This paper aimed to review the empirical research on the effectiveness of interventions to reduce the prevalence of female genital mutilation/cutting (FGM/C) in African countries, and the empirical research on contextual factors that may help explain the effectiveness, or lack thereof, of such interventions.
The study used an integrative evidence approach, whereby analyses of effectiveness data and context data were completed in separate streams, but in the final step the results were integrated from the two sets of data in a realist synthesis approach. The review includes 8 effectiveness studies and 27 context studies.
The general lack of information hampered any conclusive findings regarding both questions. However, through the realist synthesis, the study did conclude that all of the interventions were based on a theory that dissemination of information improves cognitions about FGM/C, but the interventions’ success was contingent upon a range of contextual factors.
- Regarding the effectiveness studies, all employed a controlled before-and-after study design. The quality assessment resulted in a final decision of weak study quality for all eight studies, which involved 7,042 participants across 7 African countries. Four meta-analyses were performed, but there was doubt about the validity of all results. The results showed that the effectiveness of the included interventions was limited but they pointed to potential advantageous developments as a result of the FGM/C abandonment interventions.
- The synthesis of context studies showed that the factors related to the continuance and discontinuance of FGM/C varied across contexts, but the main factors that supported FGM/C were tradition, religion, and reduction of women’s sexual desire. The main factors that hindered FGM/C were medical complications and prevention of sexual satisfaction. The study’s ability to reach conclusions regarding various factors’ impact on the continuance and discontinuance of FGM/C was limited. However, based on the context-mechanism-outcome configurations identified, all of the interventions were based on a theory that dissemination of information improves cognitions about FGM/C, but the interventions’ success was contingent upon a range of contextual factors.
There is a need to conduct methodologically rigorous intervention evaluations. Such studies should address the local communities’ enforcement systems that support FGM/C and be based on a sound theory of behavior change.