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research-article2021
JIVXXX10.1177/08862605211015257Journal of Interpersonal ViolenceGonzález-Timoneda et al.

Original Research
Journal of Interpersonal Violence
2022, Vol. 37(17-18) NP15504­–NP15531
Cultural Beliefs, © The Author(s) 2021
Article reuse guidelines:
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DOI: 10.1177/08862605211015257
https://doi.org/10.1177/08862605211015257
Experiences on Female journals.sagepub.com/home/jiv

Genital Mutilation
Among Women and
Men: A Qualitative
Analysis

Alba González-Timoneda,1, 2
Antonio Cano Sánchez,1
Marta González-Timoneda,3
and Vicente Ruiz Ros1

Abstract
The practice of female genital mutilation (FGM) is a deeply-rooted tradition
that affects predominantly regions of Africa and Asia. Because of migration
flows, FGM is an issue of increasing concern worldwide. FGM is now
carried out in Europe, North America, Australia and New Zealand, and
more specifically among immigrant communities from countries where it
is common. This study aims to assess the experience, knowledge, attitudes,
and beliefs related to FGM of migrant women and men from FGM-affected
countries residing in Spain and the United Kingdom. A phenomenological
qualitative approach was used. Participants (n=23) were recruited by using

1University of Valencia, Spain

2LaFe University Hospital, Valencia, Spain
3University Clinic Hospital, Valencia, Spain

Corresponding Author:
Alba González-Timoneda, University of Valencia, C/ JaumeRoig, s/n 46010, Spain.
Email: alba. gonzalez@uv.es
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the snowball sampling technique until data saturation was reached. Data
were collected through 18 open-ended interviews and a focus group. Of
the 23 participants, 20 women had undergone FGM. The following five
themes were generated from interviews: (a) FGM practice development, (b)
knowledge about the practice, (c) reasons for performing FGM, (d) attitudes
toward continuing or abandoning the practice, and (e) criminalization of
FGM. The study here presented identifies a lack of information, memory,
and knowledge about the practice of FGM and typology among women with
FGM. The justification of the practice seems to be based on a multifactorial
model, where sociocultural and economic factors, sexual factors, hygienic-
esthetic factors, and religious-spiritual factors take on a greater role in
the analysis of the interviews carried out. The participants practically
unanimously agree to advocate the abandonment and eradication of this
harmful traditional practice. The knowledge displayed in this study may
provide a basis for improving awareness and healthcare in such collectives,
aiming the eradication of this harmful traditional practice.

Keywords
female genital mutilation, cultural beliefs, migration, women’s experiences,
qualitative research

Background
Female genital mutilation (FGM), also known as female circumcision or
genital cutting, is a culturally determined practice, performed in 31 countries
and predominantly in parts of Africa and Asia, affecting more than 200 mil-
lion women and girls worldwide (UNICEF, 2020). FGM comprises all proce-
dures that involve a partial or total resection of the female external genitalia
or other injury to the female genitalia for cultural or other non medical rea-
sons (WHO et al., 1997). The practice is recognized internationally as a vio-
lation of the human rights of girls and women and as an extreme form of
gender discrimination, reflecting deeply entrenched gender inequality.
As FGM is practiced on young girls without consent, it is a violation of the
rights of children. It also violates a person’s rights to health, security and
physical integrity, the right to be free from torture and cruel, inhuman or
degrading treatment, and the right to life when the procedure results in death.
The practice has devastating consequences for the health and quality the lives
of women and girls both short and long terms (WHO, 2016).
FGM is carried out in the context of a community or a group and is legiti-
mized through beliefs that vary depending on ethnicity and geographic
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González-Timoneda et al. Journal of Interpersonal Violence 37(17-18)3

location, and which offer a series of explanations for its justification and
maintenance. These explanations are based on cultural, social, and commu-
nity factors. Even within the same community, the reasons for carrying out-
FGM are not homogeneous. Furthermore, similar to the communities
themselves, the justifications for FGM are not static and continue to be
adapted in the emerging sociocultural context. Most of the time, FGM is done
with the intention to provide benefit, not cause harm. Parents initiate this
procedure with the aim of securing a marriage for their daughters, as being a
wife and a mother is considered a woman’s livelihood, and not circumcising
one’s daughter is equivalent to condemning her to a life of isolation (WHO,
1999). However, the practice of FGM continues because of social pressure on
women to conform to social norms, peer acceptance, or fear of criticism
despite its illegality as reported by Sakeahet al. (2019).
FGM is mainly concentrated in countries in the western, eastern, and
north-eastern regions of Africa, along with the Middle East, and is practiced
in some countries of Asia and Latin America. The rise in international migra-
tion has also increased the number of girls and women living in the diaspora
populations (National FGM Centre, 2021; UNICEF, 2016), and this harmful
practice is now widely carried out in Europe, North America, Australia, and
New Zealand, and more specifically among immigrant communities from
countries where FGM is common (European Parliament, 2019). Aside from
girls and women living in diaspora communities, there is also evidence of the
practice in non diaspora communities in Russia and Georgia.
Therefore, the migration of families from FGM-practicing countries has
resulted in FGM becoming a global issue. Growing migration has increased
the number of girls and women who have undergone FGM or who may be at
risk of being subjected to the practice living outside their country of origin.
This fact has caused women’s healthcare providers throughout the world to
increasingly encounter women who have experienced this practice. In
Europe, it is thought that over half a million women and girls have been sub-
jected to FGM, and around 180, 000 are at risk in 13 countries alone (End
FGM European Network, 2019).
The current manuscript presents results from part of a larger research proj-
ect taking place within the doctoral thesis of the primary author in order to
identify the knowledge, attitudes, and practice among frontline professionals,
as well as knowledge, cultural beliefs, and experiences of migrant women
and men from FGM-practicing countries residing in Spain and the United
Kingdom with regard to this harmful practice.
Indirect estimates indicate that 15, 907 women and girls who have under-
gone FGM reside in Spain. Moreover, it is estimated that at least 70, 000
women and girls come from countries affected by FGM (Kaplan & López,
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4 et al. NP15507
Journal of Interpersonal Violence

2017). In the Valencian Community, the number is estimated at almost 6, 000

women and 1, 500 girls between 0 and 14 years of age from countries affected
by FGM, placing the Community as the fourth Spanish autonomous commu-
nity with the largest population (Kaplan & López, 2017). This population
comes mainly from Nigeria, Senegal, Guinea, Mali, and Cameroon.
In the United Kingdom, the prevalence of FGM varies regionally, and
there are higher rates of women affected by FGM in cities with large popula-
tions of FGM-practicing communities. In 2011, it was estimated that 137,
000 women and girls were living with FGM in England and Wales and that a
further 67, 300 girls under the age of 13 were at risk of the procedure. London
has the highest national prevalence for any city with an estimated 2. 1% of
women affected by FGM (Macfarlane & Dorkenoo, 2015).
Thus, FGM is a rising issue in western societies as a consequence of inter-
national migration. It is expected that the number of women with FGM in
Europe would rise at quite a fast rate, and future flows are expected to be
strongly geographically selective, involving mainly France, Italy, Spain, the
United Kingdom, and Sweden (Ortensi & Menonna, 2017). Limited research
has examined how migrant women and men residing in Europe think about this
practice, experience the practice itself, and what are the motivating factors for
performing FGM (Agboli et al., 2020; Ahmed et al., 2019; Gele et al., 2012;
Johns dotter et al., 2009; Moxey & Jones, 2016; Thierfelder et al., 2005).
However, knowing the attitudes of practicing communities toward FGMis
key for developing strategies to safeguard girls from FGM and to promote
behavior change toward the abandonment of FGM, and this topic should be
reinforced in future research (Larsson et al., 2018; Simpson et al., 2012). In
Spain, there is little research about female and men experiences and attitudes
surrounding the practice of FGM (Ballesteros-Meseguer et al., 2014; Jiménez
Ruiz et al., 2014; Kaplan et al., 2013; Reig-Alcaraz et al., 2014), and con-
cretely, there is no research to date that explores the practice in women and
men from FGM-practicing countries residing in the region of Valencia.
To achieve success in preventing the continuation of FGM, it is necessary
to understand the reasons underpinning the practice. Therefore, researching
family and community factors underlying this tradition and exploring the
perspectives and experiences of women affected by FGM would lead to a
better understanding of the impact of the practice and help to achieve respect-
ful and effective approaches for its eradication. In this regard, this study aims
to assess the experience, knowledge, attitudes, and beliefs related to FGM of
migrant women and men from FGM-affected countries residing in Spain and
the United Kingdom.
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González-Timoneda et al. Journal of Interpersonal Violence 37(17-18)5

