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Hassannezhad K, Asadzadeh F, Iranpour S, Rabiepoor S, Akhavan Akbari P. The comparison of sexual function in types I and II of female genital mutilation. BMC Womens Health 2024; 24:31. [PMID: 38191359 PMCID: PMC10775604 DOI: 10.1186/s12905-023-02860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Female genital mutilation has many sexual, physical, and psychological consequences. The present study aimed to examine the relationship between Female Genital Mutilation/Cutting (FGM/C), and Sexual Function among circumcised women in Sardasht City, Iran." METHODS In this present cross-sectional study, 197 women who were mutilated entered the study by simple random sampling from two healthcare centers in Sardasht, Iran. A gynecologist first performed a genital examination to identify the type of female genital mutilation of participants. Subsequently, Socio-demographic and FGM/C-related characteristics checklist and the female sexual function index questionnaire were completed by interview method. Data were analyzed using SPSS 23 software. RESULTS Type I and II of female genital mutilation were performed in 73.1 and 26.9% of the participants, respectively. The age range of performing female genital mutilation in type I and II of female genital mutilation was 4-10 years old in 67.4% and 71.1% respectively. Traditional practitioners/local women carried out the circumcision in all of the participants, and Sunnah/tradition was reported as the most common reason for doing this procedure. The average total score of FSFI index in type I and II of female genital mutilation was 23.5 ± 2.0 and 17.4 ± 2.39, respectively. In all domains of FSFI, women with type II of female genital mutilation obtained lower scores than women with type I. CONCLUSION Circumcised women have reduced scores in all domains of FSFI, and the severity of sexual dysfunction is related to the type of FGM/C. Considering the prevalence of female genital mutilation and its adverse effects, it is imperative to initiate cultural improvements through education and awareness. By educating and raising awareness among individuals about this issue, we can foster positive changes and address the problem effectively.
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Affiliation(s)
- Kosar Hassannezhad
- Department of Midwifery, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Firouzeh Asadzadeh
- Department of Midwifery, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sohrab Iranpour
- Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Soheila Rabiepoor
- Professor of Reproductive health, Reproductive Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Pouran Akhavan Akbari
- Department of Midwifery, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran.
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Hemmeda L, Anwer L, Abbas M, Elfaki L, Omer M, Khalid M, Hassan M, Mostafa M, Hamza L, Mahmoud M, Osman MM, Mohamed M, Bakheet L, Omer AT. The unbroken chain of female genital mutilation: a qualitative assessment of high school girls' perspectives. BMC Womens Health 2024; 24:11. [PMID: 38172761 PMCID: PMC10765796 DOI: 10.1186/s12905-023-02843-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Female Genital Mutilation (FGM) is defined as any procedure that involves damage to the female external genitalia. This practice is majorly prevalent in Sudan, as it is estimated that over 12 million Sudanese women are circumcised. This study uncovers rural females' knowledge and insights about FGM domestically. METHODS A qualitative, deductive study with thematic analysis was conducted. A total of 42 female high school students were recruited and divided into five focus groups, each of which included girls from four different high school classes in the main school of the study area. A topic guide was prepared and used to lead the focus groups. Thematic analysis was used, and the study data had been categorized into four themes: knowledge, procedure and performance, experience, and practice. The condensed meaning units of each theme were identified, then classified to formulate sub-themes. RESULTS All the participants indicated that FGM is a traditional practice in the village. The vast majority have heard about it from family members, mainly mothers and grandmothers. Regarding the procedure, all the participants agreed that midwives perform FGM, but most of them don't know what exactly is being removed. According to all participants, mothers and grandmothers are the decision-makers for FGM. The majority of the participants stated that they do not discriminate between the circumcised and uncircumcised women and most of them agreed that circumcision has negative side effects. They have mentioned pain, difficult urination, and walking as early side effects, while psychological impacts and labor obstruction as late ones. Generally, the majority of the participants agreed that circumcision is not beneficial and should stop. CONCLUSION Knowledge regarding the dangers of FGM among high school girls is better than expected given the high prevalence of the practice. Generally, the process is well understood, the performers are known, the experience is universal, and the side effects are acknowledged. Nevertheless, a majority still showed an intent to circumcise their daughters in the future.
