Posted July 1996

Socio-Cultural Research and Female Genital Mutilation

by Leila Dabbagh
former FAO Socio-cultural Research Advisor
UNFPA Country Support Team
Amman, Jordan

HEALTH EDUCATION research has shown that dissemination of information to the public ("awareness creation campaigns") gives no guarantee of changes in behaviour and attitudes. There are many variables that contribute to behavioural outcomes, attitudes, beliefs and values besides "lack of knowledge", and most of these variables are far more difficult to change than simply improving one's knowledge or increasing awareness about a particular issue or concept.

Studies have shown that knowledge about contraceptives does not guarantee behavioural outcomes in terms of actual use nor change in attitudes. Therefore, Information, Education and Communication (IEC) initiatives in the area of Reproductive Health (RH) should be teamed with and preceded by qualitative health education research that can identify:

• the predisposing roots of behaviour such as attitudes, values and perceptions.
• the enabling factors (skills, cost, access, availability of resources)
• the reinforcing factors (husband and family support system, social or peer pressure) existing within the socio-cultural environment of the target population.

Advertising companies use marketing research to learn about the target population, what they like and dislike, how they learn and pick up information, what motivates them to use the product, i.e. change their purchasing behaviour. The same type of research initiatives must be carried out by IEC specialists prior to embarking on a media campaign.

A few significant models (e.g. General Systems Theory, S-Matrix theory the PRECEDE model) illustrate the limitations of current crisis-oriented and reductionist schemes used as strategies aimed at changing negative health-related behaviour. The premise of these models is that the universe is a "dynamic web of interrelated events" and "none of the properties of any part of this web is fundamental; they all follow from the properties of the other parts, and the overall consistency of their interrelations determines the structure of their entire web".

Populations and societies can similarly be viewed as a web comprising a diverse set of properties whose parts should always be viewed as an interrelated whole. There are numerous influential mechanisms that exist in one's environment which act as determinants of behaviour and deterrents or persuaders with respect to the desired behavioural changes. These factors include:

• socialisation mechanisms and the influence of family and peers in the decision-making process and ultimate behaviour
• the emotional make-up of the individual such as one's sense of autonomy, well-being and self-esteem
• cognitive factors such as beliefs and perceptions about the benefits of a particular practice or its disregard
• availability, access and affordability of health care and other self-help and support group type services that can help to motivate or sustain behaviour change.

For these reasons, it is difficult to expect to implement UNFPA programming goals without the benefit of research aimed at, first and foremost, understanding the social, cultural and economic attributes of the target population that play a major role in influencing behavioural outcomes. UNFPA can take the lead in promoting this type of correlative systems approach to problem analysis and intervention design by adopting a less sectoral approach to its programming initiatives.

A reductionist approach underlies intervention strategies aimed at reducing or banning the practice of Female Circumcision and Genital Mutilation (FGM). This is one of the RH issues generating a great deal of concern in some of the countries in Near East region.

The intervention approaches aimed at curtailing FGM have focused primarily on two strategies. The first has advocated publicity campaigns, i.e. IEC initiatives and flooding the media with informational messages whose ultimate goal is to change people's behaviour and eliminate the practice of FGM. The second strategy has championed the idea of inviting political and local leaders to engage in dialogue as a means of eventually formulating an official government policy with again the ultimate goal of eventually banning the practice.

Although these initiatives may increase the dialogue about FGM in a society, neither is likely to get at the roots of the problem nor achieve any sustainable impact for the following reasons. First, in these initiatives, the target population that is engaging in FGM is for the most part treated as a passive receptive entity. The deeply imbedded cultural and economic motives associated with this practice are not given due consideration prior to embarking on such ambitious campaigning. Second, thoroughly assessing the characteristics predisposing the target audience to practice FGM and exploring the cultural and social meaning surrounding this practice is typically overlooked in the process of creating new policies or intervention strategies to restrain or outlaw the practice.

It would be more efficacious to attempt to understand FGM from the perspective of the people who support the practice, by researching and collecting qualitative information from mothers, fathers, women, men, aunts, uncles, grandparents, religious spokesmen, local and political leaders, and even those who actually perform the procedure, to get to the roots of why FGM is practised and what makes it so significant and important for the people who continue to support this custom.

Asking questions through such a socio-cultural research study would help us understand:

• historical and cultural links to the practice of FGM, associated beliefs and attitudes and how attitudes and beliefs differ across gender lines;
• social incentives that exist in relation to FGM and how FGM affects a family's status and the "marriageability" of women;
• the economic realities of FGM, alternatives can be created to ease the family economic hardships possibly associated with eliminating the practice;
• the economic and social status incentives attributed to those who perform the FGM procedure and how such gains can be shifted to other economically profitable activities;
• how women relatives feel about the practice, the role of religious beliefs, and the "neutral areas" within which appropriate and acceptable discussion of FGM can be initiated without creating defensiveness;
• the political ramifications of issuing an official government decree banning the practice of FGM and prosecuting all those who break the law.

We must also consider the possibility that parents may be more influenced to subject their daughters to FGM by their perception that the significant people in their environment will label them as "caring", "protective", and "loving" parents if they carry out such a traditional act. On the other hand, we need to also consider that parents may subject their daughters to FGM because of cultural expectations and pressures that is exerted on them rather than because of personal convictions regarding the rationality or acceptability of the practice.

These are only a few of the socio-cultural attributes possibly associated with FGM, and that are very likely linked with economic factors -- factors that, in the minds of those who practice FGM, are very real and very important.

Attempts to modify behaviour will require understanding the roots of such attitudes, beliefs and practices, and finding the appropriate non-threatening and culturally acceptable communication channels that can bring about change, prior to embarking on a media campaign that simply expects to change public opinion and practices, or gain political support to create policy reforms.

We cannot hope to induce behavioural change for ending the practice of FGM without understanding the unique characteristics of the social and cultural context in which all players, either directly or indirectly, associated with the practice, relate to one another and to the girl child. This would entail placing the girl child in the centre of an imaginary circle (flower) where all the significant players are represented by the petals, if we lose one petal, the flower begins to look lopsided or incomplete.

Therefore, assessing the links between the girl child and her potential role as an adult woman, should be reviewed in association with the practice of FGM, her parents, culture, social norms and economic conditions. Finally we must remember that if we want to create change, we must provide alternatives to the perceived benefits of the old behaviours.