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Research Topics Harmful Traditional Practices Forum Presentation Materials - Harmful Traditional Practices Glossary

Research Topics

This section provides brief summaries of current research on harmful traditional health practices relevant to low-resource settings.  More detailed discussions of specific research topics are included in the bibliography.

Behavior change communication

Exploring FGM attitudes and practices

Preventing female genital mutilation/ circumcision

The role of the law and policy in eradicating FGM

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Behavior change communication

Growing evidence on behavior change highlights the importance of involving the community in behavior change strategies, fully understanding why and how a behavior persists, and ensuring adequate time for sustainable change. Several models exist to guide program activities. For example, the Health Belief Model seeks to explain and predict behavior by analyzing attitudes and beliefs: In order to change behavior, an individual must believe that a health threat is serious and possible; that the new behavior will have a benefit; and that the new behavior won't have overly serious consequences. The S tages of Change model presents a cyclical process which includes precontemplation of new behavior, contemplation, preparation, action and maintenance. Understanding where an individual or community is in the process is important in program design (AIDSCAP, 1996). Diffusion theory looks at change from the perspective of groups rather than individuals (Rogers, 1995) . Community research must factor into program design. Showing respect for the target audience through local initiative and involvement is vital to changing behavior (Werner, 1982). For example, the Population Council is evaluating whether a participatory approach can prove more effective than more traditional approaches in the fight against FGM. The study uses social mapping, story telling, causal diagrams, and trend analysis to both assess the communities' attitudes and needs and raise awareness in respect to FGM. (A final report will be available in August 1998 from Inoussa Kaboré, Population Council, 01 BP 6250, Villa 558, Zone Residentielle du Bois, Ouagadougou, Burkina Faso, [email protected] .)

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Exploring FGM attitudes and practices

Learning more about how and why FGM is practiced in various settings is key to developing prevention strategies. Where FGM is very widely practiced, for example, older members of the community often are influential in decisions to perform the procedure on young girls (Population Council, 1996). Even where it is illegal (for example, in Burkina Faso), a significant proportion of adults may approve of the practice and plan to continue it with their daughters (Population Council, 1997). In Kenya, it was found that mothers, grandmothers, and mothers-in-law were most influential in deciding on the practice (PATH, 1996). Studies of families that have not practiced FGM have found that circumcision providers, who often are respected members of the community, are key in continuing the practice, because they believe FGM is important and benefit from it financially (Hassan, 1995).

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Preventing female genital mutilation/circumcision

Specific strategies for preventing FGM are being developed and tested. It is clear that preventing FGM is a lengthy and complicated process. The Wallace Global Foundation cites five key elements of a successful program: start with research; work with appropriate leaders; include and inform all affected members and decision-makers of the target community; provide psychological support; and use local culture and customs (Rich, 1996). Dr. Koso-Thomas, an African activist and health professional, has demonstrated the importance of earning community trust in efforts to stop FGM (Rich, 1996; Koso-Thomas, 1992). PATH and Population Action International (PAI) have worked closely with Maendeleo ya Wanawake Organization (MYWO), the largest women's organization in Kenya, to develop community-based programs to reduce the incidence of female genital mutilation through promotion of alternate "coming-of-age" rituals. The MYWO project conducted quantitative and qualitative research in four districts of the country during the design of alternate rituals. Thirty girls participated in the first alternative ceremony, which took place in Tharaka Nithi in Meru District in August 1996. Since the Tharaka Nithi experience, 49 other girls have graduated to adulthood in Meru without circumcision. The PATH Web site includes full information on this project at www.path.org/html/modern_rites_of_passage.htm.

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The role of the law and policy in eradicating FGM

To date, only basic research has been done on the actual effects of laws and policies on harmful practices like FGM. International and national policy statements alone from the United Nations probably do not cause families to make the decision to stop FGM. But they can serve as important moral backing for national and local FGM eradication programs (RAINBO, 1995).

Many of the same issues apply to legislation. Some argue that making FGM illegal drives the practice underground where it is harder to address. The same process also moves FGM further away from the hands of trained health professionals and institutions. Yet advocates for anti-FGM legislation feel strongly that it serves to delineate right from wrong and gives support to local efforts to end the practice. Over the past several years in Egypt, legal struggles raged around the possible re-legalization of FGM in that country. Ultimately, Egypt's highest court dictated that it must remain illegal.

FGM has been illegal in Sudan for decades with little effect. Other countries, including Burkina Faso and Ghana, have recently passed legislation banning FGM and have even arrested FGM practitioners. Many industrialized nations have legislated against FGM as well, including the United States and Britain, where some immigrants have brought the practice with them (Crawley, 1997).

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Overview and Lessons Learned Program Examples Bibliography Links
Research Topics Harmful Traditional Practices Forum Presentation Materials - Harmful Traditional Practices Glossary