Effects of school-based health education on attitudes of female students towards female genital mutilation in Sudan

Abstract

Background: The practice of female genital mutilation (FGM) is widespread in Sudan. Over the years, the government, civil society and the international community implemented multiple interventions to address the issue. However, due to a number of cultural and educational factors, this harmful practice continues. Aims: This study aimed to assess the effects of a secondary school-based health education intervention on the knowledge and attitude of female students towards FGM in Sudan. Methods: We conducted a quasi-experimental study in Karary Locality, Khartoum State, Sudan. A multistage sampling technique was used to determine targeted schools. Within the schools, students of two randomly selected classes received the intervention. The study included three phases; in the pre-intervention phase, data were collected from the totality of students (154 students) using a pre-tested questionnaire, after which students received health education sessions. The same questionnaire was used to recollect the data in a post-intervention phase 6 weeks later. Results: The participants were between 14 to 17 years old, 30.3% of which were subjected to FGM. The main source of information about FGM was family and friends (41.1%). The majority of participants had a negative attitude towards FGM. The means of knowledge and attitude scores increased from 8.63 (SD=2.562) and 5.76 pre-intervention (SD=1.937) to 11.99 (SD=2.264) and 6.53 post-intervention (SD=1.164), respectively. Conclusions: School-based health education has a positive impact on both knowledge and attitude of female students towards FGM in Sudan. As such, introducing health education about the complications of FGM in curricula of secondary schools in Sudan has the potential to improve students' knowledge and attitude. Ultimately, such interventions can help reduce the prevalence of the practice when students become responsible for future families.

Economic burden of female genital mutilation in 27 high-prevalence countries

“…There are multiple innovative and promising approaches being implemented in high prevalence countries, and evaluations have shown evidence on changes in intermediate outcomes such as changes in attitudes and reduced support for FGM; improved knowledge about the practice, its harms and its illegality; and intentions to perform FGM. For example, community engagement through information sessions on health, rights and female empowerment,115–117 school-based education118 and health education within health facilities119 as well as communications campaigns using social marketing and other communications approaches120–124 show promising results on intermediate outcomes such as knowledge, intentions to cut and reduction in attitudes supportive of FGM. In addition, investing in education of girls and women appears to be associated with decreased support for FGM, and women with higher levels of education were less likely to have their daughters undergo FGM 125–127.…”

Female genital mutilation and cutting in the Arab League and diaspora: A systematic review of preventive interventions

“…Eight studies [36][37][38][39][40][41][42] described interventions reporting on preventive interventions within Arab League States. Four studies [43] described interventions in the Arab diaspora (Table 2).…”

“…Designs included six quasi-experimental studies [37,[39][40][41][42]44], four descriptive qualitative [38,43,45,46], one participatory action research [47] and one randomised controlled trial with no data to report because of delays due to COVID-19 [36].…”

“…Ten interventions focussed on education with the aim of improving knowledge and changing beliefs and attitudes towards FGM/C [37][38][39][40][41][42][43][44][45][46]; one on improving the knowledge of medical professionals and strengthening healthcare systems [36]. Only one study employed a multi-sectoral approach over a 6-year period in five European Union Countries with eight immigrant communities, three of which originated from Arab League member states [47].…”

“…One study [37] evaluated the progress of a range of interventions within a public health campaign called 'Saleema' in the Sudan. Three further studies conducted in Sudan [38,39,42] and one study in the United Kingdom [43] used different forms of media designed to change FGM/C attitudes. An ongoing study protocol by Ahmed and colleagues [36] intends to use personalised communication, leaflets, posters and clinical tools to increase knowledge and assist health professionals implementing sessions aiming at reducing FGM/C.…”