Female Genital Mutilation: Prevalence, Awareness and Attitude among Igbo Women of Child-Bearing Age in Nigeria
Article Information
Nkechi B Obijiofor1, Chinedum A Enete1, Chibueze E Nnonyelu1, Osita S Umeononihu2,3, Ekene A Emeka4, Chukwuemeka C Okoro2, Josephat C Akabuike5, Charlotte B Oguejiofor2,3, George U Eleje2,3*
1Department of Community Medicine, College of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
2Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
3Department of Obstetrics and Gynecology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
4Department of Family Medicine, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
5Department of Obstetrics and Gynecology, Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, Nigeria
*Corresponding Author: George U Eleje, Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka (Nnewi Campus), P.M.B. 5001 Nnewi, Anambra State, Nigeria
Received: 18 June 2020; Accepted: 26 June 2020; Published: 09 July 2020
Citation:
Nkechi B Obijiofor, Chinedum A Enete, Chibueze E Nnonyelu, Osita S Umeononihu, Ekene A Emeka, Chukwuemeka C Okoro, Josephat C Akabuike, Charlotte B Oguejiofor, George U Eleje. Female Genital Mutilation: Prevalence, Awareness and Attitude among Igbo Women of Child-Bearing Age in Nigeria. Obstetrics and Gynecology Research 3 (2020): 145-160.
Share at FacebookAbstract
Background: To our knowledge, no studies have comprehensively evaluated the awareness, perceptions and attitudes of Igbo women of child-bearing age towards female genital mutilation (FGM) in south-eastern Nigeria.
Objective: To determine the prevalence, awareness and attitude towards the practice of FGM among Igbo women of child-bearing age in Nigeria.
Methods: The study was a cross-sectional study among Igbo women of child-bearing age. Females from 16 to 45 years were included. Interviewer administered semi-structured pretested validated questionnaires were employed. The results were collected and analyzed with the SPSS version 23. Univariate analysis was performed in order to determine independent risk factors that could possibly affect prevalent rates in the population. The level of significance was set at p<0.05.
Results: The study showed that out of 367 respondents interviewed, 49 had FGM, given a prevalence of 13.4%. However, majority (98.7%) were aware of FGM, and their major sources being from family (65.0%), friends (65.0%), and media (48.5%). However, 53.7% of the respondents noted that FGM is still being practiced. Up to 88.6% of the respondents were aware of the complications of FGM and the commonest complications expressed were severe pain during FGM (82.2%), and excessive bleeding (75.7%). Majority (91.3%) stated that it is a bad practice (91.3%) and a form of violence against women (85.8%) and 87.2% want the practice to be discontinued. Most of them (80.4%) stated that FGM has no benefit owing to the fact that it is associated with complications such as difficulty in labor (68.1%) and painful sexual intercourse (47.2%), while 13.6% were indifferent whether FGM should be criminalized. The prevalence of FGM was significantly higher in the older age group (RR=0.09; 95%CI=0.042-0.194; p<0.001) and parous women (RR=1.89; 95%CI=1.084-3.3
Keywords
Clitoris, Cutting, External Genitalia, Female Genital Mutilation, Tradition
Clitoris articles Clitoris Research articles Clitoris review articles Clitoris PubMed articles Clitoris PubMed Central articles Clitoris 2023 articles Clitoris 2024 articles Clitoris Scopus articles Clitoris impact factor journals Clitoris Scopus journals Clitoris PubMed journals Clitoris medical journals Clitoris free journals Clitoris best journals Clitoris top journals Clitoris free medical journals Clitoris famous journals Clitoris Google Scholar indexed journals Cutting articles Cutting Research articles Cutting review articles Cutting PubMed articles Cutting PubMed Central articles Cutting 2023 articles Cutting 2024 articles Cutting Scopus articles Cutting impact factor journals Cutting Scopus journals Cutting PubMed journals Cutting medical journals Cutting free journals Cutting best journals Cutting top journals Cutting free medical journals Cutting famous journals Cutting Google Scholar indexed journals External Genitalia articles External Genitalia Research articles External Genitalia review articles External Genitalia PubMed articles External Genitalia PubMed Central articles External Genitalia 2023 articles External Genitalia 2024 articles External Genitalia Scopus articles External Genitalia impact factor journals External Genitalia Scopus journals External Genitalia PubMed journals External Genitalia medical journals External Genitalia free journals External Genitalia best journals External Genitalia top journals External Genitalia free medical journals External Genitalia famous journals External Genitalia Google Scholar indexed journals Female Genital Mutilation articles Female Genital Mutilation Research articles Female Genital Mutilation review articles Female Genital Mutilation PubMed articles Female Genital Mutilation PubMed Central articles Female Genital Mutilation 2023 articles Female Genital Mutilation 2024 articles Female Genital Mutilation Scopus articles Female Genital Mutilation impact factor journals Female Genital Mutilation Scopus journals Female Genital Mutilation PubMed journals Female Genital Mutilation medical journals Female Genital Mutilation free journals Female Genital Mutilation best journals Female Genital Mutilation top journals Female Genital Mutilation free medical journals Female Genital Mutilation famous journals Female Genital Mutilation