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Abstract

In November 2008, the Norwegian Knowledge Centre for Violence and Traumatic Stress Studies (NKVTS) commissioned the Norwegian Knowledge Centre for the Health Services (NOKC) to conduct a systematic review about the factors promoting and hindering female genital mutilation/cutting (FGM/C), from the viewpoints of stakeholders residing in Western countries. The review would answer the question: What are the factors promoting and hindering the practice of FGM/C, as expressed by stakeholders residing in Western countries? We searched systematically for relevant literature in international scientific databases, in databases of international organisations that are engaged in aspects related to FGM/C, and in reference lists of relevant reviews and included studies. Additionally, we communicated with professionals working with FGM/C related issues. We selected studies according to pre-specified criteria, appraised the methodological quality using checklists, and summarized the study level results in tables before performing an integrative evidence synthesis. Our conclusions were summed in a conceptual model. We included and summarized results from 25 studies, of which 16 were qualitative investigations, eight were quantitative studies, and one was a mixed-methods study. There were three stakeholders groups: exiled members from communities where FGM/C is practiced, health workers, and government officials. The results of these stakeholders' perceptions showed that the continuance of FGM/C is largely attributable to six factors: cultural tradition, the interconnected factors sexual morals and marriageability, religion, health benefits, and male sexual enjoyment. Factors perceived as hindering its continuance included health consequences, that it is not a religious requirement, that it is illegal, and that host society discourses reject FGM/C. Our results show that an intricate web of cultural, social, religious, and medical pretexts for FGM/C exists. However, more research is needed to understand the totality and interconnectedness of factors promoting and hindering FGM/C among exiled members of practicing communities.

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