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

Female genital mutilation/cutting among girls aged 0-14: evidence from the 2018 Mali Demographic and Health Survey data

BACKGROUND

Female genital mutilation/cutting (FGM/C) is considered a social norm in many African societies, with varying prevalence among countries. Mali is one of the eight countries with very high prevalence of FGM/C in Africa. This study assessed the individual and contextual factors associated with female FGM/C among girls aged 0-14 years in Mali.

METHODS

We obtained data from the 2018 Mali Demographic and Health Survey. The prevalence of FGM/C in girls was presented using percentages while a multilevel binary logistic regression analysis was conducted to assess the predictors of FGM/C and the results were presented using adjusted odds ratios with associated 95% confidence intervals (CIs).

RESULTS

The results indicate that more than half (72.7%, 95% CI = 70.4-74.8) of women in Mali with daughters had at least one daughter who has gone through circumcision. The likelihood of circumcision of girls increased with age, with women aged 45-49 having the highest odds compared to those aged 15-19 (aOR = 17.68, CI = 7.91-31.79). A higher likelihood of FGM/C in daughters was observed among women who never read newspaper/magazine (aOR = 2.22, 95% CI = 1.27-3.89), compared to those who read newspaper/magazine at least once a week. Compared to women who are not circumcised, those who had been circumcised were more likely to have their daughters circumcised (aOR = 53.98, 95% CI = 24.91-117.00).

CONCLUSION

The study revealed the age of mothers, frequency of reading newspaper/magazine, and circumcision status of mothers, as factors associated with circumcision of girls aged 0-14 in Mali. It is, therefore, imperative for existing interventions and new ones to focus on these factors in order to reduce FGM/C in Mali. This will help Mali to contribute to the global efforts of eliminating all harmful practices, such as child, early and forced marriage and female genital mutilation by 2030.

"People will talk about her if she is not circumcised": Exploring the patterning, drivers and gender norms around female genital mutilation in Ethiopia's Somali region

Over the past decade there has been a burgeoning literature on social norms and the need to understand their context-specific patterning and trends to promote change, including to address the harmful practice of female genital mutilation (FGM), which affects around 200 million girls and women globally. This article draws on mixed-methods data collected in 2022 and 2023 with 1,020 adolescents and their caregivers, as well as key informants, from Ethiopia's Somali region to explore the patterning, drivers, and decision-making around FGM. Findings indicate that almost all Somali girls can expect to undergo FGM before age 15, and that infibulation is near universal. Critically, however, we find that respondents' understanding of infibulation is rooted in traditional practice, and many girls are now "partially" infibulated-an invasive procedure that girls nonetheless see as an improvement over the past. These shifts reflect religious leaders' efforts to eliminate traditional infibulation--and the health risks it entails--by promoting "less invasive" types of FGM as a requirement of Islam. We also find evidence of emergent medicalization of the practice, as mothers-who are the primary decision-makers-seek to further reduce risks. Adult and adolescent respondents agree that FGM is a deeply embedded social norm, but distinguish between FGM as a perceived religious requirement, and infibulation as a cultural requirement. For girls and women, the importance of FGM is framed around social acceptance, whereas boys and men focus on FGM as a requirement for marriage as it allows families to control girls' sexuality. The article concludes by reflecting on the implications of our findings for programming in high-prevalence contexts. Key conclusions include that FGM interventions should not rely on empowering individuals as "champions of change" but rather prioritize engagement with whole communities, and should be open in the short term to incremental harm-reduction approaches.

Female Circumcision and Sexual Negotiation Ability of Ethiopian Women

The following study attempts to assess the link between the circumcision status of Ethiopian women and their ability to negotiate sex. From the 2016 Ethiopian Demographic and Health Survey, we analyzed a subsample of 3,445 women aged 15 to 49. Women's sexual negotiation ability was measured by their ability to ask for condom and their ability to refuse sex. We performed a univariate, bivariate, and multiple logistic regression analysis. In the final analysis, only education, residence, media access, and sexually transmitted infections knowledge were independently associated with the sexual negotiation ability of women. Circumcision status was not associated with sexual negotiation ability.