Methods
Design
A phenomenological qualitative approach was chosen for data collection, as
this method is particularly suitable for gaining insights into human experi-
ences (Creswell, 2014). The method was informed by Husserlian philosophy
which seeks to explore the same phenomenon through rich descriptions by
individuals revealing commonalities of the experience (Husserl, 1962).

Participants
We included women and men aged 18 years and above from countries
affected by FGM who had undergone FGM or had been in close contact with
the practice, who were able to provide informed consent, and who spoke
English or Spanish or had translation assistance available for the interview. A
total of 23 participants were recruited, of whom 20 women had undergone
FGM. We also included two men and a woman who had been in close contact
with the practice since their wife and female relatives had been subjected to
the practice. One of them led the awareness campaign in his country of origin
and knew first-hand the situation of many girls and women in his community.
These three participants were considered especially knowledgeable about the
phenomenon studied and therefore were also included in the research. The
sociodemographic characteristics and the FGM status of the study partici-
pants are shown in Tables 1-3.
Purposeful sampling was used for the identification and selection of par-
ticipants. This involves identifying and selecting individuals or groups of
individuals that are especially knowledgeable about or experienced with a
phenomenon of interest (Cresswell & Plano, 2011). The “snowball” sampling
technique was chosen because of its suitability in providing forms of contact
with populations or groups characterized as difficult to access or, as referred
to in the literature, hard-to-reach populations (Atkinson & Flint, 2001;
Johnston & Sabin, 2010) or hidden populations (Petersen & Valdez, 2005;
Voicu & Babonea, 2011). Contact with the target population was made via
key informants, African associations, and different public social institutions
of the region of Valencia. Participants were approached by telephone and
face-to-face.
The sampling was carried out mainly based on the criteria of accessibility
and feasibility for the participants. We aimed to obtain a diverse range of
participants in terms of age, marital status, educational level, socioeconomic
level, and experience with FGM and geographical origin. In addition to being
6González-Timoneda et al. Journal of InterpersonalNP15509
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a purposeful and reasoned sampling, it was cumulative, sequential, flexible,

and reflective as it was modified and expanded throughout the research pro-
cess until data saturation was reached.

Data Collection
We carried out 18 face-to-face semi structured individual interviews and one
focus group. The study was carried out in two stages: the first stage was con-
ducted in London (United Kingdom) in January 2017, and the second stage
was conducted in Valencia (Spain) from February to May 2017. The focus
group was conducted in April 2017.
Two researchers were involved in carrying out the interviews. Although
initially in-depth open-ended interviews were attempted, the language limita-
tion in some cases, as well as the private and personal dimensions of the
phenomenon studied and the consideration of the topic as a taboo, prompted
the researchers to change to semi structured interviews containing open-
ended questions.
Firstly, a few questions exploring the sociodemographic characteristics of
the sample were undertaken. The following questions included women’s
experiences and perspectives around different aspects of FGM such as knowl-
edge about the practice, reasons for practicing it, or attitudes toward the con-
tinuation or abandonment of the practice. The participants chose the times
and locations for the interviews. All narratives were, after obtaining consent,
recorded in the audio format. In addition, nonverbal gestures and researchers’
observations were recorded in a field notebook.
The focus group was undertaken to encourage interaction between the par-
ticipants and explore the discourse in a given social context, capturing social
experience and the different opinions and contradictions following the
Berengueraet al. (2014) approach. In the focus group, the individual point of
view of the speech is more interesting: “listen in a group but speak as a sin-
gular interviewee” (Berenguera et al., 2014). Five Nigerian women coming
from vulnerable social groups such as prostitution and trafficking agreed to
participate. The focus group was open, nondirective and flexible, and offered
the participants the freedom to answer or not to answer the questions. A sec-
ond person who worked as a moderator was required for its implementation.

Ethical Considerations
Participants were given written and oral information about the study and
signed a consent form prior to each interview. Participants received thorough
information about the purpose of the research and confidentiality, such as that
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González-Timoneda et al. Journal of Interpersonal Violence 37(17-18)7

all person-identifying information that emerged during the interview would

be anonymized in the transcript. They were also given information about how
the recorded interviews were going to be stored and that these, together with
their contact information, would be deleted once the study was completed.
The authors emphasized in particular the right to withdraw from the study at
any time. The participation was voluntary in all cases.
The study received approval from the Ethics Committee in Human
Research of the University of Valencia, Spain.

Data Analysis
All interviews were transcribed verbatim, and the participants’ identities
were protected using code numbers. Data analysis was conducted using
Giorgi’s (1997) four-step phenomenological approach and occurred simulta-
neously with data collection: (a) reading the entire disclosure of the phenom-
enon as described by the participant to obtain a sense of the whole; (b) reading
the transcripts again breaking down the whole through analysis into common
elements; (c) transforming the language of the participants into a conceptual
perspective of the experience, relative to the phenomenon of interest; and (d)
combining and synthesizing these meaning units into a final general descrip-
tion that reflects the lived experience of the participants. Following this
approach, the transcripts were read repeatedly to determine their wholeness,
followed by a sentence-by-sentence analysis where common elements were
extracted and restated in more general terms. Meaning units were identified
and these were then coded. Subsequently, code groups or themes were formed
along the way and adjusted as new codes emerged from data. The Atlas. ti v.
8. qualitative data analysis software was used for data analysis.
Together two authors concurrently and independently analyzed the narra-
tives and interviews both as a whole and for meaning according to a phenom-
enological life world approach (Giorgi, 2009). Initial findings were conferred
in a research team meeting and discussed until consensus was reached around
themes and subthemes which added rigor to the data analysis. All the research-
ers agreed on the final thematic structure.

Rigor
In order to assess the research process developed in the framework of qualita-
tive research, we have based our work on the general criteria described by
Guba and Lincoln (1985): credibility, transferability, dependency, and con-
firm ability. The procedures used to ensure the rigor of our research were
extensive field work, researcher and methodological (within method)
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8 et al. NP15511
Journal of Interpersonal Violence

triangulation, reflexivity, confirmation with participants as well as a thorough

description of the context, phenomenon, participants, data collection tools,
analysis strategy, and findings.

