New Study On the Reliability of Self Reported Forms of FGM

This month a new study entitled ‘Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study’ has been published in the British Medical Journal (BMJ), on 15th July 2006. The research which was conducted by Susan Elmusharaf, Nagla Elhadi and Lars Almroth, in Sudan sought to assess the reliability of self reported forms of Female Genital Mutilation (FGM) and to compare the extent of cutting verified by a clinical examination to corresponding World Health Organisation classification. Previous studies had investigated the consistency between self reported and clinically determined of FGM; however there were no studies assessing the consistency of the self reporting of different forms of FGM.

Findings
The study shows that the self reporting of different forms of FGM is unreliable and under-reporting was common. The authors suggest that this should be considered as a factor in the interpretation of studies based on interviews – without medical verification – showing a change in a community’s practice towards the less severe forms of FGM. The study concludes that there could be other reasons for the increase in reporting milder forms, rather than an actual change in practice.

The results indicate an extensive over-reporting of the form of FGM traditionally known as ‘sunna’ which refers to the removal of the prepuce of the clitoris only. The study provides evidence of the alarming tendency to use the term ‘sunna’ to refer to all different types of FGM. Among the participants who reported ‘sunna’, there was not actually a single woman who had undergone the removal of the prepuce of the clitoris only; all had more extensive and harmful forms of FGM. This finding is supported by previous reports in Sudan and Tanzania and throughout our own work with girls and women affected by FGM we have also found that women are not always aware of the exact type or extent of FGM which they have undergone.

The word ‘sunna’ refers to the ‘ways or customs’ of the prophet Muhammad, however, by using the term ‘sunna,’ the practice is associated with Islam and given a religious value, even though FGM is not an Islamic requirement, in fact no religions doctrine advocates the practice of FGM. Thus, one possible reason for the widespread under-reporting in this study, of the extent of the form of FGM women have undergone could be an attempt to exonerate the practice by using a religious justification.

Recommendations
The authors, of the research, recommend that in studies estimating the prevalence of different types of FGM, without verification of a medical examination, women should be asked to explain the term that they use, including the extent of the cutting. To facilitate this process the authors make the additional recommendation of the use of visual aids.

The full article in the British Medical Journal is available online here.