Bettina Shell-Duncan

University of Washington Seattle | UW · Department of Anthropology

Recent reviews of intervention efforts aimed at ending female genital cutting (FGC) have concluded that progress to date has been slow, and call for more efficient programs informed by theories on behavior change. Social convention theory, first proposed by Mackie (1996), posits that in the context of extreme resource inequality, FGC emerged as a m...

ABSTRACT  The international campaign to eliminate female genital cutting (FGC) has, since the early 1990s, actively attempted to divorce itself from a health framework, adopting instead a human rights framework to justify intervention. Several key questions emerge regarding the prominent placement of FGC in the international human rights movement:...

Although the international community has recently promoted legislation as an important reform strategy for ending female genital cutting (FGC), there exist divergent views on its potential effects. Supporters argue that legal prohibition of FGC has a general deterrent effect, while others argue legislation can be perceived as coercive, and derail l...

Medicalization is defined by the World Health Organization as a “situation in which FGM is practiced by any category of health-care provider, whether in a public or private clinic, at home, or elsewhere” (W HO, 2010: 2). Despite the emergence of international consensus that female genital mutilation/cutting (FGM/C) is a violation of human rights, a...

Background Female genital cutting (FGC), which poses risks to the health of girls, has proved remarkably persistent in many communities in Africa, despite decades of efforts to discourage it. The social coordination norm model of FGC attributes this persistence to high social costs for uncut women, such as exclusion from marriage markets or social...

Objectives To examine the circumstances and needs of older adults who were “kinless,” defined as having no living spouse or children, when they developed dementia. Methods We conducted a secondary analysis of information from the Adult Changes in Thought (ACT) Study. Among 848 participants diagnosed with dementia between 1992 and 2016, we identifi...

Anthropogenic carbon emissions have the potential to trigger changes in climate and ecosystems that would be catastrophic for the well-being of humans and other species. Widespread shifts in production and consumption patterns are urgently needed to address climate change. Although transnational agreements and national policy are necessary for a tr...

Literature on dynamics of change in female genital mutilation/cutting (FGM/C) portray two common but conflicting views. On one side, FGM/C is seen as static and deeply entrenched, with parents lacking agency to interpret culture, evaluate options and adopt changes. An alternative perspective focuses on the fluidity of social norms, influencing whet...

Countries around the world have passed laws specifically banning female genital mutilation/cutting. Legal restrictions vary as to whether they apply to both girls and adult women or to minors only, and few address a second set of genital cutting procedures known as ‘female genital cosmetic surgeries’. Different legal framings reflect variation in v...

Background To our knowledge, no studies exist on the influence of nomadic pastoralist women’s networks on their reproductive and sexual health (RSH), including uptake of modern family planning (FP). Methods Using name generator questions, we carried out qualitative egocentric social network analysis (SNA) to explore the networks of four women. Net...

Female genital mutilation derails efforts to achieve gender equality and the empowerment of girls and women. In Kenya, national estimates show a steady decline in prevalence, although there is considerable variation at the sub-national level. There is a need to better understand female genital mutilation-related norms and meanings and whether there...

There exist two dominant but conflicting views on the role of men in the perpetuation female genital mutilation/cutting (FGM/C). One paints men as culprits, with FGM/C viewed as a manifestation of patriarchal oppression of women. An alternative portrays men as relatively uninvolved in a practice described as 'women's business'. These two perspectiv...

Abstract There exist two dominant but conflicting views on the role of men in the perpetuation female genital mutilation/cutting (FGM/C). One paints men as culprits, with FGM/C viewed as a manifestation of patriarchal oppression of women. An alternative portrays men as relatively uninvolved in a practice described as “women’s business.” These two p...

Policies and programmes designed to eliminate the practice of female genital mutilation/cutting (FGM/C) in Senegal have been implemented out over the span of several decades, but the practice has been surprisingly tenacious. Strategies for accelerating abandonment have been informed by theories of change, and social norms theory, in particular, has...

There exist two dominant but conflicting views on the role of men in the perpetuation female genital mutilation/cutting (FGM/C). One paints men as culprits, with FGM/C viewed as a manifestation of patriarchal oppression of women. An alternative portrays men as relatively uninvolved in a practice described as “women's business.” While much has been...

