Table 1 Summary of literature included in review

1.Dorkenoo, E., Morison L., & Macfarlane, A. (2007) [40]. A statistical study to estimate the prevalence of female genital mutilation in England & wales: summary report. London (UK): Forward

England & Wales

Extrapolation-of-fgm-countries-prevalence-data-method: DHS & MICS applied to Census and birth registration data from the Office for National Statistics for England and Wales (Indirect)

Estimations corrected for:

- age

- ethnicity

- religion

174.528 women resident in England or Wales in 2001, who were born in an FGM practising country (Census)

- To estimate the number and girls affect by FGM and the prevalence of FGM in England and Wales among women aged 15 and over, the number of registered maternities to women who have undergone FGM and the number of girls below the age of 15 at risk for FGM & the type of FGM

Nearly 66.000 women with FGM were living in England or Wales in 2001

2.Andro, A., Lesclingand, M., Cambois, E., & Cirbeau, C. (2009) [30]. Excision et Handicap (ExH): Mesure des lésions et traumatismes et évaluation des besoins en chirurgie réparatrice. Paris: INED.

France

Survey: Etude de L’histoire Familiale. Both quantitative and qualitative data was gathered about FGM prevalence in French speaking migrants or those born from migrant parents in a multicentric study in a medical setting (Direct)

Extrapolation-of-FGM-countries-prevalence-data-method: prevalence data observed in the countries of origin were applied to the numbers of each subgroup (Indirect)

380.000 men and women resident in France in 1999, who were born in an FGM practising country

- To estimate the number of girls and women affect by FGM and FGM prevalence on a national level

- To understand the family dynamics around the practice of FGM and the migration situation

- To estimate quantitatively het consequences of FGM for these women

Nearly 53.000 adult women with FGM were living in France in 2004. The distribution of these women in France is unequally dispersed.

3.Farina, P. (ed.) (2010) [35]. Indagine sulla presenza nel territorio lombardo di popolazione a rischio in relazione alla salute sessuale e riproduttiva e alle mutilazioni genitali femminili. Milano: Istituto Regionale di Ricerca della Lombardia.

Italy

A general survey on sexual and reproductive health using facility-based and respondent driven sampling (direct)

The survey can be compared to DHS and MICS data about FGM in the countries of origin.

2011 immigrants aged 15–49, living in Lombardy (Italy) in 2010

- To estimate the number and prevalence of women aged 15–49 living in Lombardy (Italy) subjected to FGM

- To map sexual and reproductive health among immigrants in Italy in 2010

In Lombardy (Italy) an estimated 17,2% of African immigrant women have undergone FGM, which is less than 5% of all immigrants. 1500 girls are at risk of FGM.

4.Dubourg, D., Richard, F., Leye, E., Ndame, S., Rommens, T., & Maes, S. (2011) [41]. Estimating the number of women with female genital mutilation in Belgium. The European Journal of Contraception and Reproductive Health Care, 16(4):248–57.

Belgium

Extrapolation-of-fgm-countries-prevalence-data-method: MICS & DHS data applied to 1st and 2nd generation female migrants

with estimates based on Federal Directorate General of Statistics, the Federal Agency for the Reception of Asylum Seekers (Fedasil), the Office de la Naissance et de l’Enfance (ONE) and Kind & Gezin (G&G) (indirect)

Estimations corrected for:

- age

All immigrant women from countries where FGM is practised and their daughters born in Belgium since 1998.

To estimate in Belgium:

- the number of women with FGM

- the number of girls at risk of FGM

- the target population of medical and social services

Amongst the 22.840 women & girls living in Belgium, origination from an FGM practising country, 6260 have ‘most probably undergone’ FGM and 1975 girls were at risk of FGM. The distribution of these women in Belgium is unequally dispersed.

5.Korfker, D.G., Reis, R., Rijnders, M.E.B., Meijer-van Asperen, S., Read, L., Sanjuan, M. et al. (2012) [42]. The lower prevalence of female genital mutilation in the Netherlands: a nationwide study in Dutch midwifery practices. International Journal of Public Health, 57: 413–420.

