Elsevier

Public Health

Volume 139, October 2016, Pages 53-60
Public Health

Original Research
Estimating the prevalence of female genital mutilation in Portugal

https://doi.org/10.1016/j.puhe.2016.05.002Get rights and content

Highlights

  • Due to migration, female genital mutilation/cutting (FGM/C) sprawled to countries where it did not traditionally occur.

  • We estimate that 6576 women living in Portugal were subjected to FGM/C.

  • We estimate that 1830 girls in Portugal have already or will probably undergo FGM/C.

  • This study gives information on the extension and territorial distribution of FGM/C.

  • This knowledge will contribute to more targeted and effective health public policies.

Abstract

Objectives

Due to globalized migratory processes, female genital mutilation/cutting (FGM/C) has spread to other countries, including countries in Europe, where, with a few exceptions, it remains a concealed problem. To the authors' knowledge, this is the first national extensive study to estimate the prevalence of FGM/C in Portugal.

Methods

Using extrapolation of country-of-origin prevalence data and the 2011 Census data, this study estimated: the prevalence of FGM/C in Portugal among women of reproductive age (15–49 years) and among all women aged ≥15 years; and the number of girls aged <15 years living in Portugal who have undergone or will probably undergo FGM/C.

Results

It is estimated that 6576 women aged ≥15 years living in Portugal have undergone FGM/C, with cases distributed unevenly throughout the national territory. In addition, it is estimated that 1830 girls aged <15 years living in Portugal have undergone or are likely to undergo FGM/C.

Conclusions

This study estimated that more than 6000 women living in Portugal have undergone FGM/C, and many girls remain at risk. These two groups need different types of interventions. Awareness of the number and geographical dispersion of cases of FGM/C will enable more informed and targeted definition of public health policies for protection of females who have undergone or are at risk of undergoing FGM/C.

Introduction

Female genital mutilation/cutting (FGM/C) is widely recognized as a serious violation of the human rights of women of all ages.1 It constitutes a severe social gender-based problem, rooted in an imbalance of power between men and women, and reflects one of the many forms of violence against women, representing society's control over women and perpetuating asymmetric normative gender roles that harm women in multiple ways.1, 2 FGM/C is a traditional practice embedded in the cultural framework, and practising communities consider it to be a rite of passage to adulthood necessary to raise a girl properly and to prepare her for marriage.1, 3, 4 FGM/C is associated with the control of women's bodies and sexuality by ‘guaranteeing’ their virtue, fidelity, virginity, enhancement of men's pleasure and family honour.4, 5, 6, 7, 8, 9

FGM/C has grievous consequences for women's and girls' sexuality (e.g. pain during intercourse, less sexual satisfaction). Victims experience physical (e.g. recurrent urinary tract infections, childbirth complications) and psychological (e.g. anxiety, post-traumatic stress disorder) effects. FGM/C also affects health, education and empowerment.4, 10, 11, 12, 13

The World Health Organization (WHO) defines FGM/C as ‘all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons’.1 World Health Organization has classified the diverse practices into four types of FGM/C: Type I (clitoridectomy), partial or total removal of the clitoris and/or the prepuce; Type II (excision), partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora; Type III (infibulation), narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris; and Type IV, all other harmful procedures to the female genitalia for non-medical purposes, such as pricking, piercing, incising, scraping and cauterizing.

FGM/C has been documented in 29 countries in Africa and the Middle East, although there are reports of FGM/C in many other countries, such as Mozambique, Malaysia, Israel and Colombia.14, 15, 16, 17 A recent study documented Type IV FGM/C in Tete Province, Mozambique, where it is common to elongate the labia minora in young girls (procedure locally designated as puxa-puxa, kukhuna or kupfuna). In this region, it is also common for girls and women to insert products or medicines into the vagina ‘in order to close, tighten or reduce the vaginal canal’.14

The prevalence of FGM/C varies greatly between countries. Overall, it is estimated that 100–140 million girls and women have undergone FGM/C,1 and that Types I, II and IV account for 90% of the cases. Type III FGM/C represents the remaining 10% of the cases.18

Use of the FGM/C terminology in this study is in line with current research and debate among academics and international development and human rights agencies. The term ‘mutilation’ was first used by the Inter-African Committee on traditional practices affecting the health of women and children to emphasize the severity of this practice, and to distinguish it from circumcision and has been adopted by the majority of agencies and institutions working in the field. However, the term ‘mutilation’ has been considered to be judgemental, and its use was found to be potentially disrespectful when working with practising communities. Therefore, a hybrid term—FGM/C—has been used to encompass all meanings and sensibilities.1, 19

Specifically, the aim of this paper was to communicate the results of a research project regarding estimation of the prevalence of FGM/C and the number of girls at risk of FGM/C in Portugal.

At present, few national studies have been undertaken in European Union (EU) countries to estimate the prevalence of FGM/C; Portugal is the eighth country (among the 28 EU states) to conduct such a study. This study thus contributes to data collection and discussion on this matter. This step is ‘fundamental to targeted and evidence-based policy making and measures’,13 and the study aims to shed light on a concealed issue in terms of public action and debate, and the number and geographical dispersion of cases.

In Portugal, several studies on FGM/C have been conducted previously. However, these adopted a qualitative perspective, based on case studies or specific communities,6, 7, 8 from the medical and healthcare standpoint4, 10, 20 or on the theoretical discussion regarding the associated social processes and legal issues.21, 22 The aims of these analyses were mainly to uncover and understand a reality still hidden in Portugal.

The aim of this study was to estimate the number of women living in Portugal who have undergone FGM/C, and the number of girls who have undergone or will probably undergo FGM/C.

Section snippets

Methods

A thorough review of the methodological options chosen by national studies on the prevalence of FGM/C in the EU was conducted with the aim of building a comparable knowledge set. Accordingly, the strengths and limitations of prevalence studies from Italy,23 Hungary,24 Ireland,25 Germany,26 The Netherlands,27 Belgium,28 and England and Wales29 were explored.

No common methodology was identified, and it became apparent that it would be difficult to provide an estimate that would be directly

Results

The 2011 Census data indicated that 10,617 women born in FGM/C-practising countries aged 15–49 years were living in Portugal. When the female population aged ≥50 years was included, the total reached 13,335 women.

Analysing the same data disaggregated by country of birth revealed that 89% of the women aged 15–49 years came from Guinea-Bissau (9452 women). Guinea-Bissau is, by far, the largest migrant community in Portugal among the 29 FGM/C-practising countries, given the former colonial liaison

Discussion

This study, which was the first national extensive study on the subject, aimed to estimate the prevalence of FGM/C in Portugal. It is estimated that 6576 women living in Portugal have been subjected to FGM/C (5246 aged 15–49 years and 1330 aged ≥50 years), and 1830 girls aged <15 years living in Portugal have undergone or will probably undergo FGM/C.

Currently available national prevalence studies in the EU reveal prevalence rates for FGM/C ranging from 27% to 48%.23, 24, 25, 26, 27, 28 However,

Acknowledgements

The authors wish to thank the project's team members, without whom this research would not have been possible. They also wish to thank Ana Ferreira for the invaluable review of the article and Pedro Lisboa for proofreading the text.

Ethical approval

Not required.

Funding

Fundação para a Ciência e a Tecnologia's research project grant FACC – Proc. Nº 15 7 236.

Competing interests

None declared.

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