Female genital mutilation/cutting (FGM/C), also known as female circumcision, is a global public health and human rights problem affecting women and girls. Several concerted efforts to eliminate the practice are underway in several sub-Saharan African countries where the practice is most prevalent. Studies have reported variations in the practice w...

Somatosphere Book Forum for "The Twilight of Cutting: African Activism and Life After NGOs."

OVERVIEW Humans are embedded in a thick web of social interactions, which form patterns of social networks. The study of social networks-both quantitatively and qualitatively-has emerged as a powerful approach for studying how interpersonal connections influence a person's attitudes and behaviors. The primary concern of all network analysis studies...

Background Over the last several decades, global efforts to end female genital mutilation/cutting (FGM/C) have intensified through combined efforts of international and non-governmental organizations, governments, and religious and civil society groups. One question asked by donors, program implementers and observers alike is whether there is any e...

Social norms theory has become prominent framework for understanding the perpetuation of practices such as female genital mutilation/cutting (FGM/C), and has influenced the design of interventions aimed at stopping the practice. Theoretical advances draw attention to the fact that practices such as FGM/C is often upheld by multiple interconnected n...

Medicalized female genital mutilation/cutting (FGM/C), defined as cutting procedures performed by professional health care providers, and less extensive forms of FGM/C have been advanced to minimize the attendant health risks, despite decades of opposition by international organizations and anti-FGM/C activists. Oft-repeated assertions about trends...

Social norms theory has become prominent framework for understanding the perpetuation of female genital mutilation/cutting (FGM/C), and has influenced the design of interventions aimed at stopping the practice. Theoretical advances draw attention to the fact that FGM/C is often upheld by multiple interconnected norms that may vary and shift over ti...

Background: For the last decades, the international community has emphasised the importance of a multisectoral approach to tackle female genital mutilation (FGM/C). While considerable improvement concerning legislations and community involvement is reported, little is known about the involvement of the health sector. Method: A mixed methods appr...

Purpose of Review Female genital cutting/mutilation (FGM/C) performed by health care professionals (medicalization) and reduced severity of cutting have been advanced as strategies for minimizing health risks, sparking acrimonious ongoing debates. This study summarizes key debates and critically assesses supporting evidence. Recent Findings While...

Objective: We posited a trade-off in iron nutrition, with iron deficiency decreasing risk for infection by depriving infectious agents of iron while increasing risk for infection by compromising immune protection. We described associations between iron deficiency and prevalent and incident infectious disease episodes and cell-mediated immunity (CMI...

Background: Medicalized female genital mutilation/cutting (FGM/C), defined as cutting procedures performed by professional health care providers, and less extensive forms of FGM/C have been advanced to minimize the attendant health risks, despite decades of opposition by international organizations and anti-FGM/C activist. Oft-repeated assertions a...

Objectives: To investigate the hygiene (or "old friends") hypothesis in a high-infectious disease (ID) environment, rural Kilimanjaro, Tanzania. Methods: Among a cross-sectional sample of 2- to 7-year-old children, we collected physician-diagnosed hay fever, asthma, and eczema, history of hospitalization, family size, and household environment i...

We sought to understand fertility intentions and HIV risk considerations among Kenyan HIV-serodiscordant couples who became pregnant during a prospective study. We conducted individual in-depth interviews (n = 36) and focus group discussions (n = 4) and performed qualitative data analysis and interpretation using an inductive approach. Although mos...

Early initiation of antiretroviral therapy (ART) - that is, at higher CD4 cell counts (>350 cells/μl) - is a potent HIV prevention strategy. The WHO recommends ART initiation by all HIV-infected individuals in HIV serodiscordant relationships to prevent HIV transmission, yet the acceptability of early ART among couples has not been well studied. Qu...

We evaluated sex, age, nutritional status, and infectious disease (ID) as predictors of two biomarkers of cell-mediated immunity (CMI), delayed-type hypersensitivity to Candida albicans (DTH-Candida), and anti-Epstein-Barr virus antibody (EBV Ab), among 200 children in Kilimanjaro, Tanzania. DTH-Candida, which decreases with compromised CMI, was po...

