A realist synthesis of controlled studies to determine the effectiveness of interventions to prevent genital cutting of girls

BACKGROUND Female genital mutilation/cutting (FGM/C) is a traditional practice which involves the partial or total removal or other injury to the female genital organs for non-medical reasons. Although current trends indicate that the practice is becoming less prevalent, as many as 30 million girls may still be at risk of FGM/C. Given the associated risks and violation of the human rights of girls and women, the practice is discouraged through preventative interventions. AIMS To systematically review the effectiveness of anti-FGM/C interventions, applying a realist perspective. METHODS The realist synthesis approach addressed context-mechanisms-outcomes (CMO) underlying intervention in an attempt to explain interventions' success or lack thereof. The process involved exposed the usefulness of strategies in different contexts. RESULTS Eight effectiveness studies and 27 context studies were included. All of the effectiveness studies employed a controlled, before-and-after study design. They formed five broad categories of intervention: training, formal classroom education, media communication, outreach and advocacy, and informal adult education. The CMO configurations showed that the proposed engine behind changing behaviours regarding FGM/C appeared largely to be dissemination of information. Some interventions' acceptability and success rested on the incorporation of FGM/C abandonment efforts within a larger set of related issues. However, greater success of the interventions could have materialised with systematic pre-planning involving thorough community analyses and securing religious leaders' commitment to halting FGM/C. CONCLUSION The results of this analysis point to conditions that facilitate the success of FGM/C abandonment programmes in different contexts and can be used in future prevention efforts to reduce the risk of girls being subjected to FGM/C.