Do educated women in Sierra Leone support discontinuation of female genital mutilation/cutting? Evidence from the 2013 Demographic and Health Survey

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Study Justification:
This study aims to assess the views of educated women in Sierra Leone on the discontinuation of female genital mutilation/cutting (FGM/C). FGM/C is a harmful practice that affects millions of women globally, with a prevalence of 89.6% in Sierra Leone. Education is recognized as a key strategy to end FGM/C, and understanding the perspectives of educated women can provide valuable insights for policy and intervention development.
Highlights:
– The study found that 65.5% of women with formal education and 15.6% of women without formal education believed that FGM/C should be discontinued.
– Women with higher education levels were more likely to support the discontinuation of FGM/C.
– Factors such as religion, wealth status, region, marital status, and age influenced women’s views on FGM/C discontinuation.
– The study highlights the importance of addressing the needs of uneducated women, older women, and those who have undergone FGM/C in efforts to end the practice.
– The findings support the argument that education plays a crucial role in ending FGM/C and achieving Sustainable Development Goals (SDG) three and five.
Recommendations:
– Develop and implement educational programs that target uneducated women, older women, and communities where FGM/C prevalence is high.
– Promote awareness and understanding of the negative health consequences of FGM/C through community engagement and advocacy.
– Collaborate with religious leaders and organizations to challenge the religious justifications for FGM/C and promote alternative rites of passage.
– Strengthen efforts to improve access to education for girls and women in Sierra Leone.
– Allocate resources for comprehensive healthcare services, including counseling and support for women who have undergone FGM/C.
Key Role Players:
– Ministry of Health and Sanitation
– Ministry of Education, Science, and Technology
– Non-governmental organizations working on women’s rights and health
– Religious leaders and organizations
– Community leaders and traditional authorities
– Health professionals and educators
Cost Items for Planning:
– Development and implementation of educational programs
– Training and capacity building for healthcare providers and educators
– Community engagement and advocacy activities
– Research and data collection on FGM/C prevalence and impact
– Healthcare services, including counseling and support for women affected by FGM/C
– Infrastructure and resources for improving access to education for girls and women

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is relatively strong, but there are some areas for improvement. The study utilized data from the 2013 Sierra Leone Demographic and Health Survey, which is a reliable source. The study included a large sample size of 15,228 women, which increases the generalizability of the findings. The study also conducted descriptive analysis and binary logistic regression analyses to examine the relationship between women’s educational attainment and their views on discontinuing female genital mutilation/cutting (FGM/C). The results of the regression analyses were presented as crude odds ratios (COR) and adjusted odds ratios (AOR) with 95% confidence intervals (CIs), which adds to the robustness of the findings. However, the abstract could be improved by providing more information on the methodology used in the study, such as the specific variables included in the regression analyses and any potential limitations of the study. Additionally, it would be helpful to include information on the statistical significance of the findings, such as p-values or confidence intervals. Overall, the evidence in the abstract is strong, but providing more methodological details and statistical significance would further enhance its strength.

Introduction: Female genital mutilation/cutting (FGM/C) comprises all procedures that involve the total or partial elimination of the external genitalia or any injury to the female genital organ for non-medical purposes. More than 200 million females have undergone the procedure globally, with a prevalence of 89.6% in Sierra Leone. Education is acknowledged as a fundamental strategy to end FGM/C. This study aims to assess women’s educational attainment and how this impacts their views on whether FGM/C should be discontinued in Sierra Leone. Methods: We used data from the 2013 Sierra Leone Demographic and Health Survey. A total of 15,228 women were included in the study. We carried out a descriptive analysis, followed by Binary Logistic Regression analyses. We presented the results of the Binary Logistic Regression as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with 95% confidence intervals (CIs). Results: Most of the women with formal education (65.5%) and 15.6% of those without formal education indicated that FGM/C should be discontinued. Similarly, 35% of those aged 15–19 indicated that FGM/C should be discontinued. Women with a higher education level had a higher likelihood of reporting that FGM/C should be discontinued [AOR 4.02; CI 3.00–5.41]. Christian women [AOR 1.72; CI 1.44–2.04], those who reported that FGM/C is not required by religion [AOR 8.68; CI 7.29–10.34], wealthier women [AOR 1.37; CI 1.03–1.83] and those residing in the western part of Sierra Leone [AOR 1.61; CI 1.16–2.23] were more likely to state that FGM/C should be discontinued. In contrast, women in union [AOR 0.75; CI 0.62–0.91], circumcised women [AOR 0.41; CI 0.33–0.52], residents of the northern region [AOR 0.63; CI 0.46–0.85] and women aged 45–49 [AOR 0.66; CI 0.48–0.89] were less likely to report that FGM/C should be discontinued in Sierra Leone. Conclusion: This study supports the argument that education is crucial to end FGM/C. Age, religion and religious support for FGM/C, marital status, wealth status, region, place of residence, mothers’ experience of FGM/C and having a daughter at home are key influences on the discontinuation of FGM/C in Sierra Leone. The study demonstrates the need to pay critical attention to uneducated women, older women and women who have been circumcised to help Sierra Leone end FGM/C and increase its prospects of achieving Sustainable Development Goals (SDG) three and five.

