Prevalence and belief in the continuation of female genital cutting among high school girls: a cross - sectional study in Hadiya zone, Southern Ethiopia

BACKGROUND

Female Genital Cutting is a cultural practice among many ethnic groups in Ethiopia that has affected many girls over the past centuries. Although the trend is slowly decreasing in Ethiopia, the magnitude is still very high as the procedure has no known benefit but has many consequences. The objective of this study was to assess the prevalence and belief in the continuation of FGC among High School Girls in Hadiya Zone.

METHODS

A cross-sectional quantitative survey was carried out among high school girls in Hadiya Zone from January to February 2011. A multi-staged cluster sampling method was used for sample selection. In total, 780 girls completed a self-administered questionnaire for this study. Statistical analysis was done using bivariate and multivariate logistic regression.

RESULTS

Of 780 high school girls, 82.2% were circumcised at a mean age of 11(±2.3) years. Half of the total participants responded that FGC was being practiced in their village. About 60% of the circumcisions were performed by traditional circumcisers while health professionals had performed 30% of them. A few of the circumcised girls (9.4%) supported their status as a circumcised girl, but only 5% believe in the continuation of FGC. The odds of being cut was higher among girls whose fathers and mothers had educational status under high school level (AOR = 2.04; 95% CI: 1.25, 3.09) and (AOR = 1.84; 95% CI: 1.01, 3.38) respectively when compared to those whose parents had attended high school and above. The odds of believing in the continuation of FGC was 2.33(95% CI: 1.01, 5.33) times higher among those who responded that FGC was practiced in their areas.

CONCLUSION

While there is an urgent need to stop the practice of FGC in Hadiya Zone, cultural beliefs related to the hygiene of female genitalia and other social factors contribute to sustaining the practice. Local organizations in collaboration with religious institutions and community leaders should work together to engage in a process of change within the entire community by arranging awareness creation programmes on the harmfulness of the practice especially in the rural areas of the zone.

"It is important to know that before, there was no lawalawa." Working to stop female genital mutilation in Tanzania

This article is about efforts to unearth the facts about a myth in Tanzania about lawalawa, and the use of female genital mutilation (FGM) by some Tanzanian ethnic groups to cure lawalawa. The term lawalawa, used to describe certain vaginal and urinary tract infections, appeared soon after 1968, following the ban on FGM in the Arusha Declaration, and is still used today. When working with these ethnic groups on the subject of eliminating FGM, one always hears about lawalawa. Today, the arguments for using FGM to cure lawalawa are used not only in relation to small children, but also adolescent girls and boys. Lawalawa is not always limited to vaginal and urinary tract infections, but sometimes also when girls or boys have a fever for other reasons. This article is based on information from the continuous work against FGM in 45 villages by the Singida and Dodoma chapters of the Inter-African Committee on Traditional Practices, Tanzania, from 2003 through 2012. The lesson we have learned is that the only way of eliminating FGM is to accept lawalawa as a fact and to give information and counselling. Only in this way, and not by force, will it be possible to break the connection between lawalawa and FGM.

A tradition in transition: factors perpetuating and hindering the continuance of female genital mutilation/cutting (FGM/C) summarized in a systematic review

Understanding the forces underpinning female genital mutilation/ cutting (FGM/C) is a necessary first step to prevent the continuation of a practice that is associated with health complications and human rights violations. To this end, a systematic review of 21 studies was conducted. Based on this review, the authors reveal six key factors that underpin FGM/C: cultural tradition, sexual morals, marriageability, religion, health benefits, and male sexual enjoyment. There were four key factors perceived to hinder FGM/C: health consequences, it is not a religious requirement, it is illegal, and the host society discourse rejects FGM/C. The results show that FGM/C appears to be a tradition in transition.