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Affiliation(s)
- Lina Hemmeda
- Faculty of Medicine, University of Khartoum, P. O. Box 11111, Khartoum, Khartoum, Sudan.
| | - Lena Anwer
- Faculty of Medicine, University of Khartoum, P. O. Box 11111, Khartoum, Khartoum, Sudan
| | - Marwa Abbas
- Faculty of Medicine, University of Khartoum, P. O. Box 11111, Khartoum, Khartoum, Sudan
| | - Lina Elfaki
- Faculty of Medicine, University of Khartoum, P. O. Box 11111, Khartoum, Khartoum, Sudan
| | - Maram Omer
- Faculty of Medicine, University of Khartoum, P. O. Box 11111, Khartoum, Khartoum, Sudan
| | - Maab Khalid
- Faculty of Medicine, University of Khartoum, P. O. Box 11111, Khartoum, Khartoum, Sudan
| | - Mushrega Hassan
- Faculty of Medicine, University of Khartoum, P. O. Box 11111, Khartoum, Khartoum, Sudan
| | - Mihrab Mostafa
- Faculty of Medicine, University of Khartoum, P. O. Box 11111, Khartoum, Khartoum, Sudan
| | - Lina Hamza
- Faculty of Medicine, University of Khartoum, P. O. Box 11111, Khartoum, Khartoum, Sudan
| | - Maab Mahmoud
- Faculty of Medicine, University of Khartoum, P. O. Box 11111, Khartoum, Khartoum, Sudan
| | - Maram Mohamed Osman
- Faculty of Medicine, University of Khartoum, P. O. Box 11111, Khartoum, Khartoum, Sudan
| | - Mozan Mohamed
- Faculty of Medicine, University of Khartoum, P. O. Box 11111, Khartoum, Khartoum, Sudan
| | - Lamees Bakheet
- Faculty of Medicine, University of Khartoum, P. O. Box 11111, Khartoum, Khartoum, Sudan
| | - Alaa T Omer
- Faculty of Medicine, University of Khartoum, P. O. Box 11111, Khartoum, Khartoum, Sudan
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Dura MC, Abaker Salih SM, Aktürk H, Aslan Ö. The Impact of Female Genital Mutilation on Sexual Function: A Study Conducted in Rural Sudan. Cureus 2023; 15:e51343. [PMID: 38288175 PMCID: PMC10824505 DOI: 10.7759/cureus.51343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 01/31/2024] Open
Abstract
BACKROUND There are few studies comparing sexual function in women with female genital mutilation (FGM) in the literature, and most of these were evaluated with the Female Sexual Function Index (FSFI) questionnaire. Only one used the Female Genital Self-Image Scale (FGSIS) questionnaire. AIM This study aims to evaluate the effects of FGM on sexual function in Sudanese women who did or did not undergo FGM, using the FSFI and FGSIS questionnaires. METHODS This descriptive study was conducted on Sudanese women from July 2020 to March 2021. Patients who attended to our hospital's gynecology outpatient clinic for health screening were included in this study. A total of 211 patients 113 with FGM and 98 without FGM were included in the study. The group with FGM was categorized according to the classification of the World Health Organization. The validated Arabic FSFI and FGSIS questionnaires were administered to groups with and without female genital mutilation and cutting (FGM/C). RESULTS When the FGM types of the cases participating in the study were examined, patients with FGM were classified according to the FGM/C classification defined by the World Health Organization. They were classified as 20.4% (n=23) Type 1, 49.6% (n=56) Type 2, and 30.1% (n=34) Type 3. FSFI and FGSIS scores were significantly lower in the FGM/C group, especially in Type 3 with the highest tissue loss. The survey results statistically support the possibility of sexual dysfunction in FGM group. CLINICAL IMPLICATIONS Female genital circumcision negatively affects sexual function. Therefore, clinicians should consider and sexual dysfunction in women with FGM attending primary care. Strengths and limitations: The strengths of this study are its originality, as it is the first study in the literature to use validated FGSIS and FSFI questionnaires together to assess sexual function in groups with and without FGM and to evaluate correlation of questionnaire results. We undertook the study it using validated and reliable scales, trained clinical staff, local staff gynecologist, and multivariate analysis. Limitation of the study is the chosen age range. The reason for limiting the age to under 35 is that we wanted to evaluate the more sexually active age group in our study. We cannot comment on the correlation of FSFI and FGSIS in circumcised patients over 35 years of age. CONCLUSION Sexual function and sexual self-image of women with FGM/C were found to be significantly lower compared to women without FGM when compared with the validated FSFI and FGSIS questionnaires.
