Title: Challenges perceived by social workers to prevent FGM/C in Bavaria: a prospective,
cross- sectional survey
Version: 1 Date: 16 Nov 2023
Reviewer's report:
The topic of the paper is interesting and has societal relevance. The study has the potential to
contribute to the academic literature, as well as to policy recommendations. However, multiple
clarifications and revisions are needed:
INTRODUCTION
1. I would like to invite the authors to reflect on the language and terminology used in the article.
a. Could the authors argue why they use the term “FGM-Female Genital Mutilation”?
b. The language used to describe the practice of FGM is quiet outspoken, e.g. “It is an extreme
form of discrimination against women and a cruel, inhumane act that can cause irreparable harm
to girls and women and even lead to death [Box 1] [1,3].” Could the authors argue why they
choose to use this type of language; as well as argue whether this language was also used in
interaction with respondents and how this may have affected their research results.
2. Wat is referred to with [Box 1]? If Table 1, do refer to it as table 1 and introduce the tables
discusses a methodology
3. “The number of women and girls living in Germany with a nationality from one of the
countries where FGM is practising has risen by nearly 40% since 2017.” Please do elaborate on
the methodology of this calculation including information on which countries are included in this
calculation; because as the authors state themselves, estimation of number remains challenging.
4. “Given the increase of women and girls either living with FGM or endangered by FGM in
Germany, there is a need to improve the skills of service providers not only to treat FGM but
also to prevent it [7].” This decrease was not introduced before.
5. The aim of the study needs to be clarified. In line 105-109 multiple main objectives are
presented.
6. The introduction is based on a rather limited amount of references. There should be a more
detailed overview of the state of the art concerning research on social workers and FGM
counselling. I am sure there are existing studies on training needs and challenged perceived by
social workers.
MATERIAL AND METHODS & RESULTS
7. The focus on social workers is relevant and interesting. The respondents targeted in the study
are social workers working in pregnancy counselling center. Here, more information is needed.
a. Could the author provide more information on who is targeted by pregnancy counselling
centers?
b. Are specialized FGM advice centers part of pregnancy counselling centers?
c. Could the author describe how many of social workers in pregnancy counselling centers there
are; and whether in relation to this number whether 141 respondents is a rather large/small; and
whether it is representative sample or not?
d. Where the respondents equally spread over the 144 pregnancy counselling centers?
8. The drop out after initiating the survey is extensive (39%). Did the authors examine this drop
out? Did they found a pattern in respondents who dropped out? How did this possibly affect the
results? How were the missing values handles in the analyses?
9. Knowledge on FGM seems to be measured by being able to estimate the amount of girls
cut in Germany, as well as knowing the WHO’s FGM typology. Aren’t this quiet difficult
questions; which are only know by people specialized in working on FGM? Where there also
other knowledge questions asked? If you could do the study again, would you change this
measurement?
10. Could the ethnic/migration background of the respondents be taken into account in the
analyses?
11. Do you have information on whether respondents already have had an educational session
on FGM? Could this be taken into account in the analyses?
12. Was their a fill out box for perceived challenges? Or where the categories determined
beforehand? If yes, how?
13. In general, more information is needed on the created survey. Could the survey be attached
to the article? Or at least, to the respond to reviewers?
14. “Nearly 60% perceived legal counselling as insufficient, and 21% did not know the topic.”
What does this 21% refer to? What is the relation with legal counselling?
15. “The majority (75.3%) addressed it only if the topic seemed relevant for the contact with the
client.” Do you have information on when it is perceived relevant? When is FGM not relevant
in pregnancy counselling?
16. Is the information about FGM part about information for social workers, or for clients?
Please do clarify. Moreover, is it correct that seminars/workshops/live classes are no options for
information sharing? If yet, why is this choice made? And was there an opportunity to fill out
an answer box or where the categories determined beforehand?
DISCUSSION
17. Here, again, the aim is formulated differently: “This study is, to our knowledge, the first
cross-sectional survey accessing FGM experiences and challenges in the provision to good
quality of care perceived by professionals working at pregnancy counselling centres in Bavaria.”
More consistency is needed in the manuscript.
18. The discussion gives a relevant overview of policy recommendations. However, the
academic contribution of the research is not discussed. Please do so in the discussion section.
19. Please do elaborate on on the possible selection bias mentioned in “the strengths and
limitations”
20. “In addition, mainly social workers in pregnancy counselling centres participated in the
study.” This can’t be an objective and a limitation.
21. “Lastly, due to the nature of self-evaluation, results are shaped by subjectivity.” Aren’t there
also other possible limitations related to using self-evaluation surveys?
22. “First, we used a representative e-mail distribution list, and participants from all
administrative regions in Bavaria participated.” Please discuss the representativeness of the
sample more critically. Sending out an invitation to all potential respondents does not inform us
about the representation of the sample.
23. “As the sample size is sufficiently large without important outliers distorting the picture and
data are comparable to international studies, we consider them generalisable for similar settings”
– please do deliver arguments for this statement.
GENERAL
24. Language editing is required
25.         The manuscript should include references to the tables attached to the paper