Who, What, Where: Female Genital Mutilation

This is the first in a series of Who, What, Where: A Series on Global Health Issues. We hope to introduce public health issues across the world and educate readers about their history. 

Let’s talk about Female Genital Mutilation. 

What exactly is FGM? According to the World Health Organization, it is the practice of removing the external female genitalia for non-medical purposes, often resulting in injury due to improper surgical techniques, non-sterilized equipment/environments, and inexperienced practitioners. A large percentage of these procedures causes life-long health complications such as cysts, recurrent bladder infections, and even infertility. 

Who is affected by FGM? As the name suggests, this issue is one that plagues individuals assigned female at birth —primarily African and Middle Eastern women. Some cultures view FGM as a rite of passage girls undergo before transitioning into womanhood while others believe it suppresses a woman’s sexual desire, allowing her virginity to stay intact when the time for marriage comes. The latter has fostered an environment where FGM became the norm as mothers are expected to ensure the next generation kept the traditions alive. Certain communities also believe it enhances the sexual pleasure for their husbands. 

Where is FGM most likely practiced? There are about 200 million women and girls who are currently living with the consequences. Somalia is believed to have the highest prevalence with a whopping 98%, followed by Guinea at 97%, Djibouti with 93%, etc. Although the practice is a concern in European, Asian, and South American countries alike, cases in African countries continue to soar. Preventative measures are being taken to combat FGM through educating women on the complications, advocating for fathers and men to speak against the practice, and compelling religious leaders to denounce it. The key factor is educating mothers, as the cultural expectations are deeply ingrained into their upbringing. Young girls are more likely to follow along if their mothers are uneducated about the health issues brought on by the practice.  

While International Day of Zero Tolerance for Female Genital Mutilation falls annually on February 6th as a joint effort to combat FGM on a global level, the COVID-19 pandemic has set back the goal of stamping out the practice completely by the end of 2030. The global lockdown has brought forth high rates of domestic violence incidents, has made many educational programs wholly unable to function, and families have had easier access participating in the procedure without being cornered. Despite the unforeseeable circumstances brought by the pandemic, the fight to dismantle FGM practices continues to rage on. 

Religion and Mental Health

This is the seventh part of a IH Blog series, Global Mental Health: Burden, Initiatives and Special Topics.

Out of over 7 billion people on Earth, more than 80% identify with a religious group. The Pew-Templeton Global Religious Future Project reports that Christianity is the world’s largest religion, with approximately 2.4 billion individuals affiliating as Christian. The project estimates that 1.9 billion individuals affiliate as Islamic, 1.2 billion with Hinduism, 507 million with Buddhism and 15 million with Judaism. In most countries, a majority claim that God plays an important role in their daily lives

As mentioned in the first part of this IH Blog Series, over one in three people will experience a mental health problem in their lifetime. Out of the total number of people who experience a mental health problem, 76-85% of people do not receive the treatment they need. With religion playing such a significant role in people’s lives and with mental illness being a global crisis, understanding the interplay between religion and mental health care seeking is of crucial importance. 

Religion divides but it also unites us. All religions offer explanations for the meaning of life, purpose of life and rationalize human suffering. With religion being a source of individual growth, community strength, solidarity and resilience, it is clear that a person’s faith and spirituality has implications on their mental health. For example, in Hinduism, there is a broad view of life summed up in four aims (Purushartha): Dharma, Kama, Artha and Moksha. Each highlights harmony in different dimensions of life. Religious and spiritual beliefs and activities are commonly used to cope with stressful life events. Whether an individual lives in a high, middle or low-income country, people look to religious leaders and advisors for guidance in place of or before seeking out mental health treatment. In addition to poor access, stigma, a lack of understanding and religious insensitivity by mental healthcare professionals are just a few of the barriers religious people face in seeking out formal mental health services. We are discovering more about the role religion and spirituality play in mental health care seeking globally, but there are a number of gaps in our current knowledge on the subject. Most studies on religion and mental health treatment seeking have been done in the U.S. and Europe with religiosity garnering more attention than spirituality. 

