Combining Theory and Research to Validate a Social Norms Framework Addressing Female Genital Mutilation

"[T]his paper has allowed us to operationalize a conceptual model on social norms measurement, specifically examining how social and behavior change communication can be used as a mechanism for shifting norms around a given harmful practice."

Research has established that the harmful practice of female genital mutilation (FGM) is upheld due to myriad social norms. Though this evidence has informed decades of experience and guidance on the process and scale-up of norm-shifting interventions promoting FGM abandonment, a lack of rigor and standardisation in monitoring and evaluation (M&E) of these efforts has made it difficult to attribute social and behaviour change (SBC) to them. Thus, in 2016, the United Nations Joint Program to Eliminate FGM (UNJP) funded the development and subsequent validation of an M&E framework to understand the relationship between social norms and practicing FGM (see Related Summaries, below). Evidence on the framework was gathered through a pilot study in Ethiopia. This paper uses cross-sectional quantitative data from the pilot to operationalise the framework and determine what factors are associated with practicing FGM.

The paper opens with a section summarising the literature on FGM, social norms theories and measurement, FGM-related social norms, and SBC communication (SBCC) as a strategy to shift FGM-related social norms. The reader learns, for example, about two sets of theorising around social norms that are specifically relevant for theory-driven and evidence-based SBC programming. The first set studies norms in terms of compliance associated with group dynamics. On social convention theory, shifting the convention (and sustaining it) requires a critical mass of people allowing their children to marry uncut women and hence abandoning the practice. The second approach situates norms as a mediator related to individual and social change within a larger social-ecological (individual, interpersonal, community, institutional, societal, etc.) perspective.

Developed in this context, and as detailed at Related Summaries, below, ACT is an evidence-based framework to measure FGM behaviour and social norms change over time. ACT is an acronym for the different sections of the framework. The conceptual model (see above) behind the ACT framework is based on the premise that norms influence thoughts and behaviours and that thoughts and behaviours influence norms; if social norms change, then thought and behaviour change may ensue, and vice versa. The model incorporates a social-ecological perspective; for example, it acknowledges that what individuals know and feel are affected by, and in turn affect, their social networks and the level of social support they receive and give. The ACT framework is accompanied by conceptual definitions of key constructs that comprise social norms, the operationalisation of the key constructs, and means of verification through qualitative, quantitative, and participatory tools to measure social norms change.

The conceptual model and ACT framework went through many stages of development, review, and validation prior to finalisation in 2021. As part of this process, the UNJP selected Ethiopia as a validation site and conducted a study in two regions - Afar, and Southern Nations, Nationalities and Peoples (SNNP) region - and in Addis Ababa City Administration. Seven multivariate analyses were run to examine the relationships between constructs in the conceptual model.

Among the findings: There were significant differences by respondent type for knowledge, attitudes about power and gender, attitudes about FGM, and its relationship to identity. For instance, adolescent girls had significantly lower knowledge but more progressive attitudes about FGM and its relationship to identity in comparison to the other respondent groups. Female caregivers and female social networks had fewer progressive attitudes about power and gender in comparison to adolescent girls and female influentials.

A total of 554 and 481 participants answered the question "Have you undergone FGM?" and "Do you know a family member who has undergone FGM?" respectively. Overall, 65% of participants said they had undergone FGM, and 32% said they knew someone in their family who had undergone FGM. Table 7 in the paper looks at the relationship between knowledge, attitudes, interpersonal communication (IPC), social support, and social networks on two behaviours: have not undergone FGM and family member has not undergone FGM. For example, if the family expected you to abandon FGM, you had a greater odds of knowing a family member who had not undergone FGM [43.6 (95% confidence interval (CI): 2.7-687.8)] In terms of descriptive norms, approximately two-thirds of the respondents said their family, other people in the community, and society, in general, had made a decision to abandon FGM, respectively. A similar proportion of respondents reported following injunctive norms, stating that their family, other people in the community, and society in general expected them to abandon FGM. For rewards and punishments, 64% did not identify any punishments with abandoning FGM; 57% identified rewards with abandoning FGM.

Those engaged in IPC were more likely to lean toward norms associated with FGM abandonment, and region emerged as a predictor for IPC. Respondents in the urban centre of Addis Ababa are less likely to discuss FGM. This finding can be explained by the fact that Addis Ababa is a multicultural environment with loose social connections between neighbours. Also, the prevalence of FGM is comparatively low in Addis Ababa. Reported rates of IPC around FGM with people whose opinions mattered to the respondents were significantly higher in Afar and SNNP, both of which are largely close-knit rural communities with closer social ties and also a high prevalence of FGM. One implication is that it is not enough to focus on IPC as a whole but, rather, that it is necessary to examine closely the frequency and content of the discussions and dialogues around FGM.

Another takeaway is that interventions designed to address FGM should focus on changing attitudes of married caregivers and older women to serve as change agents. This suggestion is based on the finding that over 8 out of 10 adolescent girls surveyed disagree that the performance of FGM is a religious duty. These results might indicate a divide among younger and older women, with older women, who are significantly more likely to have themselves undergone FGM, reporting positive attitudes toward the practice. Because adolescent girls are likely to have less autonomy and decision-making power in the household, initiatives to engage elders in norms-shifting interventions have been undertaken (e.g., The Grandmother Project in West Africa).

The researchers offer these reflections on the validation study: "The overall findings show that ACT constructs are associated with positive social norms. It also allows us to recommend that interventions focusing on information dissemination should likely craft messages around knowledge of social sanctions associated with FGM continuation. Creating an environment where individuals have positive attitudes and believe that their families, friends, neighbors, and community members support abandonment and discuss FGM abandonment with people whose opinion matters to them are likely to produce positive results. Public declarations to abandon FGM, which have been used as a key intervention in many countries, provide one opportunity to do this....Leveraging interpersonal communication within social networks is also important. This pilot study emphasizes the importance of interventions, that cut across individual, interpersonal, and community factors in the social-ecological model."

Plans are underway to incorporate the ACT framework into the FGM programme in Sudan, which will allow the researchers to use the pilot data to monitor and evaluate change. Thus, they conclude: "Now that this model has been developed and validated, it is likely to provide a foundation to study the direct and indirect impacts of social norms programming on changing harmful practices, such as FGM."