Risk and prevalence of female genital mutilation/cutting (FGM/C) among the immigrant population in Norway
Creators: name: Ziyada, Mai
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Public Health
subject: Medicine and Health Sciences
subject: International Public Health
subject: Countries of migration
subject: Delphi
subject: Extrapolation
subject: FGM/C
subject: Norway
subject: Prevalence
subject: Risk

description: The following text is a brief summary (Please see the supplemental file for detailed information). Using a refined methodology, this study (July 2022 - July 2025) will provide updated knowledge about the prevalence and risk of FGM/C in Norway. Because FGM/C causes physical, psychological, and sexual health problems, many vulnerable girls and women need healthcare. Those who have not been exposed need protection from FGM/C and its associated health problems. In order for the services to cater to the potential healthcare needs among the exposed, we need knowledge of the number of those affected, their age, country of origin, type of FGM/C, and thus type of needed healthcare. Similarly, preventive services need to know the number of those at risk, which factors prevent or promote the risk of FGM/C, and which municipalities to prioritize. We will organize the study in two work packages (WP). The first WP aims to identify factors influencing attitudes and behaviors towards FGM/C in Norway and estimate the effect size of migration and acculturation and preventive and protective measures (MAPPM) on attitudes and behaviors towards FGM/C among different affected migrant groups. For this package, we will combine a literature study with the expanded use of Delphi. We will also limit the target group in the first WP to the six largest affected population groups (Somalis, Sudanese, Eritreans, Ethiopians, Gambians, and Kurds). In a previous study, these six groups constituted over 90% of all girls and women subjected to FGM/C in Norway (Ziyada, Norberg-Schulz, &amp; Johansen, 2016). We will recruit people with experience from and/or knowledge of FGM/C among the target group to participate in four Delphi panels (Somalis and Sudanese, Eritreans and Ethiopians, Gambians, and Kurds). The experts will include researchers, service providers (e.g., child protection services), and those involved in FGM/C preventive works, including immigrant organizations. We will prioritize people with a background from the relevant FGM/C practicing countries while selecting the experts. Due to practical considerations, both the Delphi process and reference group meetings will be conducted electronically. The qualitative component of the Delphi method (clarifications and reasoning for the individual responses) will be collected through open-ended questions in the questionnaires. In the second WP, we will adjust the extrapolated data for the effect of MAPPM calculated in the first WP and estimate the number of girls and women subjected to FGM/C and the number of girls at risk. First WP The Delphi method is based on group consensus among experts accomplished through several rounds of structured communication (Boulkedid, Abdoul, Loustau, Sibony, &amp; Alberti, 2011; Okoli &amp; Pawlowski, 2004; Schmidt, Lyytinen, Keil, &amp; Cule, 2001). Using ranking-type Delphi (Okoli &amp; Pawlowski, 2004; Schmidt et al., 2001), we will first conduct a literature review to identify factors that influence attitudes and behaviors related to FGM/C in Norway and other countries of migration. These factors will then be discussed and adjusted in a reference group with user representatives. Thereafter, the Delphi process will be conducted in three phases combining qualitative and quantitative data. In the first phase, we will send a questionnaire with a list of identified factors via email, asking all experts to use their expertise to add to the list and explain the newly added factors. Returned questionnaires will be processed, duplicates will be deleted, and a new questionnaire with all identified factors will be developed and sent back to the experts for validation. In the second phase, we will send the new validated questionnaire to the experts on each panel and ask them to narrow down the list and justify their decisions. Subsequently, we will include factors retained by more than 50% of experts at each panel in a questionnaire with four different lists. In the third phase, we will ask the experts at each panel to use their expertise to score the effect size of each factor on their list with a total score of 10. We will also ask the experts to justify their scores. We will then analyze the data and provide the experts with an anonymized overview of both their own- and other panel participants’ weighting and justification and the opportunity to adjust their scores. This process will be repeated until consensus is reached within each panel, assessed by statistical analysis (Kendall’s W coefficient of concordance). Finally, we will calculate the MAPPM impact factor separately for each panel by summing up the scores (0-10) given to all factors related to MAPPM in each of the four lists. Second WP In the second WP, we will first estimate the number of girls and women in Norway subjected to FGM/C pre-migration by extrapolating prevalence data on FGM/C from countries of origin to our reference population and adjusting for age, education, and regional differences. We will then present this estimation stratified by types of FGM/C and the municipality of current residence. For this step, we will use data from SSB on our reference population divided by age upon arrival in Norway, place of birth, municipality of current residence, and education level upon arrival in Norway. From the latest DHS and MICS reports from the 31 FGM/C practicing countries, we will use prevalence data on FGM/C divided by region, age, levels of education, and types of FGM/C. Next, we will estimate the number of first-generation girls subjected to FGM/C post-migration, the number of second-generation girls subjected to FGM/C, and the number of first- and second-generation girls at risk of FGM/C. We will extrapolate prevalence data on FGM/C from countries of origin to our reference population and adjust for age, length of stay in Norway, and regional differences. In addition, to adjust for changes in attitudes and behaviors towards FGM/C among the reference population in countries of migration, we will use the MAPPM impact-factor values that we calculated in the first package for Somali, Sudanese, Ethiopian, Eritrean, Gambian, and Kurds. We will assign a value of “1” to the impact factor for the rest of the groups. After that, we will present the estimation of FGM/C prevalence post-migration and among second-generation girls stratified by types of FGM/C and the municipality of current residence. Similarly, we will present risk estimation stratified by the municipality of the current residence. We will use SSB data on first-generation resident girls divided by birthplace, age upon arrival in Norway, current age, and residence municipality. We will also use SSB data on second-generation resident girls divided by the mother’s birthplace and length of stay in Norway, current age, and residence municipality. DHS and MICS data will consist of the prevalence of FGM/C divided by region, age, and types of FGM/C. References Boulkedid, Rym, Abdoul, Hendy, Loustau, Marine, Sibony, Olivier, &amp; Alberti, Corinne. (2011). Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PloS one, 6(6), e20476. Okoli, Chitu, &amp; Pawlowski, Suzanne D. (2004). The Delphi method as a research tool: an example, design considerations and applications. Information &amp; management, 42(1), 15-29. Schmidt, Roy, Lyytinen, Kalle, Keil, Mark, &amp; Cule, Paul. (2001). Identifying software project risks: An international Delphi study. Journal of management information systems, 17(4), 5-36. Ziyada, M. M., Norberg-Schulz, M., &amp; Johansen, R. E. B. (2016). Estimating the magnitude of female genital mutilation/cutting in Norway: an extrapolation model. BMC Public Health, 16(110). doi: 10.1186/s12889-016-2794-6