Elena: I first became interested in the relationship between religion and mental health when I interned at the National Alliance on Mental Illness’s (NAMI) national office in Arlington, Virginia five years ago. I remember exploring the NAMI website and discovering a page on faith and spirituality with a link to NAMI’s interfaith resource network, NAMI FaithNet. As a spiritual Jewish atheist, I found this perspective to mental health eye-opening. In the summer of 2019, at the start of my Master of Public Health program at Arcadia University, I began developing my capstone research project on the topic of Black clergy and their role in the mental health of their congregants. The aim of this research was to explore Black Protestant Philadelphia clergy’s perceived self-efficacy in the mental health gatekeeper role. From my background research, I discovered that Blacks are more likely to report serious psychological distress compared to Whites, but are less likely to utilize formal mental health services. Instead of utilizing these services, many Christian Blacks seek guidance from clergy, who are increasingly being called mental health gatekeepers. Philadelphia is a large, historical center of the Black Protestant community, but through a detailed literature review, I discovered that qualitative research was lacking on this topic within this population. 

After conducting six semi-structured interviews with Philadelphia Black clergy, several themes emerged. The clergy I interviewed had differing mental health gatekeeper identities, with some considering themselves mental health gatekeepers and others not identifying with the title at all. Self-efficacy was high for clergy’s ability to recognize what was and was not within their scope of expertise, but self-efficacy varied for other skills, such as recognition of mental illness. Clergy acknowledged similar challenges in assisting congregants in need of mental health treatment and all admitted a need and desire to improve access to mental health resources. All respondents discussed interest in developing collaborations that may help them provide mental health assistance and connect congregants to mental health professionals in Philadelphia. Intervention and policy initiatives aimed at collaborating with Black Philadelphia Protestant clergy to address the perceived mental health needs of their congregations could strengthen their self-efficacy in the mental health gatekeeper role.

The role of religion in mental health and well-being is substantial. In a time when mental health outcomes globally are declining, exploring and understanding the mechanisms that shape our mental health is critical. This provides the foundation for developing effective strategies to prevent mental health issues as well as manage and treat these conditions. Further research is needed to fully elucidate the relationship between mental health and religion/spirituality in a range of populations and settings to inform intervention development and dissemination. 

About the Authors:

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Elena Schatell MPH (c) MMS (c)

Elena Schatell is a current student at Arcadia University enrolled in the Dual Master of Public Health/Master of Medical Science in Physician Assistant Program. She aims to promote public health in underserved communities as a future physician assistant. Her current public health interests include access to mental health services, stigma surrounding mental illness, and the relationship between faith and mental health. She has interned at the National Alliance for Mental Illness (NAMI) national office in Arlington, Virginia, working closely with the Advocacy and Public Policy team on conducting research on service barriers and state mental health policy. During her time at NAMI, she also authored articles for the Advocate magazine and blog.


Dr. Heather F. McClintock PhD MSPH MSW

Dr. McClintock is an IH Section Member and Assistant Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and reduce the burden of intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life Study and Integrating Management for Depression and Type 2 Diabetes Mellitus Study.

Now accepting applications for the IH Section’s Global Health Mentoring Program!

The Global Health Mentoring Program is pleased to announce the opening of applications for the 2021 cohort, which runs January 2021 – September 2021.

Please visit the link below to learn more about the Mentoring Program and how to apply. Applications are due: Friday December 4, 2020 at 11:59 PM US Eastern Time. 


For any questions please email ih.gh.mentoring@gmail.com 

Brianne Riggin-Pathak
IH Section Mentoring Committee Chair

News Round Up

Politics & Policies

Across much of the world—including one remote Nigerian village—the availability of family planning will largely depend on the outcome of the U.S. presidential election.


