Global Health

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Kaelii Cunningham

Department of Nursing, Delaware Technical Community College

NUR 310-501: Global Health

Professor: Shawntelle Winslow MSN, RN, CNEcl

November 29, 2024

 

Introduction

 

     FGM, known as Female Genital Mutilation, is a traditional practice that exists in many East African countries such as Somalia, Kenya, Ethiopia, and Tanzania. The WHO’s 2024 report indicates that this practice consists of the partial or total removal of the external female genitalia and is rooted in cultural traditions and customs, frequently being validated by beliefs associated with hygiene, sexual morality, and social acceptance. A human rights violation, FGM, is conducted on millions of women and girls annually, posing grave public health problems and long-lasting psychological impacts (UNICEF, 2022). The impacts of both levels of intervention (individual and societal) will be conceptualized using the Health Impact Pyramid to demonstrate how strengthening the societal level presents better opportunities to address FGM in East Africa.

 

Health Impact Pyramid: A Model for FGM

 

      One framework that can assist us in conceptualizing and addressing public health issues is the Health Impact Pyramid, developed by Thomas R. Frieden (Frieden, 2010). This categorization system classifies interventions into five tiers: counseling and education, clinical interventions, long-lasting protective interventions, changes to the context, and socioeconomic fulfillment. These levels can effectively be applied to the issue of Female Genital Mutilation (FGM), providing a foundation for developing more comprehensive strategies to combat the prevalence of FGM and enhance health outcomes. In Uganda, while FGM is acknowledged in both the Constitution and the law, there remains a significant gap between the harsh realities of FGM and its actual impact on women.

In the context of female genital mutilation (FGM), there are both short-term and long-term physical health consequences. Short-term complications may include severe pain, hemorrhage, and infections, while long-term effects often manifest as chronic pain, complications during childbirth, and various psychological issues such as anxiety and post-traumatic stress disorder (PTSD) (El-Dirani et al., 2022). The psychological impact of FGM is profound; many women and girls who endure this procedure experience deep-rooted trauma, often exacerbated by societal pressure to conform to such practices.

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Determinants of the Socioeconomic Factors of FGM

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     Despite ongoing efforts to eliminate the practice, female genital mutilation (FGM) remains a significant public health and human rights issue, particularly in several African communities. The motivations for continuing this practice are often rooted in cultural traditions and perceived socioeconomic benefits. Understanding these socioeconomic factors is essential for implementing effective interventions to eradicate FGM. This essay summarizes the vital socioeconomic predictors of FGM—education, economic status, cultural beliefs, and access to healthcare—and draws on recent literature to explain the trends and implications.

 

Education

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     Education plays a crucial role in shaping perceptions of FGM. There is an inverse relationship between the level of education among women and the prevalence of FGM. Women with higher education levels are less likely to support the practice, as they are more aware of its health risks and are more inclined to advocate for its abandonment (El-Dirani et al., 2022). In contrast, lower levels of education are typically associated with a higher incidence of FGM, particularly in rural areas where traditional views on the practice remain strong (Batyra et al., 2020). For instance, women with no formal education are 16 times more likely to have undergone FGM compared to those with an academic background (Female Genital Mutilation: The Role of Education, n.d.).

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Economic Status

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     Economic factors significantly influence the practice of FGM. Families in low socioeconomic circumstances within cultures that practice FGM may feel pressured to conform to cultural norms, believing that the practice will enhance their daughter's prospects for marriage and social acceptance (USAID, 2023). In regions with socioeconomic disparities in Africa, lower-income families often view FGM as an investment in their daughter's future, leading to the continuation of this tradition (Batyra et al., 2021). Conversely, as communities become more economically empowered, there is a notable reduction in the prevalence of FGM, indicating that socioeconomic development can transform cultural values.

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Cultural Beliefs 

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     Cultural practices and beliefs are closely linked to the economic context that perpetuates FGM. In many communities, FGM is viewed as a rite of passage and necessary marriage preparation, which is often considered the primary identity for women (Woffindin, 2024). Despite increasing awareness of the health risks associated with FGM, the belief that it enhances a female's purity and marriageability persists. Cultural pressure can lead families to prioritize tradition over health, perpetuating the cycle of FGM across generations. Additionally, in some areas, the practice is reinforced by communal expectations and social norms, making it challenging to break free from the tradition and legitimized by religious beliefs, which further complicates the process of changing attitudes and behaviors toward FGM (Woffindin, 2024).