This study was conducted in Sierra Leone, which shares boundaries with Liberia to the southeast and Guinea to the northeast. Sierra Leone has a tropical climate with a diverse environment, ranging from savanna to rainforests, representing a total area of 71,740 km2. The country’s population according to the 2015 population and housing census was 7,092,113 [47]. More than half (4,187,016) of the population live in rural areas, whereas 41% (2,905,097) live in urban centres. Between 2004 and 2015, the country recorded an annual population growth rate of 3.2%. The sex ratio stands at 96.8 males per 100 females. The report also shows out of the 6,589,838 people aged three years and above, 55.4% have attended school while 44.2% have never attended school. The percentages of males currently in school (39.1%) and those who ever attended school (60%) are higher than their female counterparts (35.3% and 50.9% respectively). The proportion of the population that has never attended school in rural areas is 32.7% and 11.5% in urban areas. Freetown is the country’s capital and largest city. Agriculture is the dominant economic activity. About 78% of the population is Muslim and 21% is Christian. The country is divided into five administrative regions (Eastern, Northern, North West, Southern and Western Area) which are further divided into 14 districts [47]. This present study utilised data from the women’s recode file of the 2013 Sierra Leone Demographic and Health Survey (SLDHS) [31]. This was the second Demographic and Health Survey (DHS) in Sierra Leone. DHS collates data to monitor the population and public health situation of surveyed countries. The 2013 SLDHS explored information on FGM/C and several maternal and child health indicators such as nutrition, exclusive breastfeeding and fertility. The Measure DHS determined the sample to derive a reliable estimate for important variables in the country. This occurred by considering the rural/urban settings together with the four administrative regions and all 14 districts. The sample was stratified and determined in two main stages to achieve representativeness [31]. The response rate for the survey was 99%. The sampling procedure is extensively documented in the report [31]. The authors were granted access to utilise the survey dataset from the Measure DHS Program’s website. The dataset is available to the public via https://dhsprogram.com/data/available-datasets.cfm.

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Based on the information provided, here are some potential innovations that could improve access to maternal health in Sierra Leone:

1. Education programs: Implementing comprehensive education programs that focus on reproductive health, including the dangers of female genital mutilation/cutting (FGM/C) and the importance of maternal health care.

2. Community outreach: Conducting community outreach programs to raise awareness about maternal health, FGM/C, and the benefits of seeking proper healthcare during pregnancy and childbirth.

3. Mobile health clinics: Utilizing mobile health clinics to reach remote and underserved areas, providing essential maternal health services, including prenatal care, safe delivery, and postnatal care.

4. Training healthcare providers: Offering training programs for healthcare providers to improve their knowledge and skills in maternal health care, including the management of complications during pregnancy and childbirth.

5. Strengthening healthcare infrastructure: Investing in the improvement and expansion of healthcare facilities, particularly in rural areas, to ensure access to quality maternal health services.

6. Maternal health incentives: Introducing incentives, such as financial support or access to essential resources, to encourage pregnant women to seek regular prenatal care and deliver in healthcare facilities.

7. Community-based midwifery programs: Establishing community-based midwifery programs to provide skilled birth attendants in areas where access to healthcare facilities is limited.

8. Telemedicine: Implementing telemedicine services to connect pregnant women in remote areas with healthcare professionals, allowing them to receive medical advice and support during pregnancy.