POLITICO Launches ‘Global Pulse’ Newsletter To Highlight Global Health, Discusses U.S. Drawdown From Global Health Leadership


What strategies should governments adopt to improve the health of their citizens? Amid the COVID-19 syndemic it would be easy to focus attention on global health security—at a minimum, strong public health and health-care systems. WHO has based its global health strategy on three pillars: universal health coverage, health emergencies, and better health and wellbeing. 


USAID Sends Letters To Prime Recipients Of Global Health Assistance, U.N. SG Emphasizing Expectation To Comply With Statutory, Policy Abortion Restrictions, Discussing Concerns Regarding Sexual, Reproductive Health Terminology


Health officials across the country are calling it quits in the midst of a global pandemic as otherwise below-the-radar public servants become the targets of anger and frustration in a hyperpartisan age.


Programs, Grants & Awards

In order to ensure that those exposed to COVID-19 receive the help they need to quarantine and cooperate with public health guidance, UCSF’s Pandemic Initiative for Equity and Action (UPIEA) is adding a soft-skills component to the training California contact tracers receive: cultural humility.


Dr. Anthony Fauci Launches YIGH Global Health Conversation Series Webinar


In new strategy, Wellcome Trust takes on global health concerns



By adulthood, gender inequalities in health and wellbeing are apparent. Yet, the timing and nature of gender inequalities during childhood and adolescence are less clear. Researchers describe the emergence of gender inequalities in health and wellbeing across the first two decades of life.


The burden of malaria infection in sub-Saharan Africa among school-aged children aged 5–15 years is underappreciated and represents an important source of human-to-mosquito transmission of Plasmodium falciparum. Additional interventions are needed to control and eliminate malaria. Researchers aimed to assess whether preventive treatment of malaria might be an effective means of reducing P falciparum infection and anaemia in school-aged children and lowering parasite transmission.


Unless the spread of the disease is contained, COVID-19 will likely lead to reduced life expectancy in severely affected areas, according to a new study published in the journal PLOS ONE. The study examined the impact of COVID-19-related deaths on life expectancy for four broad world regions across multiple rates of infection and age groups.


Is there a quantifiable association between the coronavirus disease 2019 (COVID-19) pandemic and the volume, type, and content of primary care encounters in the US?


Infectious diseases prevalent in humans and animals are caused by pathogens that once emerged from other animal hosts. In addition to these established infections, new infectious diseases periodically emerge. In extreme cases they may cause pandemics such as COVID-19; in other cases, dead-end infections or smaller epidemics result.


Diseases & Disasters

Representatives from the global south used this year’s World Health Summit to send a message to their counterparts in richer countries: They have a vision for how to emerge from the COVID-19 pandemic, and while they welcome advice and technical expertise, they are not interested in being told what to do.


The coronavirus pandemic has caused major disruption in global health, and exposed gaps in global health governance and coordination. But as the sector rethinks the current global health architecture, global health expert Steve Davis cautioned against trying to fix it by just setting up a new institution.


Nearly eight months after the pandemic was declared, researchers are gaining a more complete understanding of how the new coronavirus affects people.


India’s COVID-19 cases soared even higher today, as the world’s second most populous nation came closer to edging out Brazil as the second worst-hit country.



The US government has invested billions of dollars to create new health technologies — including tests, drugs, and vaccines — to combat COVID-19. These innovations could change the trajectory of the pandemic in the United States and other high-income countries, but unfortunately many of these tools may not work for people living in the world’s poorest places, where different challenges demand different solutions.


The HIMSS Global Health Equity Network and Accelerate Health are working together to host the Global Maternal Health Tech Challenge, a worldwide call to action to create technology solutions focused on improving maternal health outcomes.


New commitments from governments, international organizations and the private sector support unified approach to end pandemic, backing a response of unprecedented scale, scope and speed­—through the Access to COVID-19 Tools Accelerator­—as pandemic claims more than 1 million lives.