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Affiliation(s)
- Mustafa Cengiz Dura
- Obstetrics and Gynaecology, Bakırköy Sadi Konuk Education and Research Hospital, Istanbul, TUR
| | | | - Hilal Aktürk
- Obstetrics and Gynaecology, Bakırköy Sadi Konuk Education and Research Hospital, Istanbul, TUR
| | - Özgür Aslan
- Obstetrics and Gynaecology, Bakırköy Sadi Konuk Education and Research Hospital, Istanbul, TUR
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Al-Taj MA, Al-Hadari MH. Prevalence and drivers of female genital mutilation/cutting in three coastal governorates in Yemen. BMC Public Health 2023; 23:1363. [PMID: 37461020 DOI: 10.1186/s12889-023-16299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
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.
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Affiliation(s)
- Mansour Abdu Al-Taj
- Department of Community Medicine, Faculty of Medicine, Sana'a University, Mudbah Street, Sana'a, 773169022, Yemen.
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Al Awar S, Zareba K, Sallam GS, Osman N, Ucenic T, Khair H, Shdefat SA, Fattah HA, Maki S. Legal Awareness and Practices of Female Genital Mutilation/Cutting (FGM/C) among United Arab Emirates Medical Practitioners. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4710. [PMID: 36981617 PMCID: PMC10049077 DOI: 10.3390/ijerph20064710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
Female genital mutilation/cutting (FGM/C), due to its regional occurrence, is a marginalized issue in the international arena. The aim of the study was to verify reasons for performing a procedure prohibited by international and domestic law. A cross-sectional study was conducted among nurses and doctors practicing in the UAE. The study was conducted from the 1 of January 2020 to the 31 of December 2021. The total number of recruited individuals who agreed to participate was 120, with the rate of return being 82%. About half of the participants (n = 59, 49.2%) have seen FGM/C patients in their UAE practice. Regarding medical staff, the total knowledge score concerning possible complications of the performed procedure was assessed at 64%, i.e., at a moderate level. None of our study participants had previously performed any type of FGM/C. However, 6.7% were willing to do it upon a mother's or guardian's request. About 83% of study participants stated that FGM/C should be halted internationally. Only 26.7% of the medical practitioners were aware of UAE law concerning FGM/C, while 50% had no knowledge concerning this issue. The present study reveals that cultural conditions take priority over medical knowledge, making medical practitioners inclined to accept the circumcision of girls and women. The crucial goals of future activities should focus on sensitizing society and the medical community, the need to create clear laws penalizing the practice, and the legal obligation to report the circumcision of a girl or woman.
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Affiliation(s)
- Shamsa Al Awar
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain 17666, United Arab Emirates
| | - Kornelia Zareba
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain 17666, United Arab Emirates
| | - Gehan Sayed Sallam
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain 17666, United Arab Emirates
| | - Nawal Osman
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain 17666, United Arab Emirates
| | - Teodora Ucenic
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain 17666, United Arab Emirates
| | - Howaida Khair
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain 17666, United Arab Emirates
| | - Suzan Al Shdefat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Jordanian University of Science and Technology, Ar-Ramtha 3030, Jordan
| | - Hadya Abdel Fattah
- Nursing Department, Fatima College of Health Sciences, Al Ain P.O. Box. 24162, United Arab Emirates
| | - Sara Maki
- Department of Obstetrics and Gynecology, College of Medicine and Health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain 17666, United Arab Emirates
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Ani-Amponsah M, Richter S, Adam MAH, Osei EA, Mustapha M, Oti-Boadi E. Hot fomentation of newborn fontanelles as an indigenous practice in Ghana: implications for policy and integrated community-based health care in Covid-19 pandemic and beyond. Int J Equity Health 2023; 22:37. [PMID: 36850018 PMCID: PMC9969019 DOI: 10.1186/s12939-023-01852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 02/22/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE African newborns undergo numerous traditional and religious practices ranging from fontanelle fomentation to total head shaving, scalp molding, skin scarification and ano-genital irrigation which can negatively impact the health of neonates. Hot fomentation of fontanelles has been a predominant indigenous home-based postnatal practice in Ghana and among Africans in the diaspora. Mobility restrictions during the Covid-19 pandemic has impacted direct access to facility-based care as well as home care. The flourishing of newborn traditional practices among African populations during this Covid-19 pandemic offers opportunities to rethink the provision of family healthcare support for newborns during the ongoing pandemic