Knowledge, Attitude and Practice of Female Genital Mutilation Among Women in the Community
Chapter One
Objectives of the research
General objective
The main objective of the study was to assess Knowledge, Attitude And Practice Of Female Genital Mutilation among women in Delta State, Nigeria.
Specific Objectives
- To determine the socio-demographic characteristics that influence FGM practice in Delta State, Nigeria
- To establish women’s knowledge and attitudes on FGM risks and eradication programs in Delta State,
- To determine the effects of socio cultural and religious beliefs on FGM eradication programs in Delta State,
- To determine the reproductive health complications associated with FGM and how they are managed in Delta State,
CHAPTER TWO
LITERATURE REVIEW
Introduction
This chapter presents a review of related literature on various aspects of FGM. It lays out a description of the types of FGM practiced globally and in the study area, Nigeria. It also reviews women’s knowledge and attitudes towards FGM as well as other socio-cultural and religious determinants of FGM. Health complications experienced during and after FGM are also highlighted herein.
Types of FGM
The World Health Organization (WHO) classifies FGM into four types depending on the extent of tissue removed (Berg & Underland, 2013). 1.) Type 1(Sunna Type), the mildest of the types, involves partial or total removal of the clitoris and or the prepuce, 2.) Type II (Sunna Kabir) involves partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora. 3.) Type III, (infibulation), is the most extensive involves narrowing of the vaginal orifice with creation of a covering seal by cutting and a positioning the labia minora and or the labia majora, with or without excision of the clitoris (Yasin et al., 2013). WHO (1996) also suggests a fourth form Type 4, which includes unclassified procedures such as cauterization of the clitoris, cutting of the vagina and the introduction of corrosive substances or herbs into the vagina for the purpose of tightening or narrowing it (Pereda, Arch, & Perez-Gonzalez, 2012)
Reasons for the practice of FGM
Traditionally, the arguments that support FGM have been based on cultural, religious and social beliefs within families and communities, although religion actually offers little support and justification for the practice. The reason why the practice of FGM is performed and perpetuated has more to do with social convention, tradition and cultural ideals of communities ( Pereda, Arch, & Perez-Gonzalez, 2012).
Research has shown that in cultures which defend the practice, majority of the most highly educated classes such as university students, continue to believe that it is a religious dictate (77.4% of males and 50% of females), this being especially the case among Muslim students ( Pereda, Arch, & Perez-Gonzalez, 2012). Communities have several reasons as to why they practice FGM. FGM is often described as a means to safeguard against premarital sexual activity and as such prevent promiscuity and preserve virginity. In Kenya, 30% of women supporting continuation of the practice agreed that FGM helped to preserve virginity and avoid immorality, in Nigeria, similar rates of 36% were reported by women, while 45% of men supporting continuation of the practice agreed with this statement (Yirga et al., 2012).
FGM was believed to be proof of a girl’s virginity, thereby improving the marriage prospects of unmarried girls who have undergone the procedure. In Côte d’Ivoire, “improved marriage prospects” was cited by 36% of women favoring continuation of the practice once married. FGM is also believed by some communities to ensure that a woman is faithful and loyal to her husband (Yirga et al., 2012). There are a number of reasons why this practice continues today, including chastity, religion, culture, aesthetics and hygiene and socio-economic factors. Almost all of these are linked to girl’s social status and marriage ability. This all comes down to power over women (Molleman & Franse, 2009).
FGM in Nigeria
The Inter-African Committee on Traditional Practices affecting the health of women and children and WHO have adopted the term FGM because not only is it used as an effective policy and advocacy tool but is also a more apt description of the physical act and extent of injury on the genitalia when the procedure is performed (Berg & Denison, 2013). Although current trends indicate that the practice is becoming less prevalent, as many as 30 million girls under the age of 15 may still be at risk of FGM. In countries where more than 70% of women aged 15-49 years live with FGM for example Eritrea, Ethiopia, Mali and Nigeria, fewer daughters than mothers have been subjected to FGM. Women who underwent FGM are also noted to support continuation of FGM. An example is in Ethiopia where 31% of women believe that the practice should continue (Berg & Denison, 2013). The entire Africa FGM prevalence is illustrated in annex VI, table 1.1. WHO notes that most girls undergo this practice between birth and age 15, but FGM occurs at all ages (Human Rights Watch, 2010). FGM is performed on girls at different ages, but most commonly around the ages of 7 – 10 (The National Education Toolkit for FGM in Australia (NETFA, 2014). Sometimes it is performed on babies and sometimes on women when they are much older. Some sources say that in Nigeria, FGM is carried out on girls between 3 and 8 years of age while other sources set the age range between 4-12 years (Matsuuke, 2011). In some cultures, FGM is used to initiate girls into adulthood and to ensure their marriage ability (Human Rights Watch, 2010; NETFA, 2014).
CHAPTER THREE
RESEARCH METHODOLOGY
Research design
The study adopted a descriptive cross-sectional design. A descriptive cross-sectional study is in which the disease or condition and potentially related factors are measured at a specific point in time for a defined population (National EMSC Data Analysis Resources Center [NEDARC], 2010). A cross-sectional survey collects data to make inferences about a population of interest at one point in time thus a snapshot of the population about which it gathers data (Lavrakas, 2008). The study employed this design to describe socio demographic, knowledge, attitude on women’s health of FGM in Delta State, and effects of socio cultural and religious beliefs in Nigeria at a specific period and establish the relationship between these determinants of FGM and its practice. At the start of the study, assumption was that there was very few cases of women who had not undergone FGM, however, during the study these cases were sampled thus a description of the determinants and FGM practice among both circumcised and uncircumcised women. Therefore, by design the study was not a comparative study.
