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

Girls at risk: FGM intentions among in-school adolescents of a rural community in Osun State, Nigeria

PURPOSE

Knowledge of adolescents' intention to sustain female genital mutilation (FGM) practice is required to guide efforts to eradicate FGM in Africa and Asia where about 200 million women are affected. Nigeria has one of the highest FGM cases in the world. The study sought to determine the knowledge, attitude, and intentions of adolescents to sustain FGM practice when they become parents.

MATERIALS AND METHODS

This study is a cross-sectional descriptive survey of 195 in-school adolescents aged 14-19 years, in Imesi-Ile, a rural town in South-west Nigeria selected through a multistage sampling method.

RESULTS

Overall, 44.6% of adolescents had good knowledge of FGM, while 44.6% had a positive attitude and 55.4% had a negative attitude towards FGM. More females (57.4%) have a negative attitude towards FGM. About 42.1% of adolescents intend to continue the practice of FGM, while 47% have no intentions and 10.8% remain undecided. Gender, age group and family affluence were not statistically associated with intention to continue FGM.

CONCLUSION

Intention to continue FGM practice is high among adolescents in the rural community. FGM eradication campaign among adolescents should seek to improve knowledge, attitude and intentions towards FGM practice.

Determinants of Disagreement with Female Genital Mutilation Among Mothers

Aim

Female genital mutilation (FGM) is widely practiced in Somalia. Limited data are available on the attitude of the Somalia community regarding FGM. The present study aimed to explore the attitude of mothers toward the practice of FGM.

Methods

A cross-sectional study was conducted from March to July 2021 among mothers attending outpatient clinics at a tertiary referral hospital in Mogadishu, Somalia.

Results

A total of 247 participants were included, 65.2% of whom believed this practice should be continued. The most cited reason reported regarding FGM was a requirement for religion (90.7%). About 73.9% of mothers stated that the most cited reason reported regarding the abandonment of FGM was health complications. About 59.8% of the study participants thought that FGM could be stopped through education. The results revealed that women who graduated from primary school (OR: 2.21; 95% CI: 1.090-4.51), who had no social media account (OR: 2.305; 95% CI: 1.147-4.633), and women who were circumcised by a traditional birth attendant (OR: 4.55; 95% CI: 1.57-13.22) were more likely to think that FGM should be continued compare with their counterparts.

Conclusions

We found that mothers who were less educated, had no social account and those circumcised by a traditional birth attendant had more positive attitudes toward FGM.

Behavioral Barriers to Stop Female Genital Mutilation/Cutting in South Ethiopia: An Exploratory Qualitative Study of the Perspective of Women

Background

Female genital mutilation or cutting (FGM/C) is an act that violates the rights of girls and women and causes serious medical complications. Approximately 200 million women have undergone circumcision in 31 countries. Ethiopia, in particular, has the largest number of women who undergone FGM/C. Unfortunately, there has been minimal research into the reasons for this high prevalence in the country. Hence, this study has been conducted to explore behavioral barriers to stopping FGM/C in Southern Ethiopia.

Methods

An exploratory qualitative study was employed from October to November 2021 in two purposively selected zones of Southern Ethiopia. A purposive sampling technique was used to select respondents from the two zones. A total of fourteen study participants were selected and interviewed in-depth to obtain responses from various perspectives. A thematic content analysis was conducted to analyze the data collected from the field.

Findings

The study revealed that FGM/C is widely practiced in the study area. Respondents were found to have poor awareness and positive attitude towards continuation of FGM/C. This is possibly due to the social and cultural acceptability of the practice and influences from peers, families, future marriage partners and the community. The study shows that women are more likely to be circumcised because they want to be respected by their community, to be considered eligible for marriage and to avoid stigma and discrimination.

Conclusion

The continued practice of FGM/C was in considerable state to require the development of intervention strategies in order to eliminate it by 2030. The study’s findings recommend stronger legal actions against those who perform FGM/C, alongside behavior change communication interventions, to improve awareness of its risks and encourage the community to stop FGM/C.

Factors associated with female genital mutilation: a systematic review and synthesis of national, regional and community-based studies

BACKGROUND

This systematic review aimed to identify and describe the factors that influence female genital mutilation/cutting (FGM/C).

