PROTOCOL: Interventions to reduce the prevalence of female genital mutilation/cutting in African countries

Abstract

This systematic review aimed to answer the following research questions: 1.\tWhat is the effectiveness of interventions designed to reduce the prevalence of female genital mutilation/cutting (FGM/C) compared to no or other active intervention? 2.\tHow do factors related to the continuance and discontinuance of FGM/C help explain the effectiveness of interventions designed to reduce the prevalence of FGM/C? We used an integrative evidence approach, whereby analyses of effectiveness data and context data were completed in separate streams, but where we in the final step integrated the results from the two sets of data in a realist synthesis approach. We included eight effectiveness studies (research question 1). 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 residing in seven different African countries: Burkina Faso, Egypt, Ethiopia, Somalia/Kenya, Mali, Nigeria, and Senegal. We could perform four meta-analyses but there was doubt about the validity of all results. The results showed that the effectiveness of the included interventions was limited, although they pointed to potential advantageous developments, such as positive changes in attitudes and knowledge regarding FGM/C, as a result of the FGM/C abandonment interventions. We included 27 context studies (research question 2) from the countries where an effectiveness study had taken place (we did not identify any studies from Ethiopia). 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. Our ability to conclude regarding both the question of effectiveness of FGM/C abandonment interventions and how factors related to FGM/C help explain the effectiveness of interventions was hampered by a general lack of information. However, through the realist synthesis we 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.