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Access to Healthcare

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     Another key factor driving FGM prevalence is access to healthcare options. Women in communities without adequate healthcare infrastructure may feel unaware of the health dangers of FGM, where there are no available supportive health services (Batyra et al., 2021). Fewer women living in areas with more accessible health services underwent FGM, demonstrating the need for FGM-reduction outreach programs to incorporate health education into community members.

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      In the context of female genital mutilation (FGM), it is essential to examine how the interplay of education, economic status, cultural beliefs, and access to healthcare creates a complex environment that perpetuates this practice. Addressing the socioeconomic determinants is crucial for effective interventions aimed at eradicating FGM. As social dynamics evolve and access to education and healthcare improves, there exists significant potential for a substantial reduction in the prevalence of FGM. Promoting women's empowerment through educational and economic opportunities, while simultaneously challenging the cultural systems that support FGM, offers a viable solution to this issue. It is only by tackling this problem from multiple perspectives that we can hope to eradicate this harmful practice and safeguard the rights and health of women and girls.

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Change for Healthy Default Decisions: Female Genital Mutilation

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     Female genital mutilation (FGM) is a widely practiced traditional practice that has serious negative health consequences for women and girls. Despite global efforts to eradicate FGM, it still persists in various communities due to social norms, cultural beliefs, and a lack of awareness about its harmful effects. One promising strategy for preventing FGM is to change the context in which decisions about the practice are made, so that healthier choices become the default option. This essay builds on recent literature to explain how altering the decision-making environment can lead to more positive outcomes regarding FGM.

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Default Decision-Making Next Steps

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     People make default decisions when they do not have to choose actively. These defaults can significantly affect behavior and outcomes. Nevertheless, for a decision relating to FGM, the default is to continue because of culture and peer pressure. Research also shows that people align with healthier options when health-promoting and health-maintaining alternatives are available (Woffindin, 2024).

Change Through Interactive Education

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     Community engagement and education are essential strategies employed to tackle the issue of female genital mutilation (FGM). By collaborating with community leaders and influencers, these initiatives can reshape the dialogue surrounding health and wellness, moving away from traditional perspectives. For example, raising awareness about the health risks associated with FGM and the advantages of abandoning the practice can increase the likelihood of re-evaluating these norms within community discussions (Pallitto & Ahmed, 2021).

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Policy-making process

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     The enactment and enforcement of laws regarding female genital mutilation (FGM) are crucial for creating a protective environment for women and girls. In countries where laws against FGM have been established, there is often a noticeable decrease in its prevalence. Making the practice illegal is a significant deterrent and communicates to the community that FGM is unacceptable (UNICEF, 2022). However, the effectiveness of these laws hinges on proper enforcement and the training of community leaders to understand FGM's legal implications and advocate for victims. Successful reductions in FGM cases have been observed in nations with robust legal frameworks and active community engagement (Batyra et al., 2020).

Governments and organizations can implement policies that foster conditions conducive to ending FGM. For instance, existing legal frameworks that prohibit FGM can act as a powerful deterrent. Additionally, policies promoting women's health and education empower individuals to make informed choices regarding the prevention of FGM. When combined with community education, such legal interventions are particularly effective in transforming social norms and reducing the prevalence of FGM (Pallitto & Ahmed, 2021).

 

Educating Women and Girls

 

     Educating and empowering women and girls to achieve financial independence is essential for transforming the context surrounding female genital mutilation. Economically empowered and educated women are less likely to succumb to societal pressures that promote harmful practices. Moreover, programs focused on girls' education and empowerment have been effective in reducing the prevalence of FGM, as educated females are more inclined to advocate for their rights and make informed choices about their health (Batyra et al., 2020).