Results
Of the 23 participants, 21 were women and 2 were men. The mean age of the
men interviewed was 50 years, whereas that of the women was 31. 8 years.
All the participants came from countries affected by FGM: Mali, Somalia,
Nigeria, Burkina Faso, Senegal, Cameroon, with the exception of one partici-
pant who came from Equatorial Guinea, but her family origins were Nigerian.
The average residence time in the country of origin for women was 24. 6
years, whereas for men, it was 38. 5 years.
The following themes were derived from the interviews: (a) FGM practice
development, (b) knowledge about the practice, (c) reasons for performing-
FGM, (d) attitudes toward continuing or abandoning the practice, and (e)
criminalization of FGM. From these, several subthemes emerged, which are
described below. Representative quotations from the participants are used in
order to verify and validate the findings.

FGM Practice Development

Most of the women agree that the practice is mostly predominantly carried
out by elderly women who dedicate themselves, assuming the role of cutters
within the community. These women, who inherit this role from mothers to
daughters, do not have adequate anatomical knowledge nor adequate surgical
training. The performance of the practice by men, barbers, healers, or rela-
tives, as it is known in certain communities, has not been detected.

“They are grandmothers who do it” (I8VW).

“Her grandmother has been doing this work for more than 40 or 50 years”
(I15VM).
“Doctors don’t. In my country (Burkina Faso) they are older people” (I11VW).

However, some women referred to the concept of medicalization of

FGM. We have recognized a clear difference between Somali women resid-
ing in London and the rest of the women, where the first were mutilated by
a doctor and not by a non-healthcare professional:

“So, she called the doctor” (I1LW), “It was a doctor, in the city” (I4LW), “It
was a doctor, a man” (I5LW).
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González-Timoneda et al. Journal of Interpersonal Violence 37(17-18)9

We have also found differences between the most rural and the most urban
areas. Those families with the most economic means moved to cities to carry
out the practice by qualified medical professionals.

“The man who was doing it was a doctor, so he didn’t cut us like other people
from outside the city from the rural area. There is horrible, there’s no local
anesthetic, there’s nothing, type III […]. Any no-experienced woman could be
doing it, whoever…” (I2LW).
“In Mali they make the group and go to the forest and the mothers stay out there
and the children are cut off and then they are let out to see their mother. There
are boys and girls” (I12VW).

Other women, on the other hand, reported that the person who carried out
the practice, whether it was a doctor or an older woman, went to their own
home or a family member’s house to carry it out.

“Yes, the doctor came to my house. There was not only me, we were four girls
at the same place, in my house” (IL2W).
“It wasn’t at my house; it was at my grandmother’s house. My mother sent me
there and I did not know or have any idea what they were going to do to me…
and I remember when she took me to the bathroom…” (I 16 VW).

All the interviewees agreed that FGM is performed at a very early age.
The modal age of FGM was 6 years, but ranged from less than a week to 12
years old; 7 women could not recall the age when they were cut. Thus, most
of the participants only had vague memories of the moment of FGM. During
the focus group, when we asked if they remembered when the practice was
performed, all the women laughed:

“Childhood, we were children (they laugh in group)” (IG).

“So, normally it takes place as soon as possible…. They are old enough to
understand but not old enough to be too late to say no, and understand that is
wrong and fight it. But we didn’t thought it was wrong, because everybody was
doing it. It was our culture. You don’t realize until you grow up and see the
problems” (I2LW).
“You never know if you are cut, you are a baby […] you don’t know what is
happening” (I13VW).

Regarding the hygienic-sanitary conditions, mainly those women who

were genitally mutilated by a medical trained professional received local
anesthesia prior to the practice, it was done under aseptic conditions and anti-
biotic prophylaxis.

“So, she called the doctor. I had local anesthetic, it was a type one” (I1LW).
“I was lucky because I was in the city and it was the doctor who did the thing. I
got an injection for the pain and antiseptic to try not to have an infection” (I2LW).
González-Timoneda
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Journal of Interpersonal Violence

“After the local anesthetic no pain, just to get the anesthetic was very painful”
(I4LW).

In contrast, in rural areas where mutilation was carried out by older women
in the community, the means were scarce. FGM was performed with sharp
objects such as special knives, scalpels, or blades; anesthetics and antiseptics
were not usually used, and there was no possibility of receiving analgesia and
antibiotic therapy as reflected in the following accounts.

“They have a way to sterilize the knives (…) they do it to you and then they tell
you how to clean the girl” (I6VW).
“Without any hygiene, you know. Anything can happen in that process”
(I9VW).
“There are not so many means to do it. Likewise they cut 20 girls using the
same knife, so there are many infections, there are girls who die from
hemorrhages…” (I14VW).

In most of the reports collected, post-FGM care is carried out by the fam-
ily itself, in accordance with the accounts described previously:

“Sometimes when they cut everything, then the portions are sewn together….
When the wound is healing and they are cleaning it, they try that the skin does
not stick so much…. They clean it making a bigger hole with the finger […].
Women who cure it normally will not have the same as those who do it by
cleaning it (she makes movement with the drag index vertically) from top to
bottom” (I14VW).
“… she told me that the tradition was to use the soil from the entrance of the
house… she spread it with karite oil […]they don’t have the right medicines to
heal it” (I15VM).

We did not find excessive references regarding the recovery time needed
after FGM, since many of the participants did not remember how the practice
was carried out. In communities where infibulation is practiced, girls have
their legs tied for immobilization for 10 or 14 days, thereby allowing scar
tissue to form. This fact is reflected in the words of one interviewee:

After it was done I recovered the next day. But my brother who was older than
me -he was 6 years older than me-, had a lot of experience back home. When
the FGM was done back home (Somalia) for the girls who had type III they
wouldn’t move around for the next four or five days having their legs tied
together. So when he saw me walking around he said to my mum ‘Oh, mum,
nothing has been done for her. This is not the right way, the doctor didn’t do
anything for her’, so I had it re-done (I1LW)

Regarding the decision to cut, different testimonies have been collected

without reaching consensus. Most of the time, it is women who take the
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González-Timoneda et al. Journal of Interpersonal Violence 37(17-18)
11

initiative to mutilate the girls. Male involvement within societies that prac-
tice FGM is generally less, since the practice is considered “a women
thing”:

“No, no, no! An older woman in the family! Grandma or aunt … it depends.
For example, your father’s sister or your grandmother…. They decide” (I8VW).

The decisions made in the female sphere, however, are sometimes

endorsed by men, as some of the interviewees narrate. The pressure of a soci-
ety with a clear masculine dominance pushes women to make the decision to
mutilate their daughters or their closest relatives. We also see how under
some circumstances, some parents, neither the mother nor the father, are even
informed of the moment of the FGM.

“It is the father who says to his wife, look, this is the girl's turn…” (I6VW).
“We didn’t know when the practice was going to happen” (IG).
“I think it is culture’s pressure, because I think that FGM will come because of
the machismo, because men dominate women…” (I14VW).
“Most do it without father’s consent…” (I15VM).
“Because they do it by surprise too…. I have little sisters, I can take them and
bring them to wherever FGM is done…. Like doing them a favor” (I16VW).

However, the payment for the performance of genital mutilation is com-

pulsory in any case:

“Yes, you have to! Even if it’s local women, they are cheaper than the doctors.
When is a doctor you have to pay more for them, for the local anesthetic and all
of that” (I2LW).

Nevertheless, some of the participants indicated that they themselves

demanded FGM in an attempt to be socially accepted among their peers.
These reports relate how the fear of social rejection, marginalization, and the
desire to belong to a group are causes of FGM in some cases.

