End Female Genital Mutilation Programmes: Research And Evaluation

The UK Government National Audit Office recently invited submissions around their examination of the effectiveness of official development assistance.  Evaluation is an aspect of work on programmes to eradicate female genital mutilation (FGM) which has interested me as a sociologist for quite a while.  I therefore suggested some research questions which may be of interest to them or DfID.  National and international support for work to EndFGM is essential and it is critical that we continue to learn which aspects of these programmes are likely to have most positive impact.

There is a growing realisation that to achieve maximum impact, programmes of FGM eradication must be underpinned by a cogent discipline and understanding of what FGM is and how it maintains its legitimacy in the eyes of those who practise it: parallels here might be the studies of substance abuse or premature / teenage pregnancy.  FGM as an academic field is only now beginning to take shape (for instance, from the work at Oxford, Northwestern and other universities – please add other / your own FGM Studies courses in the Comments below). A critical part of the developing FGM Studies paradigm/s will be the development of even more effective research ‘toolkits’ to evaluate programmes of eradication at the local level, building on the pioneering global evaluations of EndFGM programmes by the UNFPA-UNICEF to establish FGM Studies as an academic discipline in its own right.

This is (a lightly edited version of my) response to the National Audit Office Investigation of the Effectiveness of Official Development Assistance Spending

I write as a long-time author and researcher on female genital mutilation to suggest some questions which may be of relevance to your study around the evaluation of DfID-funded and other EndFGM programmes.

Please note in the comments which follow that they arise from my concern that the essential funding which DfID provides should be put to the greatest use; I have no doubt that such funding is vital in supporting efforts to stop this cruel practice, but I am unclear about how the methodologies for evaluations produce the reported outcomes.  Are reports of cessation based on hard data, or on reports of attitude change?

It is evident that in research the tracking of attitudes is accomplished (more people think FGM should stop after the programmes), but how is this related to any empirical evidence of reductions in the actual imposition of FGM?  Via what methods is evidence of attitude change correlated to reduction in the practice of FGM in real terms?

To what extent is it possible to acquire ‘hard’, empirical evidence of cessation which can be compared with ‘softer’ evidence of attitude change?  (I suspect the ‘hard’ data cannot be acquired rapidly.) My primary concern is that it is much easier to measure attitude change, than it is to ascertain with any confidence changes in actual behaviour. The two do not necessarily correlate, nor as you will know is it a simple task to identify and disaggregate the factors involved.

Changes in attitudes to the practice of FGM have been demonstrated in a series of programmes which DfID has funded, directly or indirectly. It is likely that these changed opinions are a reality, being in line with other independent work which has been undertaken in this field.  For some in practising communities the realisation that FGM (and similar practices) are harmful has impact; and this may be especially the case in regard to young girls who (for a while, if not always forever) manage to escape this harm.

I am unsure however whether attitude changes as measured in relative isolation following an EndFGM programme would of themselves reflect the longer-term position.  There are many variables beyond the immediate knowledge that FGM is harmful those who undergo it, and to their futures.

Some of the factors at play may include

• Medical and health data

Do hospital and clinic data show a significant drop in occurrence? And do these data correlate with a reduction in recorded deaths associated with FGM?  (Although even these data alone may not offer clear evidence, since it is possible that, like for instance suspected suicide, there may be a reluctance to record FGM as the cause of morbidity or mortality.) Have significant proportions of clinical staff at all levels received adequate training in the diagnosis and recording of FGM, so that there is some confidence in the data available?  Are official data inclusive of the incidence of FGM beyond cases recorded in hospitals and clinics reliable (and can they be?)?  Are genuinely focused Public Health programmes now in place?

• Attitude of community (and belief) leaders, men and women – some leaders may adopt both pro- and anti-FGM stances as they deem appropriate

Some leaders may be anti-FGM to obtain more external funding but pro-FGM to win political elections. Are they willing to go on public record as against FGM? Will they reliably report perceived risks and/or observed or suspected defiance of the law to the appropriate authorities?  Is there any certainty that girls will not simply be taken elsewhere for FGM, or ‘cut’ earlier so that the act is less likely to be a matter of record?

• Legal enforcement – known to have an overall impact (albeit sometimes less than might at first be expected; see for instance this article)

What are the penalties for FGM, how often are these imposed? What level of surveillance and of public information about stopping FGM is evident? (And does the state in question pursue the eradication of FGM vigorously? – some don’t; the question then is ‘why not?’) Is infringement of the law a matter of serious media interest?  Importantly, are legal (and health) warnings available in local languages in ways which will reach those who are less literate?

• School attendance – girls who do not have FGM are more likely to stay on at school, but other issues also appertain and may affect the likelihood that FGM remains a possibility

Are girls supported to remain in school re personal hygiene and financial requirements?  Are teachers aware of the risks of FGM and how to prevent harm?  Are they willing to do so?  Do schools interact with their communities to ensure that parents understand FGM is forbidden?  Are boys as well as girls knowledgeable about FGM, and about how to avoid it?