and beyond. Hence, the aim of this critical review was to examine and describe a common indigenous practice-hot fontanelle fomentation to inform home birth support, discharge planning, and the delivery of optimal home-based care support. STUDY DESIGN This study is a review of literature on hot fomentation of newborn fontanelles. METHODS Literature search in CINAHL, PubMed, African Index Medicus and Scopus, was conducted and evidence synthesised from articles ranging from 1983-2022. Sixty articles were reviewed; however, 10 manuscripts were excluded prior to screening. The other 19 were exempted because they were either below 1983 or were not the best fit for the study purpose. In all, 31 studies were included in the study. The study was guided by Madeleine Leininger's Culture Care Diversity and Universality care theory. RESULTS The current study identifies hot fomentation of newborn fontanelles practices in Ghana, the description of hot fomentation practices and the dangers associated with it. The findings and suggested ways to help overcome this challenge. CONCLUSION There are several neonatal indigenous practices including fontanelle fomentation which pose threat to the health of the neonate as discussed in this study. Future research needs to investigate innovative ways of fontanelle fomentation where necessary instead of the use of hot water by mothers, especially in this Covid-19 pandemic where health and mobility restrictions impact physical access to timely health care. This research will help educate mothers about the dangers of fontanel fomentation and reduce the practice, especially in rural areas of developing countries. This could help reduce neonatal mortality and unnecessary healthcare costs.
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Affiliation(s)
- Mary Ani-Amponsah
- Maternal & Child Health Department, School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana
| | - Solina Richter
- Faculty of Nursing, ECHA 5-2381, Edmonton Clinic Health Academy (ECHA), University of Alberta, 11405 87 Avenue, Edmonton, T6G 1C9, Canada
| | | | | | - Mahama Mustapha
- Department of Child Health, Tamale Teaching Hospital, Tamale, Northern Region, Ghana
| | - Ezekiel Oti-Boadi
- Department of Nursing, School of Nursing and Midwifery, Valley View University, Accra, Ghana
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Fajobi O, Adeoye O, Fajobi D, Ojo TO, Afolabi OT. Girls at risk: FGM intentions among in-school adolescents of a rural community in Osun State, Nigeria. EUR J CONTRACEP REPR 2023; 28:72-78. [PMID: 36318829 DOI: 10.1080/13625187.2022.2135371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Affiliation(s)
- Olusola Fajobi
- Department of Community Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Oyelola Adeoye
- Department of Community Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | - Temitope Olumuyiwa Ojo
- Department of Community Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.,Department of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olusegun Temitope Afolabi
- Department of Community Health, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.,Department of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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Neville SE, Zidan T, Williams A, Rotabi-Casares KS. Child maltreatment and protection in the Arab Gulf Cooperation Council countries: A scoping review. CHILD ABUSE & NEGLECT 2022; 134:105924. [PMID: 36244212 PMCID: PMC10511143 DOI: 10.1016/j.chiabu.2022.105924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/08/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Research on child maltreatment and protection in the Arab Gulf Cooperation Council countries-Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE)-is limited but growing, as is child protection as a sector. OBJECTIVES We aimed to identify themes and gaps in existing research on child maltreatment and protection, identify opportunities for building capacity in research and practice. PARTICIPANTS AND SETTING N/A. METHODS We conducted a scoping review of empirical studies published in peer-reviewed journals in English and Arabic and reported methods and findings according to the PRISMA-ScR reporting protocol. Articles were coded by country, topic of research, and type of abuse studied, if any. RESULTS Our database search returned 6109 articles and 160 articles were included in our review. Themes included (1) prevalence, incidence, and characteristics of maltreatment, (2) outcomes associated with maltreatment, (3) attitudes, awareness, and reporting, (4) accidental injury and death potentially associated with neglect, (5) policy and practice. Eighty-seven articles studied Saudi Arabia, while 28 studied the UAE, 21 Kuwait, 13 Qatar, 12 Oman, and 11 Bahrain. Physical abuse was studied in 77 articles, followed by sexual abuse in 54 articles and emotional abuse in 54. CONCLUSION Although the medical community produces an encouraging volume of child maltreatment research, gaps remain. Intervention research is lacking, and further inquiry into family dynamics, culture, and spirituality could inform the development of effective interventions. Cross-sectoral collaboration among education, social work, law enforcement, and healthcare is also needed to safeguard children's rights in the GCC.