Google Scholar indexed journals Tradition articles Tradition Research articles Tradition review articles Tradition PubMed articles Tradition PubMed Central articles Tradition 2023 articles Tradition 2024 articles Tradition Scopus articles Tradition impact factor journals Tradition Scopus journals Tradition PubMed journals Tradition medical journals Tradition free journals Tradition best journals Tradition top journals Tradition free medical journals Tradition famous journals Tradition Google Scholar indexed journals female genitals articles female genitals Research articles female genitals review articles female genitals PubMed articles female genitals PubMed Central articles female genitals 2023 articles female genitals 2024 articles female genitals Scopus articles female genitals impact factor journals female genitals Scopus journals female genitals PubMed journals female genitals medical journals female genitals free journals female genitals best journals female genitals top journals female genitals free medical journals female genitals famous journals female genitals Google Scholar indexed journals child bearing articles child bearing Research articles child bearing review articles child bearing PubMed articles child bearing PubMed Central articles child bearing 2023 articles child bearing 2024 articles child bearing Scopus articles child bearing impact factor journals child bearing Scopus journals child bearing PubMed journals child bearing medical journals child bearing free journals child bearing best journals child bearing top journals child bearing free medical journals child bearing famous journals child bearing Google Scholar indexed journals married women articles married women Research articles married women review articles married women PubMed articles married women PubMed Central articles married women 2023 articles married women 2024 articles married women Scopus articles married women impact factor journals married women Scopus journals married women PubMed journals married women medical journals married women free journals married women best journals married women top journals married women free medical journals married women famous journals married women Google Scholar indexed journals pregnancy complications articles pregnancy complications Research articles pregnancy complications review articles pregnancy complications PubMed articles pregnancy complications PubMed Central articles pregnancy complications 2023 articles pregnancy complications 2024 articles pregnancy complications Scopus articles pregnancy complications impact factor journals pregnancy complications Scopus journals pregnancy complications PubMed journals pregnancy complications medical journals pregnancy complications free journals pregnancy complications best journals pregnancy complications top journals pregnancy complications free medical journals pregnancy complications famous journals pregnancy complications Google Scholar indexed journals female purity articles female purity Research articles female purity review articles female purity PubMed articles female purity PubMed Central articles female purity 2023 articles female purity 2024 articles female purity Scopus articles female purity impact factor journals female purity Scopus journals female purity PubMed journals female purity medical journals female purity free journals female purity best journals female purity top journals female purity free medical journals female purity famous journals female purity Google Scholar indexed journals
Article Details
1. Introduction
The World Health Organization defined female genital mutilation (FGM) as all procedures which involve partial or total removal of the external female genitalia and / or injury to the female genital organs whether for cultural or any other non-therapeutic reasons [1]. Female genital mutilation is an unhealthy traditional practice inflicted on girls and women worldwide. It is widely recognized as a desecration of human rights which is deeply ingrained in cultural beliefs and perception over decades and generations with no easy task for change [2]. According to WHO’s latest data, 200 million women and girls in the planet earth are thought to have been subjected to the practice and more than three million are at risk of having it performed on them yearly [1]. FGM constitutes an extreme form of discrimination and violation of human rights of girls and women with health consequences now acknowledged and documented [3-7]. It is experienced in more than 28 African countries and some communities worldwide. Its encumbrance is felt more in countries like Nigeria, Egypt, Mali, Eritrea, Sudan, Central African Republic and Northern part Ghana where it has been in existence for ages [8,9]. The highest prevalence is seen in Somalia and Djibouti where FGM is almost the norm [8]. FGM is widely practiced in Nigeria, having the highest absolute number of cases of FGM worldwide and accounting for 25% of the estimated number of women circumcised worldwide. In Nigeria, the topmost prevalence of FGM is seen in south-south region (77%), followed by southeast (68%) and southwest (65%) [2,9]. However, it is being practiced on a lesser degree in the north although unexpectedly tending to have a more extreme form [2, 9]. Nigeria has an estimated population of 200 million people in 2019, according to the latest census figures and projections from Trading Economics, with the women population forming 52% [2, 9, 10]. The Nigerian countrywide prevalence of FGM among the female population is 41% [2]. In most societies, FGM is considered a cultural tradition [11, 12, 13].
