Female genital mutilation (FGM), female cutting and circumcision are all synonyms for procedures involving partial or total removal of the external genitalia and other injury to the genital organs for non-medical reasons.(WHO 2008) It is widely practiced in 29 countries. Worldwide more than 125 million girls and women deal with the consequences and every year 3 million girls are circumcised.(UNICEF 2013)
Sierra Leone, located in West-Africa, is one of the countries where FGM is practiced (textbox 1). Here, prevalence of FGM is about 90%. Types I and II (table 1) are most prevalent, accounting together for about 75%.(DHS 2013) FGM occurs in all 16 ethnic groups in Sierra Leone, in highest amount in the Temne and lowest amount in the minority group of Christian Krio.(MICS 2011)
The procedure often occurs without local anesthesia and under non-sterile conditions. A wide range of complications can occur, reported in 84.5% of cases, including excessive pain, bleeding, shock, urine retention, septicaemia, infertility, obstructed labor, HIV and hepatitis B infection and even death. Also psycho-sexual problems are reported.( Bjälkander, Bangura, et al. 2012; MICS 2011)
Because of the negative health effects, FGM was recognized as a violation of human rights and came under attention in the international human rights law in 1993, at the Vienna World Conference on Human Rights.(WHO 2008)
Several countries in Africa and Europe enacted laws against the practice. Sierra Leone signed conventions on the subject, including the Convention for the Elimination of Discrimination against Women (CEDAW) and the UN Convention on the Rights of the Child (CRC). However, no national law prohibiting FGM has been implemented and the political will to stop the practice is low. Many politicians don't want to speak out against FGM, as they are afraid to loose votes.(Bjälkander, Leigh, et al. 2012; UNICEF 2013)
FGM is deeply rooted in the Sierra Leonean tradition, religion and culture. It has an important place in the initiation rite of girls turning into women, around the age of puberty. It also gives membership to a secret society led by women and called Bondo in the North and in Freetown and Sande in the South (figure 1).(UNHCR 2007)
So far, most interventions have not been effective, probably because FGM is rooted deeply in culture and complex causes make it hard to intervene.
The objective of this literature review is to analyze which determinants influence FGM in Sierra Leone in order to inform local Non Governmental Organizations (NGOs). This can help to implement effective interventions.
2.1 Search strategy
A search was conducted using Popline, Pubmed, the World Health Organization, UNHCR and the UNICEF website (table 2). After applying in- and exclusion criteria (table 3) and reference screening, 15 articles and reports were found useful.
When referred in this paper to initiation or...