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Affiliation(s)
| | - Tarek Zidan
- Indiana University School of Social Work, 1800 Mishawaka Ave., South Bend, IN, USA.
| | - Adam Williams
- Boston College Social Work Library, 140 Commonwealth Ave., Chestnut Hill, MA, USA.
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Laleh SS, Roshanaei G, Soltani F, Mehran FG. Socio-economic disparities in female genital circumcision: finding from a case-control study in Mahabad, Iran. BMC Public Health 2022; 22:1877. [PMID: 36207728 PMCID: PMC9547433 DOI: 10.1186/s12889-022-14247-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/06/2022] [Accepted: 09/27/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Female genital circumcision (FGC) is still a challenge in reproductive health. This study investigated socioeconomic disparities in FGC in the Kurdish region of Mahabad, Iran. METHODS A case-control study was conducted in three comprehensive health centers on 130 circumcised girls as the case group and 130 girls without a history of circumcision as the control group, according to the residential area and the religious sect. The participants completed a previously validated demographic and circumcision information questionnaire. A multivariate logistic regression model with a backward method at a 95% confidence level was used to determine the relationship between socioeconomic variables and FGC. RESULTS Multivariate logistic regression showed that a family history of FGC (AOR 9.90; CI 95%: 5.03-19.50), age ranging between 20 and 30 years (AOR 8.55; CI 95%: 3.09-23.62), primary education (AOR 6.6; CI 95%: 1.34-33.22), and mothers with primary education (AOR 5.75; CI 95%: 1.23-26.76) increased the chance of FGC. CONCLUSION The present study provided evidence on socioeconomic factors related to FGC in girls. A family history of FGC, age ranging between 20 and 30 years, and girls' and their mothers' education level were strong predictors of FGC. The findings indicate the need to design effective interventions to address these factors to help eradicate FGC.
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Affiliation(s)
| | | | - Farzaneh Soltani
- Mother and Child Care Research Center, Hamadan University of Medical Sciences, Fahmideh Ave, 6517808836 Hamadan, Iran
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Farouki L, El-Dirani Z, Abdulrahim S, Akl C, Akik C, McCall SJ. The global prevalence of female genital mutilation/cutting: A systematic review and meta-analysis of national, regional, facility, and school-based studies. PLoS Med 2022; 19:e1004061. [PMID: 36048881 PMCID: PMC9436112 DOI: 10.1371/journal.pmed.1004061] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Female genital mutilation/cutting (FGM/C) is a nonmedical procedure entailing the modification of the external female genitalia. A description of the prevalence and distribution of FGM/C allows the tracking of progress toward ending FGM/C by 2030 (Sustainable Development Goal (SDG): target 5.3). This systematic review aimed to examine FGM/C prevalence and types, by World Health Organization (WHO) region and country. METHODS AND FINDINGS A systematic search using Medical Subject Headings (MeSH) and keywords from 2009 to March 24, 2022 was undertaken in MEDLINE, PubMED, PsycINFO, Web of Science, and Embase to identify studies presenting FGM/C prevalence. Abstract and full-text screening, quality assessment, and data extraction were undertaken by 2 reviewers. Only nationally representative studies were included in the meta-analysis. Pooled FGM/C prevalence was estimated by random-effects meta-analysis using generalized linear mixed models (GLMMs). FGM/C prevalence with 95% confidence intervals (CIs), prediction intervals (PIs), and FGM/C type were presented separately by women aged 15 to 49 years and girls aged 0 to 14 years. A total of 163 studies met the inclusion criteria and 30 were included in the meta-analysis, of which 23 were from the WHO African Region (AFR), 6 from the Eastern Mediterranean Region (EMR), and 1 from the South East Asian Region (SEAR). These studies included data from 406,068 women across 30 countries and 296,267 girls across 25 countries; the pooled prevalence estimate of FGM/C among women aged 15 to 49 years was 36.9% (95% CI: 19.6% to 58.3%; PI: 0.4% to 99.0%), and 8.27% (95% CI: 3.7% to 17.3%; PI: 0.1% to 89.3%) among girls aged 0 to 14 years. Among included countries, this gave a total estimated prevalence of 84,650,032 women (95% CI: 45,009,041 to 133,834,224) and 13,734,845 girls with FGM/C (95% CI: 6,211,405 to 28,731,901). Somalia had the highest FGM/C prevalence among women (99.2%), and Mali had the highest among girls (72.7%). The most common type of FGM/C among women was "flesh removed" (Type I or II) in 19 countries. Among girls, "not sewn closed" (Type I, II, or IV) and "flesh removed" (Type I or II) were the most common types in 8 countries, respectively. Among repeated nationally representative studies, FGM/C decreased for both women and girls in 26 countries. The main limitation of the study methodology is that estimates were based on available published data, which may not reflect the actual global prevalence of FGM/C. CONCLUSIONS In this study, we observed large variation in FGM/C prevalence between countries, and the prevalence appears to be declining in many countries, which is encouraging as it minimizes physical and physiological harm for a future generation of women. This prevalence estimate is lower than the actual global prevalence of FGM/C due to data gaps, noncomparable denominators, and unavailable surveys. Yet, considerable policy and community-level interventions are required in many countries to meet the SDG target 5.3. TRIAL REGISTRATION Registration: CRD42020186937.