Abandoning female genital mutilation/cutting (FGMC) is an emerging but costly parental investment strategy in rural Ethiopia

Female genital mutilation or cutting (FGMC) has profound consequences for an estimated 200 million women world-wide, yet affected communities often resist efforts to end the practice. Marriage market dynamics have been proposed as key to this resistance, because where FGMC is normative, parents are motivated to cut their daughters to improve their marriage prospects. Some economists have also argued that financial gain, through bride wealth payments, incentivises parents to cut daughter's at time of marriage. Bride wealth, however, does not necessarily equal net economic return, confounding efforts to test this assumption. Here we use detailed data on the financial value of all exchanges at marriage from Ethiopian Arsi Oromo agropastoralists to assess their association with FGMC. We also explore the idea that parents must replace FGMC with other forms of investment (e.g., education) when cutting practices are rejected. Multivariate multilevel Bayesian models were run using data from the first marriages of 358 women to assess the association between FGMC status and education and marriage-related outcomes: bride wealth payments, dowry costs, and age at marriage. Being cut is associated with lower dowry costs and earlier age at marriage but does not predict bride wealth paid by the groom's family. School attendance is associated with higher bride wealth, particularly for women with four or more years of education, and with later age at marriage. These findings indicate that bride wealth payments do not maintain FGMC among the Arsi Oromo. While we find a relative economic loss for parents from FGMC abandonment through higher value dowry gifts, this may be traded-off against the health benefits to uncut daughters. These findings point to the emergence of new norms, whereby Arsi Oromo parents reject cutting for their daughters and prefer their daughters-in-law to be educated.

Do Attitude, Awareness and Intention to Perform Female Genital Mutilation or Cutting for Their Daughters of Women Healthcare Providers Differ from Mothers in Somalia?

Aim

This study aimed to determine whether there were differences in attitude, awareness, and intention to perform female genital mutilation or cutting for their daughters in the future between female healthcare providers and mothers.

Methods

A comparative cross-sectional study design was used.

Results

A total of 508 women were included in the study. Of the participants, 68.7% (n = 349) were mothers (Group I) who visited the hospital and 31.3% (n = 159) were women healthcare professionals (Group II) [27% (n = 137) nurses and 4.3% (n = 22) doctors]. It was found that 8 (1.6%) of the participants did not have FGM/C and the FGM/C ratio was lower in group II (95%) than in group I (100%) (p < 0.001). In group I, 99.7% (n = 299) of the participants and 30.6% (n = 19) of those in group II reported intending to perform FGM for their daughters in the future (p < 0.001). The reasons for FGM/C most cited by participants were a traditional rite of passage into womanhood (78%), religious requirement (69.3%), and preservation of their virginity until marriage (59.3%). "Stop FGM" was given as a message on FGM/C by 60% of the participants (n = 79) who answered (n = 127, 100%) to open-ended questions.

Conclusion

The results of this study show that female health professionals with higher education and monthly income had less positive perception of their FGM/C and less intention to allow their daughters to undergo FGM/C.

Grandmother-inclusive intergenerational approaches: the missing piece of the puzzle for ending FGM/C by 2030?

This brief argues that "grandmother-exclusionary bias" - or the side-lining of female elders as change agents within FGM/C programmes - represents a major obstacle to eradication of these practices. Grandmother-exclusionary bias is prevalent within FGM/C policy and programming. Yet, it goes against evidence of the extensive authority and decision-making roles that grandmothers wield in relation to FGM/C in sub-Saharan Africa, and insights from systems theory and meta-evaluations of FGM/C eradication efforts which stress that sustained change requires engaging those who wield authority over gender and social norms. We use postcolonial and decolonial theory to explain the assumptions about grandmothers which underpin grandmother-exclusionary bias. Finally, we provide recommendations for designing grandmother-inclusive, intergenerational community-led programmes based on a strategy empirically proven to shift social norms underpinning FGM/C.

How Canadian Law Shapes the Health Care Experiences of Women with Female Genital Mutilation/Cutting/Circumcision and Their Providers: A Disjuncture Between Expectation and Actuality

This study explored how the reproductive health care experiences of women with female genital mutilation/cutting/circumcision (FGC) were shaped. We used Institutional Ethnography, a sociological approach which allows for the study of social relations and the coordination of health care. From qualitatively interviewing eight women with FGC, we learned that they felt excluded within the Canadian health care system because they were unable to access reconstructive surgery, which was not covered by Ontario's universal health coverage (Ontario Health Insurance Plan). We then talked with seven obstetricians/gynecologists (OB/GYNs) and learned that while it was legal to perform certain genital (e.g., female genital cosmetic surgery) and reproductive (e.g., elective caesarean section) surgeries commonly requested by Western-born women, it was not legal for them to perform other genital surgeries often requested by immigrant populations (e.g., reinfibulation), nor were these covered by OHIP (e.g., clitoral reconstructive surgery). From participants' comparison of clitoral reconstructive surgery and reinfibulation to female genital cosmetic and gender confirming surgeries, it became clear that the law and policies within the health care system favored surgeries elected by Western adults over those wished for by women with FGC. We found that the law had an impact on the choices that OB/GYNs and the women they treated could make, shaping their respective experiences. This created ethical dilemmas for OB/GYNs and a sense of exclusion from the health care system for women with FGC.

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.

