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How Can Approaches Aimed at Preventing Female Genital Mutilation Be Improved and Developed Using Participatory Methods with Second-Generation Young People in the UK?

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How Can Approaches Aimed at Preventing Female Genital Mutilation Be Improved and Developed Using Participatory Methods with Second-Generation Young People in the UK? How can approaches aimed at preventing female genital mutilation be improved and developed using participatory methods with second-generation young people in the UK? Saadye Ali A thesis submitted in partial fulfilment of the requirements of the University of the West of England, Bristol for the degree of Doctor of Philosophy Faculty of Health and Applied Sciences, the University of the West of England, Bristol. March 2020 Dedication This thesis is dedicated to my late father. May his soul continuously rest in eternal peace – Ameen. ii Acknowledgement This research would have been impossible to complete without the help and generosity of many individuals. Although I may not be able to mention every one of them, I am extremely grateful to them all. Firstly, I am truly grateful to my Director of Studies, Professor Selena Gray, for her continuous support, patience and immense knowledge that guided me throughout this journey. Second, my sincere gratitude goes to Professor Debra Salmon for providing me with the platform to research something very close to my heart and believing in my abilities. To my supervisors, Dr Nick De Viggiani and Dr Aida Abzhaparova, for their insightful comments and encouragement, which always made a significant impact towards improving the quality of my project. I could not imagine a better supervision team for my PhD. Layla Ismail of Refugee Women of Bristol and Naana Otoo-Oyortey, Executive Director of FORWARD, for their support and advice throughout this project. Jackie Mathers, for her kind words and guidance, as I attempted to engage and safeguard young people in this research. To all the co-researchers and participants involved in this project, without their hard work and commitment, there would be no thesis. I thank you for your time, and your willingness to talk about this topic. I hope what I have written represents you fairly. Finally, a special thanks to my mum, without whom I would never have reached this point. Strength, tenacity and perseverance are the qualities I have gained from you; words cannot express my gratitude for your love and support over the years. I hope I continue to make you proud. ii Abstract Background: There is considerable interest in Female Genital Mutilation (FGM) at global level, and within the United Nations Development Programme Sustainable Development Goals (SDGs), goal 5.3 aims to eliminate all harmful practices, including reducing the global prevalence of FGM by half by 2030. The UK has played an active role in engaging with FGM-practising communities as well as in developing legislation that aims to protect women and girls at risk, which are both said to have contributed to the reduction of the prevalence of the practice. Aims: To examine how young people directly or indirectly affected by FGM interpret and understand the practice and to explore their views on current approaches aimed at preventing the practice in the UK. Methods: A community-based participatory methodology was developed, involving two phases. Phase One involved recruiting 9 young people aged 15-18 years living in Bristol and training them as co-researchers. This training required them to participate in ten 2½ hour workshops over five months that utilised a variety of participatory methods, including drawing, singing and role play. A training manual was developed with the co- researchers. The data collected from the training formed the initial phase of data collection and helped to develop the second stage of the research. Phase Two involved recruiting 20 participants aged 13-15 years from Bristol, Cardiff and Milton Keynes, who participated in focus groups and one-to-one semi-structured interviews led by the co- researchers and the lead researcher. Results: The young people involved in this study – whether as co-researchers or as phase 2 research participants – showed a general lack of knowledge about the practice of FGM. They tended to assume it to be a historical issue that was of little or no relevance to them in a UK context. Moreover, it would seem that the meaning of FGM to young people has evolved from what was formerly considered a cultural issue to a complex, multifaceted phenomenon that is concerned with identity, body image and self-esteem. The research findings reveal that young people directly or indirectly affected by FGM ii identify as “bicultural”; on the one hand, they attempt to construct a social position, identity and sense of belonging rooted in the dominant Western UK culture, whilst also identifying – to greater or lesser degrees – with the imported non-Western culture of their parents. This is challenging for young people who have to negotiate their status and identity where culture and religion intersect. This suggests that future strategies to tackle and prevent FGM – and to bring about cultural change – should embrace a positive holistic, intersectional approach, which is relevant to young people and guided by their values, beliefs and views. This implies moving beyond the preoccupation with a harm reduction approach towards one that engages with communities in positive and productive ways. iii Glossary Co-researcher: Individuals aged 16-18 years, who will assist in conducting the research. De-infibulation: Refers to the practice of cutting open a woman who has been infibulated to allow intercourse or to facilitate childbirth. FGM: Female Genital Mutilation. FGC: Female genital cutting. FGM affected community: Women and girls affected or at risk of FGM, as well as other people within their social sphere, such as children, young people, and spouses. FORWARD: Foundation for Women’s Health Research and Development. High-Income countries: High-income countries are defined as those with a gross national income per capita of $12,736 or more (World Bank, 2016). NGO: Non-government Organisation. NHS: National Health Service exists throughout the United Kingdom. Pharaonic: Type III FGM. Reinfibulation: Refers to the practice of sewing back the external labia following childbirth, after deinfibulation. Sunna: Arabic word meaning ‘tradition’ or ‘way’. Within the context of FGM, Sunna is often used to describe Type I FGM. UN: United Nations. UNICEF: United Nations International Children’s Emergency Fund. UNFPA: United Nations Fund for Population Activities. Young participant: Aged 13-15 years, they will be involved as participants in interviews and focus groups. iv Table of contents CHAPTER 1 INTRODUCTION .................................................................................................................. 1 1.1 BACKGROUND ................................................................................................................................. 1 CHAPTER 2 UNDERSTANDING THE PRACTICE OF FGM ........................................................................... 5 2.1 INTRODUCTION ............................................................................................................................... 5 2.2 SEARCH STRATEGY............................................................................................................................ 5 2.3 HISTORICAL CONTEXT ....................................................................................................................... 7 2.4 CLASSIFICATION OF FGM ................................................................................................................ 10 2.5 REASONS FOR THE PRACTICE: A SOCIAL NORMS PERSPECTIVE .................................................................. 18 CHAPTER 3 APPROACHES TO THE PREVENTION OF FGM ......................................................................37 3.1 INTRODUCTION ............................................................................................................................. 37 3.2 DEFINITION OF HEALTH PROMOTION .................................................................................................. 37 3.3 TYPOLOGY OF HEALTH PROMOTION INTERVENTIONS ............................................................................. 40 3.4 CONCLUSION ................................................................................................................................ 55 CHAPTER 4 RESEARCH DESIGN & METHODOLOGY: THE CBPR APPROACH............................................57 4.1 INTRODUCTION ............................................................................................................................. 57 4.2 ONTOLOGY AND EPISTEMOLOGY ....................................................................................................... 57 4.3 HISTORICAL AND PHILOSOPHICAL UNDERPINNINGS ............................................................................... 61 4.4 COMMUNITY-BASED PARTICIPATORY RESEARCH (CBPR) ...................................................................... 63 4.5 RESEARCH PROCESS ........................................................................................................................ 75 4.6 ETHICAL AND GOVERNANCE PROTOCOLS ............................................................................................. 80 4.7 PHASE ONE: ACCESSING AND RECRUITING CO-RESEARCHERS .................................................................. 87 4.8 PHASE TWO: ACCESSING AND RECRUITING PARTICIPANTS ...................................................................... 92 4.9 SAMPLING APPROACH ..................................................................................................................... 97 4.10 THE FORMAL DATA COLLECTION .....................................................................................................
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