Female genital mutilation and other harmful practices
Changing behaviour with regard to female genital mutilation
Are there “stages of change” in the decision for or against FGM?
As a contribution to understanding whether and how FGM can be discouraged, and even abandoned altogether, this research looked at theories of behaviour change that have been applied to decisions about other health-related behaviours. Such theories tend to see decision-making about behaviour as a process that involves “stages of change” rather than as a one-time sudden change. For instance, a person who takes a decision to change his or her behaviour (particularly if that behaviour is said to be harmful to health) can be seen as making that decision in stages – i.e. becoming aware of the possibility of change, having a favourable opinion of change, choosing to adopt or reject the change, putting the change into practice, and reinforcing or rejecting the change when faced with conflict or difficulty.
The difficulty with this type of behaviour change model is that it assumes that the individual is able to make rational and independent decisions about his or her own behaviour. However, in their study of communities practising FGM in Gambia and Senegal, the researchers found that decision-making about genital cutting was by no means solely the prerogative of the individual who would undergo the procedure.
The research – which consisted of observations by field-workers while living among the communities and interviews to obtain case histories of decision-making about FGM – showed that the decision was most often shared with extended family members, and that grandmothers and paternal aunts, in particular, often exerted considerable influence. For instance, at one Senegalese research site several young women said that, even if they did not agree with the decision of the grandmother, they could not oppose it because of respect for their elders. The research further revealed that men were rarely involved in decisions about genital cutting. In addition, while decisions about FGM were sometimes achieved through consensus, in other cases individuals acted against the will of others and took a girl to circumcision despite the opposition of other family members.
The researchers found that some elements of the traditional model of behavioural change could be applied to the decision-making process, but that abandoning FGM involves a far more complex process than an individual’s decision to give up smoking. “Because decision-making often occurs among a group, there are important aspects of the decision-making process that are not addressed by a stage of change model,” the researchers say. They argue that “careful consideration will be required for the development of instruments that capture the categories of change identified in this study”.