“I thought every woman had it, I thought that was the normal as every single
woman…. I was normal” (I1LW).
“Actually, because everybody was having this, I was the one who was pushing
my mother to do it. I wanted to be same as the others. We thought we were
growing up” (I2LW).
“We were around fouror five girls, one of them was a bit older around 13 or 14
years old because she didn’t have parents; she grown up with her grandparents.
We ashamed to become like that girl, we wanted that (FGM) at an earlier age
than that girl” (I2LW).
“I asked my parents every day, do it please! because all my friends had it. I
asked them every morning. My dad didn’t want, and I asked my mum. My dad
never supported the practice” (I4LW).
González-Timoneda
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Journal of Interpersonal Violence

“As I had friends who were a little older than me … they were going to be cut
and I asked mom … me too!” (I12VW).

One describes how the FGM rite was perceived as a moment of celebra-
tion and joy where the family offered gifts to her before the practice was
performed:

“It was explained to me but, for a 6-year-old girl, I thought I was doing something
very good, I had to please my parents, to please everyone. I was given plenty of
gifts, gold, jewelry, which is hardly praised in our culture” (I1LW).

Knowledge of the Concept of FGM

All participants knew about the practice of FGM since they had been sub-
jected to the practice or they have heard about the practice from family and
friends. Some participants stated that a small part of female genitalia is cut
during FGM, whereas others indicated that a large part is cut or even there is
a complete cut. However, the great majority of participants did not know
about the type of FGM they had experienced, even after a visual picture of
typology was showed to participants.

“It was just the top and then it is like a stopper, so that I cannot have relations
with any man” (I8VW).
“A very small cut at the top” (I13VW).
“I don’t know the grade, but I know they cut my entire clitoris (…) Yes, all
together, I only had a little hole for everything. Yes, it is a grade III” (I14VW).
“The mutilation that my wife has is the one that cuts only the clitoris, it is not
stuck” (I15VM).

Reasons for Performing FGM

A wide range of reasons for performing the practice of FGM emerged from
the interviewees (Table 4). Although the reasons may vary between commu-
nities, they share commonalities such as tradition, ensuring the girl or the
woman a status in the community, improving marriage opportunities, chas-
tity, purity, and family honor. Where women depend heavily on men, finan-
cial need can also be a powerful reason for undergoing FGM. Nearly all
participants decoupled FGM from their religion, since although the practice
can be found among Christians, Jews, and Muslims, none of the sacred texts
prescribe FGM.

“No, but it’s cultural thing and then it immigrated with the religion but it’s not
part of the religion” (I1LW).
“Well, I think that is more culture than religion, because in my country (Mali)
there are Christians, non-believers, Muslims, but everyone does it, so I would
not associate it with religion” (I14VW).
“Muslim, they do it; but we also do it” (IG).
Table 1. Sociodemographic Characteristics of Participants (Individual Interviews).
Years Out
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Place of Family of Country

Interview Sex Age Origin Ethnicity Residence Status of Origin Profession Religion
I1LW Woman 28 Kismaayo, − London, UK Married 22 Midwife Muslim
Somalia
I2LW Woman 43 Kismaayo, − London, UK Married 17 Health Muslim
Somalia Care
Assitant
I3LW Woman 44 Mogadishu, − London, UK Single 5 Health Muslim
Somalia clinic
assistant
I4LW Woman 28 Mogadishu, − London, UK Married 12 Housewife Muslim
Somalia
I5LW Woman 36 Mogadishu, − London, UK Married 13 Housewife Muslim
Somalia
I6VW Woman 43 Senegal − Valencia, Spain Single 9 Catering Christian
I7VM Man 47 Cameroon Bamileke Valencia, Spain Single 16 Catering Protestant
I8VW Woman 35 Dakar, Wolof Valencia, Spain Married 11 Hospitality Christian
Senegal
Dakar, − France Married − − −
Senegal
(originally from
Guinea)
I9VW Woman 39 Nigeria Ibu Valencia, Spain Married 11 Hospitality Christian
Journal of Interpersonal Violence 37(17-18)

(continued)
Table 1. continued

Years Out
Place of Family of Country
Interview Sex Age Origin Ethnicity Residence Status of Origin Profession Religion
I10VW Woman 40 Bata, Fang Valencia, Spain Single 18 Hospitality Christian
Equatorial
Guinea
González-Timoneda et al.

Nigeria − Valencia, Spain − − − Muslim

I11VW Woman 43 Uagadugú, Mossi Valencia, Spain Married 10 Cleaning Muslim
Burkina Faso staff
I12VW Woman 34 Mali Bambara Valencia, Spain Married 8 Housewife Muslim
I13VW Woman 31 Edo, Nigeria − Valencia, Spain Single 5 Housewife Christian
I14VW Woman 29 Kayes, Mali Mandike Valencia, Spain Divorced 8 Technical Muslim
staff in
Foundation
I15VM Man 53 Mali Bambara Valencia, Spain Married 7 Seasonal Christian
worker
I16VW Woman 28 Bamaku, Mali Fulani(Peul) Valencia, Spain Married 8 Student Muslim
I17VW Woman 25 Kayes, Mali Valencia, Spain Married 2 Housewife Muslim
I18VW Woman 26 Rural area, Valencia, Spain Married 1 Housewife Muslim
Mali
Note. I = interview; V = Valencia; L = London; W = woman; M = man.
Italics denote the characteristics of the women’s experience related by the participants.
NP15517
Table 2. FGM Characteristics of Participants (Individual Interviews).
Interview FGM Type of FGM Name of FGM Age of FGM (Years)
NP15518

I1LW Yes (in Italy) I 6

I2LW Yes II-III(Pharaon) 6-7
I3LW Yes II-III (Pharaon) −
I4LW Yes III (Oni) 9
I5LW Yes II 5-6
I6VW No − −
I7VM − − −
I8VW No − −
Yes Uncertain 12
I9VW No − −
I10VW No − −
Yes Uncertain −
I11VW Yes I Ablation 1
I12VW Yes Uncertain Circumcision 3-4
I13VW Yes Uncertain Circumcision (French) <1
I14VW Yes III Bolokoli 1 week
I15VM −*Her wife −*Type II Sili-ji −
I16VW Yes Uncertain Circumcision <7
I17VW Yes Uncertain Excision 1 month
I18VW Yes Uncertain Excision 1 month
Note. FGM = female genital mutilation; I = interview; V = Valencia; L = London; W = woman; M = man.
Journal of Interpersonal Violence 37(17-18)

Italics denote the characteristics of the women’s experience related by the participants.
González-Timoneda
16 et al. NP15519
Journal of Interpersonal Violence

Table 3. Profile of Participants of the Focus Group.

Years Out
Country of Country Marital
Interview Age of Origin of Origin Status FGM, Type Name of FGM
IG1VW 19 Nigeria 2 Single Yes, Circumcision
uncertain
IG2VW 19 Nigeria 5 Single Yes, Circumcision
uncertain
IG3VW 31 Nigeria 4 Single Yes, Circumcision
uncertain
IG4VW 22 Nigeria 1 Single Yes, Circumcision
uncertain
IG5VW 24 Nigeria 3 Single Yes, Circumcision
uncertain
Note. FGM = female genital mutilation; I = interview; G = group interview; V = Valencia; W = woman.

Attitudes Toward Continuing or Abandoning the Practice

Essentially, the positioning of the study participants was against the real-
ization and continuity of the practice of FGM (Table 5). Whereas in some
cases, the consequences of FGM on the health of girls and women are
mentioned as the main reason why the practice should be eradicated, in
other participants, the knowledge of current legislation and the possible
punitive consequence are the pretext of this position against the continuity
of the practice.

