Livia Elisa Ortensi

Estimates of first-generation women and girls with female genital mutilation in the European Union, Norway and Switzerland

Abstract Background: Female genital mutilation (FGM) is the practice of partial or total removal of female genitalia for non-medical reasons. The procedure has no known health benefits but can cause serious immediate and long-term obstetric, gynaecological and sexual health problems. Health workers in Europe are often unaware of the consequences of FGM and lack the knowledge to treat women adequately. Objective: Our goal was to estimate the number of first-generation girls and women in the European Union, Norway and Switzerland who have undergone FGM. Before migration from FGM-practicing countries began, FGM was an unknown phenomenon in Europe. Methods: Secondary analysis of data from the 2011 EU census and extrapolation from age-specific FGM prevalence rates in the immigrants’ home countries to these data were used to provide our estimates. Estimates based on census and other demographic data were compared to our results for Belgium. Results: In 2011 over half a million first-generation women and girls in the EU, Norway and Switzerland had undergone FGM before immigration. One in two was living in the UK or France, one in two was born in East-Africa. Conclusions: For the first time, scientific evidence gives a reliable estimate of the number of first-generation women and girls in Europe coming from countries where FGM is practiced. The use of census data proves reliable for policy makers to guide their actions, e.g., regarding training needs for health workers who might be confronted with women who have undergone FGM, or the need for reconstructive surgery.

Estimating the number of foreign women with female genital mutilation/cutting in Italy

BACKGROUND Female genital mutilation/cutting (FGM/C), is an emerging topic in Europe as a consequence of the increasing proportion of women migrating from Africa. The prevalence of FGM/C is however unknown in Europe, as there are no country-representative surveys on this topic. The aim of this study is to provide an estimate for Italy for the year 2010. METHODS This study relies on the results of the First Survey on Women at Risk of FGM/C held in Italy in 2010. This cross-sectional survey involved 1000 migrants from the main FGM/C practicing countries aged 15-49 living in the Italian region of Lombardy. The estimate presented is based on a method combining direct estimates for the communities involved in the survey and indirect estimates for other communities. Indirect estimations were obtained using a refinement of the most general extrapolation-of-country-prevalence-data method. RESULTS It is estimated that some 57 000 foreign girls and women aged 15-49 with FGM/C were living in Italy in 2010. The Nigerian community is the most affected, with around 20 000 women with FGM/C (35.5% of the total number women affected in Italy), followed by the Egyptian community (around 18 600 women with FGM/C; 32.5%). Another 15% of the women affected are from the Horn of Africa, notably from Ethiopia (3200 women; 5.5%), Eritrea (2800 women; 4.9%) and Somalia (2300 women; 4%). CONCLUSIONS This study offers an additional methodological advancement by proposing a combination of direct and indirect estimation of FGM/C. The results are crucial information to plan interventions and targeted policies.

Satisfied after all? Working trajectories and job satisfaction of foreign-born female domestic and care workers in Italy

ABSTRACT Foreign-born women frequently find their first job in the domestic sector. This is usually considered a stepping-stone, but it is rather a definitive condition. We analyse the working trajectory of foreign-born women with a first job in domestic work using sequence analysis and studying their association with job satisfaction by means of logistic regression models. The data were collected as part of the Foreigners’ Job Trajectories project conducted by the ISMU Foundation in Italy in 2009. We found that, after all, domestic and care workers can be satisfied with their job if basic decent working conditions are guaranteed. Particular attention is paid to the high rate of job satisfaction for women with a trajectory from live-out to live-in jobs. Possible explications for job satisfaction are extensively discussed focusing on economic drivers, the agency of domestic workers, and the emotive dimension of domestic and care works.

The Integration of Forced Migrants Into the Italian Labor Market

Forced migrants in Italy have so far received limited assistance and follow integration trajectories into the job market typical of economic migrants. Using a multilevel statistical approach and a new source of survey data, this article describes key aspects of the economic integration of forced migrants. Particular attention is paid to testing the hypothesis that there are significant differences between them and other migrants in the risk of unemployment and in access to the primary job market. Results from this study show a higher risk of unemployment than for other migrants but no difference in their access to regular employment.

Migrating with Special Needs? Projections of Flows of Migrant Women with Female Genital Mutilation/Cutting Toward Europe 2016–2030

Female genital mutilation/cutting (FGM/C) is a rising issue in western societies as a consequence of international migration. Our paper presents demography-driven projections of female flows with FGM/C from each practicing country to each EU28 member state for the 3 sub-periods 2016–2020, 2021–2025, and 2026–2030, with the aim of supporting resource planning and policy making. According to our projections, the EU28 countries will receive a flow of around 400,000 female migrants between 2016 and 2020, and around 1.3 million female migrants between 2016 and 2030 from FGM/C practicing countries. About one-third of them, corresponding to an estimated 127,000 between 2016 and 2020, and more than 400,000 between 2016 and 2030 will have undergone FGM/C before migration. Among these female flows, slightly more than 20% is expected to be made up of girls aged 0–14. According to the expected age at arrival, 20% of these girls are expected to have already undergone FGM/C, while slightly less than 10% are to be considered potentially at risk of undergoing FGM/C after migration. As the number of women with FGM/C in Europe is expected to rise at quite a fast rate, it is important to act timely by designing targeted interventions and policies at the national and at the European level to assist cut women and protect children. Such measures are particularly compelling in France, Italy, Spain, UK, and Sweden that are expected to be the most affected countries by migration from FGM/C practicing countries.

