Reviewer ’s report  
 
Title: “When my mother called to say that the time of cutting had arrived, I escaped to Belgium  
with my daughter ”: Identifying turning points in the change of attitudes towards the practice of  
Female Genital Mutilation among migrant women in Belgium  
 
Version: 0 Date: 13 Feb 2020  
 
Reviewer: Dennis Matanda  
 
Reviewer's report:  
 
This is a well written paper tackling an important topic on female genital mutilation. My 
comments are majorly about how the authors can strengthen the paper. All the best .  
 
1. TITLE: Suggestion, do away with the quotation as it doesn't add much value. "Identifying 
turning points in the change of attitudes towards the practice of Female Genital Mutilation 
among migrant women in Belgium" seems appropriate.   
 
2. BACKGROUND: T here is need for a proper study rationale and a statement of the 
problem/issue that this study addresses. What is the gap in the literature that this study tries to 
fill? Why should we care about the turning point/critical life events among migrant women w ith 
regards to changes in attitude towards FGM? Is this a novel study that uses the turning point 
approach in relation to FGM? This needs to come out clearly backed with a thorough literature 
review.  
 
3. METHODS: Line 2 -5, pg 5. What does "had experienced F GM" mean? Did the women self -
report that they had been cut? Since this was an inclusion/exclusion criteria for selecting study 
respondents, clarity is important.  
 
4. METHODS: Line 32 -34, pg 5. Since the biographical narrative interview method (BNIM) was 
used in conducting interviews, it will be more helpful to briefly describe what BNIM entails; 
rather than just providing a reference.  
 
5. RESULTS: Line 51 -54, pg 7. Couldn't make sense of the statement. The authors haven't 
shared any results so far, and yet th ey are stating that "our results confirmed the practice of FGM 
as a social norm..." I think such statements should appear in the conclusion section rather than 
under "participants characteristics". Importantly, I did not see data that would enable the 
investigators state that their results confirmed FGM as a social norm.  
 
6. RESULTS: There is a consistent mention of "patriarchal system" and how such a system 
propagates FGM. I think this is an important finding that needs to be highlighted and more data 
provided. This is because a patriarchal system speaks to gender norms that most researchers and 
program implementers don't pay attention to; and yet in most societies this is what defines 
"male" and "female" roles that are linked to harmful traditional practic es such as FGM and child 
marriage.  
7. DISCUSSION: The discussion needs more reflection by comparing/contrasting findings with 
what is in the literature. Currently, it is very thin on this. For example, there is a lot of literature 
on how health education c an enable people to change simple behavior and whether this is true for 
complex behaviors driven by social norms such as FGM. What about when people become 
aware of the health consequences of their behavior? does this lead to total abandonment or 
modificat ion of behavior? In the FGM arena, we have seen people modifying how they perform 
FGM (lesser cut, medicalisation, younger age at cutting) after being exposed to information 
about the health consequences of performing FGM. What about social interaction? Do es this 
enable people to deliberate as a community on FGM and therefore lead to abandonment as 
explained in the social norms theory? I hope the authors will dig in a little more and be critical.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments t o the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain i n your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
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