This systematic review examined empirical research on: the effectiveness of interventions to reduce the prevalence of FGM/C in African countries; and on contextual factors that may help explain the effectiveness, or lack thereof, of such interventions. It was hampered by a lack of available information. However, it identified 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. Its findings included that educational sessions for men and women demonstrated an increase in awareness of the risks of FGM/C.
Female Genital Mutilation/Cutting (FGM/C) has negative health consequences for women, ranging from pain, bleeding, and shock due to chronic infections. Around 140 million girls and women live with the risks caused by FGM/C, of which 92 million girls and women are in Africa. In December 2012, 194 UN member states passed a resolution for intensifying the efforts to ban the practice across the globe.
The review included eight effectiveness studies, which involved 7,042 participants from different African countries including Burkina Faso, Egypt, Ethiopia, Somalia/Kenya, Mali, Nigeria and Senegal. Twenty seven context studies were included from those countries where an intervention study had already taken place (except Ethiopia).
The findings show that much work remains to be conducted regarding the evaluation of FGM/C abandonment efforts. 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 behaviour change. Findings from the review suggest that:
- Legislation alone has at best a limited effect. It is necessary to work directly with parents, community leaders and those who perform FGM/C. The presence of a law may help legitimise these interventions and underpin opposition to FGM/C.
- Working with health workers requires intensive engagement. A training programme for health workers in Mali showed no difference in the prevalence of the practice, possibly because of the limited time allocated for training the health personnel.
- Working with communities can change attitudes, but it depends on design, implementation and context. The Tostan education programme in Senegal and Mali succeeded in shifting attitudes against FGM/C. The programme was tailored to local needs, including separate educational sessions for men and women. But the same programme in Burkina Faso failed to retain participants, undermining potential achievements. Programmes in Nigeria, Ethiopia and Somalia also affected beliefs through community-based initiatives including group meetings with community leaders, multimedia communications, and action plans that improved advocacy efforts. In Ethiopia, inclusion of religious leaders facilitated greater knowledge uptake.
- Working with youth may be a cost effective alternative. A programme for second year female university students in Egypt made a substantial difference to their knowledge about the dangers of FGM/C. As future mothers such an approach may be cost effective, but may also be ineffective without shifting the attitudes of men and community leaders.
See also the 3ie policy brief on the review’s findings.