Mother to daughter transmission of Female Genital Cutting in Egypt, Burkina Faso and Senegal

The aim of article is to assess the determinants of mothers to daughters transmission of female genital cutting (FGC) in Senegal, Burkina Faso and Egypt. Using the most recent DHS surveys the study confirms that the main dimension related to daughters’ circumcision is mother’s personal experience as circumcised mothers more likely to perpetrate the practice on daughters. Policies aim at changing this social norm could therefore generate a virtuous circle: for each child who is not circumcised, a risk-free third-generation is projected. Factors related to women’s empowerment as better education, higher autonomy and wealth of the family as well social environment against FGC also discourage the continuation of the practice and protect daughters from the risk to be circumcised in each country analyzed.

Female genital mutilation/cutting in Italy: an enhanced estimation for first generation migrant women based on 2016 survey data

BackgroundMigration flows of women from Female Genital Mutilation/Cutting practicing countries have generated a need for data on women potentially affected by Female Genital Mutilation/Cutting. This paper presents enhanced estimates for foreign-born women and asylum seekers in Italy in 2016, with the aim of supporting resource planning and policy making, and advancing the methodological debate on estimation methods.MethodsThe estimates build on the most recent methodological development in Female Genital Mutilation/Cutting direct and indirect estimation for Female Genital Mutilation/Cutting non-practicing countries. Direct estimation of prevalence was performed for 9 communities using the results of the survey FGM-Prev, held in Italy in 2016. Prevalence for communities not involved in the FGM-Prev survey was estimated using to the ‘extrapolation-of-FGM/C countries prevalence data method’ with corrections according to the selection hypothesis.ResultsIt is estimated that 60 to 80 thousand foreign-born women aged 15 and over with Female Genital Mutilation/Cutting are present in Italy in 2016. We also estimated the presence of around 11 to 13 thousand cut women aged 15 and over among asylum seekers to Italy in 2014–2016. Due to the long established presence of female migrants from some practicing communities Female Genital Mutilation/Cutting is emerging as an issue also among women aged 60 and over from selected communities. Female Genital Mutilation/Cutting is an additional source of concern for slightly more than 60% of women seeking asylum.ConclusionsReliable estimates on Female Genital Mutilation/Cutting at country level are important for evidence-based policy making and service planning. This study suggests that indirect estimations cannot fully replace direct estimations, even if corrections for migrant socioeconomic selection can be implemented to reduce the bias.

The impact of the law in the prevention of FGM : legal analysis

Health professionals have a critical role to play in the prevention and management of FGM. However, several KAP (Knowledge, Attitudes and Practices) studies conducted in high and low income countries have shown a lack of knowledge on WHO classification, diagnosis and management of FGM. Although several countries have developed FGM guidelines for professionals and have voted specific laws against the practice, the studies showed that these measures are not sufficient and that educational activities are needed to implement existing guidelines. Integration of the thematic in the curriculum of health professionals is a longstanding recommendation, but few countries have done it. Evidence of best practices in educational programs is lacking; a recent review only found two studies meeting the study selection criteria. There is a need for highquality research on educational strategies using common indicators in order to allow comparisons between country programs. Professionals need operational tools: case studies, videos, and pictures. New technology is an opportunity: E-learning tools and visual tools to identify different types of FGM could make the difference. The KAP studies have also shown the ambivalence of health staff who are caring for women affected by FGM but may also perform FGM in some contexts (medicalization). There is a need for the integration of a discussion on ethics and the role of professionals in prevention in training programs. The last point highlighted by the KAP studies is the lack of knowledge of professionals on the cultural context and on psychological and sexual consequences of FGM (and its management). This should be the new focus of training modules on FGM, established with the active participation of psychologists, sexologists, and peer educators from the community.

The impact of the law in the prevention of FGM

Health professionals have a critical role to play in the prevention and management of FGM. However, several KAP (Knowledge, Attitudes and Practices) studies conducted in high and low income countries have shown a lack of knowledge on WHO classification, diagnosis and management of FGM. Although several countries have developed FGM guidelines for professionals and have voted specific laws against the practice, the studies showed that these measures are not sufficient and that educational activities are needed to implement existing guidelines. Integration of the thematic in the curriculum of health professionals is a longstanding recommendation, but few countries have done it. Evidence of best practices in educational programs is lacking; a recent review only found two studies meeting the study selection criteria. There is a need for highquality research on educational strategies using common indicators in order to allow comparisons between country programs. Professionals need operational tools: case studies, videos, and pictures. New technology is an opportunity: E-learning tools and visual tools to identify different types of FGM could make the difference. The KAP studies have also shown the ambivalence of health staff who are caring for women affected by FGM but may also perform FGM in some contexts (medicalization). There is a need for the integration of a discussion on ethics and the role of professionals in prevention in training programs. The last point highlighted by the KAP studies is the lack of knowledge of professionals on the cultural context and on psychological and sexual consequences of FGM (and its management). This should be the new focus of training modules on FGM, established with the active participation of psychologists, sexologists, and peer educators from the community.

Reti sociali e senso di appartenenza nel contesto migratorio. Un’indagine in Lombardia

Il presente contributo indaga il ruolo delle reti sociali amicali, familiari e lavorative degli immigrati sul sentimento di appartenenza all’Italia. L’analisi si basa sull’indagine 2013 effettuata in Lombardia dall’Osservatorio Regionale per l’Integrazione e la Multietnicita della regione Lombardia (Orim) su un campione di 4.000 stranieri o immigrati provenienti da paesi a forte pressione migratoria. I risultati mostrano con evidenza il ruolo cruciale delle reti sociali, in particolare quello della componente bridging, nel creare senso di appartenenza tra gli stranieri che vivono in Lombardia. Gli stranieri che provano il maggior senso di appartenenza all’Italia sono persone che hanno nella propria rete amicale una buona presenza di italiani se non addirittura una prevalenza di questi rispetto agli stranieri e che dichiarano di condividere appieno le norme sociali e i valori che caratterizzano la societa italiana e ne regolano la vita quotidiana.