Criminalization of FGM
Almost all participants knew the current legislation in the United Kingdom
and Spain. Some also told us how the legislation in their respective countries
of origin is changing.

“I’m not allowed to touch my daughter!” (I2LW)

“Now there is a law, up to three years in prison and a fine for women who do it
in Senegal” (I8VW).
“You are not allowed to do FGM in this country, you are not allowed to practice
in this country, and you are not allowed to practice on UK citizens abroad,
under the age of 18…. I’m not sure, or 16, I think” (I1LW).
“Yes, I know, 10 years in prison!” (IL4W).
“Yes, Spanish law condemns FGM. Yes, it is illegal in Spain” (I7VM).
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González-Timoneda et al. Journal of Interpersonal Violence 37(17-18)
17

Table 4. Reasons for Conducting FGM.

Subthemes Quotations
Culture and tradition “She had it done, her mother had it done, her
mother’s sister had it done, and it was continuously
not stop” (I1LW). “But we didn’t think it was wrong
because everybody was doing it. It was our culture.
You don’t realize until you grow up and see the
problems” (I2LW). “In a family that believes in FGM,
all the girls that are born are circumcised. It is
tradition, there is no option” (I8VW).“Whether you
want it or not, they have to do it to you” (I10VW).
Hygiene and esthetical
appeal “But if they take your clitoris away you are good
girl, that you know, you are clean. It’s also another
thing they say. Women who have it done they look
much cleaner than the others” (I1LW).“If a woman
is not mutilated, it is as if she is dirty” (I7VM).
“Because a girl who is not mutilated, people call
them ‘bilákoro’, it’s like… if you are dirty you
cannot come with us…” (I15VM).
Prevent illnesses or
bad luck “Some other think that if she is not cut and that
girl becomes pregnant (…) if the clitoris touches
the baby's head at the time he’s born, then the boy
will go crazy” (I15VM). “If you are working in the
field, and your wife brings you food there (…) if
that woman touches you without cutting the
clitoris, enters the rice field, the rice dries, the
potato dries, the field will not produce well, it's bad
luck for your cultivation…” (I15VM).
Chastity and virginity
“Men can marry four women and mutilated
women do not usually reveal themselves much,
because look, if I am married to a man, then if that
man is going to marry another, I cannot do anything;
I cannot do anything because I do not like having a
sexual relationship with this person either, because
having FGM, sexual relations are very painful… so
why would I go find another man?” (I14VW).
“People believe that a girl who is not mutilated is a
girl who can play outside her marriage” (I15VM).
“It’s done so that the woman does not have so
much desire” (I17VW). “We think it’s something
they do to prevent girls from having sex” (IG).
(continued)
González-Timoneda
18 et al. NP15521
Journal of Interpersonal Violence

Table 4. continued

Subthemes Quotations
Marriage “They cut it off and they put a thing that works as a
opportunities, stopper so she cannot have sex with any other man
prerequisite to (…) it stays there until the day they get married.
marriage But then on the wedding’s day they take it away to
hand her over to the husband” (I8VW). “And that
has to be opened before the relationship … With
the knife!” (I14VM). “On the day of the wedding,
we accompany the wife and the husband to the
bedroom, and there is an old woman who stays at
the door to watch and says if the girl is virgin or
not” (I15VM). “The husband must open that…
firstly he tries with the penis, if it does not open
with the penis, he tries with anything else”
(I15VM). “I thought that if a woman was not
mutilated, she could not have children” (I16VW).
Note. FGM = female genital mutilation; I = interview; V = Valencia; L = London; W = woman;
M = man; G = group interview.

Table 5. Positioning About the Practice.

Subthemes Quotations
Against FGM “It should be stopped” (I1LW) (I2LM). “I’m not
allowed to touch my daughter!” (I2LW). “No,
no. I hope they stop that” (I4LW). “It must be
eradicated!” (I9VW) (I11LW). “One day talking to
my mother she said she was waiting for my daughter
be to cut with the other girls in Mali, and I said to
my mum, what are you saying?” (I14VW). “I believe
that this practice has to be eradicated […] There
is a will there is a way! I didn’t know that I could
convince my mother either”(I14VW). “Neither does
my husband; he says it to me, I love you very much,
but if you do, I denounce you” (I17VW).
Pro FGM
“But even today my sister-in-law thinks that
FGM must still be continued even though all
the inconveniences that she has experienced.
She is afraid that her daughters will not keep
their virginity until the day of their marriage in
a country where everything is permitted”
(I8VW).
Note. FGM = female genital mutilation; I = interview; V = Valencia; L = London; W = woman;
M = man.
NP15522
González-Timoneda et al. Journal of Interpersonal Violence 37(17-18)
19

“I told him that this is not done here (Spain) … if you do it, they put you in jail
here” (I16VW).

Discussion
Despite the fact that the women interviewed came from different countries of
origin, this study showed that FGM is mainly performed by elderly women
coinciding with Ballesteros-Meseguer et al. (2014) and Reig-Alcaraz et al.
(2014) in similar studies carried out in Murcia, Spain. The practice was car-
ried out in their countries of origin except for one of them, who was subjected
to FGM twice, in Italy. The EU tackles FGM in various ways in its internal
and external actions, and there are at least 50 criminal court cases of FGM in
Europe, and most of them took place in France in the 1980s and 1990s
(Mestre i Mestre, Johnsdotter, 2019).
Regarding the age at which the practice was carried out, all the interview-
ees agreed that it was carried out during their childhood before menarche,
although most women did not remember with certainty the age at which they
were subjected to the practice. FGM is usually performed on girls between
the ages of 4 and 15 (UNAF, 2013; WHO, 2016). However, it has recently
been stated that the majority of girls were mutilated before the age of 5
(UNICEF, 2016). This could be based on the assumption that “the younger
the child, the less resistance” or that the healing capacity of girls is foresee-
ably greater at a younger age (Kaplan, 2013; Touray & Piniella, 2013).
FGM was considered to be a “female thing, ” and this study reveals that
women or grandmothers decide to do FGM with the belief that a mutilated
woman will be more feminine, cleaner, honorable, and beautiful (Little,
2003). The participants agree with Kaplan et al. (2013) that although men do
not play an active part in decision-making, it does not mean that they do not
have the power to influence it. We also agree with Jiménez Ruiz (2015) when
he affirms that the power of men in societies where FGM is routinely carried
out influences in an invisible and silent way the decision to cut or not to cut.
Thus, the decision-making process about cutting or not cutting seems to be
very complex, and several factors are involved. However, the obligatory
nature of the practice does not entail an understanding of what actually hap-
pens in the mutilation process. Men generally know little or nothing, since it
is part of the feminine sphere, and a large part of the women do not remember
their mutilations and only assist in carrying them out in certain circumstances
(Touray & Piniella, 2013).
Also surprising are the stories of women where it is evident that they
themselves had to beg their parents to carry out the practice:

“I asked my parents every day” (I4LW), “I was the one who was pushing my
mother to do it. I wanted to be same as the others” (I2LW).
González-Timoneda
20 et al. NP15523
Journal of Interpersonal Violence