The World Health Organization categorizes the FGM into four distinct classifications [1, 14, 15]. Three of the four categories are further broken down into subcategories that classify the specific type of mutilation that was performed. Type I is known as clitoridectomy and includes any procedure that totally removes the clitoris and/or the prepuce [14]. Type Ia is the removal of the clitoris hood or prepuce only while Type Ib includes the removal of both the clitoris and the prepuce [14]. Type II, or excision, is the partial or total removal of the labia minora unrelated to any mutilation performed on the labia majora. Type IIa includes the removal of the labia minora only. Type IIb is the removal of the labia minora and the partial or total removal of the clitoris [14]. Type IIc involves the removal or the clitoris, labia minora, and labia majora. Infibulation, or Type III, is the third category of mutilation procedures defined as the narrowing of the vaginal orifice with the sealing of the perineum by cutting and repositioning the labia minora and labia majora with or without the excision of the clitoris. Type IIIa references specifically procedures done with the removal and apposition of the labia minora, while Type IIIb includes procedures done with only the labia majora [14]. Type IV is a broad category that includes all other harmful techniques done devoid of medical purpose to the female genitals. This includes any cutting, herbal treatments, or burns that change or harm the patient’s body [1]. Despite all influence of medical innovation as well as earnest and conscientious activity such as awareness programs, public orientations, funding of researches, publication by the government and non- governmental organization and also private individual both at the national and international level to eradicate this bigoted practice, the phenomenon appears to still be in vogue till date [16]. In Nigeria there are still cases in which children at infancy and childhood age are being circumcised in isolation as a result of their cultural and religious beliefs, norms and myth and the likes. Despite the fact that the health risks associated with FGM are numerous, this harmful practice has continued unabated and the burden is high in low-income countries especially in Nigeria. There is need for creating awareness of the health risks to prevent the physical, and psychological sexual trauma that follows female genital mutilation. To our knowledge, no studies have comprehensively evaluated the awareness, perceptions and attitudes of FGM in south-eastern Nigeria. This study was aimed at determining the awareness, perception and attitude of Igbo women of child-bearing age towards the practice of FGM in south-east Nigeria.
2. Methods
This was a cross sectional descriptive and questionnaire-based study conducted between October 1, 2015 and April 30, 2016 in a rural community (Nanka, Orumba North Local Government Area, Anambra state, south-east Nigeria) among women of child bearing age. Females below the age of 16 years or above age of 45 years were excluded. A systematic random sampling technique was used in selecting the women who participated in this study. Data collection involved house to house visitation and meeting at public places like markets, and churches. If the member of the household who was eligible to be a study subject was not present at the time of the visit, a second visit was arranged and the data were obtained. Using a semi structure interviewer administered questionnaire, data was obtained from 367 respondents after obtaining their consent. The questionnaire was in 4 sections. Section A had a questionnaire on socio- demographic data, section B had questions on awareness of FGM, and section C had questions on attitude towards FGM. Section D had questions on practice of FGM. The questionnaire was developed first in English and was then translated back into the vernacular (Igbo language), and the translated Igbo version was administered. The researcher or research assistants interviewed the women. The study was approved by the ethics committee of the Nnamdi Azikiwe University Teaching Hospital prior to commencement. All participants provided verbal informed consent and were assured of confidentiality. A distinct population proportion formula was used to determine the sample size assuming that 41% of Nigerian countrywide prevalence of FGM among the adult population (as reported in a previous study in Nigeria [2]), and with a 5% level of significance (α = 0.05) and a 7% margin of error (ω = 0.07). The ultimate sample size was adjusted to allow a nonresponse rate of 10%, and was calculated as 362. The data collected were checked on a daily basis for completeness and appropriateness. For the sake of confidentiality, any label identifying the respondent was avoided in the questionnaire. Thus, the data were made anonymous. The data collected were analyzed using the SPSS statistical package version 23.0 (SPSS Inc, Chicago, Illinois, USA). The Chi-square test or Fisher’s exact test was used for the comparisons of categorical variables. Univariate analysis was performed in order to determine the possible association between the prevalent rates of FGM in the population and age and parity. The level of significance was set at p<0.05.