METHODS

Searches were conducted in Medline, PsycInfo, Web of Science, Embase and the grey literature from 2009 to March 2020 with no language restrictions, using related MESH terms and keywords. Studies were included if they were quantitative and examined factors associated with FGM/C. Two researchers independently screened studies for inclusion, extracted data and assessed study quality. The direction, strength and consistency of the association were evaluated for determinants, presented as a descriptive summary, and were disaggregated by age and region.

RESULTS

Of 2230 studies identified, 54 published articles were included. The majority of studies were from the African Region (n=29) followed by the Eastern Mediterranean Region (n=18). A lower level of maternal education, family history of FGM/C, or belonging to the Muslim religion (in certain contexts) increased the likelihood of FGM/C. The majority of studies that examined higher paternal education (for girls only) and living in an urban region showed a reduced likelihood of FGM/C, while conflicting evidence remained for wealth. Several studies reported that FGM/C literacy, and low community FGM/C prevalence were associated with a reduced likelihood of FGM/C.

CONCLUSIONS

There were several characteristics that appear to be associated with FGM/C, and these will better enable the targeting of policies and interventions. Importantly, parental education may be instrumental in enabling communities and countries to meet the Sustainable Development Goals.

Predictors of uncircumcised primary school girls’ intention to genital cutting in South Ethiopia: Application of theory of planned behavior

Background

Female genital cutting (FGC) is still among the most common harmful traditional practices, especially in Africa and Asia. Despite the existence of rich evidence on the prevalence of FGC, information about the primary target audiences’ (girls’) intention toward FGC is limited. Therefore, this study aimed to identify the predictors of primary school girls’ behavioral intention toward female genital cutting.

Methods

An institution-based cross-sectional study was conducted from May 08 to 28, 2019 in Dunna district, South Ethiopia. A two-stage sampling technique was used to select 354 uncircumcised female students. A self-administered pre-tested structured questionnaire was used for data collection. Data were entered into Epi data manager version 4.0.2 and exported to STATA version 16.0. Descriptive analyses such as frequency, percentage, mean and standard deviation were performed as necessary. Univariable and multivariable linear regression analyses were conducted to identify predictors of primary school girls’ intention to experience FGC.

Results

The mean age of the respondents was 13.09±1.69 years with an age range of 10 to 18 years. Of the 354 respondents, 156 (44.1%) intended to experience FGC. The model accounted for 76.58% of the variance in primary school girls’ intention to experience FGC. Among socio-demographic characteristics, mothers’ educational level of ≤8 grade (β = 1.95, p<0.001) and the age of the respondents (β = -0.23, p = 0.036) predicted primary school girls’ intention toward FGC. Among the constructs of the theory of planned behavior (TPB), direct perceived behavioral control (β = 0.47, p = 0.015), indirect perceived behavioral controls (β = 0.05, p = 0.002), and direct subjective norms (β = 0.18, p = 0.039) predicted primary school girls’ intention to experience FGC.

Conclusions

In this study, we found that primary school girls’ intention toward FGC was high. The educational level of mothers and the age of the respondents had a great influence on primary school girls’ intention to experience FGC. Perceived lack of power and social pressure also predicted primary school girls’ intention to engage in genital cutting. The findings suggest that FGC is mainly performed by the decision of the parents irrespective of the girls’ preferences. Therefore, behavioral change communication interventions such as media campaigns, peer education and community dialogue guided by the TPB for empowering girls to confront FGC and reducing the influence of referents need to be focused.

Attitudes toward Female Genital Mutilation/Circumcision: A Systematic Review and Meta-Analysis

Background: Understanding the attitudes toward FGM/C held by people who have been involved in this practice can lead to more active interventions to prevent this harmful practice. In order to achieve this, a systematic review was performed on scientific articles. Methods: Electronic databases (PubMed, Scopus, and Science Direct) were examined to identify articles. Results: Our initial search resulted in 3013 articles, of which 40 articles with estimations of attitudes toward FGM/C were reviewed. The results indicate that the random-effects pooled estimation of negative attitudes toward FGM/C practice was 53% (95% CI 47–59; p < 0.001). Furthermore, the pooled estimation of attitudes toward the decision not to circumcise young daughters was 63% (95% CI 46–80; p < 0.001). Conclusion: Despite the increased awareness and efforts to ban FGM/C in many countries around the world, our review demonstrates that positive attitudes toward FGM/C are still far from being eradicated and have hardly changed in the past years. This issue reflects deeply rooted cultural and social concerns of health care professionals with regard to continuing the practice. The authors believe that circumcised women can play a key role in encouraging the abandonment of FGM/C through educational and cultural campaigns.