Objective The objective of the present study was to evaluate the effect of settlement on the nutrition and health status of pastoral women of reproductive age.Design A cross-sectional survey that included a 24 h dietary recall was administered to 224 randomly selected Gabra women. Height and weight were used to compute BMI. Whole capillary blood wa...

Multiple lines of evidence suggest that infections in early life prevent the development of pathological immune responses to allergens and autoantigens (the hygiene hypothesis). Early infections may also affect later immune responses to pathogen antigen. To evaluate an association between early infections and immune responses to pathogen antigen, d...

Background Consistent condom use reduces HIV-1 risk and is important for HIV-1 serodiscordant couples (where one partner is HIV-1-infected and the other is HIV-1-uninfected). This study explored barriers to consistent condom use among heterosexual HIV-1 serodiscordant couples. Methods This qualitative study used 28 in-depth interviews and 9 focus g...

Newborns are dependent on breastmilk vitamin A for building hepatic stores of vitamin A that will become critical for survival after weaning. It has been documented that vitamin A concentrations in breastmilk decline across the first year postpartum in both well-nourished and malnourished populations. The reason for this decline has been assumed to...

We used community-based ethnography and public health risk assessment to assess beliefs about pesticide exposure risks among farmworkers in the Lower Yakima Valley of Washington State. We used unstructured and semistructured interviews, work-site observation, and detailed field notes to gather data on pesticide exposure risks from 99 farmworkers. F...

The relative dose-response (RDR) test, which measures the percentage of change in serum retinol concentration in response to an oral vitamin A (VA) dose, is a functional reference method to assess low hepatic VA stores. However, problems due to the relative instability of retinol, which is measured in the traditional RDR test, could be circumvented...

An evolutionary perspective suggests that iron deficiency may have opposing effects on infectious disease risk, decreasing susceptibility by restricting iron availability to pathogens, and increasing susceptibility by compromising cellular immunocompetence. In some environments, the trade-off between these effects may result in optimal iron intake...

An evolutionary perspective suggests that iron deficiency may have opposing effects on infectious dis-ease risk, decreasing susceptibility by restricting iron availability to pathogens, and increasing susceptibility by com-promising cellular immunocompetence. In some environments, the trade-off between these effects may result in optimal iron intak...

This study explores the effect of women's autonomy on children's health. Research was conducted among the Rendille, a traditionally nomadic pastoralist population living in northern Kenya. Using data collected from 435 women and 934 of their children, we tested the hypothesis that women with higher levels of autonomy would have children with better...

Vitamin A deficiency (VAD) is a significant public health problem in many countries. While cost-effective interventions are available to control VAD, reliable information is needed to the track progress of control programmes. However, assessment of VAD is uncommon because current approaches are expensive and not feasible in low-resource settings. T...

Retinol-binding protein (RBP) is accepted as a surrogate biochemical marker for retinol to determine vitamin A (VA) status. A recently developed enzyme immunoassay for RBP uses serum or whole blood stored as dried blood spots (DBS). However, the stability of RBP in DBS has not been examined. RBP stability was studied in a laboratory and in field co...

Though the literature aimed at deepening our understanding of the practice of female genital cutting (FGC) is vast and growing, the issue of behavior change remains poorly understood. In this paper, we argue that, both within and beyond the context of formal intervention, the decision of whether, when, and how to perform FGC results from a constant...

Female "circumcision" or, more precisely, female genital cutting (FGC), remains an important cultural practice in many African countries, often serving as a coming-of-age ritual. It is also a practice that has generated international dispute and continues to be at the center of debates over women's rights, the limits of cultural pluralism, the bala...

We have in this chapter attempted to untangle some of the complex ways in which the migration of people from circumcising societies is giving rise to challenging transcultural encounters in areas that include health care and child rearing, asylum law, sexuality, and human rights. We have wielded two overlapping metaphors. On the one hand we invoke...

To elucidate associations between beliefs in abstinence, fidelity, and condom use (the "ABCs" of preventing HIV and other sexually transmitted infections) and associated self-reported risk behaviors among Kenyan men. We assessed associations of beliefs in the ABCs with sociodemographic characteristics and sexual risk behaviors in a respondent-drive...