Jacobson et al. (2018) also recorded stories of women who requested to be

mutilated and eagerly awaited the day of FGM. Both in Somalia and in other
countries, social pressure and the desire to belong seem to have played an
important role (Ballestros-Meseguer et al., 2014; Jacobson et al., 2019;
Jiménez Ruiz, 2015).
For the women interviewed, FGM is “something you must go through”
and the testimonies collected in our study about the secrecy surrounding the
performance of the practice coincide with those referenced by other research-
ers (Ballestros-Meseguer et al., 2014; González-Henao, 2011; Jacobson et
al., 2018). We see how FGM is considered by many of our participants to be
a taboo subject, and they themselves declare that they do not speak about it in
their family or social circle. On one occasion, the women interviewed told us
that they had never shared their stories of FGM before. On the other hand, the
participants spoke of a community silence regarding not being told what
would happen during FGM or the benefits obtained from not carrying out-
FGM. This coincides with the WHO report (1999), where it is reflected how
girls are sometimes made to swear to keep silent about the practice, pain, and
associated techniques.
Many women revealed feelings of terror, humiliation, and pain. Ballesteros-
Meseguer et al. (2014) highlighted that this fact may favor the climate of
submission and silence in relation to FGM. However, during the interviews
with Somali women living in London, we were impressed by the presence of
laughter in the narratives of their personal stories about FGM. This fact is
also mentioned by Jacobson et al. (2018) in their study of Somali women
residing in Canada.
On the practice itself and aftercare, we agree with Reig-Alcaraz et al.,
(2014) regarding the little literature found in this regard. Somali women’s
reference to the received pre-FGM ceremony is highlighted, which coincides
with that described by Touray and Piniella (2013). From the participants’
verbatims, we observed how the practice is normally carried out with razor
blades, scissors, or any sharp object, and how post-FGM healing and recov-
ery are carried out in most cases by the family itself, fundamentally by moth-
ers and grandmothers, with the few means available to them at home. The
fact of not having antiseptics, antibiotics, or even running water in their
homes accentuates the development of potential complications. This differs
from that mentioned by Kaplan et al. (2013) in the Gambia, where traditional
knives appear to be being replaced by individual razor blades as a result of
HIV transmission prevention campaigns, as well as traditional herbs and
charms that are used for the cure and prevention of bleeding being replaced
by modern drugs.
NP15524
González-Timoneda et al. Journal of Interpersonal Violence 37(17-18)
21

All the women and men interviewed knew about the practice of FGM and
its existence in their regions of origin. In addition, although sometimes the
practice was not carried out in its place of origin, they knew the origin of the
practice and neighboring communities where it was carried out. However,
regarding the type of FGM, more than half of the participants could not iden-
tify which one of them had been practiced, finding differences between
groups depending on the country of origin. Thus, we see how women from
Somalia have been subjected to more aggressive genital mutilation for the
most part, except for one of the participants who, having been mutilated in
Italy, suffered FGM type I. Statistics reflect that although it is only estimated
that 15%-20% of women who have been mutilated have suffered type III
(WHO, 2008), in some countries such as Somalia figures of 93% were
reached in 2006 and 86% in 2011 (UNICEF, 2013).
The reasons for practicing FGM mentioned by the study participants were
different, although they all coincide with those described in the reviewed lit-
erature (Berg & Denison, 2013). Most of the reasons lie in gender consider-
ations and, therefore, in social constructions that attribute certain behaviors
and functions to women (premarital virginity, fidelity, beauty, etc.) and that
are truly discriminatory. Mainly, it is observed that FGM continues to be
practiced mainly due to conformity and social pressure, a statement widely
described in the literature (Gallego & López, 2010; Grose et al., 2019; Lucas,
2008; Sakeah et al., 2019; WHO, 2008).
Evidence states that fathers, mothers, and grandmothers are the main deci-
sion-makers (Alradie-Mohamed et al., 2020). However, FGM is found to be
more prevalent among daughters whose mothers want FGM to continue and
fathers are opposed or undecided than those whose fathers are the sole parent
supporting its continuation (Cappa et al., 2020). Our findings also suggest
that parental opinions may not be always a determinant, since some girls have
parents who oppose the practice, and the personal attitudes, family and social
norms are the ones that play an important role in determining whether the
girls will undergo FGM.
Practically, all the interviewees reported being against the conduct of
FGM, and only one of them told us about the experience of a close person
who advocated for FGM. The reasons for abandoning the practice were
mainly the consequences for the health of girls and women and the criminal
consequences if FGM is carried out, since most of the participants knew the
current legislation in the United Kingdom and Spain, as well as that of their
countries of origin. This fact coincides with the national statistics of the dif-
ferent countries where, for the most part, there is a positive trend toward the
abandonment of the practice. These investigations also indicate that the
daughters of more educated mothers and those from urban areas are less
González-Timoneda et al.
22 Journal of InterpersonalNP15525
Violence

likely to be subjected to FGM, with the trend that a higher level of instruction
results in greater conviction toward abandonment (DHS, 2018; EDS, 2004,
2010).

Strengths and Weaknesses

Researchers closely engage with the research process, and participants and
are therefore unable to completely avoid personal bias. The subjective nature
of qualitative research may make it difficult for the researcher to be detached
completely from the data. For this reason, the results were triangulated with
one of the participants and with other data collection methods.
Moreover, because of the sensitive nature of the topic, some of the inter-
viewees may not have been able to express their feelings and experiences
with complete spontaneity and freedom. It was also considered that the par-
ticipants did not fully tell the truth in some of the aspects discussed, since,
among other things, FGM is a penalized and harmful practice both in the
United Kingdom and Spain.
When using the “snowball” sample, one of the possible biases could be
over representation or over sampling of a network of peers. Although they
were not a homogeneous group in themselves, they may have shared charac-
teristics because some of them were known to each other. In order to mini-
mize this, different snowball chain starts were used. Some may have been
willing to participate in our study because of their outgoing personalities.
The use of a focus group with a homogeneous group of women facilitated
a richer interactive discourse that helped us explore various aspects of FGM
in a context of highly vulnerable women. Furthermore, and in line with Toner
(2009), small groups are beneficial as they highlight emotions and give par-
ticipants more space to express themselves.

Conclusions
This study provides insights into women’s experiences after being subjected
to FGM. The knowledge displayed may provide a basis for improving aware-
ness and healthcare in such collectives, aiming toward the eradication of this
harmful, traditional practice. The study presented here identifies a lack of
information, memory, and knowledge about the practice of FGM and typol-
ogy among women with FGM. The justification of the practice seems to be
based on a multifactorial model, where sociocultural and economic factors,
sexual factors, hygienic-esthetic factors, and religious-spiritual factors take
on a greater role in the analysis of the interviews carried out. The participants
NP15526
González-Timoneda et al. Journal of Interpersonal Violence 37(17-18)
23

practically unanimously agree to advocate the abandonment and eradication

of this harmful and traditional practice.
In order to guarantee a multidisciplinary, cross-cultural, and respectful
approach to FGM in our community, it is necessary to make the problem of
FGM known to the general population and to front-line professionals, increas-
ing their knowledge of this practice. Further research is needed to better
understand the roots and motives for practicing FGM and to examine the role
of different preventive measures in reducing the prevalence of FGM.

Acknowledgments
The authors would like to thank all the women and men who participated in this study
for their time and for revealing their stories.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interests with respect to the authorship
and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publi-
cation of this article.

