The objective of this study was to describe the attitudes towards the practice of female genital mutilation in relation to different health systems and the factors that favour its discontinuation. It employed an integrative review, consisting of publications from the period 2006 to 2013. 16 studies were selected, focusing on diverse contexts that assessed the attitudes of both men and women regarding the perpetuation of this practice. Several areas of investigation were explored (factors contributing to the continuation of female genital mutilation, factors contributing to its discontinuation, feelings about the health system).
Factors that contribute to the discontinuation of FGM:
- The above results indicate that the incidence of FGM tends to decline when women migrate to countries in the West. Although they carry their cultural heritage with them when they migrate, sooner or later the phenomenon of acculturation emerges and they adapt to the customs of their host country. The new social context implies greater pressure, given that FGM is not only frowned upon but also punishable by law. This means that, over the years, new attitudes towards the eradication of FGM are adopted in the women’s place of residence.
- The empowerment of women and girls is a key factor to consider in the elimination of FGM. Other factors such as the legislation and culture and social environment of host countries contribute towards changing immigrant women and men’s attitudes towards FGM. The fact that there is legislation that punishes FGM means that we run the risk of promoting the secret nature of this practice. Despite the importance of legislation against FGM, evidence suggests that laws are usually incomplete or have been developed without a clear strategic plan with regard to the mechanisms of application and consequences. Furthermore, few laws introduce protection measures for girls at risk and measures of prevention of FGM in the communities where it is practiced.
- Finally, the studies state that the media plays a major role in the eradication of FGM. The media can help clarify doubts and misconceptions about FGM and the reasons for its continuation, as well as help in health promotion and FGM eradication programmes. Television, radio, newspapers, community meetings, discussions with family members or friends, and mosque or church sermons are a number of the means of communication described in the articles as methods for learning about FGM, which need to be emphasized in order to exploit their potential.
Factors that contribute to the continuation of FGM:
FGM, however, is still very deeply rooted in the cultural traditions of its countries of origin. From the perspective of the anthropology of care, culture can be defined as ‘the set of behaviours (events), ideas, values, beliefs and feelings (thoughts) involved in the process of satisfying the needs of a group of people in a given situational context‘. Thus, as a custom with many links to tradition, FGM forms an integral part of society. In fact, of the many factors that the women in the studies selected for this review reported as contributing to the continuation of FGM, tradition and social pressure were the most compelling. These aspects give rise to a feeling of respect and cohesion within the community and are still held dear by immigrant communities inWestern countries, as have been shown in two studies where the acculturation process had not occurred. There is evidence that refugee immigrant groups in Europe, the USA and other developed countries continue to practice FGM, and that genital cutting is performed extensively.
Religion: two sides of the same coin:
The factor of religion has produced opposing stances. Many of the study participants who supported the practice firmly believed that FGM is a religious precept. However, those who did not support FGM maintained that the practice was contrary to religious precepts, and moreover, had received information in mosques and churches in favour of the elimination of FGM. This contrast can be explained by the illiteracy rates in these countries, which leave a section of the population without direct access to religious texts; hence, beliefs are based on the interpretations that are transmitted, which may distort the original texts.
Feelings towards health systems:
As regards feelings about health systems, there is clear evidence of the need for healthcare professionals to have a thorough understanding of the practice of FGM in order to provide culturally competent treatment and care, foster trust and communication, and put an end to the marginalization of and discrimination against these women. Nursing staff needs to assess not only the extent to which women identify with their traditional culture but also with the new dominant culture in order to assess their level of acculturation, because health care should reflect a unified understanding of the values, beliefs and attitudes of individual acculturation processes.