• Local and national media and politics

Do print, radio and visual media reflect any different understandings of FGM after the programme interventions? Is there a convergence between any new media positions and those reflected in political positions?  Have there been any shifts towards more substantial local / national resourcing of EndFGM programmes after the interventions?

• FGM ‘cutters’

Have any positive changes been made to accommodate the new position of previous ‘cutters’ (maybe after their criminal sentence)?   Are there viable alternative employment possibilities, where these are appropriate, which also accord suitable status for the cutters who have previously been community leaders or influencers?  Have any of these women or men now taken on roles, e.g., as ‘barefoot grannies’ or similar?

• Girls’ future adult status and careers

What is the post-programme situation in regard to bride-price / dowry? Is there evidence which might be associated with the programme to suggest girls now have more opportunity e.g. to gain post-school education, own land, and have status independent of their husbands? What are the positive (and possible negative) economic impacts of these programmes, at the local, regional and national level?

• How is the EndFGM message being spread?

Which local organisations are being brought into the initial EndFGM programme, and with what assurance that the message is being taken further? How are key messages distributed and what checks are available to ensure that these messages are genuinely understood and adopted in a meaningful way? What follow-ups are in place? And how are resources distributed, by what criteria and with what expectations?

• Who is undertaking the evaluations?

What are the initial criteria for selecting organisations to run EndFGM programmes, and how are the outcomes determined and evaluated? Have the evaluators adopted both qualitative and quantitative methodologies which have been tested?  To whom must they report, and why?

These are just some of the questions which might be asked in the course of evaluations, but I hope they serve to demonstrate that attitude testing and reliance on immediate changes are unlikely alone to be adequate to fully informative evaluations of EndFGM programmes.

Please note again that my current focus is specifically around measurement methodologies for EndFGM programme outcomes.  These measures are essential to obtain the best possible impact from vital funding in this critical field, as we learn more about ‘what works’. Opportunities to develop methodologies for the meaningful long-term evaluation of EndFGM programmes will continue to be a valuable aspect of DfID’s work.

Other posts here on FGM /public health research and paradigm formation include

Brussels Places Research On Female Genital Mutilation Centre-Stage

The Many ‘E’s Of FGM Eradication – And Why They All Lead Via ‘Economics’ And ‘Epidemics’ To Public Health 

and

Epidemiology And Community Health: A Strained Connection?

Your Comments on this topic are welcome.  
Please post them in the box which follows these announcements…..

You will also find many other posts about FGM on this website. Click on topics in the WordCloud (above, to your right) to find issues of interest.

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Books by Hilary Burrage on female genital mutilation

https://orcid.org/0000-0002-6684-2740

Eradicating Female Genital Mutilation: A UK Perspective (Hilary Burrage, Ashgate / Routledge 2015).
Full contents and reviews   HERE.
 
FEMALE MUTILATION: The truth behind the horrifying global practice of female genital mutilation  (Hilary Burrage, New Holland Publishers 2016).
Full contents and reviews   HERE.

FURTHER INFORMATION AND ACTION

There is a free FGM hotline for anyone in the UK: 0800 028 3550, or email: fgmhelp@nspcc.org.uk

Details of NHS Specialist Services for FGM here.

More info and posts on FGM here.

Activists, service providers and researchers may like to join the LinkedIn group Female Genital Mutilation (FGM): Information, reports and research, which has several hundred members from around the world.

The (free) #NoFGM Daily News carries reports of all items shared on Twitter that day about FGM – brings many organisations and developments into focus.

Also available to follow at no cost or obligation is the #NoFGM_USA Daily News.

Twitter accounts:          @NoFGM_UK  @NoFGMBookUK @FemaleMutlnBook  @FGMStatement  @NoFGM_USA @NoFGM_Kenya  @NoFGM_France  @GuardianEndFGM [tag for all: #NoFGM] and @StopMGM.

Facebook page: #NoFGM – a crime against humanity

Email contact: via Hilary

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[NB The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children, which has a primary focus on FGM, is clear that in formal discourse any term other than ‘mutilation’ concedes damagingly to the cultural relativists – though the terms employed may of necessity vary in informal discussion with those who by tradition use alternative vocabulary. See the Feminist Statement on the Naming and Abolition of Female Genital Mutilation,  The Bamako Declaration: Female Genital Mutilation Terminology and the debate about Anthr/Apologists on this website.]

PLEASE NOTE:

This article concerns approaches to the eradication specifically of FGM.  I am also categorically opposed to MGM, but that is not the focus of this particular piece.

Anyone wishing to offer additional comment on more general considerations around infant and juvenile genital mutilation is asked please to do so via these relevant dedicated threads.

Discussion of the general issues re M/FGM will not be published unless they are posted on these dedicated pages. Thanks.