Organizations involved
Ahfad University for Women; Population Council
Summary
This was a community-based, cross-sectional, comparative, mixed-methods study (2016-2017). The main aim of the study was to inform the development of future interventions by generating evidence on the drivers of shifts in the practice of female genital mutilation (FGM) in the Khartoum and Gedaref States of Sudan, where there has been an increase in the medicalisation of FGM. Target populations included families that did and did not practice medicalised FGM, and health care providers (HCPs) offering medicalised FGM. In rural areas, traditional birth attendants were also interviewed. Study findings show that shifts to less severe forms of FGM in some communities is driven in part by social and religious norms and in part by awareness of the health consequences of FGM. This awareness also drives the medicalisation of the practice and increases social pressure on health providers to perform FGM. Midwives’ refusal to perform severe forms of FGM is also believed to drive the shift to less severe cutting.
Social norms of interest
Medicalisation of FGM
Behaviors of interest
Reduced sexual desire of the female; Prohibited pre-marital sex; Hygiene
Project components
A total of 480 household interviews, 58 in-depth interviews (with mothers and midwives), and 13 focus group discussions (FGDs) (four with mothers, three with fathers, three with grandmothers, and three with girls) were conducted. Data was collected using a semi-structured interview guide and a structured survey instrument. Descriptive statistics were generated using the quantitative data. Qualitative data were analysed through applied coding and memo writing to create categories that represent the participants’ perspectives.
Social norms measurement
Focus group discussions were conducted with young girls, mothers, fathers and grandmothers. In-depth interviews were conducted with mothers and midwives. Social norms theory was applied by examining: individual family members’ and HCPs’ personal attitudes towards FGM and trends in the type of cutting; individual family members’ and HCPs’ perceptions about FGM and trends in the type of cutting; families’ and HCPs’ social expectations (who and what others in reference group do, prefer to do, and expect them to do); whether families and HCPs think others are practicing medicalisation, and how many are seeking HCPs or are other HCPs cutting (empirical experience); and individual family members’ and HCPs’ perceptions about why people would want to use a HCP, whether they approve of HCPs performing FGM, and whether HCPs counsel families not to cut their daughters (normative experience).
Key findings to date
The key findings confirmed that there has been a shift to less severe forms of cutting and a shift to medicalisation; the most common drivers for these shifts were found to be social norms, reduced health effects and religious reasons. Interviews with fathers, mothers, grandmothers, and girls revealed that the drivers of FGM included enhanced marriageability, urbanization (belief that the practice is more prevalent in cities), and fear of stigma. According to participants, the increasing use of HCPs to perform the cut was influenced by reference groups, the availability of practicing HCPs, and campaigns that highlighted the health risks of FGM. Many did not consider the type of cut (type I) to be FGM but described it as a practice approved by religion and/or a safer form of FGM. However, some families believed it was important for them to continue practicing more severe forms of FGM (type III) to conform to traditional beliefs and their identity.
Attribution statement
Bedri, N., Sherfi, H., Rodwan, G., Elhadi, S., and Elamin, W. (2018) Medicalisation of Female Genital Mutilation/Cutting in Sudan: Shift in Types and Providers. Gender and Reproductive Health and Rights Resource and Advocacy Center, Ahfad University for Women.
Population Council (2015) Evidence to End FGM/C: Research to Help Girls and Women Thrive. New York: Population Council.
