Health education interventions and Female Genital Mutilation/Cutting (FGM/C) in Birmingham, UK: a mixed method inquiry

Health education interventions aimed at preventing female genital mutilation/cutting (FGM/C) have been implemented in numerous communities globally; however, the practice continues. This doctoral research aimed to explore health education interventions intended to prevent FGM/C locally and globally, in order to identify factors affecting their effectiveness and guide professionals caring for communities and patients/service users affected by FGM/C. A mixed method research methodology was used, underpinned theoretically by intersectionality. The research was undertaken in three phases. First, a systematic review examined the effectiveness of health education interventions designed to prevent FGM/C in affected communities globally. Second, a survey investigated the experiences and views of health professionals in Birmingham regarding the discussion of FGM/C with their patients/service users. Third, a generic qualitative study explored the experiences and views of individuals from communities with a history of FGM/C in Birmingham regarding health and wellbeing programmes/sessions (HWPs). Findings from the three phases uncovered several interrelated factors affecting the effectiveness of FGM/C health education interventions: 1) social structures (including factors relating to inclusivity, privilege checking, gender disparities and generational differences); 2) culture (comprising beliefs, attitudes, cultural competence and active communication); and 3) media contributions (incorporating the platforming of inequalities while also acknowledging disparities within media, such as the use of illustrations and language, e.g. type and utterance). All of these factors play an important role in determining the effectiveness of FGM/C health education interventions, and a Theory of Change (ToC) approach is used to illustrate the steps of implementing these interventions successfully. A novel ‘Six Aspects of FGM/C Education’ (SAFE) model was developed, informed by the factors identified from this research which affect the effectiveness of health education interventions. The SAFE model offers guidance to the design and implementation of effective FGM/C interventions