Cohort analysis of the state of female genital cutting in Nigeria: prevalence, daughter circumcision and attitude towards its discontinuation

Psychosocial and Sexual Aspects of Female Genital Circumcision in a Sample of Kurdish Women in the Kurdistan Region of Iraq

BACKGROUND AND AIM

Female genital circumcision (FGC), a prevalent practice in the Kurdistan Region of Iraq, has significant psychosocial and sexual implications for affected women. Therefore, this study aimed to investigate these impacts among circumcised and non-circumcised Kurdish women.

METHOD

This comparative study was conducted from January 2 to June 27, 2023, at the Al Mesalla for Human Rights Improvement organization in Erbil, Iraq. Purposive sampling was used to collect data using a comprehensive questionnaire. The questionnaire included demographic information, the Depression, Anxiety, and Stress Scale (DASS-21), the Rosenberg Self-Esteem Scale (RSE), and the New Sexual Satisfaction Scale-Short Form (NSSS-S). Statistical analysis was performed using SPSS version 26 (IBM Corp., Armonk, NY), with frequency and percentage used for categorical variables and mean and standard deviation for quantitative variables. Independent sample t-tests and Chi-square tests were conducted to compare groups. A p-value of less than 0.05 was considered statistically significant.

RESULTS

A total of 772 participants were enrolled in the study, including 382 circumcised and 390 non-circumcised women. The study found significant differences between the two groups in terms of depression, self-esteem, and sexual satisfaction. Circumcised women had higher mean scores for depression (12.19 ± 5.6 vs. 10.68 ± 5.3), lower mean scores for self-esteem (24.4 ± 12.1 vs. 30.3 ± 10.1), and lower mean scores for sexual satisfaction (52.4 ± 24.6 vs. 67.6 ± 20.4) compared to non-circumcised women (all p < 0.001).

CONCLUSIONS

The study demonstrated that FGC is associated with higher levels of depression, lower self-esteem, and lower sexual satisfaction among Kurdish women. It is recommended for policymakers and healthcare providers to develop targeted interventions to address the psychosocial and sexual health needs of circumcised women in the Kurdistan Region of Iraq.

Determinants of Female Genital Mutilation Among Under Five-Year Children in Motta Town, Northwest Ethiopia, 2022: Unmatched Case Control Study

Introduction

Female genital mutilation is the removal of a woman's external genitalia in whole or in part for a non-obvious medical reason. Female genital mutilation causes short- and long-term complications like bleeding, pain, infection and exposes girls to sexually transmitted diseases. The determinants of female genital mutilation among children under the age of five have received less attention. As a result, the purpose of this study was to determine the factors that influence female genital mutilation in children under the age of five.

Methods

A community-based unmatched case control study design was used. The study participants were chosen using computer-generated simple random sampling technique. With a ratio of 1:4 between cases and controls, 323 participants were recruited. Data were collected using an interviewer-administered questionnaire. The association between each independent variable and the dependent variable was determined using binary logistic regression. In a multivariable analysis, variables were considered statistically significant if they had a P-value of less than 0.05 at a 95% confidence interval.

Results

In this study, mothers' circumcision status (AOR = 4.6; 95% CI: 2.29-9.25), mothers who had an unfavorable attitude (AOR = 4.15; 95% CI: 1.96-8.82), households in the poorest wealth quintile (AOR = 3.65; 95% CI: 1.2-11.54), mothers who had inadequate knowledge (AOR = 3.31; 95% CI: 1.51-7.25) and antenatal care visit of mothers (AOR = 2.46; 95% CI: 1.03-5.83) were found to be determinant factors of female genital mutilation.

Conclusion and Recommendation

Mothers' circumcision status, mother's attitude, wealth quintile, knowledge of mothers, and number of antenatal care visits were factors associated with female genital mutilation. Regular awareness-building on the impacts of the practice and special attention to the mother's attitude are important to eliminate female genital mutilation.

Female Genital Mutilation/Cutting and Breastfeeding Outcomes: The Modifying Effects of Healthcare Access and Women’s Attitudes to FGM/C

The prevalence of female genital mutilation/cutting (FGM/C) in Nigeria is on the rise, although the practice has no known medical/health benefits. This study aims to assess FGM/C’s effect on breastfeeding outcomes and to identify the role of women’s attitudes and their access to healthcare services on these relationships. Associations between FGM/C and breastfeeding outcomes were measured using multi-logistic regression. About 32% of women underwent FGM/C, and 23% believed FGM/C should continue. Women exposed to FGM/C were less likely to initiate early breastfeeding (OR = 0.56, [95% CI = 0.47–0.66]) or to breastfeed exclusively (0.64, [0.57–0.73]). FGM/C acceptance reduced odds of early initiation of breastfeeding (0.57, [0.45–0.73]) (p for interaction < 0.001) and exclusive breastfeeding (0.65, [0.59–0.78]) (p for interaction < 0.001). Four or more antenatal care visits while pregnant modified the associations between FGM/C and early initiation (1.55, [1.26–1.90) (p for interaction < 0.001) or exclusive breastfeeding (2.01, [1.73–2.330]) (p for interaction < 0.001), respectively. FGM/C is associated with breastfeeding outcomes, but this association may be improved with healthcare access and attitudinal changes towards FGM/C. Targeted public health education interventions raising awareness about FGM/C and breastfeeding and policy changes increasing access to prenatal healthcare services in underserved areas are recommended.

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.

Variations in the Prevalence of Female Genital Mutilation Among Reproductive-aged Women in Nigeria Across Three Generations

BACKGROUND AND OBJECTIVE

Female genital mutilation (FGM) is widespread mainly in low and middle-income countries. Nigeria is one of the countries with the highest prevalence of FGM, accounting for about one of every four cases globally. The purpose of this study was to determine the prevalence of FGM among three generations in Abuja, the federal capital city of Nigeria.

METHODS

This is a cross-sectional study among women of reproductive age (15-49 years) within two area councils of Abuja (Bwari and Abuja Municipal) and Nyanya suburban district adjoining the federal capital territory in Nigeria. The respondents are pregnant women attending antenatal care at four selected health facilities. Data were collected using Google Forms and were analyzed with SPSS for Windows version 25.

RESULTS

This study comprised data from 634 females (who had an average age of 33±6.0 years) from four major healthcare facilities in Abuja. The most common age group was 30 - 34 years (29.2%). The prevalence of FGM in the first generation (37.7%) was significantly higher than in the second (28.5%) and the third generations (8.7%) (p<0.01). The prevalence of FGM in the second generation was also significantly higher than in the third (p<0.01). The predictors of women circumcising their daughters include primary/no-education AOR 1.48 (95% CI: 0.41-5.31; p<0.05), being a traditionalist 4.94 (95% CI: 0.29-84.56; p<0.05), or Muslim 2.27 (95% CI: 0.94-5.49; p<0.05), respondent's mother being circumcised 1.69 (95% CI: 0.26-10.85, p<0.05) or mother's circumcision unknown 5.41 (95% CI: 0.78-37.34; p<0.05), respondents being circumcised 54.71 (95% CI: 0.78-37.34; p<0.001), culture 2.48 (95% CI: 1.00-6.19; p<0.05), and ignorance of adverse psycho-social/emotional effects of FGM 4.39 (95% CI: 1.46-13.17; p<0.05).

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

Although there is a decline in FGM prevalence from the first generation to the third generation in Nigeria, the current prevalence of 8.7% remains a public health concern. Nigerian women's ongoing experience of FGM requires both individual and stakeholders' involvement to eradicate health-related problems such as tissue damage, infection, scarring, infertility, and pains during sexual intercourse, urination, and menstruation.