“You must cut that long and stinking thing”: uncovering the lived experiences of uncircumcised pokot women in North-Eastern Uganda

Background

Female circumcision remains a dominant practice among the Pokot of North-Eastern Uganda. This paper explores the lived experiences of uncircumcised Pokot women, as they continue to live in a community, where the practice is cherished.

Methods

This qualitative study adopted an ethnographic research design. The study was based on thirty [30] serial interviews with 15 uncircumcised women in the Pokot local language between August and October 2021. Five [5] Key Informant Interviews were also conducted with key informants from Amudat District. A Focus Group Discussion with women, irrespective of their circumcision status, was organized as an entry point to identify the initial uncircumcised woman. Uncircumcised women were recruited using respondent-driven sampling while key informants were purposively selected. Data were analyzed thematically. Participants were allocated codes to ensure anonymity.

Results

Participants expressed understanding of female circumcision, and the procedure although they were not circumcised. Denial of participation in community and cultural functions, rejection by elders and relatives, difficulties in getting marriage partners, denial of conjugal rights and basic needs, refusal to give names to their children, and home desertion were the negative experiences reported by uncircumcised women. Sexual enjoyment during sexual intercourse, epitomized by the ease of reaching orgasms, fewer complications while giving birth as well as reduced risk of exposure to sexually transmitted diseases were mentioned by participants as their positive experiences.

Conclusion

Uncircumcised Pokot women continue to experience unbearable challenges since female circumcision is perceived as the only rite of passage to womanhood. This calls for intensified awareness of the population on the challenges associated with female circumcision refusal while demonstrating the positive experiences mentioned by uncircumcised women, that can be exploited as the beacon of hope.

Does previous circumcision and wealth index influence women’s attitude to discontinue the practice of female genital mutilation and cutting (FGM/C) in Ethiopia?

Introduction

understanding women’s attitudes towards female genital mutilation is an important step towards eliminating this practice. We used the 2016 Ethiopia Demographic and Health Survey (EDHS) data set to examine the relationship between wealth index, and previous history of circumcision on women’s opinions whether female genital mutilation (FGM) should be continued or stopped in Ethiopia.

Methods

Data from 6984 women aged 15–49 years were extracted from the 2016 Ethiopia EDHS data set. Multivariable logistic regression analysis was performed to analyse the data.

Result

In this study, women with a higher level of education and wealth index were more likely to support the cessation of FGM. However, circumcised women (AOR: 0.22; 95% CI: 0.15–0.32), women from the Afar region (AOR: 0.34; 95% CI: 0.22–0.50), Somali region (AOR: 0.42; 95% CI: 0.27–0.65), and Dire Dawa region (AOR: 0.51; 95% CI: 0.32–0.83) were less likely to support discontinuation of FGM.

Conclusion

The present study revealed that wealth index, education level, history of circumcision, and regional variation are associated with women’s attitude towards discontinuation of the practice of FGM in Ethiopia. Empowering women in terms of socioeconomic status and education can change attitudes and might help prevent female genital mutilation in the future. Furthermore, interventions targeting FGM practices should focus on regional variance in order to have a meaningful impact on reducing this harmful cultural practice in Ethiopia.

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 men's opinion about female genital mutilation in Ethiopia

BACKGROUND

Female genital mutilation (FGM) is considered a human rights violation against women and girls causing serious short and long-term health complications. Despite being a criminal offence in Ethiopia since 2004, the practice continues. Minimal research has been published on factors associated with men's opinion about FGM in Ethiopia.

OBJECTIVE AND AIMS

The present cross-sectional study used secondary data to identify factors associated with men's opinions about the practice of FGM.

METHODS

Secondary data analysis was conducted using data from 8,718 men who responded to the 2016 Ethiopian Demographic and Health Surveys (EDHS). The dependent variable was men's opinion about FGM. Demographic, socioeconomic, and other characteristics were examined.

RESULTS

Variables associated with men's support for FGM were lack of education (AOR = 2.91; 95% CI: 1.93, 4.40, p = <0.001), poor wealth index (AOR, 1.76; 95% CI 1.32, 2.35, p = 0.001), ethnically Afar (AOR = 2.50, 95% CI: 1.27, 4.95, p = 0.009) and Somali (AOR = 2.02, 95% CI: 1.15, 3.54, p = 0.015), Muslim religion (AOR = 1.58, 95% CI 1.13, 2.50, p = 0.007), and support for wife beating with at least one justification (AOR = 2.04, 95% CI: 1.66, 2.50, p = <0.001).

CONCLUSION

Lack of education, poor household wealth index, being Muslim and being a member of the Afar or Somali ethnicity and having a tendency that it is appropriate for a husband to beat his wife, were positively associated support for FGM. These findings suggest that context-specific interventions are needed to eradicate the practice.

