Baseline data from a planned RCT on attitudes to female genital cutting after migration: when are interventions justified?

Anna Wahlberg, Sara Johnsdotter, Katarina Ekholm Selling, Carina Källestål, Birgitta Essén, Anna Wahlberg, Sara Johnsdotter, Katarina Ekholm Selling, Carina Källestål, Birgitta Essén

Abstract

Objectives: To present the primary outcomes from a baseline study on attitudes towards female genital cutting (FGC) after migration.

Design: Baseline data from a planned cluster randomised, controlled trial. Face-to-face interviews were used to collect questionnaire data in 2015. Based on our hypothesis that established Somalis could be used as facilitators of change among those newly arrived, data were stratified into years of residency in Sweden.

Setting: Sweden.

Participants: 372 Somali men and women, 206 newly arrived (0-4 years), 166 established (>4 years).

Primary outcome measures: Whether FGC is acceptable, preferred for daughter and should continue, specified on anatomical extent.

Results: The support for anatomical change of girls and women's genitals ranged from 0% to 2% among established and from 4% to 8% among newly arrived. Among those supporting no anatomical change, 75%-83% among established and 53%-67% among newly arrived opposed all forms of FGC, with the remaining supporting pricking of the skin with no removal of tissue. Among newly arrived, 37% stated that pricking was acceptable, 39% said they wanted their daughter to be pricked and 26% reported they wanted pricking to continue being practised. Those who had lived in Sweden ≤ 2 years had highest odds of supporting FGC; thereafter, the opposition towards FGC increased over time after migration.

Conclusion: A majority of Somali immigrants, including those newly arrived, opposed all forms of FGC with increased opposition over time after migration. The majority of proponents of FGC supported pricking. We argue that it would have been unethical to proceed with the intervention as it, with this baseline, would have been difficult to detect a change in attitudes given that a majority opposed all forms of FGC together with the evidence that a strong attitude change is already happening. Therefore, we decided not to implement the planned intervention.

Trial registration number: Trial registration number NCT02335697;Pre-results.

Keywords: Somalis; Sweden; female genital mutilation; intervention; migration; pricking.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Visual Analogue Scale, ranging from 0 to 100 mm, used in the questionnaire to capture all different forms of female genital cutting based on anatomy, and approximately how this corresponds to the WHO classification and Somali terminology. 1 WHO type IV includes several procedures, defined as ‘all other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization’. In this context, pricking is most relevant.
Figure 2
Figure 2
Acceptability of different forms of FGC (outcome 1, upper graphs) and preferred form of FGC of daughter (outcome 2, lower graphs), stratified on established (n=166) and newly arrived (n=206). 0=No form of FGC; 100=All forms of FGC. FGC, female genital cutting; VAS, Visual Analogue Scale.
Figure 3
Figure 3
Attitudes regarding what form of female genital cutting that should continue to be practised (outcome 3), stratified on established (n=166) and newly arrived (n=206).

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