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Review
. 2013 Nov;33(4):322-33.
doi: 10.1179/2046905513Y.0000000086.

A realist synthesis of controlled studies to determine the effectiveness of interventions to prevent genital cutting of girls

Rigmor C Berg  1 , Eva M Denison
Affiliations
Free PMC article
Review

A realist synthesis of controlled studies to determine the effectiveness of interventions to prevent genital cutting of girls

Rigmor C Berg et al. Paediatr Int Child Health. 2013 Nov.
Free PMC article

Abstract

Background: Female genital mutilation/cutting (FGM/C) is a traditional practice which involves the partial or total removal or other injury to the female genital organs for non-medical reasons. Although current trends indicate that the practice is becoming less prevalent, as many as 30 million girls may still be at risk of FGM/C. Given the associated risks and violation of the human rights of girls and women, the practice is discouraged through preventative interventions.

Aims: To systematically review the effectiveness of anti-FGM/C interventions, applying a realist perspective.

Methods: The realist synthesis approach addressed context-mechanisms-outcomes (CMO) underlying intervention in an attempt to explain interventions' success or lack thereof. The process involved exposed the usefulness of strategies in different contexts.

Results: Eight effectiveness studies and 27 context studies were included. All of the effectiveness studies employed a controlled, before-and-after study design. They formed five broad categories of intervention: training, formal classroom education, media communication, outreach and advocacy, and informal adult education. The CMO configurations showed that the proposed engine behind changing behaviours regarding FGM/C appeared largely to be dissemination of information. Some interventions' acceptability and success rested on the incorporation of FGM/C abandonment efforts within a larger set of related issues. However, greater success of the interventions could have materialised with systematic pre-planning involving thorough community analyses and securing religious leaders' commitment to halting FGM/C.

Conclusion: The results of this analysis point to conditions that facilitate the success of FGM/C abandonment programmes in different contexts and can be used in future prevention efforts to reduce the risk of girls being subjected to FGM/C.

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Figure 1
Data synthesis approach
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References

    1. World Health Organization. Geneva: WHO; 2008. Eliminating Female Genital Mutilation: an Interagency Statement.
    1. UNICEF. Statistics by Area/Child Protection/Female Genital Mutilation. Updated February 2013. http://www.childinfo.org/fgmc_progress.html.
    1. World Health Organization. Geneva: WHO; 2000. A Systematic Review of the Health Complications of Female Genital Mutilation Including Sequelae in Childbirth.
    1. Berg RC, Denison E. Does female genital mutilation/cutting (FGM/C) affect women’s sexual functioning? A systematic review of the sexual consequences of FGM/C. Sex Res Soc Policy. 2012;9:41–56.
    1. Berg RC, Underland V. The obstetric consequences of female genital mutilation/cutting: A systematic review and meta-analysis. Obstet Gyn Int. 2013. DOI: 10.1155/2013/496564. - PMC - PubMed

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