Variables
The independent variables were socio demographic characteristics, knowledge and attitudes of FGM, socio cultural and religious beliefs and health complications experienced by women who undergone FGM. The dependent variable was FGM practice. To assess women’s knowledge on FGM, women were asked whether they knew what FGM was and to describe what it involved. To assess women’s attitude towards FGM women were asked whether FGM should be stopped, whether it prevents promiscuity and whether uncircumcised women were unclean. To assess FGM practice women were asked whether they had undergone FGM. FGM complications were assessed by asking the women whether they thought FGM had associated health complications.
Study population
The state has an estimated population of 61,140 people as at January 2015 according to Southern regional administration. Women of the reproductive age (15-49 years) compose approximately 23% (14,062) of the population. The target population composed of women of reproductive age who lived within Delta State especially Ethiope East state-ward which has a total of 3,250 households. The study also targeted professional midwives, head nurses and traditional birth attendant as key informants; and women organizations, religious leaders, local authority of the state and youth organizations for the focus group discussions.
CHAPTER FOUR
DATA ANALYSIS AND FINDINGS
Socio demographic characteristics and influence on FGM practice
Majority 125(38.8%) of the circumcised women were aged between 21 and 30 years while most 19(70.4%) of the uncircumcised women were similarly aged between 21 and 30 years. There was a significant association between age and FGM practice (p- value<.001). This implied that there was age difference between circumcised and uncircumcised women.
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATION
Discussion
Heath complications associated with FGM
Majority of the women perceived that FGM was associated with health complications including pain during sexual intercourse; bleeding; pain and difficulties with menstruation; urine retention; birth complications; and infections that can cause infertility, tumor, removal of uterus, urine retention and menstrual pain. Other associated psychological problems include trauma, stress, and family conflict. According to data from SOS Children Hospital abnormal birth rate was at 12.5% (out of 3223 births between May to October 2014), however these complications could not be directly attributed to FGM alone. The severe effects of FGM on the health of girls and women have been widely documented (World Bank, 2004). Similarly, in a study done by Yasin et al. (2013), FGM was associated with a series of health risks and consequences including pain, bleeding, difficult in passing urine, infection, death and hemorrhage. According to the World Bank (2004) long-term consequences of FGM include infibulation cysts, keloid scar formation, damage to the urethra resulting in urinary incontinence, pain during sexual intercourse, sexual dysfunction and difficult in childbirth, difficult menstrual periods among others. Similar complications including bleeding, infection and painful coitus were identified in a study by Dike et al. (2012). According to UNFPA, 2010, FGM has both immediate consequences including severe pain, shock, hemorrhage, tetanus or infection, urine retention, ulceration of the genital region and injury to adjacent tissue, wound infection, urinary infection, fever and septicemia. Hemorrhage and infection can be of such magnitude as to cause death and long-term consequences include anemia, the formation of cysts and abscesses, keloid scar formation, damage to the urethra resulting in urinary incontinence, dyspareunia (painful sexual intercourse) and sexual dysfunction, hypersensitivity of the genital area.
Action taken on health complications associated with FGM
Actions taken by the women to reduce the effects of FGM complications included mainly seeking medication; taking pain killers and community awareness to stop FGM. This finding was similar to that in a study done by Ahmadu (2007) where some of the popular interventions employed to reduce the effects of FGM complications included; health risk information, conversion of exercisers, training of health professionals as change agents, alternative rites programs, and community led approaches, public statements and legal measures. In this study, some women were not advised on what to do about the complications. Apart from self, women were mainly advised on how to handle FGM complications by health workers. Trained staff can recognize and manage the physical, sexual and psychological complications of FGM (World Bank, 2004).
Conclusions
From the study findings and objectives the study concludes as follows:
Uncircumcised women were younger as compared to circumcised women. The education levels among circumcised and uncircumcised women were similar. Most uncircumcised women were single as a result of fewer men being interested in them for marriage. Family type and FGM practice were not associated.
FGM was widely known and practiced in Delta state. The commonly known and practiced FGM types in this state were Type 3 and Type 1. Anti-FGM interventions carried out by women organizations and media in this state although not very popular were succeeding in reducing FGM incidences, however circumcised women were more aware of these interventions than uncircumcised women.
FGM was practiced mainly in Delta State because of cultural and religious reasons such as to keep virginity and to get a husband in future. According to women in this State FGM does not prevent promiscuity; women who have not undergone FGM were perceived to be clean. Sunna circumcision was unsafe. There was a wide support of interventions geared towards stopping FGM since most women in this state call for a stop in all forms of FGM.
Women in Delta State perceive FGM to have associated health complications. The most common health complications associated with FGM experienced by women who have undergone FGM in Delta State included pain, bleeding, difficulties with menstruation, infections and among others. Most women seek medical attention to counter the effects of FGM. Health workers were the main source of health information regarding FGM complications in this state.
Recommendations
From the study objectives and conclusions the study recommends as follows:
- The government of Nigeria should sensitize the public on the illegality of FGMtogether with associated health risks. Specific law against female circumcision should be put in place and initiatives that prohibit the practice
- There is need to strengthen health institutions to properly deal with FGM associated immediate and long-term illness since its prevalence is still high; and to reduce occurrence of abnormal
- Since FGM has been shown to be slowly fading away as indicated by its highprevalence among the old as compared to the young women, there is need to continue with community awareness campaigns to ensure that young women do not continue with the practice especially on their girls. Community awareness should be adopted to reduce the rigidity of men to marry uncircumcised women.
- There is need to engage religious leaders, TBAs and health professionals in theanti-FGM interventions including campaigns. These persons are more influential and strategic in disseminating information that clearly differentiates religious and cultural practices; and also the short and long term health risks associated with
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