Table 1: A summary of the main advantages and challenges of popular approaches towards the abandonment of FGM.

ApproachAdvantages and potential successful resultsRisks and disadvantagesMeasures to overcome risks and disadvantages

Health risk info(i) Stimulate resistance to FGM among
 lay people → reflection/abandonment
 religious leaders → fatwa
 politicians → laws and policies
 health providers → share information +
 denounce medicalization
(ii) Improve health care for complications
(i) Medicalization
(ii) Change type of FGM
(ii) Disbelief
(iv) Inadequate quality of information
(v) Defence reactions
(vi) Social norm overrules health risks
(i) Ensure health information is locally adapted, communicated nondjudgementally by a reliable source and combined with care for complications gibing space for reflection and experience exchange

Conversion of excisers (i) Reduce availability of excisers
(ii) Easy success indicators
(iii) Media coverage providing visibility to issue
(i) Does not reduce demand for FGM
(ii) Continue secretly or by apprentices
(iii) Others take over task
(iv) Ex-excisers unreliable sources against FGM
(v) Alternative income may not motivate abandonment
(i) Ensure that work with excisers is only an aspect of a wider approach adapted to their roles in the particular community.   
(ii) Do not expect it to reduce the demand
for FGM

Training of health professionals (i) Improved quality of care
(ii) Refrain to perform FGM
(iii) Provide information and counselling
(iv) Build local evidence on health consequences
(i) Resistance to work against FGM
(ii) Inadequate content of training
(iii) Lack of time and recourses to implement
(i) Comprehensive training for prevention and management into standard curricula
(ii) Training target potential acceptance of the practice.
(iii) Ensure an enabling environment for implementation of knowledge.

Alternative rites (i) Facilitate community ownership and support, as it maintains key cultural practice
(ii) Increased knowledge and empowerment of girls
(iii) Publicity about change through community celebrations
(i) Only viable in communities in which FGM is a part of a rite of passage
(ii) Limited integration of the whole community
(iii) Insufficient adaptation into the specific sociocultural situation of each community
(i) Use only where fit into local culture
(ii) Include the whole family and community
(iii) Consider alternative measures if the actual cutting is done at other times
(iv) Ensure community ownership for sustainability.

Community-led (i) Community own problem and solution
(ii) Broader support, less resistance
(iii) Addressing underlying causes
(iv) Reduce/remove FGM as a social norm, facilitating and stimulating change
(i) The community might decide to change, rather than to abandon, the practice.
(ii) Failing to ensure community participation and resorting to traditional “lecturing”
(i) Ensure community ownership and adaptation
(ii) Ensure long-term support to secure viable and broad change, reaching reluctant abandoners and neighbouring communities

Public statements(i) Create a sense of social change among a group
(ii) Facilitate and stimulate abandonment for group members
(i) Public statements by subgroups only lack of community ownership
(ii) “Fake” opinions and/or lack of authority
(i) Ensure community-wide support
(ii) Having legislation and policies in place provides support to people ready to change
(iii) Further research is needed to investigate the effects of public statements from single groups, especially religious leaders (e.g., fatwas).

Legal measures(i) Create an enabling framework
(ii) Discourage FGM
(i) Practice can go underground
(ii) Fear of seeking health care for complications
(i) Ensure community support for the law
(ii) Ensure regulations that guarantee care for complications.