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Affiliation(s)
- Leen Farouki
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Zeinab El-Dirani
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sawsan Abdulrahim
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Christelle Akl
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Chaza Akik
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Stephen J. McCall
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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11
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Management of Female Genital Mutilation/Cutting-Related Obstetric Complications: A Training Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159209. [PMID: 35954566 PMCID: PMC9367947 DOI: 10.3390/ijerph19159209] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/25/2022]
Abstract
Although female genital mutilation/cutting (FGM/C) is a prevalent practice in Liberia, healthcare workers lack the capacity to provide adequate care for FGM/C survivors. Therefore, Liberian nurses, physician assistants, midwives and trained traditional midwives were trained in sexual, obstetric and psychosocial care for FGM/C survivors in 2019. Through questionnaires, we assessed knowledge acquisition, trainee attitudes towards FGM/C care and acceptability to implement WHO-endorsed recommendations. The questionnaires were analyzed using descriptive statistics for quantitative data and an inductive approach for qualitative data. A total of 99 female and 34 male trainees participated. Most trainees perceived FGM/C as harmful to women’s health, as a violation of women’s rights and showed a willingness to change their clinical practice. While 82.8% (n = 74/90) perceived their role in advocating against FGM/C, 10.0% (n = 9/90) felt that they should train traditional circumcisers to practice FGM/C safely. The pre-training FGM/C knowledge test demonstrated higher scores among physician assistants (13.86 ± 3.02 points) than among nurses (12.11 ± 3.12 points) and midwives (11.75 ± 2.27 points). After the training, the mean test score increased by 1.69 points, from 12.18 (±2.91) points to 13.87 (±2.65) points. The trainings successfully increased theoretical knowledge of FGM/C-caused health effects and healthcare workers’ demonstrated willingness to implement evidence-based guidelines when providing care to FMG/C survivors.
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12
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Abidogun TM, Alyssa Ramnarine L, Fouladi N, Owens J, Abusalih HH, Bernstein J, Aboul-Enein BH. Female genital mutilation and cutting in the Arab League and diaspora: A systematic review of preventive interventions. Trop Med Int Health 2022; 27:468-478. [PMID: 35348264 DOI: 10.1111/tmi.13749] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Female Genital Mutilation and Cutting (FGM/C) is an act of gender-based violence (GBV) and a global public health issue with well-documented adverse outcomes. With the rise in global migration, there is an increasing prevalence of FGM/C among Arab diaspora living in the West and Global South. What remains unclear is how to reduce the practice. This study was designed to identify interventions exerting an effect on reducing the practice of FGM/C. METHODS A systematic review of peer-reviewed articles was conducted on interventions targeting individuals and/or the broader community to prevent FGM/C within the Arab League and its diaspora, up to December 2021. Databases searched included PubMed, Medline, Web of Science, PsycINFO, EMBASE, CINAHL, BIOSIS, ASSIA and Scopus. Quality assessment used the Mixed Methods Appraisal Tool (MMAT) 2018. RESULTS Twelve of 896 studies met the inclusion criteria. Eight interventions relied entirely on education with short-term gains but unchanged practices. Three interventions used social marketing and mixed media. Only one study took a multi-sectoral approach. CONCLUSIONS At a macro level, opportunities to reduce or to end the practice of FGM/C exist through legislation, policy, a public health approach grounded in gender equality and human rights. Using multi-sectoral actions that consider the social context and challenge social norms at macro, meso and micro levels appears more effective than individual-level interventions. Promoting advocacy and developing supportive environments to reduce GBV, enhance gender equality and empower communities is crucial for interventions to succeed and achieve the Sustainable Development Goal target of FGM/C abandonment by 2030.
