‘ Hear our Voices’ -women’s Health and Family Services



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Conclusion
FGM/C is deeply rooted in the cultural traditions of its countries of origin (Reig Alcaraz et al. 2014). Shell-Duncan & Hernlund argue that we must be wary of the Trivialisation of culture, whereby the social significance and historical context of a practice is ignored in favour of labeling it as mindless and barbaric, as this can be highly offensive to the very people we are trying to communicate with (Toubia, 1985). . According to social convention theory the actions of individuals are interdependent and this fits with the finding that it is the proximate persons or people that our close to individuals (family members, friends and other trusted sources) who shape opinions and intentions around the practice of FGM/C. Imoh (2012) makes the important point that cultural values are not static and we need to engage local communities in an ongoing dialogue about their own local practices. Furthermore, Imoh argues that this environment of dialogue and self-scrutiny and reflection by local communities presents an opportunity for policy makers and practitioners to develop partnerships with local communities in which the priorities and needs of all stakeholders are seriously considered, rather than imposing behaviour change. The work of Women’s Health & Family Services in Tower Hamlets http://www.whfs.org.uk/ provides us with a fine example of this.
Interventions designed to change behaviour without documenting how they work are not evidence-based. WHO (1999) note that one of the most neglected areas is that of applied or operational research on how to design interventions that would convince both individuals and communities to stop the practice. In order to bring about changes in practice with respect to FGM/C, three clear conclusions emerge from this literature review. Hence we need to be careful in our use of terminology and portrayal in the media and health campaigns of FGM/C, so as not to deter women coming forward to seek help. To quote Gruenbaum, 2005, p.8:
“Change strategies should be based not on the assumption that traditional beliefs are irrational and just need a good dose of public health education, but should reflect an accurate assessment of the different meanings and motivations”

As alluded to throughout this review, interventions need to be based on a sound understanding of the cultural values and social conventions that may dictate the responses of individuals and an entire community. The empirical evidence suggests a community-focused approach that draws upon theory-based models of change is likely to be most successful.


“There is a need for ongoing community-based prevention work, including: creating safe spaces for women to talk about FGM, using culturally affirmative approaches, and developing the confidence of community-based champions to counter the concept of FGM/C as essentially linked to cultural identity.” The quote comes from the FGM/C initiative (2013) funded by the Esmee Fairbairn Foundation and ROSA (the UK fund for women and girls). The approach taken was based on Participatory Ethnographic Evaluation Research (PEER), in which PEER researchers were women who had had some contact with the project (for instance, who had attended a workshop), who interviewed ‘friends’ who were known and trusted to them, in order to elicit detailed narratives on FGM/C in the UK. Similarly the WHFS report (2014) also funded by ROSA supports the use of community champions to effect changes in erroneous beliefs that raise awareness among the gatekeepers in the community (be they grandparents, husbands, Imams).

References


Askew, I. (2005). Methodological issues in measuring the impact of interventions against female genital cutting. Culture, Health & Sexuality, September-October 2005, 7(5), 463-477.
Berg, R. & Denison, E. (2013). A Tradition in Transition: Factors Perpetuating and Hindering the Continuance of Female Genital Mutilation/Cutting (FGM/C) Summarized in a Systematic Review. Health Care for Women International, 34:10, 837-85

Brady, C. M., & Files, J. A. (2007). Female genital mutilation: cultural awareness and clinical considerations. J Midwifery Womens Health. 2007 52(2), 158-63.


Chege, J., Aksew, I. & Liku, J. (2001) ‘An Assessment of the Alternative Rites Approach for Encouraging Abandonment of Female Genital Mutilation in Kenya’. Washington D.C.: Frontiers in Reproductive Health.

Diop, N.J. & Askew, I. (2009). ‘The Effectiveness of a Community-Based Education Program on Abandoning Female Genital Mutilation/Cutting in Senegal’. Studies in Family Planning 40(4): 307-318

Elnashar, A. & Abdelhady., R. (2007). The impact of female genital mutilation on the health of newly married women, International Journal of Gynecology and Obstetrics 97, 238–244.

Gage, A.J. & Van Rossem, R. (2006). Attitudes toward the discontinuation of female genital cutting among men and women in Guinea. International Journal of Gynaecology and Obstetrics, 92 (1), 92–96.

Gele, A., Bø, B.P. & Sundby, J. (2013). Attitudes toward Female Circumcision among Men and Women in Two Districts in Somalia: Is It Time to Rethink Our Eradication Strategy in Somalia? Obstetrics and Gynecology International Volume 2013, 1-12
Goldstein, R.A. (2014). Female Genital Cutting: Nursing Implications, Journal of Transcultural Nursing 25(1) 95–101


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