Perceptions of the psychological experiences surrounding female genital mutilation/cutting (FGM/C) among the Izzi in Southeast Nigeria

Psychological consequences of female genital mutilation: A mixed-method systematic review

Background

Female genital mutilation (FGM/C) defined as 'all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons' is a cultural practice having several consequences on women's health. Medical and sexual consequences have been documented, but the link between FGM/C and the development of psychological symptoms is not clearly established. The influence of contextual factors is poorly understood.

Objectives

To evaluate the psychological impact of FGM/C and how victims experience it.

Method

A mixed method systematic review was conducted. The inclusion criteria were observational primary studies involving women who had undergone FGM/C and had experienced psychological symptoms. Publication bias was assessed by using the Mixed Methods Appraisal Tool. A configurative strategy that involved a comparison of quantitative and qualitative data was used, followed by an analysis of causal link between FGM/C and induced psychological disorders.

Results

Fourteen studies were included. Post-traumatic stress disorder (PTSD), depression, anxiety and somatisation showed a significantly higher prevalence in women who have experienced FGM/C versus non-mutilated women. Female genital mutilation type II or III were identified as predictors of disorder severity. Qualitative studies showed a significant difference in the perception of FGM/C between immigrant and non-immigrant women, as well as the multidimensional nature of the factors influencing disorders' onsets.

Conclusion

Our study showed a high association of FGM/C (and its degree of severity) with psychological disorders such as PTSD, depression, anxiety and somatisation. It also illustrates contextual factors, including socio-cultural factors that may influence the intensity of these psychological disorders.

Clinical implications

It is important for health professionals to be aware of the psychological consequences of FGM/C and the different factors influencing FGM/C perception. Indeed, a feeling of 'Being abnormal' can be awakened among patients because of health professionals' incorrect behaviours.

Prevalence, knowledge, attitude, motivators and intentional practice of female genital mutilation among women of reproductive age: a community-based analytical cross-sectional study in Tanzania

BACKGROUND

To harmonize and enhance economic growth at the individual, family, community, and national levels, healthy women embody the guardian of family health and a healthy world. They are anticipated to have the freedom to choose their identity in opposition to female genital mutilation in a thoughtful, responsible, and informed manner. Despite restrictive traditions and culture, it is unclear from the available information what exactly would be the drivers of FGM practices in Tanzania from an individual or social perspective. The purpose of this study was to evaluate female genital mutilation among women of reproductive age in terms of its frequency, knowledge, attitudes, and purposeful practice.

METHODS

Three hundred twenty-four randomly selected Tanzanian women of reproductive age were studied using a community-based analytical cross-sectional study design quantitatively. Structured questionnaires from earlier studies that were delivered by interviewers were utilized to gather information from the study participants. The statistical software package Statistical Packages for Social Science was used to examine the data. (SPSS v.23). A 5% significance threshold was used with a 95% confidence interval.

RESULT

A total of 324 women of reproductive age participated in the study with a 100% response rate with a mean age of 25 ± 7.481 years. Findings revealed that 81.8% (n = 265) of study participants were mutilated. 85.6% (n = 277) of women had inadequate knowledge about FGM, and 75.9% (n = 246) had a negative attitude toward it. However, 68.8% (n = 223) of them were willing to practice FGM. Their age (36-49 years) (AOR = 2.053; p < 0.014; 95%CI: 0.704, 4.325), single women (AOR = 2.443; p < 0.029; 95%CI: 1.376, 4.572), never go to school (AOR = 2.042; p < 0.011; 95%CI: 1.726, 4.937), housewives (AOR = 1.236; p < 0.012; 95%CI: 0.583, 3.826), extended family (AOR = 1.436; p < 0.015; 95%CI: 0.762, 3.658), inadequate knowledge (AOR = 2.041; p < 0.038; 95%CI: 0.734, 4.358) and negative attitude (AOR = 2.241; p < 0.042;95%CI: 1.008, 4.503) were significantly associated to practice female genital mutilation.