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Affiliation(s)
- Tolulope M Abidogun
- School of Public Health, Department of Health Policy & Management, University of Maryland, College Park, Maryland, USA
| | - Leah Alyssa Ramnarine
- School of Public Health, Department of Health Policy & Management, University of Maryland, College Park, Maryland, USA
| | - Negin Fouladi
- School of Public Health, Department of Health Policy & Management, University of Maryland, College Park, Maryland, USA
| | - Janine Owens
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Howeida H Abusalih
- Epidemiology Program, College of Health Sciences and Rehabilitation, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Joshua Bernstein
- A.T. Still University of Health Sciences, Kirksville, Missouri, USA
| | - Basil H Aboul-Enein
- Department of Health Science, College of Health & Wellness, Johnson & Wales University, Providence, Rhode Island, USA.,Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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13
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Almeer HH, Almulla AA, Almugahwi AA, Alzaher MZ, Alshammasi MM, Menezes RG. Female Genital Mutilation in Saudi Arabia: A Systematic Review. Cureus 2021; 13:e19300. [PMID: 34900477 PMCID: PMC8649978 DOI: 10.7759/cureus.19300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2021] [Indexed: 11/05/2022] Open
Abstract
Female genital mutilation (FGM) or circumcision refers to the unnecessary procedure that damages or removes the external genitalia of females. It is mostly practiced in African countries and some Asian regions, particularly the Middle East, and is performed because of cultural, religious, and social reasons. FGM can negatively affect the lives of women and lead to devastating consequences, ranging from immediate to long-term complications. These complications can be in the physical, psychological, reproductive, or sexual health domains. In this systematic review, we aim to highlight the prevalence and practice of FGM in Saudi Arabia. We conducted a literature search at PubMed to identify studies related to the practice of FGM reported from Saudi Arabia. The results indicate that FGM can still be found in Saudi Arabia both in Saudi women and non-Saudi residents. Most of the non-Saudi women with FGM were Sudanese, Somali, Eritrean, and Egyptian. FGM is prevalent in regions such as Jeddah and Hali, Al Qunfudhah Governorate, Saudi Arabia. FGM is considered illegal in most countries around the world. However, in Saudi Arabia, there is no clear and specific law against the practice of FGM. More research on the practice of FGM in Saudi Arabia needs to be conducted to get a better grasp of the true nature of the problem in the country, which could potentially lead to specific and clear legislation that would prevent the social evil of FGM in Saudi Arabia.
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Affiliation(s)
- Hashim H Almeer
- Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Ali A Almulla
- Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | - Mohamad Z Alzaher
- Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Birge Ö, Serin AN, Bakır MS. Female genital mutilation/cutting in sudan and subsequent pelvic floor dysfunction. BMC Womens Health 2021; 21:430. [PMID: 34961500 PMCID: PMC8713407 DOI: 10.1186/s12905-021-01576-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background We aimed to evaluate the socio-demographic characteristics of women with female genital mutilation/cutting (FGM/C) and the results of FGM/C due to pelvic floor dysfunction. Results The prevalence of FGM/C was 87.2% in Sudan and Type 3 (50.4%) was the most prevalent, followed by Type 2 (35%) and Type 1 (8.5%). In the multinominal logistic regression analysis performed to show the effect of FGM/C on pelvic organ prolapse (POP), it was observed that FGM/C frequency in POP group 2 was statistically similar when POP group 1 was taken as reference category. In the evaluation for symptomatic POP (POP group 3), risk of developing POP in patients without FGM/C was significantly lower than patients with type 3 FGM/C with a rate of 82.9% (OR(odds ratio): 0.171 (p: 0.002), (Confidence Interval (CI) %95; 0.058–0.511). Risk of developing POP rate in patients with type 1 FGM/C was 75% (OR:0.250 (p: 0.005), CI %95; 0.094–0.666) and in patients with type 2 FGM/C was 78.4% (OR:0.216 (p: 0.0001), CI%95; 0.115–0.406). In the multinominal logistic regression analysis including other variables affecting POP, when group 1 was taken as the reference category, it was found that the possibility of developing mild POP (group 2) decreased in FGM/C type 1 and 2 compared to FGM/C type 3 but it was not statistically significant. However, the evaluation for the symptomatic POP group showed up a significantly lower risk of developing POP in patients with type 2 FGM/C compared to patients with type 3 FGM/C, with a rate of 58.4%. (OR:0.419 (p: 0.016), CI%95; 0.206–0.851) (Table 3). In addition, older age was found to be significant risk factor for increasing symptomatic POP (p: 0.003). Conclusions Type 2 and 3 FGM/C continues to be an important health problem in terms of complications that may develop in advanced ages as well as many short-term complications as a result of mechanical or physiological deterioration of the female genital anatomy.