Labia minora elongation as understood by Baganda male and female adolescents in Uganda

Labia minora elongation is a common traditional female genital modification practice among the members of the Baganda ethnic group in Uganda. In 2002, a study carried out by the Padua Working Group on Female Genital Mutilation analysed how Baganda girls residing in Wakiso District graphically represented their experiences of labia minora elongation. In the present study, using the same methodology and in the same geographic setting 10 years later, we asked young men and women to prepare graphical representations of this rite. The purpose was to learn about how the practice is perceived and represented, describing the differences found in their testimonies, and comparing the findings with the former study. A total of 36 respondents (21 male and 15 female), aged between 9 and 15 years old participated in the study. The drawings were analysed using a three-themes analysis frame with a focus on setting, subject and operator. Differences were detected between how young women and men represented this practice. Educational interventions may be helpful to address the doubts, concerns, anxieties and misconceptions that Baganda youth may have concerning traditional genital practices.

Prevalence and determinants of the practice of genital mutilation of girls in Khartoum, Sudan

BACKGROUND

Female genital mutilation (FGM) is widely practised in Sudan, despite many decades of attempts to prevent it.

AIMS

To estimate the prevalence of FGM, identify the types performed in Khartoum and investigate whether FGM is associated with various social factors.

METHODS

Girls aged 4-9 years (n=255) presenting to a paediatric emergency ward were recruited. A detailed history was obtained and full examination, including inspection of the genitalia, was performed to verify the type and extent of FGM.

RESULTS

Twenty per cent of the study group had undergone FGM, 50% of guardians indicated that it would be done later, and 29% stated that the child would not undergo FGM. In 66% of those who had undergone FGM, it was WHO type III. All operations had been performed by health professionals, mainly midwives. Those who had allowed or intended to allow their daughters to undergo FGM were of significantly lower socio-economic status (p=0.0008) and had spent significantly fewer years in school (both mothers, p=0.0015, and fathers, p=0.0266) than those who had not/would not. All who had undergone FGM were Muslims. None of the 16 Christians had undergone FGM. In girls over 7 years of age, there was a higher risk of having FGM in those who attended school than in those who did not.

CONCLUSION

FGM is still practised widely in Khartoum and probably in many parts of northern Sudan and the type undertaken is often the most severe. Parental education, socio-economic level and religion are important determinants of the practice, but social pressure on parents and girls seems to play an important role.

Female genital cutting: an evidence-based approach to clinical management for the primary care physician

The United States has more than 1.5 million immigrants from countries in Africa and the Middle East where female genital cutting (FGC) is known to occur. Often, FGC occurs in infancy and childhood in the countries where it is practiced, but patients of any age can present with complications. Lack of understanding of this common problem can potentially alienate and lower quality of care for this patient population. We provide an introduction to the practice of FGC and practice guidelines for the primary care physician. We reviewed original research, population-based studies, and legal research from PubMed, Scopus, CINAHL plus, PsycINFO, and Legal Trac. The terms searched included female genital cutting, female genital circumcision, and female genital mutilation alone and with the term complications or health consequences; no limit on date published. Legal databases were searched using the above terms, as well as international law and immigration law. Editorials and review articles were excluded. This review discusses the different types of FGC, important cultural considerations for physicians caring for patients with FGC, the common early and late medical complications and their management, and psychosocial issues associated with FGC. Current laws pertaining to FGC are briefly reviewed, as well as implications for patients seeking asylum status in the United States because of FGC. Finally, the article presents evidence-based, culturally sensitive approaches to discussions of FGC with girls and women for whom this is an issue.

Perception and practice of female genital cutting in a rural community in southern Nigeria

This study was carried out to determine the awareness and practice of FGC in a rural community in southern Nigeria. A cross sectional study was carried out among Ayadehe women in Itu, LGA Akwa Ibom State, Nigeria using a semi-structured interviewer administered questionnaire. Information obtained was analysed using SPSS version 17. A total of 218 respondents participated in the study. Majority, 215 (98.6%) were aware of the practice of FGC. Type 2 FGC was the commonest type reported by 71.2% of respondents. Prevalence of FGC was 92.7%. A total of 69.8% were circumcised at 6-12 years. Health complications experienced included excruciating pains, (36.6%), severe bleeding, (15.8%), and painful urination, (26.7%). Up to 53.5% were circumcised by traditional birth attendants. The belief that FGM should be discontinued increased with educational level. The practice of FGC was high in this community. Increased female education, community involvement and legislation are needed to reduce this practice.