ORCID iD
Alba González-Timoneda https://orcid. org/0000-0003-1871-7758

References
Agboli, A. A. Richard, F. & Aujoulat, I. (2020). “When my mother called me to say
that the time of cutting had arrived, I just escaped to Belgium with my daugh-
ter”: Identifying turning points in the change of attitudes towards the practice of
female genital mutilation among migrant women in Belgium. BMC Women’s
Health, 20(1), 107. https://doi.org/10.1186/s12905-020-00976-w
Ahmed, H. M. Shabu, S. A. & Shabila, N. P. (2019). A qualitative assessment of
women’s perspectives and experience of female genital mutilation in Iraqi
Kurdistan Region. BMC Women’s Health, 19(1), 66. https://doi.org/10.1186/
s12905-019-0765-7
Alradie-Mohamed, A. Kabir, R. & Arafat, S. M. Y. (2020). Decision-making pro-
cess in female genital mutilation: A systematic review. International Journal of
Environmental Research and Public Health, 17, 3362. https://doi.org/10.3390/
ijerph17103362
Atkinson, R. Flint, J. (2001). Accessing hidden and hard-to-reach populations:
Snowball research strategies. Social Research Update, 33. http://sru. soc. surrey.
ac. uk/SRU33.html
González-Timoneda et al.
24 Journal of InterpersonalNP15527
Violence

Ballesteros-Meseguer, C. Almansa-Martínez, P. Bravo, Pastor M. D., M. Jiménez-

Ruiz, & I. (2014). La voz de las mujeressometidas a mutilación genital femeni-
naen la Región de Murcia [The voice of women subjected to female genital
mutilation in the Region of Murcia]. Gaceta Sanitaria, 28(4), 287–291. https://
doi.org/10.1016/j. gaceta. 2014. 02. 006
Berenguera, A. Fernández de Sanmamed, M. J. Pons, M., Pujol, E., Rodríguez,
D. Saura, S. (2014). Escuchar, observar y comprender. Recuperando la nar-
rativaen las Ciencias de la Salud. Aportaciones de la investigacióncualitativa
[Listen, observe and understand. Recovering the narrative in the Health Sciences.
Contributions of qualitative research]. InstitutUniversitarid’InvestigacióenAtenci
óPrimària Jordi Gol. http://congresoenfermeria. es/2016/sites/default/files/styles/
escucharobservarcomprender1parte_1424533205197.pdf
Berg, R. Denison, E. (2013). A tradition in transition: Factors perpetuating and hinder-
ing the continuance of female genital mutilation/cutting (FGM/C) summarized in
a systematic review. Health Care for Women International, 34(10), 837−859.
https://doi.org/10.1080/07399332. 2012. 721417
Cappa, C. Thomson, C. Murray, C. (2020). Understanding the association between
parental attitudes and the practice of female genital mutilation among daugh-
ters. PloSOne, 15(5), Article e0233344. https://doi.org/10.1371/journal. pone.
0233344
Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed meth-
ods approaches (4th ed.). SAGE Publications.
Cresswell, J. W. Clark, Plano V. L. (2011). Designing and conducting mixed method
research (2nd ed.). SAGE Publications.
End FGM European Network. (2019). Annual report. https://www.endfgm.eu/who-
we-are/annual-report/
European Parliament. (2019). Resolution on an EU strategy to put an end to female
genital mutilation around the world (2019/2988(RSP)).
Gallego, M. A. López, M. I. (2010). Mutilación genital femenina. Revisión y aspectos
de interésmédico legal [Female genital mutilation. Review and aspects of legal
medical interest]. Cuadernos de MedicinaForense, 16(3), 145−151. http://scielo.
isciii. es/pdf/cmf/v16n3/original2.pdf
Gele, A. Kumar, B. Hjelde, K. & Sundby, J. (2012). Attitudes towards female cir-
cumcision among Somali immigrants in Oslo: A qualitative study. International
Journal ofWomen’s Health, 4, 1−11. https://doi.org/10.2147/IJWH.S27577
Giorgi, A. (2009). The descriptive phenomenological method in psychology. A modi-
fied Husserlian approach. Duquesne University Press.
González-Henao, R. (2011). Female genital ablation in emberachami communities
[La ablación genital femenina en comunidades emberá chamí]. CadernosPagu,
37, 163−183. https://doi.org/10.1590/S0104-83332011000200006
Grose, R. G. Hayford, S. R. Cheong, Y. F. Garver, S. Kandala, N. -B. & Yount,
K. M. (2019). Community influences on female genital mutilation/cutting in
Kenya: Norms, opportunities, and ethnic diversity. Journal of Health and Social
Behavior, 60(1), 84–100. https://doi.org/10.1177/0022146518821870
NP15528
González-Timoneda et al. Journal of Interpersonal Violence 37(17-18)
25

Husserl, E. (1962). Ideas pertaining to a pure phenomenology and to a phe-

nomenological philosophy (2nd ed.). Fondo de culturaeconómica. https://
profesorvargasguillen.files.wordpress.com/2012/11/husserl-edmund-ideas-rela-
tivas-a-una-fenomenologia-pura-y-una-filosofia-fenomenologica-ocr.pdf
Jacobson, D. Glazer, E. Mason, R. Duplessis, D. Blom, K. Mont, Du J. Einstein, G.
(2018). The lived experience of female genital cutting in Somali-Canadian wom-
en’s daily lives. PLoSOne, 13(11), Article e0206886. https://doi.org/10.1371/
journal.pone.0206886
Johnsdotter, S. Moussa, K. Carlbom, A. Aregai, R. & Essén, B. (2019). “Never my
daughters”: A qualitative study regarding attitude change toward female genital
cutting among Ethiopian and Eritrean families in Sweden. Health Care for Women
International, 30(1–2), 114–133. https://doi.org/10.1080/07399330802523741
Kaplan, A. Cham, B. Njie, L. Seixas, A. Blanco, S. & Utzet, M. (2013). Female
genital mutilation/cutting: The secret world of women as seen by men.
Obstetrics and Gynecology International, 2013, Article 643780. https://doi.
org/10.1155/2013/643780
Kaplan, A. Gay, & López A. (2017). Mapa de la Mutilación Genital FemeninaenEspaña
2016 [Map of Female Genital Mutilation in Spain 2016]. AntropologíaAplicada
3. UniversitatAutònoma de Barcelona, Fundación Wassu-UAB. https://mgf.uab.
cat/esp/publicaciones_cient%C3%ADficas.html
Larsson, M. Cohen, P. Hann, G. Creighton, S. M. Hodes, D. (2018). An exploration
of attitudes towards female genital mutilation (FGM) in men and women access-
ing FGM clinical services in London: A pilot study. Journal of Obstetrics and
Gynaecology, 38(7), 1005–1009. https://doi.org/10.1080/01443615.2018.14377
Little, C. M. (2003). Female genital circumcision: Medical and cultural consider-
ations. Journal of Cultural Diversity, 10(1), 30−34.
Lucas, B. (2008). Aproximaciónantropológica a la práctica de la ablación o Mutilación
Genital Femenina[Anthropological approach to the practice of female geni-
tal mutilation or ablation]. Cuadernoselectrónicos de filosofía del derecho, 17.
https://dialnet.unirioja.es/servlet/articulo?codigo=3032545
Macfarlane, A. & Dorkenoo, E. (2015). Prevalence of female genital mutilation in
England and Wales: National and local estimates. City University.
Mestre, Mestrei R. M. & Johnsdotter, S. (2019). Court cases, cultural expertise, and
“female genital mutilation” in Europe[Special Issue]. Studies in Law, Politics,
and Society, 78, 95–113. https://doi.org/10.1108/S1059-433720190000078006
Moxey, J. M. Jones, L. L. (2016). A qualitative study exploring how Somali women
exposed to female genital mutilation experience and perceive antenatal and
intrapartum care in England. BMJOpen, 6(1), Article e009846. https://doi.
org/10.1136/bmjopen-2015-009846
Statistics, National Agency for [Senegal], Demography (2016). Senegal: Demographic
and Continuous Health Survey (EDS-Continue 2015). https://dhsprogram.com/
pubs/pdf/FR320/FR320.pdf
Centre, National FGM (2021). Prevalence map. www.nationalfgmcentre.org.uk
González-Timoneda
26 et al. NP15529
Journal of Interpersonal Violence