Emotional Health Work of Women With Female Genital Cutting Prior to Reproductive Health Care Encounters

We used institutional ethnography to explore the social relations that shaped the reproductive health care experiences of women with female genital cutting. Interviews with eight women revealed that they engaged in discourse that opposed the practices of cutting female genitals as a human-rights violation. This discourse worked to protect those affected by the practices, but also stigmatized female genital cutting, making participants anticipate experiencing stigmatization during health care. Women's engagement in this discourse shaped their emotional health work to prepare for such encounters. This work included navigating feelings of worry, shame, and courage to understand what to expect during their own appointment; learning from family/friends' experiences; and seeking a clinic with the reputation of best care for women with female genital cutting. It is important to strive for more inclusive health care in which women do not have to engage in emotional health work to prepare for their clinical encounters.

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.

Female genital mutilation/cutting in sudan and subsequent pelvic floor dysfunction

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.

Attitude towards female circumcision among women in Ethiopia

Female genital mutilation or cutting (FGM/C) is a global phenomenon mostly practiced in Africa, Asia, and the middle east. It involves the removal of the external female genitalia for non-medical reasons. The practice cuts across different ethnic and religious groups in Africa and is associated with several health complications. The following study assessed attitude towards the practice among Ethiopian women aged 15-49. Using the Ethiopia Demographic and Health Survey from 2016 as a data source, we analyzed a sample of 6984 women. We used the respectable femininity discourse to inform our variable selection. The main outcome variable assessed whether women supported or rejected the continuation of the practice. In the bivariate analysis, all the sociodemographic variables including women's circumcision experience were strongly associated with the outcome variable. In the multiple logistic regression, only education, wealth, religion, and circumcision status were independently associated with women's attitude towards FGM/C. For instance, compared to women with no education, women with at least a secondary education were more than 4 times (AOR 4.2, 95% CI 2.53-7.04, P-Value < 0.001) more likely to agree with the termination of the practice. Our findings suggest that changing attitudes towards FGM/C may require uplifting the social and economic status of women, working with those who have experienced FGM/C and collaborating with religious leaders.

Understanding Women's Responses to Sexual Pain After Female Genital Cutting: An Integrative Psychological Pain Response Model

The World Health Organization estimates that over 200 million women and girls have experienced female genital cutting (FGC). Many women and girls who have undergone FGC have migrated to areas of the world where providers are unfamiliar with the health needs associated with FGC. Both providers in Western healthcare systems and female immigrant and refugee patients report communication difficulties leading to distrust of providers by women who have experienced FGC. Sexual pain is one common problem requiring discussion with healthcare providers and possible intervention. Yet, existing clinical and research literature provides little guidance for assessment and intervention when sexual pain is a result of FGC. Several conceptual frameworks have been developed to conceptualize and guide treatments for other types of pain, such as back pain and headaches. In this article, we integrate four prominent models-the fear avoidance model, eustress endurance model, distress endurance model, and pain resilience model-to conceptualize sexual pain in women who have experienced FGC. The resulting integrative psychological pain response model will aid in providing culturally responsive clinical management of sexual pain to women who have experienced FGC. This integrative model also provides a theoretical foundation for future research in this population.

The Consequences of Female Genital Mutilation on Psycho-Social Well-Being: A Systematic Review of Qualitative Research

The health consequences of female genital mutilation (FGM) have been described previously; however, evidence of the social consequences is more intangible. To date, few systematic reviews have addressed the impact of the practice on psycho-social well-being, and there is limited understanding of what these consequences might consist. To complement knowledge on the known health consequences, this article systematically reviewed qualitative evidence of the psycho-social impact of FGM in countries where it is originally practiced (Africa, the Middle East, and Asia) and in countries of the diaspora. Twenty-three qualitative studies describing the psycho-social impact of FGM on women's lives were selected after screening. This review provides a framework for understanding the less visible ways in which women and girls with FGM experience adverse effects that may affect their sense of identity, their self-esteem, and well-being as well as their participation in society.

Association between maternal attitude towards female circumcision and daughter's circumcision status

OBJECTIVE

Female genital mutilation is a public health problem resulting in multiple health complications. In Ethiopia, female circumcision is widely practiced, with women taking center stage in the perpetuation of the practice. Using the Theory of Planned Behavior for variable selection, the following study assessed the association between maternal attitude towards female circumcision and daughter's circumcision status.

METHODS

From the 2016 Ethiopian Demographic and Health Survey, we analyzed a subsample of 6948 women. The outcome variable assessed daughter's circumcision status; the main independent variable assessed participant's opinion towards female circumcision. We conducted univariate, bivariate, and multiple logistic regression analyses.