Investigation of Prevalence and Complications of Female Genital Circumcision: A Systematic and Meta-analytic Review Study

OBJECTIVE

The present study was conducted to investigate the complications of circumcision and determine its prevalence in the studied areas.

METHODS

In this study, the electronic databases of Scopus, PubMed, SID, Web of Science and Magiran were selected to search the total population of observational studies published in Persian and English on the prevalence and circumcision complications in girls. The keywords searched for this purpose were as follows: female genital mutilation, Infibulations, Epidemiologic Methods, Clitorectomies, Female Circumcision, Clitorectomy, Clitoridectomy Complications, Prevalence, associated disease, coexistent conditions, and sequels associated with concomitant conditions, and coexistent disease and their Persian equivalent words. Prevalence estimates of all studies were pooled using a random-effects model at a confidence level of 95%. The bias in the published results of the studies and any reporting errors were examined using Begg and Egger's statistical tests. Out of 3756 studies, 45 articles were included in the study after excluding irrelevant and repetitive articles.

RESULTS

After reviewing the articles in this field, it was determined that female genital mutilation has sexual complications, problems during childbirth, physical and psychological complications. The prevalence of female genital circumcision in the world and Iran in the study areas was obtained using the random effect model, which was estimated to be 61% (95%, CI = 0.49, 0.73) and 61% (95%, CI = 0.52, 0.70), respectively. In other areas, the prevalence was reported to be close to zero. In total, among different countries of the world, of the 207,709 participants surveyed, 110,596 had undergone female genital circumcision (110,596 of 207,709).

CONCLUSION

The effects of female genital mutilation on girls are high and require government intervention in various countries.

Prevalence of female genital mutilation among women in Ethiopia: A systematic review and meta-analysis

Background

Female genital mutilation affects the social, psychological, spiritual and physical well-being of women. In Ethiopia, studies regarding the female genital mutilation were conducted in various settings and years.

Objective

This systematic review and meta-analysis was aimed to summarize the prevalence of female Genital Mutilation in Ethiopia.

Methods

A systematic search of articles was conducted in PubMed, African Journals Online (AJOL), Excerpta Medica database (EMBASE), SCOPUS, Web of Science, and JSTOR. Data were extracted using a standardized data extraction format prepared in Microsoft Excel. The data were analyzed using STATA version 11 software. Cochrane Q statistic was used to assess the presence of significant between-study heterogeneity. I² was used to quantify between-study heterogeneity. A leave-one-out sensitivity analysis and subgroup analysis based on a study period and setting were done. The funnel plot and Egger's regression tests were used to measure the presence of substantial publication bias. The pooled estimated prevalence of female genital mutilation was conducted using a DerSimonian and Laird random effects model.

Results

The pooled prevalence estimate of FGM was 77.28% (95% CI: 55.81, 98.76). The pooled prevalence was higher in studies conducted from 2013-2017 (78.39%, 95%CI: 48.24, 108.54) and studies conducted in Hospital (92.02: 95%CI: 55.81, 98.76).

Conclusion

The prevalence of Female Genital Mutilation is high. Therefore, interventions that are focused on health education, social support and advocacy are recommended.

Pupil's perspectives on female genital cutting abandonment in Harari and Somali regions of Ethiopia

BACKGROUND

Female Genital Cutting (FGC) is a harmful traditional practice that affects the physical and mental health of girls and women in many ways. In Ethiopia, although both governmental institutions and None-Governmental- Institutions (NGOs) launched different campaigns against FGC, their effects on the peoples' attitudes towards the practice have not been deeply investigated yet. Hence, this study particularly aimed to investigate the pupils' perspectives on FGC abandonment in the Harari and the Somali Regional States of Ethiopia where the prevalence of the practice was thought to be high.

METHODS

A school-based cross-sectional study was conducted in the Somali and the Harari Regional States of eastern Ethiopia from October to December 2015. While purposive sampling was implemented to select the study areas from the two Regional States, stratified random sampling method was used to select 480 study subjects from those areas.

RESULTS

The findings showed that the participants who received information through multiple information channels were more likely to support the abandonment of FGC than those who received information from a single source (p < 0.05). Similarly, the findings indicated that school-based awareness campaigns and TV-based media communications were the main sources of information that influenced a high proportion of young people to support the abandonment of the practice. The findings revealed that the majority of the participants strongly supported the abandonment of FGC.