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Ahmed CA, Khokhar AT, Erlandsson K, Bogren M. Defibulated immigrant women's sexual and reproductive health from the perspective of midwives and gynaecologists as primary care providers in Sweden - A phenomenographic study. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100644. [PMID: 34265570 DOI: 10.1016/j.srhc.2021.100644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/19/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To capture care providers' perceptions of defibulated immigrant women's sexual and reproductive health, illuminated by their experiences as care providers for these women. METHODS Individual interview study with 13 care providers at Swedish healthcare facilities: six gynaecologists and seven midwives caring for defibulated immigrant women, analysed with a phenomenographic method. FINDINGS One of the care providers' perceptions of women who had been defibulated was that they had an altered genital function, meaning a wider introitus, improved vaginal intercourse, and more ease urinating and menstruating. The care providers also perceived that women who were defibulated had to balance their wellbeing, struggling between a positive self-image and handling their emotions. Existing in-between cultural values led to a fear of being excluded while at the same time having a desire to be included in the new culture. CONCLUSION Defibulation affects women's sexual and reproductive health and calls for a holistic perspective when providing services, individualized according to the woman's care needs. Support and counselling, should include information about defibulation already during the adolescent years to promote sexual and reproductive health and well-being.
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Affiliation(s)
- Caisha Arai Ahmed
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - Kerstin Erlandsson
- Women's and Children's Health, Karolinska Institutet, Solna, Sweden; School of Education, Health and Social Studies, Dalarna University, Dalarna, Sweden.
| | - Malin Bogren
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
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Ogunsiji O, Ussher J. Beyond illegality: Primary healthcare providers' perspectives on elimination of female genital mutilation/cutting. J Clin Nurs 2021; 30:1253-1262. [PMID: 33465840 DOI: 10.1111/jocn.15667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To report primary healthcare providers' perspectives on elimination of female genital mutilation/cutting (FGM/C). BACKGROUND Eradication of FGM/C by 2030 is one of the United Nations Sustainable Development goals. World Health Organization recognises the unique role of nurses and other primary healthcare providers. However, their voices on the current legislative approach are underreported. These voices are important in informing directions that can expedite achievement of the global goal. DESIGN Qualitative interpretivist phenomenology. METHODS This qualitative study used purposive sampling approach and involved 19 individual interviews conducted face to face or by telephone with Australian primary healthcare providers. Data collected between October and December 2019 were transcribed verbatim and thematically analysed. Three themes exploring Australian healthcare providers' perspectives on elimination of FGM/C were identified, namely understanding Australian laws against FGM/C; perspectives on culturally sensitive education; and exploring public awareness raising activities in Australia. This study was guided by Consolidated Criteria for Reporting Qualitative Research, the checklist for qualitative studies. RESULTS "Understanding Australian laws against FGM/C" identified participants' knowledge that FGM/C is illegal in Australia and that mandatory reporting applies if a child is or at risk of being taken oversees for the procedure. Through "Perspectives on culturally sensitive education," the participants argued that education is the key to questioning the practice of FGM/C. "Exploring public awareness-raising activities in Australia" described the need for collective action germane to FGM/C eradication. CONCLUSIONS This study emphasised that laws and legislation prohibiting FGM/C need to be complemented with culturally sensitive education and public awareness-raising activities, to produce optimal outcome for the elimination of FGM/C in Australia. RELEVANCE TO CLINICAL PRACTICE Voices of these healthcare providers are crucial for FGM/C to be eradicated. Listening and acting on these voices are important in achieving the global sustainable development goal of eradicating FGM/C.
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Affiliation(s)
- Olayide Ogunsiji
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Jane Ussher
- Women's Health Psychology, Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW, Australia
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Okagbue HI, Ijezie OA, Samusenkov VO, Erondu EC, Eze GA. Female life expectancy, maternal mortality, fertility and birth rates of female genital mutilation high prevalence countries. SCIENTIFIC AFRICAN 2020. [DOI: 10.1016/j.sciaf.2020.e00647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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