). The role of men in abandonment of female genital mutilation: a systematic review. BMC public health, 15(1), 1034.
Vu, A., Adam, A., Wirtz, A., Pham, K., Rubenstein, L., Glass, N., … & Singh, S. (2014). The prevalence of sexual violence among female refugees in complex humanitarian emergencies: a systematic review and meta-analysis. PLoS currents, 6.
Wirtz, A. L., Perrin, N. A., Desgroppes, A., Phipps, V., Abdi, A. A., Ross, B., Kaburu, F., Kajue, I., Kutto, E., Taniguchi, E., & Glass, N. (2018). Lifetime prevalence, correlates and health consequences of gender-based violence victimisation and perpetration among men and women in Somalia. BMJ global health, 3(4), e000773. https://doi.org/10.1136/bmjgh-2018-000773