CONCLUSIONS

Multiple information channels that include school-based awareness campaigns were found to be the best way to support the abandonment of FGC. Although the study shows an impressive improvement among the school girls and boys in recognizing the harmful effects FGC, complete abandonment of the practice might not be easily achieved due to its deep-rooted nature. Thus, to quicken the perpetuation of FGC in the stated Regional States, awareness creating campaigns that change the attitudes of youths towards the practice should be delivered through various sources. In this regard, school-based education, school mini-media, social media, and using the co-curricular activities to uncover the danger of this harmful practice could play significant roles in changing the pupils' attitudes towards the practice.

Attitude toward female genital mutilation among Somali and Harari people, Eastern Ethiopia

Background

Female genital mutilation (FGM) is a worldwide problem, and it is practiced by many communities in Africa and Asia as well as immigrants from those areas. This practice results in short- and long-term health consequences on women’s health. Like many other developing countries, FGM is widely practiced in Ethiopia, especially among Somali and Harari ethnic groups. Despite intensive campaigns against FGM in Ethiopia, since 2011, it has been practiced in the aforementioned communities. There is no recent information as to whether these campaigns have an impact on the attitude and practice of the community regarding FGM. This qualitative research was aimed at exploring the attitudes of Somali and Harari people between 18 and 65 years toward FGM.

Methods

A purposive sampling technique was used to recruit 64 (32 in each region) participants. Data were collected from October to December 2015 in Somali and Harari Regions.

Results

The findings showed that there was a strong support for the continuation of the practice among female discussants in Somali region, whereas male discussants from the same region and the majority of the participants from Harari region had a positive attitude toward the discontinuation of the practice. Marriageability was the major reason for practicing FGM in Somali region, whereas making girls calm, sexually inactive, and faithful for their husbands were mentioned in Harari region. Although young men in both the regions prefer to marry uncircumcised girls, the study showed that there are some differences in the attitude toward the FGM practice between the people in the two regions.

Conclusion

The findings show that there is an attitudinal difference between the people in the two regions, which calls for behavioral change communication using women-centered approach and culturally appropriate strategies. As young people in both the regions had the intention to marry uncircumcised girls, there has to be a strong advocacy and multisectoral collaboration to stop FGM in both the regions.

Prevalence and associated factors of circumcision among daughters of reproductive aged women in the Hababo Guduru District, Western Ethiopia: a cross-sectional study

Background

Female genital mutilation is currently a public health problem which needs investigation and immediate action. Ethiopia is the second-ranked African country in terms of having higher numbers of circumcised girls. This study aimed to determine prevalence and associated factors of circumcision among daughters of reproductive aged women.

Methods

A community based cross-sectional study was conducted on 610 mothers. The total sample was allocated proportionally in three randomly selected kebeles based on the number of reproductive age mothers with at least one daughter under 15 years old. A systematic random sampling technique was used to draw the respondents. A structured and interviewer administered questionnaire was used to collect data. Logistic regression analyses were used to see the association of different variables.

Results

Out of 610 mothers, 293 (48 %) had at least one circumcised daughter. Having a good knowledge about genital mutilation (Adjusted Odds Ratio [AOR] =0. 14, 95 % CI: 0.09–0.23), positive attitude (AOR = 0. 26, 95 % CI: 0.16–0.43), being literate (AOR = 0.50, CI: 0.28–0.91) and living in urban area (AOR = 0.30, 95 % CI: 0.17–0.51) had a lower odds of female genital mutilation. In addition, not knowing genital mutilation as a crime (AOR = 5, 95 % CI: 3.07–8.19), and being in the age group of 40–49 (AOR = 2.56, 95 % CI: 1.40–4.69) had a higher odds of having circumcised daughter. Furthermore, fathers being traditional religion followers (AOR = 0.22, 95 % CI: 0.07–0.74) had less odds of having a circumcised daughter as compared to those who follow Ethiopian Orthodox Christian.

Conclusions

In this study, about half of the mothers had at least one circumcised daughter. Mothers’ knowledge, attitude, age, residence, educational status and fathers’ religion were significantly associated with female genital mutilation. Hence, convincing mothers about the ill effects of circumcision and working with religious leaders is recommended.