CONCLUSION

The study observed that the rate of female genital mutilation was significantly high and still, women demonstrated the intention to continue practicing it. However, their sociodemographic characteristic profiles, inadequate knowledge, and negative attitude towards FGM were significantly linked with the prevalence. The private agencies, local organizations, the Ministry of Health, and community health workers are alerted to the findings of the current study to design and develop interventions and awareness-raising campaigns for women of reproductive age against female genital mutilation.

Escaping social rejection, gaining total capital: the complex psychological experience of female genital mutilation/cutting (FGM/C) among the Izzi in Southeast Nigeria

Background

While the deleterious effects of FGM/C on physical health are well documented, the psychological experience of this harmful practice is a neglected area of research, which limits global mental health actions. As FGM/C was a traditional practice in some areas of Nigeria, the study aimed to understand the psychological experience of FGM/C in context.

Methods

This qualitative study was completed in urban and rural Izzi communities in Southeast Nigeria where FGM/C was widely practiced. In-depth interviews were completed with 38 women of the same ethnicity using the McGill Illness Narrative Interview (MINI) to explore the collective psychological experience of FGM/C before, during and after the procedure. The MINI was successfully adapted to explore the meaning and experience of FGM/C. We completed thematic content analysis and used the concepts of total capital and habitus by Bourdieu to interpret the data.

Results

During the period of adolescence, Izzi young women who had not yet undergone FGM/C reported retrospectively being subjected to intense stigma, humiliation and rejection by their cut peers. Alongside the social benefits from FGM/C the ongoing psychological suffering led many to accept or request to be cut, to end their psychological torture. Virtually all women reported symptoms of severe distress before, during and after the procedure. Some expressed the emotion of relief from knowing their psychological torture would end and that they would gain social acceptance and total capital from being cut. Newly cut young women also expressed that they looked forward to harassing and stigmatizing uncut ones, therein engaging in a complex habitus that underscores their severe trauma as well as their newly acquired enhanced social status.

Conclusion

FGM/C is profoundly embedded in the local culture, prevention strategies need to involve the whole community to develop preventive pathways in a participatory way that empowers girls and women while preventing the deleterious psychological effects of FGM/C and corresponding stigma. Results suggest the need to provide psychological support for girls and women of practicing Izzi communities of Southeast Nigeria.

While the deleterious effects of FGM/C on physical health are well documented, we have little knowledge on the psychological experience of this harmful practice. This study aimed to understand the psychological experience of FGM/C in Izzi communities in Southeast Nigeria where FGM/C was widely practiced. In-depth interviews were completed with 38 women from the same ethnic group to explore the collective psychological experience of FGM/C before, during and after the procedure.

Our results found that during adolescence, Izzi girls who had not yet undergone FGM/C reported being subjected to intense stigma, humiliation and rejection by their cut peers. This ongoing psychological suffering led many young women to accept or request to be cut, in order to end their psychological torture. Virtually all women reported experiencing severe distress before, during and after the procedure. Some expressed relief from knowing their psychological torture would end and that they would gain social acceptance and a rise in status from being cut. Newly cut young women also expressed that they looked forward to harassing and stigmatizing uncut ones, therein engaging in a complex behaviour that underscores their severe trauma as well as their newly acquired enhanced social status. Our results suggest that prevention strategies need to involve the whole community to develop preventive pathways in a participatory way that empowers girls and women while preventing the deleterious psychological effects of FGM/C and corresponding stigmatizing behaviour towards the uncut. Results suggest the need to provide psychological support for girls and women of practicing Izzi communities of Southeast Nigeria.

Circumcising daughters in Nigeria: To what extent does education influence mothers' FGM/C continuation attitudes?

