The Australian Centre for Public and Population Health Research, Faculty of Public Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
Ministry of Health, PO Box 30016-00100, Nairobi, Kenya.
Reprod Health. 2019 Jul 22;16(1):113. doi: 10.1186/s12978-019-0774-x.
Female genital mutilation (FGM) is prevalent in communities of migration. Given the harmful effects of the practice and its illegal status in many countries, there have been concerted primary, secondary and tertiary prevention efforts to protect girls from FGM. However, there is paucity of evidence concerning useful strategies and approaches to prevent FGM and improve the health and social outcomes of affected women and girls.
We analysed peer-reviewed and grey literature to extract the evidence for FGM prevention interventions from a public health perspective in high income countries by a systematic search of bibliographic databases and websites using appropriate keywords. Identified publications were screened against selection criteria, following the PRISMA guidelines. We examined the characteristics of prevention interventions, including their programmatic approaches and strategies, target audiences and evaluation findings using an apriori template.
Eleven documents included in this review described primary and secondary prevention activities. High income countries have given attention to legislative action, bureaucratic interventions to address social injustice and protect those at risk of FGM, alongside prevention activities that favour health persuasion, foster engagement with the local community through outreach and the involvement of community champions, healthcare professional training and capacity strengthening. Study types are largely process evaluations that include measures of short-term outcomes (pre- and post-changes in attitude, knowledge and confidence or audits of practices). There is a dearth of evaluative research focused on empowerment-oriented preventative activities that involve individual women and girls who are affected by FGM. Beattie's framework provides a useful way of articulating negotiated and authoritative prevention actions required to address FGM at national and local levels.
FGM is a complex and deeply rooted sociocultural issue that requires a multifaceted response that encompasses socio-economic, physical and environmental factors, education and learning, health services and facilities, and community mobilisation activities. Investment in the rigorous longitudinal evaluation of FGM health prevention efforts are needed to provide strong evidence of impact to guide future decision making. A national evidence-based framework would bring logic, clarity, comprehension, evidence and economically more effective response for current and future prevention interventions addressing FGM in high income countries.
女性生殖器切割（FGM）在移民社区中普遍存在。鉴于该行为的有害影响及其在许多国家的非法地位，已经采取了一致的初级、二级和三级预防措施，以保护女孩免受 FGM 的侵害。然而，关于预防 FGM 和改善受影响妇女和女孩的健康和社会成果的有用策略和方法的证据很少。
我们从公共卫生的角度分析了同行评议和灰色文献，通过使用适当的关键词对文献数据库和网站进行系统搜索，从高收入国家中提取了 FGM 预防干预措施的证据。根据 PRISMA 指南，对符合入选标准的出版物进行筛选。我们使用预先制定的模板，检查预防干预措施的特征，包括其方案方法和策略、目标受众和评估结果。
本综述共纳入 11 篇文献，描述了初级和二级预防活动。高收入国家已经关注立法行动、解决社会不公和保护那些面临 FGM 风险的人的官僚干预措施，以及有利于健康说服的预防活动、通过外展和社区拥护者的参与来促进与当地社区的接触、医疗保健专业人员的培训和能力建设。研究类型主要是过程评估，包括短期结果的测量（态度、知识和信心的变化前后，或实践的审计）。缺乏以赋权为导向的预防活动为重点的评估研究，这些活动涉及受 FGM 影响的个别妇女和女孩。Beattie 的框架提供了一种有用的方式，可以表达解决国家和地方一级 FGM 所需的协商和权威预防行动。
FGM 是一个复杂且根深蒂固的社会文化问题，需要多方面的应对措施，包括社会经济、身体和环境因素、教育和学习、卫生服务和设施以及社区动员活动。需要对 FGM 健康预防工作进行严格的纵向评估投资，以提供有力的影响证据，为未来的决策提供指导。一个国家循证框架将为当前和未来解决高收入国家 FGM 的预防干预措施提供逻辑、清晰度、理解、证据和更经济有效的应对。