3. Results
Among 390 questionnaires administered, 367 (94.1%) were properly completed and used for analysis. The study showed that out of 367 respondents, 49 had FGM, given a prevalence of 13.4%. As shown in Table 1, of the 367 respondents, majority (33.8%) were between the age of 26 and 30 years. Majority (84.5%) were married. The entire women (367) were Igbo women and less than half of the respondents (45.5%) had tertiary Education, 34.9% were traders. Civil servants accounted for 29.7%. The majority, (99.5%) were Christians and more than half of the respondents (56.7%) had 1-4 children. The frequency distribution of responses by participants to questions on awareness of FGM is shown in Table 2. Considering participant’s awareness of the health risk associated with FGM, 98.9% have heard of FGM, and their sources being from family (65.0%), friends (65.0%), health personnel (30.9%), media (48.5%), religious teaching (7.4%), and women seminars (9.4%). Also, 88.6% of the respondents were aware that there could be complications like infections (46.5%), excessive bleeding (75.7%), severe pain during the procedure (82.2%), difficulty labor (52.3%), postpartum hemorrhage (19.7%), painful sexual intercourse (31.1%) and painful menstruation (17.8%). The frequency distribution on response of participants on attitude of FGM is shown in Table 3. Majority (85.8%) of the participants stated that FGM is a form of violence against women and 87.2% of the respondents do not want the practice to continue. Few participants (7.1%) suggested that the practice should continue that it ensures female purity (11.5%), prevents promiscuity (11.5%), maintain custom (7.7%) and leads to sexual satisfaction by their husbands (0.9%). However, 80.3% stated that FGM has no benefit owing to the fact that it is associated with complications such as difficulty in labor (68.1%), painful sexual intercourse (47.2%), and increased risk of vaginal bleeding after delivery (27%). Some of the respondents (14.8%) opined that FGM should be criminalized but did not give reasons, 14.7% did not think it should be criminalized while 13.6% were indifferent. Table 4 shows the frequency distribution of the responses of participants to the practice of FGM. Up to 53.7% of respondents stated that FGM is still being practiced in their community, giving reasons which are as follows, tradition (57.4%), to prevent promiscuity (83.6%), to prevent pre-marital sex (20.8%), to ensure female purity (14.4%), to increase chances of marriage (2.0%). Three (1.5%) of the respondents stated that the reason is for women to satisfy their husbands sexually. The result also showed that 82.0% of FGM is done by traditional birth attendants using razor in 51.8% of cases, scissors in 27.7% of cases, knife in 57.8% of cases and in hot water 1.6% of cases. Majority (86.6%) of respondents reported that FGM is done within the age of 5 years after delivery. Most (86.6%) of respondents were not circumcised. As shown in Table 5, the prevalence of FGM was significantly higher in the older age group (p<0.001) and parous women (p=0.025) compared to the younger age group and nulliparous women respectively.
Characteristics |
Frequency (n) |
Percentage (%) |
Age |
||
15-20 |
11 |
3.0 |
21-25 |
36 |
9.7 |
26-30 |
124 |
33.8 |
31-35 |
66 |
18.0 |
36-40 |
63 |
17.2 |
41-45 |
67 |
18.3 |
Marital Status |
||
Single |
55 |
15.0 |
Married |
310 |
84.5 |
Others |
2 (divorced) |
0.5 |
Religion |
||
Christian |
365 |
99.5 |
Muslim |
- |
- |
Others |
2 (traditionalists) |
0.5 |
Ethnic Group |
||
Igbo |
367 |
100.0 |
Others |
0 |
0.0 |
Educational Status |
||
No Formal education |
43 |
11.7 |
Primary |
53 |
14.7 |
Secondary |
104 |
28.3 |
Tertiary |
167 |
45.3 |
Occupation |
||
Trader |
128 |
32.6 |
Civil servant |
79 |
21.5 |
Student |
51 |
13.8 |
Farmer |
78 |
21.2 |
Unemployed |
40 |
10.9 |
Parity |
||
0 |
64 |
17.4 |
1-4 |
208 |
56.7 |
>5 |
95 |
25.9 |
Table 1: Socio-demographic characteristics of the respondents.