National Institute of Statistics (INS) [Camerún] and ORC Macro (2005). Demographic
and Health Survey (DHS), 2004. http://dhsprogram.com/pubs/pdf/FR163/
FR163-CM04.pdf
National Institute of Statistics (INSTAT) [Mali], Planning and Statistics Unit Health-
Social Development and Family Promotion Sector and ICF. (2019). Demographic
and Health Survey (DHS), 2018. https://www.dhsprogram.com/pubs/pdf/FR358/
FR358.pdf
Statistics, National Institute of Faso], Demography (INSD) [Burkina International,
ICF. (2012). Multiple Demographic and Health Survey (DHS), 2010. https://
dhsprogram.com/pubs/pdf/FR256/FR256.pdf
Ortensi, L. E. & Menonna, A. (2017). Migrating with special needs? Projections of
flows of migrant women with female genital mutilation/cutting toward Europe
2016-2030. European Journal of Population, 33(4), 559–583. https://doi.
org/10.1007/s10680-017-9426-4
Reig-Alcaraz, M. González, Siles J. Solano Ruiz, C. (2014). Attitudes towards female
genital mutilation: An integrative review. International Nursing Review, 61(1),
25−34. https://doi.org/10.1111/inr. 12070
Ruiz, Jiménez I. Bravo, Pastor M. D. M. AlmansaMartínez, P. Ballesteros Meseguer,
C. (2014). Men facing the ablation/female genital mutilation (A/FGM): Cultural
factors that support this tradition. Procedia - Social and Behavioral Sciences,
132, 631–638. https://doi.org/10.1016/j.sbspro.2014.04.365
Ruiz, Jiménez I. (2015). Enfermería y Cultura: las fronteras del androcentrismoen
la Ablación/Mutilación Genital Femenina[Nursing and Culture: the frontiers of
androcentrism in female genital ablation/mutilation] [Doctoral thesis, University
of Murcia, Spain]. http://hdl.handle.net/10201/45704
Sakeah, E. Debpuur, C. Aborigo, R. A. Oduro, A. R. Sakeah, J. K. Moyer, C. A.
(2019). Persistent female genital mutilation despite its illegality: Narratives from
women and men in northern Ghana. PLoSOne, 14(4), Article e0214923. https://
doi.org/10.1371/journal.pone.0214923
Simpson, J. Robinson, K. Creighton, S. M. Hodes, D. (2012). Female genital mutila-
tion: The role of health professionals in prevention, assessment, and manage-
ment. British Medical Journal, 344, e1361. https://doi.org/10.1136/bmj.e1361
Thierfelder, C. Tanner, M. & Bodiang, C. M. (2005). Female genital mutilation in
the context of migration: Experience of African women with the Swiss health
care system. European Journal of Public Health, 15(1), 86–90. https://doi.
org/10.1093/eurpub/cki120
Toner, J. (2009). Small is not too small reflections concerning the validity of very
small focus groups. Qualitative Social Work, 8(2), 179−192. https://doi.
org/10.1177/1473325009103374
Touray, I. Piniella, Z. (2013). Mutilación genital femenina. MGF: Qué. Aclaracion
esterminológicas[Female genital mutilation. MGF: What. Terminological clari-
fications]. In A. Sequi, I. Touray, & Z. Piniella (Eds.), La erradicación de la
Mutilación Genital Femenina. Enfoques y perspectivasdesde la cooperaciónin-
ternacional para el desarrollo [The eradication of Female Genital Mutilation.
NP15530
González-Timoneda et al. Journal of Interpersonal Violence 37(17-18)
27

Approaches and perspectives from international development cooperation].

O’DAMONGD. Retrieved March 5, 2020, from http://carei.es/wp-content/
uploads/ERRADICACION_MGF_ODAM13.pdf
UNICEF. (2013). Female genital mutilation/cutting: A statistical overview and explo-
ration of the dynamics of change. Retrieved March 7, 2020, from https://www.
unicef.org/publications/index_69875.html.
UNICEF. (2016). Female genital mutilation/cutting: A global concern. Retrieved
from https://data.unicef.org/resources/female-genital-mutilationcutting-global-
concern
UNICEF. (2020). UNICEF data: Monitoring the situation of children and women.
Retrieved July 25, 2020, from https://data.unicef.org/topic/child-protection/
female-genital-mutilation/.
Unión Nacional de AsociacionesFamiliares [UNAF]. (2013). Guía para profesion-
ales. MGFenEspaña. Prevención e intervención[Guide for professionals. FGM
in Spain. Prevention and intervention]. Retrieved May 10, 2020, from https://
unaf.org/wp-content/uploads/2015/10/Guia-MGF-2015.pdf.
Varol, N. Turkmani, S. Black, K. Hall, J. Dawson, A. (2015). The role of men in
abandonment of female genital mutilation: A systematic review. BMC Public
Health, 15, 1034.
Voicu, M. & Babonea, A. (2011). Using the snowball method in marketing research
in hidden population. Challenges of the Knowledge Society, 1, 1341−1351.
WHO. (1999). Female genital mutilation. Programmes to date: What works
and what doesn’t. Department of Women’s Health Systems and Community
Health. Retrieved March 05, 2020, from https://apps.who.int/iris/bitstream/han-
dle/10665/65857/WHO_CHS_WMH_99.5.pdf;jsessionid=A5F0E45705F043B
AABC05BD3C09AD566?sequence=1.
WHO. (2008). Eliminating female genital mutilation: An interagency statement
UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCHR, UNHCR, UNICEF,
UNIFEM, WHO. https://www.who.int/reproductivehealth/publications/
fgm/9789241596442/en/
WHO. (2016). WHO guidelines on the management of health complications from
female genital mutilation. Retrieved March 05, 2020, from http://www.who.int/
reproductivehealth/topics/fgm/management-health-complications-fgm/en/.
WHO UNFPA & UNICEF. (1997). Female genital mutilation: A joint WHO/
UNICEF/UNFPA statement. Retrieved March 05, 2020, from https://apps.who.
int/iris/handle/10665/41903.

Author Biographies
Alba González-Timoneda, CNM, PhD, is an associate professor in the Department
of Nursing at the University of Valencia, Spain. She also works as a midwife at the
University and Polytechnic Hospital la Fe of Valencia. Her research interest involves
women’s health, interpersonal violence, gender violence, and woman-centeredcare.
28 Journal of Interpersonal Violence
González-Timoneda et al. NP15531

Antonio Cano Sánchez, MD, PhD, is a professor of Obstetrics and Gynaecology

at the University of Valencia and the head of the department of this specialty at
the Clinic University Hospital of Valencia, Spain. His main interest is gyneco-
logical endocrinology.

Marta González-Timoneda, MD, PhD student, is a fourth-year resident doctor in

Gynaecology and Obstetrics at the Clinic University Hospital of Valencia, Spain.

Vicente Ruiz Ros, RN, PhD, is a professor of Nursing at the University of Valencia,
Spain. He also works as a nurse researcher at the Cardiology Service of the Clinic
University Hospital of Valencia.
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