9. Maternal health awareness campaigns: Launching targeted awareness campaigns to educate communities about the importance of maternal health, dispel myths and misconceptions, and promote positive health-seeking behaviors.

10. Policy advocacy: Advocating for policy changes and legal reforms to protect women’s rights, including the elimination of FGM/C and the promotion of safe and respectful maternal health care.

It is important to note that these recommendations are based on the information provided and may need to be further tailored and adapted to the specific context and needs of Sierra Leone.
AI Innovations Description
The study titled “Do educated women in Sierra Leone support discontinuation of female genital mutilation/cutting? Evidence from the 2013 Demographic and Health Survey” provides insights into the relationship between women’s education and their views on discontinuing female genital mutilation/cutting (FGM/C) in Sierra Leone. The study found that women with higher levels of education were more likely to support the discontinuation of FGM/C. Other factors that influenced women’s views included religion, wealth status, region, marital status, and personal experiences with FGM/C.

Sierra Leone, located in West Africa, has a population of approximately 7.1 million people. The country has a diverse environment, ranging from savanna to rainforests, and is divided into five administrative regions and 14 districts. The majority of the population lives in rural areas, and agriculture is the dominant economic activity. The country has a relatively high prevalence of FGM/C, with 89.6% of females having undergone the procedure.

The study utilized data from the 2013 Sierra Leone Demographic and Health Survey (SLDHS), which collected information on various maternal and child health indicators, including FGM/C. The survey sample was designed to be representative of the country’s population, considering rural/urban settings, administrative regions, and districts. The response rate for the survey was 99%.

The findings of the study highlight the importance of education in ending FGM/C. To improve access to maternal health and address the issue of FGM/C in Sierra Leone, it is recommended to focus on providing education and awareness programs targeting uneducated women, older women, and those who have undergone the procedure. These programs should emphasize the health risks and negative consequences of FGM/C, promote alternative cultural practices, and empower women to make informed decisions about their own bodies. Additionally, efforts should be made to engage religious leaders and communities in advocating for the discontinuation of FGM/C. By addressing these factors, Sierra Leone can work towards achieving Sustainable Development Goals related to maternal health and gender equality.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health in Sierra Leone:

1. Increase access to education: As the study suggests, education plays a crucial role in ending female genital mutilation/cutting (FGM/C) and improving maternal health. Implementing programs that focus on increasing access to education, especially for girls and women, can help raise awareness about maternal health and promote positive attitudes towards discontinuing harmful practices like FGM/C.

2. Strengthen healthcare infrastructure: Improving access to maternal health services requires a well-functioning healthcare system. Investing in healthcare infrastructure, including hospitals, clinics, and trained healthcare professionals, can ensure that pregnant women have access to quality prenatal, delivery, and postnatal care.

3. Enhance community engagement and awareness: Engaging with local communities and raising awareness about maternal health can help dispel myths and misconceptions, address cultural barriers, and encourage positive health-seeking behaviors. Community-based interventions, such as health education campaigns and support groups, can play a vital role in improving access to maternal health services.

4. Provide financial support: Financial barriers often prevent women from accessing maternal health services. Implementing programs that provide financial support, such as subsidies for healthcare services or health insurance schemes, can help alleviate the financial burden and improve access to essential maternal health services.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define indicators: Identify key indicators that measure access to maternal health, such as the percentage of pregnant women receiving prenatal care, the percentage of births attended by skilled health personnel, or the maternal mortality rate.

2. Collect baseline data: Gather data on the selected indicators before implementing the recommendations. This data will serve as a baseline for comparison.

3. Implement interventions: Implement the recommended interventions, such as increasing access to education, strengthening healthcare infrastructure, enhancing community engagement, and providing financial support.

4. Monitor and collect data: Continuously monitor the implementation of interventions and collect data on the selected indicators. This data can be collected through surveys, interviews, or existing health information systems.

5. Analyze data: Analyze the collected data to assess the impact of the interventions on the selected indicators. Compare the post-intervention data with the baseline data to determine any improvements in access to maternal health.

6. Evaluate and adjust: Evaluate the effectiveness of the interventions and make adjustments as needed. This may involve refining strategies, reallocating resources, or implementing additional interventions based on the findings.

By following this methodology, policymakers and stakeholders can gain insights into the potential impact of the recommended interventions on improving access to maternal health in Sierra Leone.

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