Characteristic |
Frequency (n) |
Percentage |
Have you heard of FGM |
||
Yes |
363 |
98.9 |
No |
4 |
1.1 |
Total |
367 |
100.0 |
If YES, from what source? |
||
Family |
||
Yes |
236 |
65.0 |
No |
127 |
35.0 |
Total |
363 |
100.0 |
Friends |
||
Yes |
236 |
65.0 |
No |
127 |
35.0 |
Total |
363 |
100.0 |
Health personnel |
||
Yes |
112 |
30.9 |
No |
251 |
69.1 |
Total |
363 |
100.0 |
Media |
||
Yes |
176 |
48.5 |
No |
187 |
51.5 |
Total |
363 |
100.0 |
Religious teaching |
||
Yes |
27 |
7.4 |
No |
336 |
92.6 |
Total |
363 |
100.0 |
Women seminar |
||
Yes |
34 |
9.4 |
No |
329 |
90.6 |
Total |
363 |
100.0 |
Are you aware of the complication |
||
Yes |
325 |
88.6 |
No |
42 |
11.4 |
Total |
367 |
100.0 |
If YES, what are the complications? |
||
Infections |
||
Yes |
151 |
46.5 |
No |
174 |
53.5 |
Total |
325 |
100.0 |
Excessive bleeding |
||
Yes |
246 |
75.7 |
No |
79 |
24.3 |
Total |
325 |
100.0 |
Severe pain during FGM |
||
Yes |
267 |
82.2 |
No |
58 |
17.8 |
Total |
325 |
100.0 |
Difficulty labor |
||
Yes |
170 |
52.3 |
No |
155 |
47.7 |
Total |
325 |
100.0 |
Post-partum hemorrhage |
||
Yes |
64 |
19.7 |
No |
261 |
80.3 |
Total |
325 |
100.0 |
Painful sexual intercourse |
||
Yes |
101 |
31.1 |
No |
224 |
68.9 |
Total |
325 |
100.0 |
Painful menstruation |
||
Yes |
58 |
17.8 |
No |
267 |
82.2 |
Total |
325 |
100.0 |
Table 2: Frequency distribution of responses by participants to questions on awareness.
Characteristics |
Frequency (n) |
Percentage |
Is FGM a good practice |
||
Yes |
19 |
5.7 |
No |
337 |
91.3 |
I don’t know |
10 |
3.0 |
Total |
367 |
100.0 |
Is FGM a form of violence against women |
||
Yes |
315 |
85.8 |
No |
41 |
11.2 |
I don’t know |
10 |
3.0 |
Total |
367 |
100.0 |
Do you think the practice should be continued |
||
Yes |
26 |
7.1 |
No |
320 |
87.2 |
I don’t know |
21 |
5.7 |
Total |
367 |
100.0 |
If YES, why? |
||
To ensure female purity |
||
Yes |
3 |
11.5 |
No |
23 |
88.5 |
Total |
26 |
100.0 |
To prevent promiscuity |
||
Yes |
3 |
11.5 |
No |
23 |
88.5 |
Total |
26 |
100.0 |
To maintain certain customs |
||
Yes |
2 |
7.7 |
No |
24 |
92.3 |
Total |
26 |
100.0 |
To prevent premarital sex |
||
Yes |
2 |
7.7 |
No |
24 |
92.3 |
Total |
26 |
100.0 |
No reason |
||
Yes |
1 |
3.8 |
No |
25 |
96.2 |
Total |
26 |
100.0 |
If NO, why? |
||
It has no benefit |
||
Yes |
257 |
80.3 |
No |
63 |
19.7 |
Total |
320 |
100.0 |
It increases difficulty in labor |
||
Yes |
218 |
68.1 |
No |
102 |
31.9 |
Total |
320 |
100.0 |
Brings about painful sexual intercourse |
||
Yes |
151 |
47.2 |
No |
169 |
52.8 |
Total |
320 |
100.0 |
Increases risk of vaginal bleeding after delivery |
||
Yes |
87 |
27.2 |
No |
233 |
72.8 |
Total |
320 |
100.0 |
No reason |
||
Yes |
47 |
14.7 |
No |
273 |
85.3 |
Total |
320 |
100.0 |
OTHERS (SPECIFY) |
||
Increases sexual satisfaction of their husbands |
||
Yes |
3 |
0.9 |
No |
317 |
99.1 |
Total |
320 |
100.0 |
Should FGM be criminalized |
||
Yes |
263 |
71.6 |
No |
54 |
14.7 |
I don’t know |
50 |
13.6 |
Total |
367 |
100.0 |
Table 3: Frequency distribution on response of participants on attitude of FGM.
