Shifts in FGM/C practice in Sudan: communities’ perspectives and drivers

Abstract

BackgroundAlthough Sudan has one of the highest prevalence of female genital mutilation or cutting (FGM/C), there have been shifts in e practice. These shifts include a reduction in the prevalence among younger age cohorts, changes in the types of FGM/C, an increase in medicalization, and changes in age of the practice. The drivers of these shifts are not well understood.MethodQualitative data drawn from a larger study in Khartoum and Gedaref States, Family and Midwife individual interviews and focus group discussions. Analysis and categorization within a Social Norms theoretical framework.ResultsMajor findings confirmed shifts in the type FGM/C (presumably from infibulation to non-infibulating types) and increasing medicalization in the studied communities. These shifts were reported to be driven by social, professional and religious norms.ConclusionChanges in FGM practice in Sudan include drivers which will not facilitate abandonment of the practice instead lead to normalization of FGM/C. Yet professionalisation of Midwives including their oath to stop FGM/C has potential to facilitate abandonment rapidly if developed with other Sudan health professionals.

Negotiating Female Genital Cutting in a Transnational Context

“…The transnational setting of the diaspora also leads to changes in the decision-making processes and distribution of decision-making power. In the country of origin, FGC decisions are commonly made by larger groups of people, in which girls’ mothers may have had limited decision-making power (Bedri et al, 2019). Furthermore, decisions have commonly been strongly influenced by community pressure (Hamed et al, 2017; Newell-Jones, 2016).…”

“…Despite the stronghold of traditional FGC-norms in both Somalia and Sudan (Bedri et al, 2019; Powell & Yussuf, 2018), international norms have been known for decades in both countries (Boddy, 2007; Lunde & Sagbakken, 2014). However, early initiatives targeted mainly infibulation (Abdalla, 1982; Boddy, 2007), which may have contributed to the current support for a change to a less extensive form of FGC rather than full abandonment of the practice (Crawford & Ali, 2014; Elmusharaf et al, 2006).…”

“…This new type is commonly referred to as sunna circumcision, a term otherwise used to designate religiously recommended practices in Islam. A major motivation for the change of type is to mitigate the health risks associated with infibulation (Bedri et al, 2019; Powell & Yussuf, 2018). However, while there is an association between the anatomical extent of FGC and related health complications, there is no agreement about the physical extent of sunna circumcision, as the term has been used to denote procedures that are encompassed by all of the four types of FGC outlined by WHO (Crawford & Ali, 2014; Elmusharaf et al, 2006; Johansen, 2019): Type I—removal of part or all of the clitoral glans and/or its prepuce; Type II—removal of part or all labia minora, often with the clitoral glans and/or its prepuce; Type III—infibulation, that is, cutting and apposition of labia minora and/or majora to form a seal of skin that covers most of the vulva, usually following the removal of tissue from the clitoris and labia; and Type IV—any other procedure that may harm the external genitalia but that do not include tissue removal (World Health Organization, 2020).…”

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

“…Other researchers argue that to achieve a collective approach, there needs to be a shift in consciousness so abandonment of the practice occurs without risk of judgement or alienation [25]. Shifts in the practice of FGM/C may occur through its 'medicalization', or focus on its health-related effects, including social and religious norms and increased awareness of its negative health effects [26]. Evidence suggests that medicalization fails to reduce the practice, merely shifting it into the hands of medical practitioners [27].…”

Female Genital Mutilation in Sudan: is a new era starting?

“…Unfortunately, this study didn’t include Sudan that, from a FGM/C point of view is going through an interesting and potentially revolutionary phase. In fact, FGM/C practices in Sudan started some fifty years ago and recent data showed a prevalence of 87% among women at reproductive age 15–49 years and 31% among young girls (< 15 years) (Bedri et al 2019 ). However, recently, a law has been enacted making FGM/C prohibited.…”