3.7. Limits of the study
3.7.1. Unique focus on Sub-Saharan Africa
The study focused exclusively on countries in Sub-Saharan
Africa. Other countries where the practice is known to exist
were not taken into consideration. We did not include the
immigrant population from Egypt and Yemen in the research
even though both countries have integrated the issue in the
questionnaire of the Demographic and Health Surveys and
have presented solid estimations for the prevalence rates
of FGM/C in their countries (96% for Egypt and 27% for
Yemen).
The number of registered immigrants from Yemen is very
small in Hamburg (22 men and seven women). We could not
focus our resources on such a small community. The Egyptian community is more relevant in terms of numbers and
the high prevalence rate in the country. There are offi cially
1249 immigrants of Egyptian origin registered in Hamburg.
Most of them are men (857), but among the 392 registered
girls and women, there are 105 girls below 18 years of age.
It is recommended that the further study include or investigate specifi cally the knowledge of, attitudes toward and
ways of practicing FGM/C in the Egyptian immigrant community in Hamburg.
3.7.2. No random sampling for the quantitative survey
As described in section 3.3.2.1, we had no means to conduct
a probability survey for the collection of the quantitative
data. It can be assumed that the probability of getting
interviewed was not the same for all immigrants from
Sub-Saharan Africa. Community members outside social
networks (church, mosque, integration classes, community
events and meetings) or who abstain from visiting typical
meeting places (Afro shops, main station, betting agencies)
were less likely to be interviewed. At the same time, persons
acquainted with one of the researchers were more likely
to be interviewed. The snowball sampling and the efforts
undertaken to collect data from various districts of Hamburg
aimed to balance this effect. It is clear, however, that the
unfeasibility of random sampling reduces the validity of the
data and has to be taken into consideration when interpreting the results.
3.7.3. Oral reports as the only source
The qualitative and quantitative research tools allowed only
the collection of data based on oral testimonies. Previous
studies on FGM/C, however, have indicated that verbal
reports can be biased. This is usually due to efforts of
participants to provide socially desirable answers (see for example Cellule de Planifi cation et de Statistique du Ministère
de la Santé, Direction Nationale de la Statistique et de
l’Informatique du Ministère de l’Économie, de l’Industrie et
du Commerce et al. 2006). It can also be linked to the lack of
knowledge. Circumcised women, for example, are sometimes
not aware about the form of FGM/C they have undergone
and give inexact descriptions of what has been done (see
for example Asefaw 2007). Furthermore, some of the study
participants feared negative sanctions after responding
truthfully to certain questions. This makes it likely that some
of the data collected during the current project is subject to
reporting bias. We tried to mitigate this limitation by taking
note of non-verbal reactions and interview compliance and
by excluding dubious responses from the data analysis.
3.7.4. Small sample sizes for some countries
The sample sizes of immigrant populations from Eritrea,
Sudan, Tanzania, Somalia, Guinea Bissau, Sierra Leone, and
Liberia are too small for an in-depth analysis. For the fi rst
four countries, the small number of immigrants reached
can be explained through the small population size of the
communities in Hamburg. For the three other countries, we
recommend further studies to gather additional information. Listening to African Voices 21
Literature review
The fi rst part of the current chapter furnishes general
information on the practice of FGM/C (section 4.1-4.5). The
second part summarises knowledge of FGM/C in immigrant
communities in Europe and in Germany in particular (section
4.6 and 4.7).
4.1. FGM/C and its different forms
FGM/C is defi ned as “all procedures involving partial or total
removal of the external female genitalia or other injury to
the female genital organs for non-medical reasons” (WHO,
UNICEF et al. 1997). The WHO/ UNICEF/ UNFPA published
an initial categorisation of FGM/C in four different types
(WHO, UNICEF et al. 1997). In 2008, a group of United Nation’s agencies launched a joint statement which introduces
a revised version of the four types. They are defi ned as
follows:
Type I: Partial or total removal of the clitoris and/or the
prepuce (clitoridectomy).
Type II: Partial or total removal of the clitoris and the
labia minora, with or without excision of the labia
majora (excision).
Type III: Narrowing of the vaginal orifi ce with creation
of a covering seal by cutting and appositioning
the labia minora and/or the labia majora, with or
without excision of the clitoris (infi bulation).
Type IV: All other harmful procedures to the female
genitalia for non-medical purposes, for example:
pricking, piercing, incising, scraping and cauterisation.
Moreover, the joint statement proposes two sub-categories
for the three fi rst types respectively in order to make it
easier to classify the variety of forms of FGM/C practiced in
different contexts (UNAIDS, UNDP et al. 2008).
4.2. Prevalence and geographic spread of the
practice of FGM/C
According to estimations from the WHO in between 100
to 140 million women have undergone FGM/C and two to
three million girls and women are at risk of being subjected
to the practice every year (UNICEF 2005; UNAIDS, UNDP et
al. 2008). Most of the women and girls live in Sub-Saharan
Africa (UNICEF 2005). The map below gives an approximate
picture of the geographic spread across the African conti