RESULTS

In the bivariate analysis, none of the variables, except for religion, showed any association with daughter's circumcision status. In the multivariable regression model, several variables showed a significant association with daughter's circumcision status. Older, rural, and circumcised women were more likely to have at least one daughter circumcised, but wanting female circumcision to stop, being a Muslim, and having at least a secondary education were negatively associated with daughter's circumcision status.

CONCLUSION

Our findings suggest that eliminating female circumcision may require changing maternal attitudes towards the practice by targeting rural, circumcised, and older women with no formal education.

Combating female genital mutilation in Northeast (Horn) Africa and its challenges

BACKGROUND

This article investigates the practice of female genital mutilation as a long-held custom in the countries of Northeast Africa, known as Horn of Africa, where many women in rural and urban areas are faced with different physical and psychic consequences in their future lives.

OBJECTIVE

To investigate the prevalence of FGM in the Horn of Africa and the traditional thinking of People about it.

METHODS

This study was based on descriptive analysis method. The questions of the study are (a) Why female circumcision is widely practiced in Horn of Africa; (b) What are the mental and physical consequences of female genital mutilation for the women; and (c) How regional and international entities, whether governmental or NGOs, are combating this tradition.

RESULTS

This article has found out that female genital mutilation in Northeast African countries has resulted in many lifelong diseases and sexual degradation in many women and the best way to combat this tradition is to inform people by gradual (not abrupt) trainings without any insult to the beliefs of the people.

CONCLUSION

This study reveals the Health education based on behavioral change. In doing so, the unity of policies between regional and international actors along with attracting the support of tribal elites is also needed.

Changing prevalence and factors associated with female genital mutilation in Ethiopia: Data from the 2000, 2005 and 2016 national demographic health surveys

Setting

Female genital mutilation (FGM) is a traditional surgical modification of the female genitalia comprising all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for cultural or nontherapeutic reasons. It can be harmful and violates girls’ and women’s human rights. FGM is a worldwide problem but mainly practiced in Africa. FGM is still widely practiced in Ethiopia despite being made a criminal offence in 2004.

Objective

Using data from three Ethiopian Demographic Health Surveys (EDHS) conducted in 2000, 2005 and 2016 the objective was to assess changes in prevalence of FGM and associated factors among women of reproductive age and their daughters.

Methods

EDHS datasets for the three surveys included data on FGM prevalence and socio-demographic factors. After weighting, the data were analysed using frequencies, proportions and the chi square test for trend. Categorical variables associated with FGM in 2016 were compared using OpenEpi and presented as prevalence ratios (Pr) with 95% Confidence Intervals (CI). Levels of significance were set at 5% (P<0.05).

Results

There was overall decline in FGM prevalence (from 79.9% to 74.3% to 65.2%, P<0.001), especially in younger women aged 15-19 years, and in the proportion of women who believed that the practice should continue (from 59.7% to 28.3% to 17.5%, P<0.001). There was also a decreasing trend of FGM in the daughters of the mothers who were interviewed, with prevalence significantly lower in mothers who had not themselves undergone FGM. Most (88.3%) women with FGM had the surgery as a child with the procedure mainly performed by a traditional circumciser (87.3%). Factors associated with higher FGM prevalence and lack of progress over the sixteen years included living in certain regions, especially Somali where FGM prevalence remained consistently >95%, lack of school education, coming from rural areas and living in less wealthy households.

Conclusion

Although progress has been slow, the prevalence of FGM in Ethiopia has declined over time. Recommendations to quicken the trajectory of decline targeting integrated interventions to high prevalence areas focusing on mothers, fathers, youngsters, religious leaders and schools and ensuring that all girls receive some form of education.

Leadership among Women Working to Eradicate Female Genital Mutilation: The Impact of Environmental Change in Transcultural Moments

The study of cultural moments can identify the level of acceptance of female genital mutilation and the visibility of the involved health problems in a globalized world.

AIMS

To describe the transcultural process through which immigrant women who have experienced female genital mutilation become leaders against this practice.

METHOD

Descriptive research with cross-cultural principles and a qualitative approach. A semi-structured interview was the chosen technique for data collection. A total of 18 women participated in the preliminary observation and analysis unit, and only 8 women (38.8%) were ideologically against female genital mutilation (FGM).

INCLUSION CRITERIA

The selected women had undergone FGM and were fully prepared to discuss it.

RESULTS

Staying in a different country and the associated social relations reduce cultural pressure and promote critical thinking. Cultural moments reflect the different situations that affect the perception and practice of female genital mutilation. Health problems associated with female genital mutilation (sexual, reproductive, and psychological) become visible at transcultural moments.

CONCLUSIONS

Environmental country change affects the cultural pressure that sustains this practice in individual minds, institutions, structures, and bodies. These changes produce transcultural moments. The practice of female genital mutilation constitutes a significant segment of gender-based violence.