Characteristics |
Frequency (n) |
Percentage |
Is FGM practiced in your community |
||
No |
40 |
10.9 |
Yes |
197 |
53.7 |
I don’t know |
130 |
35.4 |
Total |
367 |
100.0 |
If YES, WHY |
||
Tradition |
||
Yes |
113 |
57.4 |
No |
84 |
42.6 |
Total |
197 |
100.0 |
To prevent promiscuity |
||
Yes |
165 |
83.6 |
No |
32 |
16.4 |
Total |
197 |
100.0 |
To prevent premarital sex |
||
Yes |
41 |
20.8 |
No |
156 |
79.2 |
Total |
197 |
100.0 |
To ensure female purity |
||
Yes |
28 |
14.4 |
No |
169 |
85.6 |
Total |
197 |
100 |
To increase chance of marriage |
||
Yes |
4 |
2.0 |
No |
193 |
98.0 |
Total |
197 |
100.0 |
Others |
||
Yes |
3 (to sexually satisfy their husband) |
1.5 |
No |
194 |
98.5 |
Total |
197 |
100 |
Who performs the practice |
||
Traditional birth attendant (TBA) |
301 |
82 |
Village women other than TBA |
58 |
15.8 |
Health professional |
8 |
2.2 |
Total |
367 |
100 |
INSTRUMENT USED |
||
Razor |
||
Yes |
190 |
51.8 |
No |
177 |
48.2 |
Total |
367 |
100 |
Scissors |
||
Yes |
100 |
27.7 |
No |
267 |
72.3 |
Total |
367 |
100 |
Knife |
||
Yes |
212 |
57.8 |
No |
155 |
42.2 |
Total |
367 |
100.0 |
Others |
||
Yes |
6 (hot water) |
1.6 |
No |
361 |
98.4 |
Total |
367 |
100.0 |
At what age is FGM done |
||
At birth |
62 |
16.9 |
0 – 5 years |
253 |
68.9 |
6 –10 years |
52 |
14.2 |
11 – 15 years |
||
>15 years |
||
Total |
367 |
100.0 |
Were you circumcised |
||
Yes |
49 |
13.4 |
No |
318 |
86.6 |
Total |
367 |
100.0 |
Table 4: Frequency distribution on responses of participants on practice of FGM.
Variables/subgroup |
FGM Group (N=49) |
No FGM group (N=318) |
RR (95%CI) |
P-value |
Age Range |
||||
15-35 years |
7 (14.3) |
230 (72.3) |
0.09 (0.042-0.194) |
<0.001 |
36-45 years |
43 (87.7) |
88 (27.7) |
||
Parity |
||||
Nulliparous |
14 (49.0) |
50 (12.6) |
1.89 (1.084-3.309) |
0.025 |
Parous |
35 (51.0) |
268 (87.4) |
Table 5: Association between prevalence of FGM and age/parity of the respondents based on univariate test.
4. Discussion
This present study evaluated the prevalence, awareness and attitude of Igbo women of child bearing age in Nigeria towards the practice of female genital mutilation (FGM). In this study, the prevalence of FGM was 13.4% and the 98.9% of respondents have heard of FGM their sources being from family (65.0%), friends (65.0%), health personnel (30.9%), media (48.5%), religious teaching (7.4%) and women seminars (9.4%). Additionally, 86.6% of the respondents are aware of the complications which are as follows; infection (46.5%), excessive bleeding (75.7%), severe pain during FGM (82.2%), difficulty labor (52.3%), postpartum hemorrhage (19.7%), painful sexual intercourse (31.1%), and painful menstruation (17.8%). The women were aware of the health risks enumerated and their consequences. The present study has revealed the prevalence of FGM was 13.4%. This finding is lower than the WHO general rate of 41% for Nigerian population. In Nigeria, the peak prevalence of FGM is seen in south-south region (77%), followed by southeast (68%) and southwest (65%) [2, 9]. The prevalence of 13.4% seen in this study could signify a falling trend in the society. In similar Nigerian study by Johnson and Okon, 98.6% of respondents were aware of the practice of FGM [17]. In another similar study, Dattijo et al [18] showed that 94.6% were aware of FGM of which mass media was their main source of information unlike in my study where family was their main source of information [18]. Contrariwise, a similar community based cross-sectional study in Ethiopia by Yirga et al revealed a lower awareness rate of 38.5% [19]. This disparity in awareness rate may be due to differences in religious orientation of the two populations. The result from the Nigerian study done by Johnson and Okon among Ayadehe women in Itu, Nigeria reported that the health complications experienced by women following FGM were excruciating pains (36.6%), severe bleeding (15.8%), painful urination (26.7%) as against severe pains (81.4%), severe bleeding (75.8%) recorded in our present study[18]. In a qualitative study conducted in Monrovia, Liberia by Tarr-Attia et al among twenty midwives on FGM revealed that sexual impairment and intrapartum vulvo-perineal laceration with ensuing hemorrhage were defined as frequent FGM-attributable complications [20]. In a study done by Nwaokoro et al in Awka, Nigeria, 68.2% of respondents perceived that FGM is a bad practice and the practice should be abolished [21]. This concurs with our findings where 91.8% of respondents stated that FGM is a bad practice, with majority (85.8%) stating that it is a form of violence against women and 87.2% of respondents want the practice to be discontinued. In another study in Ethiopia by Belda and Tololu, 12.8% of respondents desire that the practice of FGM should continue, even though 87.2% of them do not want their daughters to be circumcised [22]. However, in our findings, 7.1% of respondents desire that the practice should be continued because of the following reasons; it ensures female purity (11.5%), it prevents promiscuity (11.5%) and maintenance of custom (7.7%). Nonetheless, the result from the study done by Dattijo et al showed that the majority (83.8%) of the respondents wanted the practice to be discontinued, while 31.1% reported to have a plan to circumcise their daughters