title: Female genital mutilation: a systematic review of research on its economic and social impacts across four decades.
abstract: BACKGROUND
  Global efforts to end female genital mutilation (FGM) have intensified in recent decades because of the rising awareness that such a practice is an act of extreme violence against women and girls. Articles on FGM have been published highlighting the combined efforts of international and non-governmental organizations, governments, as well as religious and civil society groups to end the practice. However, the consequences of this research are not well known, and it seems that the socioeconomic aspects of the practice are underreported.
  
  
  OBJECTIVE
  This review aims to characterize over a 40-year period the scientific output on the consequences of FGM in African countries, the most affected region known for the high prevalence of FGM, and review data on the socioeconomic consequences of the practice.
  
  
  METHODS
  A systematic review of literature was done, looking at the following databases: PubMed, Embase, CINAHL, BDSP, Web of Science, PsycINFO, FRANCIS, Sociological Abstracts, WHOLIS, RERO, and SAPHIR. The analysis was limited to articles concerning the African continent, published in English and French, from January 1, 1972, to December 31, 2011.
  
  
  RESULTS
  One hundred ninety-eight articles were reviewed. More than half of the articles were published during the last decade of the study period. The majority of papers were published in biomedical journals (64.1%). Most studies looked at Africa as a region (33.3%). Nigeria was the single country most investigated (19.2%), followed by Egypt (10.6%). Most first authors were affiliated to non-African countries (60.6%): among them 21.2% were US-based, 4% were from African institutions, and 16.2% from Nigeria.The medical and psychological consequences (51.5%) and the prevalence and ethics of the practice (34.4%) were the most frequently investigated topics. The socioeconomic consequences were addressed in a minority of the papers (14.1%): they were classified into direct economic consequences (2.5%), school attendance (1%), marriageability (2%), sexual and marital consequences (3.5%), fertility (2.5%), domestic violence (1%), and discrimination (1.5%).
  
  
  CONCLUSIONS
  The publication of articles on the consequences of FGM is increasing, but there is little research on the socioeconomic consequences of the practice. More scientific data focusing on this dimension is necessary to strengthen prevention, advocacy, and intervention campaigns.
authors.affiliation: Department of Community Health and Medicine, Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland; Emmanuel.Kabengele@unige.ch.
authors.forename: Emmanuel Kabengele
authors.initials: EK
authors.lastname: Mpinga
authors.affiliation: Department of Community Health and Medicine, Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Macias
authors.affiliation: Department of Community Health and Medicine, Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hasselgard-Rowe
authors.affiliation: Department of Mathematics, Physics and Electrical Engineering, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK.|Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Ngianga-Bakwin
authors.initials: NB
authors.lastname: Kandala
authors.affiliation: Department of Epidemiology and Public Health Sciences, The Institut Supérieur des Techniques Médicales, Kinshasa, Democratic Republic of Congo.
authors.forename: Tshimungu Kandolo
authors.initials: TK
authors.lastname: Félicien
authors.affiliation: University of Applied Sciences of Western Switzerland, Sion, Switzerland.
authors.forename: Henk
authors.initials: H
authors.lastname: Verloo
authors.affiliation: Department of Public Health Sciences, Wichita State University, Wichita, KS, USA.
authors.forename: Ngoyi K Zacharie
authors.initials: NK
authors.lastname: Bukonda
authors.affiliation: Department of Medicine, University of Fribourg, Fribourg, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Chastonay
mesh_terms: D019093:Circumcision, Female; D003906:Developing Countries; D017579:Domestic Violence; D005260:Female; D006801:Humans; D009549:Nigeria; D015995:Prevalence; D012725:Sexual Behavior; D012922:Social Change
keywords: Africa; female genital mutilation; medical and psychological consequences; prevalence and ethics; socioeconomic consequences; systematic review