study on health-seeking behaviours was undertaken by a humanitarian
non-governmental organization (NGO)
in a rural
village in an African country
where the prevalence of child global acute malnutrition was high. The study focused on health-seeking practices during diarrhoea
episodes among children
under the age of five, as diarrhoea is one of the underlying causes of child undernutrition. The research aimed to study access to and utilization of health services. The country’s national ethics review committee
approved the research.
Qualitative fieldwork was conducted which aimed to better understand the cultural values and practices related to the therapeutic path of children with diarrhoea. Interviews were conducted with parents and other key informants in the village
(e.g. community leaders, elders, traditional healers)
forms were signed by the participants, but as the NGO was mostly known in the area as an assistance provider, it was not always clear to the researchers whether participants freely consented to take part in the research or whether they assumed they had to participate in order to receive assistance, or out of gratitude.
collection, the investigator found that a traditional treatment
among baby girls
(from three months of age) was female genital mutilation (FGM)
. This practice was intended to remove “impurity” that interfered with a girl’s
well-being. FGM was practised in the village by a traditional healer
with a razor blade and without hygienic precautions. “If the diarrhoea is caused by a worm, we have to remove the impure part of a girl’s body; it will kill the worm and cure the girl
,” a traditional FGM practitioner said during an interview.
According to the testimonies gathered during the research, FGM is highly valued in the local culture
. In addition to being considered an effective traditional cure for girls’ diarrhoea
, FGM is part of the accepted and expected identity of a woman. “Uncircumcised” girls are marginalized, are a source of shame for their family and have difficulty finding a husband. FGM also has religious and social significance. This act is symbolically seen as a ritual of incorporation of the girl
into the rest of the community
At the global level, FGM is considered a violation of human rights
, and it is also prohibited by law in the country where the research took place. “Female genital mutilation
and cutting is a violation of the basic rights of women
and girls,” said Carol Bellamy, then executive director of the UN’s Children’s Fund (UNICEF)
, on the International Day of Zero Tolerance for FGM in 2005. “It is a dangerous and irreversible procedure that negatively impacts the general health, child bearing capabilities and educational opportunities of girls and women.”
In the research setting of this case study, most of the participants in the interviews had never been to primary school and were illiterate. For them, local habits and regulations took precedence over national or international laws and codes of conduct.
The national ethical review
committeeFootnote 1 and the research team did not anticipate this finding, as their members did not have a deep understanding of the local culture
and the norms of the specific community
and individuals. Because this traditional cure for diarrhoea
was an unexpected finding, participants had not been previously informed by the researchers of what they could be exposed to while they proudly exhibited their traditional culture.
When a researcher from an NGO
witnesses a human rights
abuse, there is always a risk
of that organization, when managing the resulting conflicts, being accused of complicity, and/or of violating the interests of both the individuals and international ethical standards
. In this case the researcher acted in accordance with his own model of norms and values, and one based on national and international codes of law and ethics, rather than with the way in which the causal model of illness was understood locally, and the implications of this for the social construction of female identity. The researcher and the NGO
decided to report the practices in a public report in order to protect baby girls
from a recognized and illegal
However, this approach had serious consequences: it offended participants and the wider community, and led to the social rejection of girls
who had not received FGM
− they were stigmatized
in the community − and intensified community tensions. It also jeopardized the NGO’s capacity to operate in the area.
Communities felt betrayed by the NGO, as they were expecting humanitarian
relief from the organization. They felt that the research was not responsive to their needs as they did not feel any benefit
. On the contrary, its findings had exposed vulnerable
communities and respondents to retribution from a coercive government
, and endangered the local social structure.