In recent years there has been growing interest in developing theoretical models for understanding behaviour change with respect to the practice of female genital cutting (FGC). Drawing on extensive qualitative data collected in Senegal and The Gambia, the research reported here explores whether and how theoretical models of stages of behaviour cha...

The purpose of this study was to examine the context of iron deficiency and feeding patterns of iron-rich foods among northern Kenyan school-aged children. A nutrition survey was conducted among 300 subjects in two Rendille communities, Korr and Karare. The objectives were to determine the prevalence of iron deficiency as it relates to parasitic in...

Attitudes and practices concerning genital hygiene may influence topical microbicide use by men. This study examines knowledge and behaviours related to hygiene, genital hygiene, circumcision and hygiene, and to genital hygiene before and after sex among men in Nairobi, Kenya. We conducted 463 interviews of men recruited by respondent driven sampli...

Food insecurity is a public health problem. Information on how cultures perceive the experience of a financial crisis and resultant food insecurity is limited. Our purpose in this study was to understand how poor families residing in urban slums in Thailand perceive their food situation. Interviews were conducted with 30 women aged 20-65 years who...

Maternal depletion syndrome, defined as a broad pattern of maternal malnutrition resulting from the combined effects of dietary inadequacy, heavy workloads, and energetic costs of repeated rounds of reproduction, has been determined to be an important predictor of maternal and child health. Debates regarding the existence of maternal depletion synd...

Community-based surveys of iron deficiency (ID) require simple, accurate methods that can be used in remote areas. The objective of this study was to assess iron status in rural Kenya using "field-friendly" methods for capillary blood, including an improved dried blood spot assay for transferrin receptor (TfR). A single finger stick was used to obt...

Iron-deficiency anemia (IDA) in refugees is reported to be among the major medical problems worldwide. Because food rations are typically inadequate in iron, long-term reliance is a key predictor of anemia among displaced people. Comprehensive nutritional assessments of refugee children from Burma have not previously been completed. Refugee childre...

Iron deficiency is the most common micronutrient deficiency worldwide, and transferrin receptor (TfR) level has been identified as an important measure of iron status that is not confounded by inflammation. However, logistical constraints associated with sample collection and processing have limited efforts to measure TfR, particularly at the commu...

Iron-deficiency anemia (IDA) in refugees is reported to be among the major medical problems worldwide. Because food rations are typically inadequate in iwn, long-term reliance is a key predictor of anemia among displaced people. Comprehensive nutritional assessments of refugee children from Burma have not previously been completed. Refugee children...

In recent decades the practice of female "circumcision" has come under intense international scrutiny, often conceptualized as a violation of women's basic right to health. Although the adverse health consequences of female "circumcision" form the basis of opposition to the practice, anti-circumcision activists, as well as many international medica...

The research reported here examines child nutrition in a population that is currently experiencing a transition in subsistence, shifting from nomadic pastoralism to a variety of settled lifestyles. We investigate the range of nutritional consequences of settlement both within and between communities by examining individual, household, and community...

The Turkana people live in the savanna of northwestern Kenya, a dry grassland where they herd livestock, spending at least part of the year on migration in search of grazing pasture. Their herds provide them with food, as well as being an essential source of wealth and resources to be sold and exchanged. This unique, multidisciplinary study of the...

A number of African countries, including Kenya, have experienced a marked rise in births among unmarried women. In Western countries, reproduction outside of marriage is assumed to be illegitimate and a social problem. One hypothesis used to explain the increasing incidence of premarital fertility in Africa is a breakdown of traditional social cont...

A 10-month prospective study of children from a nomadic pastoralist community in northwest Kenya was conducted to examine the relationship between nutritional status, cell-mediated immunity (CMI), and morbidity due to gastroenteritis and acute respiratory infection (ARI). In children ages 6 months to 10 years, nutritional status and cellular immuno...

While an association between severe protein-energy malnutrition and diminished cellular immunity has been documented, the impact of lesser grades of malnutrition on cellular immunosuppression is less clear. This study emphasizes that the relationship between mild-to- moderate malnutrition and cellular immune function, assessed through delayed-type...