School of Nursing Sciences, University of Nairobi, Nairobi, Kenya.
Africa Coordinating Centre for the Abandonment of Female Genital Mutilation /Cutting (ACCAF), Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
PLoS One. 2020 Mar 2;15(3):e0228410. doi: 10.1371/journal.pone.0228410. eCollection 2020.
Although female genital mutilation/cutting (FGM/C) has declined, it is pervasive albeit changing form among communities in Kenya. Transformation of FGM/C include medicalization although poorly understood has increased undermining abandonment efforts for the practice. We sought to understand drivers of medicalization in FGM/C among selected Kenyan communities. A qualitative study involving participants from Abagusii, Somali and Kuria communities and key informants with health care providers from four Kenyan counties was conducted. Data were collected using in-depth interviews (n = 54), key informant interviews (n = 56) and 45 focus group discussions. Data were transcribed and analyzed thematically using NVivo version 12. We found families practiced FGM/C for reasons including conformity to culture/tradition, religion, marriageability, fear of negative sanctions, and rite of passage. Medicalized FGM/C was only reported by participants from the Abagusii and Somali communities. Few Kuria participants shared that medicalized FGM/C was against their culture and would attract sanctions. Medicalized FGM/C was perceived to have few health complications, shorter healing, and enables families to hide from law. To avoid arrest or sanctions, medicalized FGM/C was performed at home/private clinics. Desire to mitigate health complications and income were cited as reasons for health providers performing of FGM/C. Medicalization was believed to perpetuate the practice as it was perceived as modernized FGM/C. FGM/C remains pervasive in the studied Kenyan communities albeit changed form and context. Findings suggest medicalization sustain FGM/C by allowing families and health providers to conform to social norms underpinning FGM/C while addressing risks of FGM/C complications and legal prohibitions. This underscores the need for more nuanced approaches targeting health providers, families and communities to promote abandonment of FGM/C while addressing medicalization.
尽管女性外阴残割/切割（FGM/C）有所减少，但在肯尼亚的社区中，它仍然普遍存在，尽管形式正在发生变化。FGM/C 的转变包括医学化，尽管人们对此了解甚少，但却增加了对放弃该实践的努力的破坏。我们试图了解肯尼亚选定社区中 FGM/C 医学化的驱动因素。一项涉及 Abagusii、索马里和 Kuria 社区的参与者以及来自肯尼亚四个县的医疗保健提供者的关键信息提供者的定性研究。使用深入访谈（n = 54）、关键信息提供者访谈（n = 56）和 45 个焦点小组讨论收集数据。使用 NVivo 版本 12 对数据进行转录和主题分析。我们发现，家庭进行 FGM/C 的原因包括遵守文化/传统、宗教、婚姻、害怕受到负面制裁和成年礼。只有来自 Abagusii 和索马里社区的参与者报告了医学化的 FGM/C。少数 Kuria 参与者表示，医学化的 FGM/C 违反了他们的文化，会引起制裁。医学化的 FGM/C 被认为并发症较少，愈合较快，并且使家庭能够逃避法律。为了避免被捕或制裁，医学化的 FGM/C 在家庭/私人诊所进行。减轻并发症和获得收入被认为是医疗保健提供者进行 FGM/C 的原因。医学化被认为是维持该实践的原因，因为它被视为现代化的 FGM/C。在研究的肯尼亚社区中，FGM/C 仍然普遍存在，尽管形式和背景发生了变化。研究结果表明，医学化通过允许家庭和医疗保健提供者在解决 FGM/C 并发症风险和法律禁止的同时，遵守支持 FGM/C 的社会规范，从而维持 FGM/C。这凸显了需要采取更细致入微的方法来针对医疗保健提供者、家庭和社区，以促进放弃 FGM/C，同时解决医学化问题。