Public health, cultural norms and the criminal law: an inconvenient union? A case study of female genital cutting

Social and cultural stereotypes held about women and their health needs constitute a significant barrier to the enforcement of laws protecting women's health. While the promulgation of remedial legislation to address the problem is a positive step towards protecting women's health, these laws are promulgated in a cultural milieu that remains unwelcoming to women's rights. The clash between long-held cultural perceptions and health laws, such as those affecting women's reproductive health, engenders more problems for women's health because the laws sometimes fail to produce the desired behavioural changes. This paper attempts to debunk the uncritical assumption that legislative reforms without more are positive instruments of change in protecting women's health. In outlining this thesis, the paper examines the legal prohibition of Female Genital Cutting ('FGC') as a case study. To determine whether FGC prohibition laws are likely to be effective in achieving the public health agenda of protecting women's health, the paper analyzes FGC laws against the normative and instrumental theories of legal compliance, as well as against the socio-cultural worldviews underlying the practice. It concludes that legislative efforts to protect women's health may remain ineffective without structured efforts between health systems, governments or legal institutions and the cultural society.

Successful cultural change: the example of female circumcision among Israeli Bedouins and Israeli Jews from Ethiopia

Female genital mutilation (FGM) is practiced in many areas of the world, including the Middle East, Africa and Australia. Although it is most common in Muslim populations it is not a dictate of Islam. In the 1980s this practice was reported among Bedouin tribes, originally nomadic, in the southern area of Israel. Almost all of the women interviewed in the first study intended to continue the practice by performing FGM on their daughters including educated women who were teachers, dental assistants or university students. A second study was therefore done based in the obstetrical clinic where only women from tribes reporting to undergo FGM were examined for signs of FGM by an experienced gynecologist, in the presence of an Arabic-speaking female nurse and translator, as part of a gynecologic examination that was indicated for other reasons. In no cases was clitoridectomy or any damage to the labia found. All women had a small scar from a 1cm. incision somewhere on the labia or prepuce of the clitoris. this study concluded that the importance of the ritual in this population was unrelated to its severity. the ritual had apparently become over time a small symbolic scar, even though this population continued to believe in its importance. By contrast, a group of Ethiopian Jews who had immigrated to Israel was interviewed by an Amharic translator, and examined during routine gynecological examination in the same manner as the Bedouin group above. In Ethiopia, FGM is universal among Christian, Muslim and Jewish groups. All women interviewed reported that FGM was universal in Ethiopia, but none intended to continue this practice with their daughters. All stated that this was a practice that would be left behind in their country of origin. On physical examination many of the women had amputation of the clitoris. The conclusion of this study was that the severity of the operation performed had no relation to the social and cultural adherence to the operation, since the Ethiopian Jews who practiced a more severe form of the operation intended to abandon this practice while the Muslim Bedouin who had a much milder form intended to continue it. A follow-up study in 2009 of the Bedouin population of southern Israel has found that FGM had disappeared, both by self-report of women under the age of 30, and by physical examination of women under the age of 30 in an obstetrical clinic. These results suggest an optimistic approach toward cultural change involving unhealthy cultural practices and emphasize the importance of cognitive approaches to cultural change.

Coping and chronic psychosocial consequences of female genital mutilation in The Netherlands

OBJECTIVE

The study presented in this article explored psychosocial and relational problems of African immigrant women in The Netherlands who underwent female genital mutilation/cutting (FGM/C), the causes they attribute to these problems--in particular, their opinions about the relationship between these problems and their circumcision--and the way they cope with these health complaints.

DESIGN

This mixed-methods study used standardised questionnaires as well as in-depth interviews among a purposive sample of 66 women who had migrated from Somalia, Sudan, Eritrea, Ethiopia or Sierra Leone to The Netherlands. Data were collected by ethnically similar female interviewers; interviews were coded and analysed by two independent researchers.