Knowledge, attitude, practice, and predictors of female genital mutilation in Degadamot district, Amhara regional state, Northwest Ethiopia, 2018

BACKGROUND

Female genital mutilation is defined as all procedures that involve partial or total removal of external female genitalia, or other injuries to the female genital organs for cultural and religious purposes. In Ethiopia, the prevalence of female genital mutilation practice was 70.8% according to Ethiopian demographic and health survey 2016. This practice is against females' reproductive health rights with many serious consequences in physical, mental, social and psychological makeup. Therefore, this study aimed to assess knowledge, attitude, practice, and predictors of female genital mutilation in Degadamot district.

METHODS

A community-based cross-sectional study design was conducted. Three hundred twenty-five mothers who had under 5 years old female children were selected using systematic random sampling from seven kebeles of Degadamot district. Data were collected using an adapted semi-structured face to face interview questionnaire. Data were entered into Epi-data version 3.1 and then exported to SPSS version 20 for analysis. Logistic regression analysis with 95% confidence intervals was carried out to determine the associations between predictor variables and outcome variables.

RESULT

The finding of this study revealed that 56.6% of mothers had good knowledge about female genital mutilation and 54.2% of participants had a favorable attitude about female genital mutilation. 70.8% of under 5 years old female children's had female genital mutilation. Marital status AOR = 7.19(95%CI3.22-16.03), monthly income AOR = 1.97(95% CI 0.26-3.81), custom AOR = 2.13(95% CI 1.20-3.78), belief AOR =2.47(95% CI 1.39-4.39), value AOR = 0.37(95% CI 0.22-0.63), and attitude AOR = 24.4(95% CI 20.01-34.76) towards female genital mutilation had significant association with female genital mutilation practice.

CONCLUSION

Prevalence of FGM practices among female children of under 5 years of age was found to be high as compared to the national level (64%). 56.6% of mothers had good knowledge about FGM. The majority of the women had a favorable attitude to keep FGM practice among their under 5 years old daughters. Marital status, monthly income, custom, belief, value, and attitude had a significant association with FGM practice.

Experiences of young women who underwent female genital mutilation/cutting

AIM AND OBJECTIVES

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

BACKGROUND

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

DESIGN

A qualitative descriptive design.

METHODS

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

FINDINGS

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

CONCLUSION

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

RELEVANCE TO CLINICAL PRACTICE

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

Female genital mutilation/cutting in Sierra Leone: are educated women intending to circumcise their daughters?

Background

Female genital mutilation/cutting (FGM/C) has been recognized as a gross violation of human rights of girls and women. This is well established in numerous international legal instruments. It forms part of the initiation ceremony that confers womanhood in Sierra Leone. Girls and women who are subjected to this practice are considered to be ready for marriage by their parents and communities and are rewarded with celebrations, gifts, and public recognition. Following this, we examined the relationship between education and women’s FGM/C intention for their daughters in Sierra Leone.

Methods

We used cross-sectional data from the women’s file of the 2013 Sierra Leone Demographic and Health Survey (SLDHS) to explore the influence of education on FGM/C intention among women in the reproductive age (15–49). A sample of 6543 women were included in the study. Our analysis involved descriptive computation of education and FGM/C intention. This was followed by a two-level multilevel analysis. Fixed effect results were reported as Odds Ratios and Adjusted Odds Ratios with their respective credible intervals (CrIs) whilst results of the random effects were presented as variance partition coefficients and median odds ratios.

Results

Our findings showed that women who had no formal education were more likely to intend to circumcise their daughters [aOR = 4.3, CrI = 2.4–8.0]. Among the covariates, women aged 20–24 [aOR = 2.3, CrI = 1.5–3.4] were more likely to intend to circumcise their daughters compared to women between 45 and 49 years old. Poorest women were more likely to report intention of circumcising their daughters in the future compared with the richest [aOR = 2.1, CrI = 1.3–3.2]. We noted that, 63.3% of FGM/C intention in Sierra Leone is attributable to contextual factors.

Conclusion

FGM/C intention is more common among women with no education, younger women as well as women in the lowest wealth category. We recommend segmented female-child educational and pro-poor policies that target uneducated women in Sierra Leone. The study further suggests that interventions to end FGM/C need to focus on broader contextual and social norms in Sierra Leone.

