Journal of Reproductive Health, Gender, and HIV in Africa | 23 January 2004
A Theoretical Framework for Analysing the Association Between Female Genital Mutilation/Cutting and Skilled Birth Attendance Utilisation in the Somali Region, Ethiopia
S, o, f, i, a, M, o, h, a, m, m, e, d, ,, D, i, a, n, e, C, l, a, y, t, o, n
Abstract
Female genital mutilation/cutting (FGM/C) is highly prevalent in the Somali Region of Ethiopia. Its potential role as a barrier to maternal healthcare utilisation, specifically skilled birth attendance (SBA), is a significant public health concern. The pathways linking FGM/C status to SBA use are not well theorised, hindering effective intervention. This article proposes a theoretical framework to analyse the association between a woman’s FGM/C status and her utilisation of skilled birth attendants in the Somali Region. It aims to delineate the socio-cultural, physical/clinical, and health system factors that may mediate or moderate this relationship. The framework is developed through a synthesis of established health behaviour and access theories, including the Andersen Behavioural Model and the Three Delays Model. These are contextualised within the specific cultural and healthcare environment of the Somali Region and integrated with conceptual domains from literature on FGM/C and maternal health-seeking. Key insights: The framework posits that the association is not direct but mediated by factors such as perceived birth complications, social norms discouraging examination by male providers, and healthcare provider attitudes. A key insight is that women with more severe types of FGM/C may face compounded barriers, significantly reducing the likelihood of SBA use compared to uncut women or those with less severe forms. This theoretical framework provides a structured, multi-level tool for understanding the complex relationship between FGM/C and SBA utilisation. It moves beyond simple correlation to hypothesise testable causal pathways specific to the Somali context. Researchers should apply this framework to guide quantitative and qualitative study designs. Programme planners should use it to identify intervention points, such as training healthcare workers in FGM/C management and addressing community-level stigma associated with maternal healthcare. female genital mutilation/cutting, skilled birth attendance, maternal health, theoretical framework, Somali Region, Ethiopia This work provides a novel theoretical framework for analysing how FGM/C influences skilled birth attendance utilisation, offering a contextualised tool for research and programming in the Somali Region of Ethiopia.