Environmental Health

The world has already observed many devastating effects of human-induced climate change. A vivid manifestation is the several large wildfires that have occurred recently — in some cases, fires of unprecedented scale and duration — including wildfires in Australia in 2019 to 2020, the Amazon rainforest in Brazil in 2019 and 2020, the western United States in 2018 and 2020, and British Columbia, Canada, in 2017 and 2018. Since August of this year, record-breaking wildfires have burned 2.7 million hectares (as of September 18, 2020) along the West Coast of the United States, killing more than 30 people and leaving tens of thousands homeless. Robust projections indicate that the risk of wildfires will continue to increase in most areas of the world as climate change worsens and that the fires will increase excess mortality and morbidity from burns, wildfire smoke, and mental health effects.


Yale School of Public Health offers new climate change and health concentration


Improving health care in rural Indonesia reduced incentives for illegal logging in a nearby national park, averting millions of dollars’ worth of atmospheric carbon emissions, a study finds. The finding indicates that accessible and affordable health care could be a key tool for addressing the climate crisis. Although the link may not be obvious, health care and climate change—two issues that pose major challenges around the world—are more connected than people may realize.


With storms to the east and wildfires to the west, the climate crisis is currently at the forefront of public consciousness. But aside from dramatic disasters there is another, pernicious threat that comes with a warming climate: diminishing global crop yields.


Equity & Disparities

If wealthy countries such as Canada crowd out vaccine access for poor countries, they should help support social protections, food security and health care.


The world will not return to normal until a vaccine against the coronavirus is distributed widely and not just to developed nations, one of the leading vaccine experts said in a wide-ranging interview Wednesday.


The coronavirus pandemic has hit disproportionately hard in Black and Hispanic communities, where infection rates and death rates have reached staggering levels. 

But as scientists race to develop vaccines against the SARS-CoV-2 virus and treatments for the COVID-19 disease it causes, many trials are struggling to enroll people from those very communities.


Women, Maternal, Neonatal & Children’s Health

The year 2020—five years since 189 countries signed the Sustainable Development Goals (SDGs)—has been consumed by the global response to COVID-19. One collateral effect of COVID-19 has been the setting aside of many SDGs and efforts to track progress towards them. Attention to children during the pandemic has concentrated on school closures, food insecurity, and access to care within health systems taxed by COVID-19 mitigation and response efforts. The situation of child and adolescent health before COVID-19, and consequences of the pandemic on specific health targets for SDG 3, therefore deserve attention.


One stillbirth occurs every 16 seconds, according to first ever joint UN estimates


Children, women, migrants all at increased risk of exploitation and trafficking during second COVID wave, U.N. expert warns


Congratulations to the 2020 APHA International Health Section Award Winners!

This year, we had a good pool of candidates for the various awards offered by our Section. Congratulations to our colleagues whose outstanding accomplishments in international health are being recognized by our Section this year.

Carl Taylor Lifetime Achievement Award in International Health
Dr. Gopal Sankaran

Mid-Career Award in International Health
Mr. William Rosa

Gordon-Wyon Award for Community-Oriented Public Health, Epidemiology and Practice
Dr. Paul Freeman

Young Professional Award
Ms. Jessica Keralis

Distinguished Section Service Award
Ms. Laura Arntson

The Awards Committee encourages all to nominate a colleague and/or be willing to be nominated next year. To find out more information about nominating a colleague or to view a list of past award winners, please visit the IH Section’s Awards webpage.

We would also like to congratulate this year’s top-scoring Early Career Professional abstracts:

Mara Howard-Williams: Policy precedes law: A legal epidemiology study of mental health and international human rights law

Hannah Stewart: Impact of natural disasters on mental health outcomes of first responders in central Myanmar

Qing Xu: Content analysis of Chinese-language social media user-generated expression of uncertainty during the covid-19 outbreak on weibo

Every year the IH section awards $500 scholarships to top scoring abstracts submitted by IH Early Career Professionals. Don’t forget to submit your abstract to next year’s meeting in Denver!

Missed the awards ceremony? Re-watch the ceremony here.