The present study directly compares

The present study directly compares attitudes about female genital cutting among Sudanese living in Switzerland to attitudes among Sudanese living in Sudan. Whether or not Sudanese immigrants are a special subset of the Sudanese population, and regardless of whether or not they move toward the values of Switzerland after immigrating, we focus directly on identifying any attitudinal differences by using the same fully anonymous method to measure implicit attitudes in both countries. Importantly, we previously validated our implicit attitudinal measure by showing that measured attitudes in Sudan were highly correlated with incidence at the buy bepridil level (Vogt, Zaid, Ahmed, Fehr, & Efferson, 2016). This correlation provides us with a relationship between attitudes and a girl\'s risk of being cut. We use this relationship in conjunction with our attitudinal data from Switzerland to discuss the magnitude of the migration and acculturation impact factor on the risk of being cut for girls in the Sudanese immigrant population. Moreover, using control data collected in Switzerland, we also provide results relevant to the question of whether attitudinal differences are due to selective migration or acculturation.
Effects of selection and acculturation The extrapolation method is a feasible and practical method for the difficult problem of estimating the risk of cutting among immigrant girls (European Institute for Gender Equality, 2013, 2016). It has the particular advantage that it relies on representative surveys in countries of origin. Representative samples among immigrant populations are extremely challenging. In general, we do not have country-wide sampling frames that include first-generation and second-generation immigrants, families with only one parent from a country where cutting is practiced, and asylum seekers who are not yet registered (Ziyada et al., 2016). In addition to the fact that we often do not know how to delimit the immigrant population of interest, we also have little understanding of how selective migration and acculturation affect attitudes toward female genital cutting (European Institute for Gender Equality, 2016). First, migrants may constitute a special subset of the population of origin (Leye et al., 2014; Ortensi et al., 2015). Research has demonstrated that attitudes about cutting in many African countries vary tremendously among and even within households in a local area (Bellemare, Novak, & Steinmetz, 2015; Efferson, Vogt, Elhadi, Ahmed, & Fehr, 2015; Hernlund & Shell-Duncan, 2007). This kind of variation implies ample scope for emigration that is somehow conditional on attitudes about cutting (Ortensi, Farina, & Menonna, 2015). If this kind of selection occurs, those who emigrate will not have the same attitudes regarding cutting as those who do not. Farina and Ortensi (2014), for example, surveyed immigrants from practicing countries in Italy and concluded that ignoring selective migration can lead one to overestimate the prevalence and risk of cutting in immigrant populations. Second, in addition to selection, immigrants in Europe and North America might have attitudes about cutting that differ from countries of origin because immigrants change their attitudes after arriving in their new country (Farina & Ortensi, 2014; Johnsdotter et al., 2009). Some might become more negative about cutting as they integrate in a non-cutting society, while others might become more positive about cutting as a way to maintain and assert cultural ties to their native countries. All in all we know little about the net effect of attitudinal changes after migrating (Leye et al., 2014). Generically, however, we expect both selective migration and attitudinal changes to considerably complicate the task of estimating risk among immigrants. Recent extrapolation studies have confronted this problem by developing a number of techniques for adjusting risk based on the joint effect of selection and acculturation. Exterkate (2013) used insights from focus groups to specify high-risk, medium-risk, and low-risk scenarios for immigrant girls in the Netherlands. Ortensi et al. (2015) addressed selection by considering variation in prevalence among regions within practicing countries. They specifically distinguished between countries where cutting is widespread and countries where the practice is regionally clustered, and they used this information to adjust risk estimates for immigrant populations. Ziyada et al. (2016) carefully distinguished between the cutting risk among first-generation and second-generation immigrants, and they additionally accounted for the age of immigration. More broadly, the European Institute for Gender Equality (2016) has produced a detailed and thorough review of how to address the potential effects of selective migration and acculturation.