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Educating the Public & Community Awareness Campaigns Community

         

     Education and awareness campaigns are among the most potent long-term interventions against FGM. These initiatives are aimed at transforming social norms by educating the community on the health risks associated with FGM and the benefits of its abandonment. Studies have demonstrated that if members of a community, particularly those with significant influence in their communities, are made aware of the detrimental impacts of FGM, they are more inclined to support its cessation (Pallitto & Ahmed, 2021). Programs in which community dialogues and workshops could create an environment that supports change. In one referenced example, educational programs in Somalia were shown to shift perceptions amongst the community and, therefore, decrease the in-practice occurrence of FGM (Pallitto & Ahmed, 2021).

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Health Care Provider Training

 

     Enhancing training for healthcare providers to better recognize and address the needs of women and girls affected by female genital mutilation (FGM) is essential for sustainable intervention. Healthcare professionals play a crucial role in both caring for individuals who have experienced FGM and educating communities about the associated health risks. Unfortunately, many providers lack sufficient training in this area. Implementing cultural programs aimed at teaching healthcare providers how to offer culturally competent care and counseling can significantly mitigate the health impacts of FGM. Furthermore, integrating FGM education into medical curricula would ensure that future healthcare providers are adequately equipped to address this important issue.

 

Engaging Men and Boys

 

     Men and boys play a crucial role in achieving sustainable change towards ending FGM. Advocating for substances used in media factors is beneficial to encourage change and prevent FGM from being passed on. So, with tradition, media exploration of FGM can help to address media factors for education, although men are essential for changing gender roles as traditional norms play. Programs that promote men's and boys' understanding of the adverse health effects on women and girls contribute to supportive attitudes toward abandonment. Male participation is another body of evidence that suggests that the decrease in female genital mutilation prevalence has occurred by including males in the community debate (El-Dirani et al., 2022).

 

Multidisciplinary Approach

 

     Failure to address the physical, psychological, and social needs of women with FGM illustrates the need for multidisciplinary care. Such a unique approach is utilized through the multi-disciplinary teamwork of healthcare professionals, mental health practitioners, social workers, and community leaders to develop a holistic care-sensitive plan encompassing physical and psychological health needs (Tammary & Manasi, 2023). The multidisciplinary care model aims to provide holistic support and resources for FGM survivors, which has better health outcomes.

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Psychological Counseling & Support

 

     FGM victims also need psychological support, as they can also experience mental disorders such as anxiety, depression, and post-traumatic stress disorder (PTSD). This necessitates mental healthcare as a part of clinical intervention, which provides counseling and care specific to the needs of FGM survivors. Studies show that the inclusion of psychological support in routine health care for FGM survivors enhances their general well-being and quality of life (Tammary & Manasi, 2023).

 

Community Health Education

 

     Clinical response cannot end with treating those affected; the surrounding community should also be educated. Healthcare providers can play a critical role in educating communities about the health hazards of FGM and the need to eradicate the practice. This may be achieved through workshops or information sessions with affected populations to provide communities with the information they need to enable people to make the best-informed choices regarding FGM (Batyra et al., 2020).

 

Reconstructive surgery

 

     Therefore, reconstructive surgery for women who have experienced FGM can be one of the possible clinical approaches that can overcome the complications of post-FGM and improve the quality of life. Reconstructive surgery is used to help treat sexual impairment and discomfort (Almadori et al., 2024). However, we admit that such procedures should only be carried out by those qualified and who understand the nuances of FGM as well as the psychological damage it may have to the person involved. This underscores the importance of thorough patient counseling on surgical options before any intervention (Almadori et al., 2024).

Counseling, Education, and the Role of the Nurse in Health Behavior Change Theory for Female Genital Mutilation (FGM)

Female genital mutilation (FGM) is a deeply rooted cultural practice that poses significant health risks to women and girls. Addressing FGM requires a multifaceted approach that encompasses counseling, education, and the active involvement of healthcare professionals, especially nurses. It investigates the role of nurses in promoting health behavior change related to FGM, supported by recent literature.