citing tradition, marriage prospects and faithfulness to their husbands as their reasons [18]. There are many reasons for the practice of FGM, and it is often described as a means to safeguard against premarital sexual activity and, as such, prevent female promiscuity and preserve virginity. This is seen in the present study as up to 53.7% of the respondent stated that FGM was practiced because of traditional belief (57.4%), and for prevention of promiscuity (83.6%). In a previous study by Yirga et al, the main reason for the practice of FGM was reduction of female sexual hyperactivity as the authors reported in 60.3% of cases [19]. Similarly, in one prior World Health Organization study in Egypt, 33.4% of subjects perceived the practice of FGM to be a religious tradition [23]. Apart from the notable traditional reason for FGM, our findings have revealed that other reasons the respondents thought about reasons for persistence of practice of FGM was to prevent promiscuity (83.6%), to prevent premarital sex (20.8%), to ensure female purity (14.4%), to increase the chance of marriage (2.0%) and to satisfy respective husbands (1.5%). In a recent Ghanaian study by Sakeah et al it was revealed that easy movement of women across borders, belief that FGM will preserve virginity and reduce promiscuity, male dominance and lack of female autonomy ensures continuation of the FGM practice [24]. This is in tandem with the findings of our index study. The greater number of respondents (82.0%) believes that the traditional birth attendants performed FGM. However, they revealed that traditional birth attendants perform this practice using razor in 51.8% of cases, scissors in 27.7% of cases, knife in 57.8% of cases and hot water in 1.6% of cases. Similarly, according to Banda report, 90% of FGM performed in Guinea and Eritrea is done by traditional/ local healers [25]. Thus, the use of these unhygienic procedures in the community may increase the risk of infection and later reproductive complications in women after undergoing FGM. Many respondents stated that it is done from birth to 5 years in 68.9% of cases and 13.4% were circumcised. These findings were similar to the WHO report in other African countries [26]. When FGM procedure is being performed, 50% of females cut in regions of Ethiopia, Mali, and Mauritania were under 5 years of age, whereas 76% of those in Yemen were performed when they were not more than two weeks of age [26]. Nonetheless, if the procedure is done during childhood, it leaves a scar that narrows the female genitalia and complicates childbirth, causing injury, and has a negative impact on sexuality at a later age [27]. Since the practice is often done under forceful and aggressive moments, and performed without the consent of the victim, it is unethical, and even more so when performed on young girls who are put through enormous suffering. The present study has shown that the prevalence of FGM was significantly higher in the older age group (p<0.001) and parous women (p=0.025) compared to the younger age group and nulliparous women. This finding is understandable and it appears to be dissimilar to previous report in India by Tag-Eldin et al [23]. This finding signifies abating prevalence in the community since the older age groups have high frequency of it. Age too is a function of parity. Ordinarily, older age are commonly seen in parous women. The present study has some limitations. There could be recall bias on some of the women interviewed because of the cross-sectional design of the study. The only one rural community setting employed in the study is also a limitation because multi-settings could have increased the reliability of findings. The strength of the study is that this is an updated data on the awareness and attitudes of FGM in Nigeria.
5. Conclusion
This study showed that despite the high awareness and negative attitude of the populace to the practice of female genital mutilation and its consequences, FGM has continued to persist in Nigerian communities. The prevalence of FGM was 13.4%. The reasons for its continued persistence include, traditional norms, preventing promiscuity and pre-marital sex, enhancement of female purity, increase chances of marriage and sexual satisfaction. More effective measures like legislation, in addition to the ongoing mass education should be put in place to stop these obnoxious practices. The practice of FGM is a violation of human rights and has to be stopped altogether. Integrated efforts by policy-makers, the Ministry of Health, and international organizations are needed all over the country. It might continue to be a challenge in public health practice, but educating women is likely to have the most impact.
Author’s Contribution
NBO, CAE and CEN contributed to the study conceptualization and methodology; NBO conducted the field work, ensured completion of the participants data and extracted the required data; OSU, CCO, and GUE analyzed the data and drafted the original manuscript; EAE, CCO, JCA and EAE worked with NBO on formal analysis; NBO, CAE, CEN, CBO and EAE contributed to the project administration, writing (review and editing), data visualization, and supervision. All authors have seen and approved their contributions and the final version of the manuscript.
