An Exploration of Methods to Estimate the Number of Immigrant Girls and Women at Risk of Female Genital Mutilation or Cutting in Canada
2023/09/07 Leave a comment
Of note:
Executive summary: It is estimated that at least 200 million girls and women around the world have experienced female genital mutilation or cutting (FGM/C). The World Health Organization defines FGM/C as “all procedures involving partial or total removal of the external female genitalia or injury to the female genital organs for non-medical reasons” (World Health Organization 2008). The practice of FGM/C is concentrated in Africa, the Middle East, and parts of Asia. However, estimates of FGM/C prevalence vary greatly by country and even by region within countries, and FGM/C has been documented in as many as 92 countries (End FGM European Network, U.S. End FGM/C Network, Equality Now 2020).
This report explores different approaches used in previous research to estimate the number of girls and women currently living in Canada who may be at riskNote for FGM/C based on their (and their parents’) country of birth. Information on FGM/C in Canada may help to inform health care providers, community service providers, and policy makers interested in women, health care, and immigration about this issue in Canada. Additionally, this information may inform intervention strategies focusing on women’s human rights, gender equality, and women’s health (Ortensi and Menonna 2017).
In Canada, FGM/C is considered a form of aggravated assault under the Criminal Code (Department of Justice 2017). However, there is a lack of information on the prevalence of FGM/C in Canada. This information gap was highlighted on the International Day for Zero Tolerance for FGM/C in 2021, when Prime Minister Trudeau issued a statement indicating a need for improved data to address FGM/C within Canada (Government of Canada 2021). Monitoring FGM/C in Canada is important for addressing Sustainable Development Goal indicator 5.3.2, which is focused on determining the proportion of girls and women aged 15 to 49 years who have undergone FGM/C, by age (United Nations n.d.). Currently, there are no available data on this issue for Canada.
While other nations, such as Australia and the United States, have estimated the number of immigrant girls and women at risk for FGM/C in their countries (Australia Institute of Health and Welfare 2019; Population Reference Bureau 2016), previous research examining FGM/C in Canada has largely been qualitative and focused on specific immigrant groups (e.g., Chalmers and Omer Hashi, 2000; 2002; Jacobson et al., 2018; Omorodian, 2020; Perovic et al., 2021). Therefore, an understanding of the number of women and girls in Canada who may be at risk for having experienced FGM/C is lacking. This information would be especially valuable for Canadian health care providers, because a recent study indicated that less than 10 percent of Canadian health care providers felt “very prepared” to care for FGM/C patients, and 90 percent indicated they would benefit from more information and training related to FGM/C (Deane et al., 2022). Additionally, FGM/C patients have reported negative experiences with health care providers in Canada including stigmatization, shame, judgment, inappropriate care, and disregard for health care preferences (e.g., method of delivery), with many indicating that they had delayed seeking health care during pregnancy because of these issues (Chalmers and Omer Hashi, 2000; Jacobson et al., 2022).
Since no national surveys directly collect information on FGM/C, estimates of FGM/C are derived through indirect measures, an approach consistent with other countries (e.g., the United States and Australia). Similar to FGM/C research in other nations, country- and age-specific prevalence rates from international surveys are used (Australian Institute of Health and Welfare 2019; Population Reference Bureau 2016). Data on the country-specific estimated prevalence rates of FGM/C were obtained from the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS) (UNICEF 2017). These estimates were applied to the 2016 Census Canadian population counts of women living in Canada who were born in one of the 29 countries for which nationally representative data on FGM/C prevalence were available at the time of this analysis.
Four different methods were used to estimate the number of girls and women living in Canada who may be at risk for FGM/C. In approach A, the estimated number of at-risk women in Canada was based on the 2016 Census immigration counts multiplied by 2017 UNICEF estimates for in-country prevalence of FGM/C. Approach B slightly refined this method by using age-specific estimates of FGM/C prevalence. Approach C added first-generation immigrant girls aged 0 to 14 years, as well as women aged 50 and older. Finally, approach D included second-generation immigrants—that is, those who were born in Canada and have at least one parent who was born outside of Canada. Since the rate of FGM/C among second-generation immigrants living in Canada is unclear, approach D estimated a range of risk for FGM/C, varying from no risk among the second generation (i.e., no cases of FGM/C if born in Canada) to the same risk as first-generation immigrants (high-end or upper-bound estimate).
Among the approximately 125,000 reproductive-aged girls and women (aged 15 to 49) who were currently living in Canada, but had immigrated from one of the 29 countries where the practice of FGM/C was documented (UNICEF 2017), about 58,000 were estimated to be at risk for having experienced FGM/C. When the other first-generation immigrant girls and women (i.e., those aged 0 to 14 years and 50 and older) as well as second-generation girls and women aged 0 to 49 years were included, approximately 95,000 to 161,000 girls and women currently residing in Canada were estimated to be at risk of experiencing or having experienced FGM/C.
Canada is home to a significant number of first- and second-generation immigrant girls and women who may be at risk for FGM/C, which may have implications for public policy related to health care, immigration, and public safety. However, several limitations warrant consideration. First, selective migration was not considered—that is, women who are more highly educated, who have higher incomes, and who are from urban areas are more likely to immigrate to Canada than their counterparts, and they (and their daughters) may be less at risk of having undergone or undergoing FGM/C (UNICEF 2013; Ortensi, Farina and Menonna 2015; Farina, Ortensi and Menonna 2016). Additionally, there is some evidence that women who migrate may be less likely to have undergone FGM/C, in particular if they are from countries with moderate or low prevalence of FGM/C (UNICEF 2013). Second, acculturation in Canada may mean that second-generation girls and women are less likely to undergo FGM/C. Third, the FGM/C estimates used in this analysis may be limited—rates in many countries are declining over time, and there may be variation in the rate of FGM/C within a country depending on the time of measurement. Moreover, since prevalence rates were only available for 29 countries, there may be women and girls in Canada from other countries of origin where FGM/C is practised that are not included in the calculations. Because of these factors, the estimates could over- or under-estimate the number of girls and women in Canada who are at risk for FGM/C and should not be interpreted as official estimates of FGM/C in Canada.
Future work may include a qualitative exploration of the experiences of women from countries that practise FGM/C who now live in Canada. A qualitative approach is necessary to understand topics that are difficult to address through surveys, especially when the topics are sensitive and the terms used to describe and understand FGM/C vary. Additionally, qualitative research may better capture differing perspectives and cultural traditions associated with the practice of FGM/C. Future work is needed to inform regional variations within a country, as well as the applicability of country-specific rates of FGM/C to second-generation girls and women. Other research methods could also be explored to better understand the health implications and to address policies, programs, and interventions geared toward this group of women.