The Netherlands

Extrapolation-of -prevalence-data-method based on a retrospective nationwide survey of midwives (indirect)

All 513 midwifery practices in the Netherlands were invited. The response rate was 93% (n = 478).

- To estimate the FGM prevalence and number of girls and women subjected to FGM giving birth in 2008 in the Netherlands.

Retrospective reports by midwives led to a number of 470 women (0,32%) with a history of FGM who gave birth in 2008 in the Netherlands.

6.Köszeghy, L. (2012) [31]. FGM prevalence in Hungary-estimation. Retrieved March 26, 2015, from: http://mona-alapitvany.hu/wp-content/uploads/2012/11/fgm-prevalence-in-hungary-estimation.pdf

Hungary

Extrapolation-of-fgm-countries-prevalence-data-method: applied to all women with all kinds of permits coming from FGM-countries (indirect)

All women from countries where FGM is prevalent:

- with a residence permit

- those who obtained a refugee status in the past 10 years

- those who obtained temporarily protected status

- currently residing in one of the reception centres

- To estimate the number of girls and women affect by FGM and FGM prevalence in Hungary

The number of migrant women subjected to FGM in Hungary is estimated to lie between 170 and 350. There is an unequal distribution of these women in different Hungarian areas.

7.Exterkate, M. (2013) [43]. Female Genital Mutilation in the Netherlands. Prevalence, incidence and determinants. Utrecht: Pharos Centre of Expertise on Health for Migrants and Refugees

The Netherlands

Extrapolation-of-fgm-countries-prevalence-data-method:

Data from national representative surveys in the country of origin were used: DHS, MICS. These data were combined with data from registers from the Dutch Central Statistical Office, Central Agency for the Reception of Asylum Seekers, Youth Health Care and Reporting Centres of Child Abuse and Neglect. (Indirect)

Estimations corrected for:

- age

- region of origin

- religion

Qualitative contextual information was also gathered through focus group discussions.

Women living in the Netherlands in 2012 and originating from countries where FGM is traditionally practised.

- To estimate the prevalence of FGM and number of girls and women at risk of FGM in the Netherlands

The total number of women with FGM is estimated on 29.120 women in the Netherlands. From almost 70.000 women (1% of the Dutch female population) origination from FGM practising countries, nearly 40% have undergone FGM.

8.Dubourg, D., & Richard, F. (2014) [34]. Studie over de prevalentie van en het risico op vrouwelijke genitale verminking in België. Brussel: FOD Volksgezondheid.

Belgium

Extrapolation-of-fgm-countries-prevalence-data-method: estimation 1st & 2nd generation (based on ADSEI, data on asylum seekers, birth registration), extrapolation of this prevalence (per age category) in country of origin (DHS & MICS) on women & girls living in Belgium (indirect)

Estimations corrected for:

- age

All immigrant women from countries where FGM is practised and their daughters born in Belgium since 1998.

To update the data from 2008 on the prevalence of FGM in Belgium:

- the number of women with FGM

- the number of girls at risk

- the target population of medical and social services

Among the 48.092 girls and women living in Belgium on 31 December 2012, originating from a country where FGM is practised and their daughters born in Belgium, it was estimated that 13.112 of them ‘had probably already undergone FGM’ and that 4084 were ‘potentially at risk of FGM’.

9.Macfarlane, A., & Dorkenoo, E. (2014) [44]. Female genital mutilation in England & Wales: Updated statistical estimates of the affected women living in England and Wales and girls at risk. Interim report on provisional estimates. London: City University London & Equality Now.

United Kingdom

Extrapolation-of-fgm-countries-prevalence-data-method: DHS, MICS, Census 2011, birth registration

women born in FGM practicing countries, but who are member of a non-practicing FGM population were excluded (indirect)

Estimations corrected for:

- age

- ethnicity

- religion

- prevalence in FGM practicing countries

Women who were born in countries where FGM is traditionally practised and data on FGM is available. Women belonging to populations or religions that do not practise FGM were excluded.

- To update the estimation of the prevalence of FGM in England and Wales from 2007.

- To produce updated and reliable estimates of the prevalence of women born in FGM practicing countries, the number of women with FGM living in England and Wales as a whole and in each local authority area.