Acknowledgment
The authors wished to thank the women who volunteered to participate in the study.
Funding Source
Nil
Conflict of Interest
Authors declare no conflict of interest.
References
- World Health Organization. Female Genital Mutilation, (2020).
- Okeke TC, Anyachie USB, Ezenyeaku CK. An overview of Female Genital Mutilation in Nigeria. Ann Med Health Sci Res 2 (2012): 70-73.
- Dare FO, Oboro VO, Fadiora SO, et al. Female genital mutilation: An analysis of 522 cases in south-western Nigeria. J Obstet Gynaecol 24 (2004): 281-283.
- Behrendt A, Moritz S. Posttraumatic stress disorder and memory problems after female genital mutilation. Am J Psychiatry 162 (2005): 1000-1002.
- Alsibiani SA, Rouzi AA. Sexual function in women with genital mutilation. Fertil Steril 93 (2010): 722-724
- Morison L, Scherf C, Ekpo G, et al. The long-term reproductive health consequences of female genital cutting in rural Gambia: a community based survey. Trop Med Int Health 6 (2001): 643-653.
- WHO study group on female genital mutilation and obstetric outcome, Banks E, Merik O, et al. Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. Lancet 367 (2006): 1835-1841.
- Chibber R, El- saleh E, El Harmi J. Female circumcision: obstetric and psychological sequelae continues unabated in the 21st century. J. Matern. Fetal Neonatal Med 24 (2011): 833-836.
- Children’s and Women’s rights in Nigeria: A wakeup call situation assessment and analysis. Harmful traditional practice (FGM) Abuja NPC and UNICEF Nigeria. 2001: 195-200
- Trading Economics. Nigeria Population 1960-2019 Data (2020).
- Ismail EA. Female genital mutilation survey in Somali and Hargeisa: Somaliland: Edna Aden Maternity and teaching Hospital 2009 (2002): 2009.
- Odoi AT. Female genital mutilation In: Kwawukume E.Y, Emuveyan E.E editors, comprehensive Gyneocology in the topics. 1st Edition. Accra: Graphic packaging ltd (2005): 268-278.
- Asaad MB. Female circumcision in Egypt social implication current research and prospects for change. Study FGM plan 11 (1980): 3-16.
- Odemerho BI, Baier M. Female genital cutting and the need for culturally competent communication. Journal for Nurse Practitioners 8 (2012): 452-457.
- Boyoudh F, Barrack SS, Ben-Fred’s N, et al. Study of custom in somalia, the circumcision of girls. Med trop 55 (1995): 238-242.
- European Parliament. Resolution of March 2009 on combating female genital mutilation in EU.2008, 2017(INI), (2009).
- Johnson OE, Okon RD. Perception and practice of female genital cutting in a rural community in southern Nigeria. Afr J Reprod Health16 (2012): 132-139.
- Dattijo LM, Nyango DD, Osagie OE. Awareness, perception and practice of female genital mutilation among expectant mothers in Jos University Teaching Hospital Jos, north-central Nigeria. Niger J Med 19 (2010): 311-315.
- Yirga WS, Kassa NA, Gebremichael MW, et al. Female genital mutilation: prevalence, perceptions and effect on women's health in Kersa district of Ethiopia. Int J Womens Health 4 (2012): 45-54.
- Tarr-Attia CK, Boiwu GH, Martínez-Pérez G. 'Birds of the same feathers fly together': midwives' experiences with pregnant women and FGM/C complications - a grounded theory study in Liberia. Reprod Health 16 (2019): 18.
- Nwaokoro JC, Ede AO, Dozie IJ, et al. Attitude and Perception on the Impact of Female Genital Mutilation on Health and Sex Drive among Married Women in Ebenebe, Awka North L.G.A., Anambra State. Austin J Public Health Epidemiol 3 (2016): 1047.
- Belda SS, Tololu AK. Knowledge, attitude and practice of mothers towards female genital mutilation in South West Shoa zone, Oromia region, Ethiopia. MOJ Public Health 6 (2017): 279-286.
- Tag-Eldin MA, Gadallah MA, Al-Tayeb MN, et al. Prevalence of female genital cutting among Egyptian girls. Bull World Health Organ 86 (2008): 269-274.
- Sakeah E, Debpuur C, Aborigo RA, et al. Persistent female genital mutilation despite its illegality: Narratives from women and men in northern Ghana. PLoS One 14 (2019): e0214923.
- Banda F. National legislation against female genital mutilation. Eshborn, Germany: German Technical Cooperation (2003).
- Progress in sexual and reproductive health research. Geneva: WHO (2006).
- Jasmine A, Christine M, Michel B, et al. Care of women with female genital mutilation/cutting (2011).