Reviewer’s report
Title: 
Women’s empowerment and female genital mutilation intention for
daughters in Sierra Leone: a multilevel analysis
Version: 
0 
Date: 
07 Jul 2020
Reviewer's report:
In this manuscript, the authors examine the association between indicators of
women's empowerment and women's intentions to have their daughter undergo
female genital mutilation (FGM). Given that FGM is widely considered a
violation of the rights of women and girls and the wealth of evidence showing
the negative health and social impacts of the practice, this paper addresses an
important topic. That said, the paper has several shortcomings that the authors
would need to address for the paper to be publishable. 
In particular, the paper would benefit from a more critical appraisal of the
conceptualization of women's empowerment and how it might relate to FGM. In
the Sierra Leone context, in particular, the authors suggest that in contrast to
claims by feminists and other scholars that FGM "serves as a tool to subordinate
and control women", women in Sierra Leone themselves organize FGM and
ensure its continuity. The authors may benefit from reading the following article,
which highlights the complexities of the Bondo society particularly with respect
to its continuity in a patriarchal community.
Chi Adanna Mgbako, Meghna Saxena, Cave Anna, and Nasim Farjad,
Penetrating the Silence in Sierra Leone: A Blueprint for the Eradication of
Female Genital Mutilation, 23 Harv. Hum. Rts. J. 111 (2010). Available at:
https://ir.lawnet.fordham.edu/faculty_scholarship/398 
Additional comments are provided below
Abstract: In the abstract the authors note that FGM is common in Sierra Leone,
then state that "as a result, empowering women will provide protective benefits
for women against FGM/C." The basis for this claim is not articulated. It would
be useful for the authors to highlight previous findings with respect to the link
between FGM and women's empowerment and highlight the research gap that
this study is expected to fill. 
Background: In the second paragraph, the authors note that legal efforts appear
to be ineffective in countries like Sierra Leone, where they note that about 90%
of women have undergone FGM. A look at DHS data shows that there is a
difference in the prevalence of the practice across different age cohorts, with the
prevalence being lowest among younger cohorts. As explained in
https://www.popcouncil.org/uploads/pdfs/2018RH_ReferenceGuideFGMC.pdf
"When using national DHS data, the best way to determine a change in a
country's FGM/C rate over time is to compare the prevalence of the oldest age
group (ages 45 to 49) to the youngest age group (ages 15 to 19) within a single
survey." While the change may not be as a result of the law, it would be good for
the authors to acknowledge the possibility of positive change. 
Methods: The measurement of women's empowerment needs to be reconsidered.
In particular, the measurement of labor force participation is limited to whether
or not a woman was employed. One of the previous studies that the authors cite
—Sebayang et al—had a more nuanced operationalization of labor force
participation. They assessed labor force participation in six dimensions (work in
the last 12 months, for whom the women work, women's occupation, type of
payment, frequency of work, and earnings compared to their husband). This
level of nuance is important as previous studies have shown that the type of
employment may matter. 
In addition, while Sebayang et al conceptualized knowledge as a variable
accounting for formal educational level and access to media, it may be useful to
separate these variables in this analyses in line with previous studies that use
DHS data to assess the correlates of FGM. 
In the methods, the authors should also clarify that the sample of women
included in the analyses is restricted to those with a living daughter who is not
circumcised and should discuss the implications of this restriction on their
interpretation of the results.
Results: The writing of the results is somewhat awkward. I believe that this can
partly be addressed by presenting column percentages in Table 1 rather than row
percentages. So, for example, among women who intended to cut their girls,
what proportion of them were employed and how does this compare to the
proportion among those who did not intend to cut their daughter.
Discussion: In discussing the findings on the association between participation in
the labor force and FGM intentions, the authors note that their findings are
inconsistent with previous evidence and instead note that the association
observed is plausible in Sierra Leone where FGM is culturally entrenched. FGM
is culturally entrenched in the different contexts where it is practiced. As noted
above, the inconsistencies may stem from differences in how this variable is
measured across studies. 
The explanation of the finding that older women are less likely to intend to
circumcise their daughter is not very convincing - they note that older women
might have undergone FGM and recollect the pain and hence, not wish to have
their daughter experience the same pain. Yet, the next paragraph speaks to the
higher likelihood that women who had undergone FGM intend to circumcise
their daughter compared to those who had not been cut. Instead, as noted by
Shell-Duncan et al in their research in Senegal, older women may be more open
to re-evaluating social norms and practices and given their age, and, hence,
social status, may have more "power to negotiate change". 
Shell-Duncan B, Moreau A, Wander K, Smith S. (2018). The role of older
women in contesting norms associated with female genital mutilation/cutting in
Senegambia: A factorial focus group analysis. PLOS ONE 13(7): e0199217.
https://doi.org/10.1371/journal.pone.0199217
Under limitations, the authors note that the findings can be generalized to all
women in Sierra Leone, however, as I note above, the questions on intentions to
circumcise one's daughter are limited to those who have at least one
uncircumcised daughter.
Minor edits
Throughout the document the authors should use either FGM or FGM/C
consistently
Abstract (methods): delete "version of" in the first sentence
Background, line 4, para 1: replace "female children" with "girls"
Background, line 6, para 1: replace "gains" with "reasons" 
Background, line 6 para 1: rephrase sentence beginning with "FGM has
received…" as "Several global, regional and national level policies and
legislative instruments address FGM"
Results, line 10, para 1: correct spelling of intention (not intension)
Throughout the results rather than writing more or less "probable to intend"
rephrase as more or less "likely to intend"
References: Reference 5 and 19 are the same; reference 18 is incomplete
Overall, the manuscript needs a close read through for grammar 
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No
Are the methods appropriate and well described?
If not, please specify what is
required in your comments to the authors.
No
Does the work include the necessary controls?
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controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
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please explain in your comments to the authors.
No
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I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the
manuscript:
Needs some language corrections before being published
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