RESULTS

One in six respondents suffered from post-traumatic stress disorder (PTSD), and one-third reported symptoms related to depression or anxiety. The negative feelings caused by FGM/C became more prominent during childbirth or when suffering from physical problems. Migration to the Netherlands led to a shift in how women perceive FGM, making them more aware of the negative consequences of FGM. Many women felt ashamed to be examined by a physician and avoided visiting doctors who did not conceal their astonishment about the FGM.

CONCLUSION

FGM/C had a lifelong impact on the majority of the women participating in the study, causing chronic mental and psychosocial problems. Migration made women who underwent FGM/C more aware of their condition. Three types of women could be distinguished according to their coping style: the adaptives, the disempowered and the traumatised. Health care providers should become more aware of their problems and more sensitive in addressing them.

Clinical issues in refugee healthcare: the Somali Bantu population

With an estimated 803,500 refugees residing in the United States, many NPs will encounter patients who do not speak, read, or understand English. Many of these patients have challenging health issues such as parasitic diseases and chronic or acute diseases not commonly seen in the United States and NPs will need to be prepared for these challenges.

Female genital mutilation: applications of nursing theory for clinical care

Female genital mutilation (FGM) is a continuing practice among some immigrant groups. As mobility increases among this population, NPs in primary care will continue to see women who have experienced FGM. NPs must gain a better understanding of the practice in order to provide optimal, culturally appropriate clinical care.

Religious differences in female genital cutting: a case study from Burkina Faso

The relationship between religious obligations and female genital cutting is explored using data from Burkina Faso, a religiously and ethnically diverse country where approximately three-quarters of adult women are circumcised. Data from the 2003 Burkina Faso Demographic and Health Survey are used to estimate multilevel models of religious variation in the intergenerational transmission of female genital cutting. Differences between Christians, Muslims, and adherents of traditional religions are reported, along with an assessment of the extent to which individual and community characteristics account for religious differences. Religious variation in the intergenerational transmission of female genital cutting is largely explained by specific religious beliefs and by contextual rather than individual characteristics. Although Muslim women are more likely to have their daughters circumcised, the findings suggest the importance of a collective rather than individual Muslim identity for the continuation of the practice.

Elongation of labia minora in Uganda: including Baganda men in a risk reduction education programme

Okukyalira ensiko or 'visiting the bush' is how, in Uganda, the Baganda people name the practice of elongating the labia minora, which young girls start performing before menarche. As a mandatory rite of passage that identifies membership of the tribe, one of its main purposes is to enhance sexual pleasure for both male and female partners. The conditions in which it is practiced involve certain physical health risks. In this qualitative study carried out in Wakiso district, a semi-structured interview was conducted among 31 Baganda men, in order to understand their perceptions, attitudes and knowledge toward the way in which their daughters practise labia minora elongation. According to our results, men highly value this practice for its capacity to enhance sexual stimulation even though they are aware of its risks. Since genital stretching is likely to endure, the authors discuss the possibility of addressing Baganda men by health workers in an education programme aimed at minimising the risks attached to the procedure and, hence, improving the sexual and reproductive health of Baganda girls.

Female Genital Mutilation: Cultural Awareness and Clinical Considerations

Clinicians in the United States are increasingly encountering girls and women who have undergone female genital mutilation. To foster a more trusting relationship with such patients, health care providers must have an accurate understanding of the cultural background surrounding this practice, a working knowledge of the different types of female genital mutilation procedures that may be encountered, and an awareness of both the acute and long-term complications. Some of these complications are potentially fatal, and the correct clinical diagnosis can be lifesaving.

Female genital mutilation: medico-legal issues

The rising prevalence and severe impact of HIV/AIDS in relation to women still persists in South Africa. Both economically and socially the HIV/AIDS pandemic strikes women the hardest, with disadvantaged black women mainly at risk of higher infection. The theoretical framework of this paper focuses on the connection between HIV/AIDS, sexual inequalities and sexual violence, and more precisely, female genital mutilation, a cultural practice and custom which amplifies women's exposure to HIV. Pertinent to this focus is inescapably an analysis of apparent threats to precise essential human rights as a result of the continued use of the practice of female genital mutilation in South Africa.