- To disseminate these estimations to local authorities to enable them to provide guidance in the reduction of FGM in their area.

In 2011, an estimated 137.000 girls and women with FGM were permanent residents in England and Wales. There were 103.000 women aged 15–49; 24.000 were 50 and over; and nearly 10.000 girls aged 0–14 were at risk of FGM.

10.Baillot, H., Murray, N., Connelly, E., & Howard, N. (2014) [45]. Tackling Female Genital Mutilation in Scotland. A Scottish model of intervention. Glasgow: Scottish Refugee Council, London School of Hygiene & Tropical Medicine

United Kingdom

Extrapolation-of-fgm-countries-prevalence-data-method: Examination of available secondary data (2011 Census, birth registration data 1993–2012, 2013 Pupil Census) and administrative records from stakeholders on the FGM strategic were used too (indirect)

Men, women and children living in Scotland and origination from one of 29 FGM-practising countries identified by UNICEF in 2013.

- To identify populations which are potentially subjected to FGM and to explore interventions across the European Union in order to present data and recommendations for the development of a Scottish model of intervention.

In 2011, 23.979 men, women and children, origination from FGM practising countries, were living in Scotland. Potentially affected communities can be found in every local authority area in Scotland.

11.Farina, P., & Ortensi, L. (2015). Improving estimates of the prevalence of Female Genital Cutting among migrants in Western countries. Retrieved March 26, 2015, from: http://paa2015.princeton.edu/uploads/152685

Italy

Extrapolation-of-fgm-countries-prevalence-data-method:

DHS, MICS (indirect)

Estimations corrected for:

- age

- selectivity of migration

- region of origin

- prevalence in FGM practicing countries

Survey:

Migrants’ Selection Hypothesis is used to correct national prevalence estimates. This correction was calculated on the prevalence variations among different socio-demographic groups and inter-regional variations in the migrants’ countries of origin + assessment of the reliability of this correction (comparison with direct estimates)

Women aged 15–49, born in FGM practising countries and living in Italy, more specific in the region of Lombardy. All women were selected irrespective of current nationality or legal status.

- To present a new method to estimate the prevalence of FGM among first generation migrants.

The selection Hypothesis corrects the prevalence estimation among immigrants in Lombardy, Italy to a lower number than expected based on the prevalence in their respective practising country.

12.Ortensi, L., Farina, P., & Menonna, A. (2015) [36]. Improving estimates of the prevalence of Female Genital Mutilation/Cutting among migrants in Western countries. Demographic Research, 32: 543–562.

Italy

Extrapolation-of-fgm-countries-prevalence-data-method:

DHS, MICS (indirect)

Estimations corrected for:

- age

- selectivity of migration

- region of origin

- prevalence in FGM practicing countries

Survey:

Migrants’ Selection Hypothesis is used to correct national estimates of prevalence and to obtain a better estimation of the prevalence of FGM among overseas communities (comparison with direct estimates)

Women aged 15–49, born in FGM practising countries and living in Lombardy (Italy). All women were selected irrespective of current nationality or legal status.

- To present an improved method of indirect estimation of the prevalence of FGM among first generation migrants based on a migrant selection hypothesis.

- To provide a criterion to assess the reliability of indirect estimates.

The Selection Hypothesis leads to a prediction of a lower prevalence of FGM than can be expected based on the prevalence in the country of origin.

13.Terre des Femmes (2015). Dunkelzifferstatistik zur weiblichen Genitalverstümmelung in Deutschland. Retrieved March 26, 2015, from: http://www.frauenrechte.de/online/index.php/themen-und-aktionen/weibliche-genitalverstuemmelung2/aktuelles

Germany

Extrapolation-of-fgm-countries-prevalence-data-method:

DHS, MICS.

Effects of migration were also taken into account.

Estimations corrected for:

- age (2013 + 2015)

- migrant generation (2015)

Women living in Germany, originating from countries where FGM is practiced (Africa & Asia).

- To estimate FGM prevalence in Germany

- To show that FGM prevalence is reduced by migration

An estimated 5956 women at risk of FGM and 35.715 women who underwent FGM, are living in Germany. These numbers are lower than estimated in the countries of origin