Daughters at Risk of Female Genital Mutilation: Examining the Determinants of Mothers' Intentions to Allow Their Daughters to Undergo Female Genital Mutilation

Female genital mutilation (FGM) is still a common practice in many countries in Africa and the Middle East. Understanding the determinants of FGM can lead to more active interventions to prevent this harmful practice. The goal of this study is to explore factors associated with FGM behavior among Iranian mothers and their daughters. Based on Ajzen's theory of planned behavior, we examined the predictive value of attitudes, subjective norms, perceived behavioral control and several socio-demographic variables in relation to mothers' intentions to mutilate their daughters. A paper-and-pencil survey was conducted among 300 mothers (mean age = 33.20, SD = 9.09) who had at least one daughter and who lived in Ravansar, a county in Kermanshah Province in Iran. Structural equation modeling was used to investigate the relationships among the study variables. Our results indicate that attitude is the strongest predictor of mothers' intentions to allow their daughters to undergo FGM, followed by subjective norms. Compared to younger mothers, older mothers have more positive attitudes toward FGM, perceive themselves as having more control over their behavior and demonstrate a greater intention to allow their daughter to undergo FGM. Furthermore, we found that less educated mothers and mothers living in rural areas had more positive attitudes toward FGM and feel more social pressure to allow FGM. The model accounts for 93 percent of the variance in the mothers' intentions to allow their daughters to undergo FGM. Intervention programs that want to decrease FGM might focus primarily on converting mothers' neutral or positive feelings toward FGM into negative attitudes and on alleviating the perceived social pressure to mutilate one's daughter. Based on our findings, we provide recommendations about how to curtail mothers' intentions to allow their daughters to undergo FGM.

Female genital cutting: confronting cultural challenges and health complications across the lifespan

Female genital cutting affects over 140 million women worldwide. Prevalent in certain countries of Africa and the Middle East, the practice continues among immigrants to industrialized countries. Female genital cutting is a deeply rooted tradition that confers honor on a woman and her family, yet also a traumatic experience that creates significant dermatological, gynecological, obstetric and infectious disease complications. Little is known about postmenopausal health in cut women. The international community views this practice as a human rights violation. In addition to genital health complications, the medical community must confront an understudied concern of what happens as this population ages. These challenges must be addressed to provide optimal care to women affected by female genital cutting.

Female genital mutilation – why does it still exist in Africa?

Female genital mutilation (FGM) includes all procedures that involve partial or total removal of the external female genitalia for non-medical reasons. FGM is practised in many parts of the world – including 28 African countries, some countries in the Middle East and Asia, and some population groups in Central and South America. Its prevalence rates range from 0.6% up to 97.9%, and it has been classified as a violation of human and children’s rights. Consequently, several countries have passed laws against the practice and many international programmes have been implemented to abandon it. Yet, FGM still prevails in many countries. This literature review aimed at identifying the underlying reasons for the perpetuation of FGM, ascertaining forces that foster its promotion and persistence and who is responsible for pushing its continuation. The main goal was to try to understand the underlying causes that make FGM resistant against initiatives and campaigns targeting its elimination. A literature search was carried out using several databases. All sources that approached the topic of FGM were incorporated including literature reviews, systematic reviews, qualitative and quantitative as well as mixed-method studies that described attitudes towards FGM and factors associated with its practice. Different factors that were interlinked could be identified at the individual, interpersonal, organisational/institutional as well as the community/societal level as the underlying causes of the perpetuation for FGM. These factors varied within and between different settings, and include individual characteristics such as parents’ level of education, place of residence, personal beliefs (aesthetics, health benefits, hygiene) about FGM as well as the medicalisation of FGM and the involvement of health care professionals at the institutional level. Cultural factors like gender inequality, social norms and pressure also played an important role. Surprisingly, no evidence that supported religious motives could be found in any of the three monotheistic religions. This review suggests that the reasons behind the performance of FGM differ between and within countries and contexts, but cannot be found in the scriptures even though it is mainly practiced by Muslims. Girls with low education living in small Muslim communities, in rural areas in Africa and whose parents especially the mother had a low educational level, were at increased risk of undergoing FGM. Successful actions to eliminate this practice require a balance between respect of culture and human rights. Practising communities should be involved in each step of every programme. Finally, it is crucial to target the young generations through education, women empowerment and reduction of gender inequality.