Education has been adjudged as an important behavioural change intervention and a key player in combating Female Genital Mutilation/Cutting (FGM/C). An assumed pathway is that it influences FGM/C attitudes. However, empirical evidence that explores this assumption is scarce. Hence, our study examines whether the associative effect of FGM/C continuation attitudes on circumcision of daughters is influenced by the level of a mother's education in Nigeria. We extracted data from the 2018 Nigeria Demographic and Health Survey (NDHS). The study focused on youngest daughters that were born in the last five years preceding the survey. A sample of 5,039 children with complete data on variables of interest to the study were analysed. The main outcome variable for this study is "circumcision among youngest daughters". The key explanatory variables were maternal "FGM/C continuation attitudes" and "education". At 95% confidence interval, we conducted a two-level logistic regression modelling and introduced interaction between the key independent variables. In the study's sample, the prevalence of FGM/C was 34%. It was lower for daughters whose mothers had higher education (12%) and believe FGM/C should discontinue (11.1%). Results from the multivariate analysis show statistically significant odds of circumcision for a daughter whose mother has had higher education and believes FGM/C should discontinue (OR-0.28, 95%CI: 0.08-0.98). For women who believe FGM/C should discontinue, the probability of daughter's circumcision reduced by 40% if the mother has attained higher education. Among those who believe FGM/C should continue, the probability of daughter's circumcision worsened if the mother had attained higher education (64%), however, this result was influenced by mothers' experience of circumcision. Education influences FGM/C attitudes, nonetheless, women's cutting experience can be a conduit for which the practice persists. Promoting female education should be accompanied by strong political commitment towards enforcing laws on FGM/C practice.

FGM and Restorative Justice-A Challenge for Developing Countries and for Refugee Women

Female Genital Mutilation (FGM) has been identified as one of the most serious human rights violations women are exposed to in many countries, in spite of national and international efforts. The actual implementation of preventive strategies and support of victims faces a number of challenges that can only be addressed by an interdisciplinary approach integrating public health and legal considerations. FGM in the context of women as refugees who left their country to escape FGM has rarely been covered in this context. This article summarizes the most important international standards and initiatives against FGM, highlights the medical, legal, and psychological factors identified so far, and explores the interdisciplinary considerations in changing a country and society to permit safe return of those escaping FGM to third countries and support public health in the country.

Experiences of young women who underwent female genital mutilation/cutting

AIM AND OBJECTIVES

To describe the FGM/C experiences of young women living in Nigeria.

BACKGROUND

Globally, several activities have been targeted at ending female genital mutilation/cutting (FGM/C). However, the practice is ongoing, especially in countries such as Nigeria, which is reported to be having a population boom. Therefore, there is a need to investigate the FGM/C experiences of young women in such countries so that efforts towards ending it can be accelerated using evidence-based, community-led interventions.

DESIGN

A qualitative descriptive design.

METHODS

The study took place in two states of south-eastern Nigeria with a high prevalence of FGM/C. The snowball sampling method was used to recruit 22 women, aged 20-40, who had undergone FGM/C. Participant's experiences were explored through semi-structured interviews, and the qualitative content analysis was used for data analysis. The consolidated checklist for reporting of qualitative studies guided the reporting of this study.

FINDINGS

Three themes and seven subthemes emerged from the data. The themes were as follows: cultural issues, life as a circumcised woman and the future with FGM/C. Half of the participants could not recall their experiences on the day of their circumcision, as they were circumcised at infancy. However, those who were older when circumcised experienced it as a painful, traumatic experience forced upon them. Some of the participants experienced sexual and childbirth problems due to this procedure, and this was of great concern to them.

CONCLUSION

Female genital mutilation/cutting was a traumatic experience forced on the participants. They felt helpless as they could not choose and had to do the "right thing." Despite the trauma and complications caused by the cutting, some still supported the continuation of the practice.

RELEVANCE TO CLINICAL PRACTICE

Understanding the experiences of genitally mutilated women could assist healthcare practitioners in rendering quality, and contextualised services to these women.