 

Theoretical Framework: Health Behavior Change Theories

 

     Health behavior change theories provide a framework for understanding how to effectively influence individuals' decisions regarding health practices, including FGM. The Health Belief Model (HBM) and the Transtheoretical Model (TTM) are two prominent theories that can be applied to address FGM. The HBM posits that individuals are more likely to engage in health-promoting behaviors if they perceive a high risk of adverse health outcomes, believe that the benefits of change outweigh the costs, and feel confident in their ability to make changes (Alyafei & Easton-Carr, 2024). The TTM emphasizes the stages of change individuals undergo when altering behavior, including pre-contemplation, contemplation, preparation, action, and maintenance (Raihan & Cogburn, 2023)

 

The Role of Nurses in Counseling

 

     Nurses play a vital role in counseling individuals affected by Female Genital Mutilation (FGM). As often the first point of contact in healthcare settings, they provide essential support and guidance. Effective counseling helps individuals understand the health risks associated with FGM and empowers them to make informed decisions about their health. A study by Ozdemir and Kaplan (2024) found that when nurses used empathetic counseling techniques, patients were more likely to voice their concerns about health issues and seek additional information. This approach aligns with the principles of the Health Belief Model (HBM), as it encourages individuals to recognize the risks associated with FGM and the benefits of abandoning the practice.

 

Education as a Tool for Change

 

     Education plays a crucial role in facilitating health behavior change, especially in communities where female genital mutilation (FGM) is standard. Nurses can spearhead educational initiatives that raise awareness about the physical and psychological repercussions of FGM. Research shows that community-based education programs led by healthcare professionals can significantly diminish the prevalence of FGM by shifting social norms and enhancing awareness of its harmful effects (Adogho et al., 2020). For example, educational workshops that address the legal ramifications of FGM and highlight the rights of women and girls can empower communities to reconsider the practice.

 

     In addition to offering counseling and education, nurses can advocate for change within their communities. By collaborating with local leaders and organizations, nurses can help foster supportive environments that encourage the abandonment of female genital mutilation (FGM). Advocacy efforts can encompass lobbying for policy reforms, participating in community health initiatives, and working alongside other healthcare providers to deliver comprehensive care for FGM survivors (Batyra et al., 2020). This collaborative strategy aligns with the Transtheoretical Model (TTM), highlighting the significance of social support in facilitating behavior change. There are numerous ways for nurses to engage and help eliminate FGM in the context of global health.

 

Career in Global Health

 

     A global health career provides nurses with diverse opportunities to impact health outcomes worldwide. Key pathways include:

1. Clinical Practice: Nurses can work in international healthcare facilities or NGOs, providing direct patient care and managing health programs in low-resource settings.

2. Public Health Nursing: Focused on community health and disease prevention, nurses may collaborate with organizations like WHO or CDC to promote health equity globally.

3. Global Health Policy and Advocacy: Nurses can influence health policies and advocate for vulnerable populations through research and policy development roles with governmental and non-governmental organizations.

4. Research and Academia: Engaging in global health research or teaching, nurses can focus on critical areas such as infectious diseases and maternal health.

5. Emergency and Disaster Response: Specializing in disaster management, nurses provide essential care during crises, requiring additional training in emergency medicine.

6. Global Health Education and Training: Nurses can educate and mentor healthcare workers in low-resource settings, enhancing local skills and knowledge.

7. NGO Involvement: Working with NGOs enables nurses to participate in various health initiatives, from direct care to program development in areas like maternal health and nutrition.

 

Conclusion

 

     In conclusion, addressing female genital mutilation (FGM) in East Africa requires a comprehensive, community-centered approach that not only tackles the immediate health consequences but also challenges the deeply entrenched cultural norms supporting this practice. Utilizing the Health Impact Pyramid framework, we can implement multi-level interventions that empower women and girls, ensuring their health and human rights are prioritized. The eradication of FGM is not just a health issue; it is a societal imperative that calls for the collective action of all stakeholders, including governments, non-governmental organizations, and local communities. We can dismantle the cultural foundations perpetuating this harmful practice by standing united with compassion and understanding. As we strive for a future free from FGM, we envision a time when we can look back on this chapter of our history as a painful memory, transformed by our commitment to justice, equality, and the well-being of all individuals. Together, we can create a world where the health and rights of women and girls are safeguarded and where cultural practices enhance, rather than inhibit, their dignity and potential.

 

 

 

 

                                                                                     References

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