Prevalence and risk factors of female genital mutilation in Egypt: a systematic review

Female genital mutilation: trends, economic burden of delay and basis for public health interventions

BACKGROUND

The practice of female genital mutilation (FGM) is a health and social problem. Millions of girls and women have undergone FGM or will soon, and more information is needed to effectively reduce the practice. The aim of this research is to provide an overview of the FGM trendlines, the inequality of its prevalence, and the economic burden. The findings shed light on 30-year trends and the impact of the pandemic on planned efforts to reduce FGM which helps with public health interventions.

METHODS

Temporal trend analysis, and graphical analysis were used to assess the change and inequality over the last 30 years. We included 27 countries in which FGM is prevalent. We calculated the extra economic burden of delayed interventions to reduce FGM like COVID-19.

RESULTS

For the 27 countries analyzed for temporal trendlines, 13 countries showed no change over time while 14 had decreasing trends. Among the 14, nine countries, Uganda, Togo, Ghana, Benin, Kenya, Nigeria, Central African Republic, Chad, and Ethiopia had high year-decrease (CAGR - 1.01 and - 10.26) while five, Côte d'Ivoire, Egypt, Gambia, Djibouti, and Mali had low year-decrease (CAGR>-1 and < 0). Among these five are the highest FGM prevalence similar distribution regardless the wealth quintiles or residence. There is an economic burden of delay or non-decline of FGM that could be averted.

CONCLUSION

Findings indicate that some countries show a declining trend over time while others not. It can be observed that there is heterogeneity and homogeneity in the FGM prevalence within and between countries which may indicate inequality that deserves further investigation. There is considerable economic burden due to delays in the implementation of interventions to reduce or eliminate FGM. These insights can help in the preparation of public health interventions.

Prevalence and drivers of female genital mutilation/cutting in three coastal governorates in Yemen

BACKGROUND

Female genital mutilation/cutting (FGM/C), a violation of human rights, remains common in the coastal areas of Yemen.

OBJECTIVE

This study aimed to identify the prevalence of FGM/C and its risk factors among the youngest daughters in families in the Yemeni coastal areas, as well as the knowledge and attitudes of the local population towards FGM/C.

METHODS

A cross-sectional survey was conducted among 646 women and 345 men from six districts in three Yemeni coastal governorates between July and September 2020 using a structured questionnaire. Categorical data were described by proportion. The chi-square test was used to identify factors associated with FGM/C. All factors with a p-value of ≤ 0.05 were included in the multivariate analysis. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated in the multivariate logistic regression analysis.

RESULTS

The prevalence of FGM/C in Yemeni coastal areas was 89.0% (95% CI 84.0%-92.5%) among women and 79.8% (95% CI 73.5%-84.8%) among the youngest daughters in the surveyed families. Nearly two-thirds of women and half of the men recorded a poor knowledge level about the harms of FGM/C. Furthermore, almost two-thirds of both women and men would like to continue the practice of FGM/C. Among women, significant predictors of FGM/C among youngest daughters included advanced maternal age of ≥ 40 years (AOR 7.16, 95% CI 2.73-18.76), mother's desire to continue FGM/C (AOR 8.07, 95% CI 3.64-17.89), and living in a rural area (AOR 3.95, 95% CI 1.51-10.30). Daughters of mothers who did not undergo FGM/C were more protected from FGM/C than those whose mothers had undergone FGM/C (AOR 0.04, 95% CI 0.02-0.09). Among men, the father's desire to continue FGM/C (AOR 15.10, 95% CI 6.06-37.58) was significantly associated with FGM/C among the youngest daughters.

CONCLUSION

This study confirmed that FGM/C is still prevalent among communities in Yemeni coastal areas. Thus, community-based interventions with a focus on the rural population are vital to improving the awareness of various harms of FGM/C.

Exploring the association between perceived male attitudes and female attitudes toward the discontinuation of Female Genital Mutilation/Cutting in Egypt

Introduction

There are 200 million girls and women alive worldwide that have undergone the practice of Female Genital Mutilation/Cutting (FGM/C) and 4 million girls are at risk of undergoing the practice each year. FGM/C provides no known health benefits, while puts a plethora of medical, psychological, and sexual health risks into perspective. One of the countries where the prevalence of FGM/C is the highest in the World, even though local authorities legally banned the practice in 2008, is Egypt. Within the Egyptian context, there are several complex socioeconomic, religious, and cultural drivers that influence the familial decision making of the daughters being cut. Female attitudes hold great significance in the process, because mothers and female family members are typically the prime decision makers at the daughter's circumcision. However, whilst FGM/C is often performed to enhance marriageability and address male preferences, in practicing communities there is little to no open communication between men and women about the practice, making women rely on their perceptions on FGM/C related expectations of men. Even though the connection between female and perceived male attitudes toward the discontinuation was established almost 20 years ago, since then to our knowledge little is known about the further characteristics of this association. Therefore, this study aims to explore the association between female and perceived male attitudes within families of a younger cohort and moreover attempts to provide a more layered picture of it within different levels of education.

Methods

To explore the relation between female and perceived male attitudes toward the discontinuation of FGM/C we conducted a 3-step binary logistic regression model.

Results

Our results show that women are significantly less likely to favor a continuation of FGM/C if they think men are disapproving of the practice, compared to women that think men want it to continue. The strength of this association partially varies between the different levels of education as it is less pronounced at the level of secondary education, compared to the reference group.

Discussion

In alignment with previous findings in the literature, women were more likely to support the discontinuation of FGM/C if they believed that men want the practice to discontinue as well and vice versa. At a higher level of secondary education however this association is less pronounced. This result concludes that the role of perceived male attitudes should be an important factor associated with female ones and studied further, and underlines the importance of education in women empowerment.