Current critiques of the WHO policy on female genital mutilation

In recent years, the dominant Western discourse on "female genital mutilation" (FGM) has increasingly been challenged by scholars. Numerous researchers contest both the terminology used and the empirical claims made in what has come to be called "the standard tale" of FGM (also termed "female genital cutting" [FGC]). The World Health Organization (WHO), a major player in setting the global agenda on this issue, maintains that all medically unnecessary cutting of the external female genitalia, no matter how slight, should be banned as torture and a violation of the human right to bodily integrity. However, the WHO targets only non-Western forms of female-only genital cutting, raising concerns about gender bias and cultural imperialism. Here, we summarize ongoing critiques of the WHO's terminology, ethicolegal assumptions, and empirical claims, including the claim that non-Western FGC as such constitutes an extreme form of discrimination against women. To this end, we highlight recent comparative studies of medically unnecessary genital cutting of all types, including those affecting adult women and teenagers in Western societies, individuals with differences of sex development (DSD), transgender persons, and males. In so doing, we attempt to clarify the grounds for a growing critical consensus that current anti-FGM laws and policies may be ethically incoherent, empirically unsupportable, and legally unsustainable.

Trends and Spatio-temporal variation of female genital mutilation among reproductive-age women in Ethiopia: a Spatio-temporal and multivariate decomposition analysis of Ethiopian demographic and health surveys

BACKGROUND

Female genital mutilation (FGM) is a serious health problem globally with various health, social and psychological consequences for women. In Ethiopia, the prevalence of female genital mutilation varied across different regions of the country. Therefore, this study aimed to investigate the trend and determinants of female genital mutilation among reproductive-age women over time.

METHODS

A secondary data analysis was done using 2000, 2005, and 2016 Demographic Health Surveys (DHSs) of Ethiopia. A total weighted sample of 36,685 reproductive-age women was included for analysis from these three EDHS Surveys. Logit based multivariate decomposition analysis was employed for identifying factors contributing to the decrease in FGM over time. The Bernoulli model was fitted using spatial scan statistics version 9.6 to identify hotspot areas of FGM, and ArcGIS version 10.6 was applied to explore the spatial distribution FGM across the country.

RESULTS

The trends of FGM practice has been decreased from 79.9% in 2000 to 70.4% in 2016 with an annual reduction rate of 0.8%. The multivariate decomposition analysis revealed that about 95% of the overall decrease in FGM practice from 2000 to 2016 was due to the difference in the effects of women's characteristics between the surveys. The difference in the effects of residence, religion, occupation, education, and media exposure were significant predictors that contributed to the decrease in FGM over time. The spatial distribution of FGM showed variation across the country. The SaTScan analysis identified significant hotspot areas of FGM in Somali, Harari, and Afar regions consistently over the three surveys.

CONCLUSION

Female genital mutilation practice has shown a remarkable decrease over time in Ethiopia. Public health programs targeting rural, non-educated, unemployed, and those women with no access to media would be helpful to maintain the decreasing trend of FGM practice. The significant Spatio-temporal clustering of FGM was observed across regions in Ethiopia. Public health interventions must target the identified clusters as well.

Decision-Making Process in Female Genital Mutilation: A Systematic Review

Female genital mutilation/cutting “FGM/C” is a deep-rooted damaging practice. Despite the growing efforts to end this practice, the current trends of its decline are not enough to overcome the population’s underlying growth. The aim of this research is to investigate the FGM/C household decision-making process and identify the main household decision-makers. A review of peer-reviewed articles was conducted by searching PubMed, JSTOR, Ovid MEDLINE, Ovid EMBASE, EBSCO, and CINAHL Plus via systematic search using keywords. The found publications were screen using inclusion and exclusion criteria in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After critical appraisal, seventeen articles were included in this review. The data extracted from the articles regarding FGM/C household-decision making process and decision-makers were analyzed using narrative analysis. FGM/C decision-making process varies from a region to another; however, it generally involves more than one individual, and each one has different power over the decision. Fathers, mothers, and grandmothers are the main decision-makers. It was shown from this review that opening the dialogue regarding FGM/C between sexes may lead to a productive decision-making process. The participation of fathers in the decision-making may free the mothers from the social-pressure and responsibility of carrying on traditions and create a more favorable environment to stop FGM/C practice.

The impact of health education on attitudes of parents and religious leaders towards female genital mutilation

BACKGROUND

Previous studies conducted in Iraqi Kurdistan have reported that parent's decisions to circumcise their daughters are based on religious or cultural beliefs. Despite the widespread practice of female genital mutilation (FGM), the effectiveness of educational strategies to change attitudes towards FGM has not been examined in this region. The present investigation examined the effectiveness of a short-term educational intervention to change the attitudes of parents and religious leaders towards FGM.

METHODS

192 Mullahs (religious leaders), 212 Mokhtars (traditional leaders) and 523 parents in rural areas in Iraqi Kurdistan were invited to participate in a pre- and post-test community-based interventional study in 2017. The Health Belief Model informed the intervention, and participants' attitudes were compared across two stages of the study.

RESULTS

The attitudes of Mullahs, Mokhtars and parents substantially changed from a position of supporting female circumcision to expressing a wish to abandon the practice and not cut their future daughters (OR 1.57, 95% CI 1.02 to 2.42; OR 1.99, 95% CI 1.3 to 3.04 and OR 0.13, 95% CI 0.09 to 0.18, respectively).

