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.