CONCLUSIONS

The present study suggests that brief educational interventions can be an effective strategy for changing the attitudes of parents and public leaders towards FGM. Health education is a useful strategy for changing attitudes. However, such interventions must be delivered alongside other strategies to ensure a multifaceted approach to addressing complex social dynamics. A comprehensive public health approach is, therefore, necessary that includes legal measures, community-based action and an appropriate health system approach.

A qualitative assessment of women's perspectives and experience of female genital mutilation in Iraqi Kurdistan Region

Background

Female genital mutilation (FGM) is prevalent in Iraqi Kurdistan Region, but there is a lack of adequate knowledge about how the practice is perceived by the women population who are the direct victims of the practice. This study aimed to assess the knowledge, beliefs, and attitude of a sample of Kurdish women of FGM and identify the main enabling factors for performing this practice and the barriers to ending it.

Methods

This qualitative study was based on six focus groups involving a sample of 51 women. We used a topic guide to lead discussions, which included questions on women’s perspectives of different aspects of FGM such as the reasons for practicing it, the positive and negative consequences, the continuation of the practice and tackling this problem in the community. Content analysis was used for the qualitative analysis of the data.

Results

The women had poor knowledge about different aspects of FGM particularly concerning the procedure and the consequences. The mutilated participants revealed the devastating experience of the pain and the psychological effects they have experienced. Reducing sexual desire, having halal (permissible by Allah) hands, and religious requirement were the main reasons for practicing FGM. Reduction in women’s sexual desire and the related social problems with the husband were the main problems identified to be associated with FGM. Most women did not support the continuation of FGM practice, but some women still think that FGM should be left to the people’s preference. The participants identified raising people’s awareness, active involvement of religious leaders in prevention efforts and the issuance and enforcement of legislation against FGM as the primary measures to reduce FGM practice.

Conclusion

Passing through FGM at childhood is an overwhelming experience with long-term effects for women. There is still a significant segment among the women population that do not oppose the continuations of FGM and need religious and scientific evidence against FGM. Some reasons for practicing FGM are deeply embedded in the culture and traditions, and there is a need for extensive efforts to raise the awareness of the population and change their thoughts and behavior about FGM.

Electronic supplementary material

The online version of this article (10.1186/s12905-019-0765-7) contains supplementary material, which is available to authorized users.

The lived experience of female genital cutting (FGC) in Somali-Canadian women's daily lives

Many of the Somali women who have immigrated to other countries, including Canada, have experienced Female Genital Circumcision/ Mutilation/ Cutting (FGC). While there is literature on the medical aspects of FGC, we were interested in understanding the daily life experiences and bodily sensations of Somali-Canadian women in the context of FGC. Fourteen women living in the Greater Toronto Area were interviewed. Interview data were analyzed using a phenomenological approach. We found that the memory of the ceremonial cutting was vivid but was frequently described with acceptance and resignation–as something that just is; that was normal given the particular context, familial and cultural, and their young age. Most of the women recounted experiencing pain and discomfort throughout their adult lives but were intent on not noticing or giving the pain any power; they considered themselves healthy. The following themes emerged from our interviews: Every Body Had It: Discussing FGC, I’m Normal Aren’t I?, and Feeling in My Body–all themes that work at normalizing their bodies in a society that they know views them as different. They dealt with both pain and pleasure in the context of their busy lives suggesting resilience in spite of the day-to-day difficulties of daily life.

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.

Female Genital Mutilation in Sudan

BACKGROUND:

Female genital mutilation or female circumcision (FGM) is a serious health problem in Sudan. This procedure is harmful to women and causes many complications during pregnancy and childbirth.

OBJECTIVE:

This study aims to determine the female genital mutilation (FGM) and its associated factors in Sudan.

SUBJECTS AND METHODS:

Data from Sudan Multiple Indicator Cluster Survey (MICS - UNICEF) was used in this research. The survey was carried out in 2014 and included women aged between 14 – 49 years. A logistic regression model was used to find an association between dependent and independent variables.

RESULT:

Total numbers of 21947 women were included in the survey and out of the 6249 (28.5 %) from urban and 15698 (71.5%) from rural areas. The prevalence of female circumcision was 89%. Women who had circumcised daughters were 32.1 %. The highest prevalence of FGM was reported from South Kordofan state with 7.8%, and lowest was in Red Sea state (7.6%). A significant association was observed between circumcised women and their marital status, daughter circumcision, and the level of education.

CONCLUSION:

The practice of female genital mutilation is spread all over the country. Poor women with low level of education are at high risk for this phenomenon. More efforts have to be provided to end this dangerous practice.