The study explored factors influencing attitudes towards the practice of female genital cutting (FGC) among women in Oromia region, Ethiopia. Representative data from 2221 women aged 15–49years from the Ethiopia Demographic and Health Survey in 2005 were evaluated. Overall, 88.4% of women had undergone FGC. Prevalence significantly decreased with birth date, ranging from 95.1% in women aged 45–49 years to 75.8% in those aged 15–19 years. Overall, 63.7% of women favoured the discontinuation of FGC, while 29.7% favoured its continuation. Education was strongly correlated with a stance against the practice: while only 54.6% of illiterate women were against it, this figure was 95.5% among women who had completed secondary school. While the reported prevalence was similar among Christian (87.8%) and Islamic women (89.1%), 56.3% of Islamic women favoured discontinuation compared with 70.5% of Christian women. The higher that women scored on empowerment indices, the more they opposed the practice. In logistic regression models, educational level (P = 0.001), personal FGC experience (P = 0.001), religious affiliation (P = 0.02) and self-empowerment were factors (P = 0.01 and P = 0.004) significantly associated with favouring discontinuation. Future efforts encouraging an end to FGC must include the illiterate population in the Oromia region and focus on improving the status of women.
Introduction
Female genital cutting (FGC), also known as female circumcision and female genital mutilation, is a traditional practice common to most societies in north-eastern Africa, where it was almost universally conducted until some decades ago (Baron and Denmark, 2006, Klouman et al., 2005, Missailidis and Gebre-Medhin, 2000, Msuya et al., 2002, Tag Eldin et al., 2008, UNICEF, 2005). The World Health Organization (WHO) estimated that more than 130 million women are affected by FGC worldwide (WHO, 2008). FGC has been subject to considerable debate for about half a century and 30 years ago the WHO launched a programme to support governments in an attempt to combat FGC (WHO, 2008). In line with this, the Ethiopian Ministry of Health subsequently began educational programmes to eradicate the practice 20 years ago (Ethiopia Demographic and Health Survey, 2006).
Ethiopia belongs to one of the least developed countries worldwide with a fertility rate of 5.4%, a crude birth rate of 39 per 100,000 and a life expectancy at birth of 53 years as of 2007 (UNICEF, 2007). It is home to some 80 ethnic groups, of which the Oromo group constitutes the largest one, comprising about 30% of the country’s population of some 80 million people. While the ethnic group of Oromo is spread throughout the entire country, the Oromia region is an administrative unit situated around the capital Addis Ababa, stretching from the border of the Sudan in the east to the Kenyan and Somalian borders in the south-west. In this region, 85% of the population identifies themselves as belonging to the Oromo.
The practice of FGC is widespread throughout the country, with 74% of women of reproductive age having undergone the procedure as of 2005 (Ethiopia Demographic and Health Survey, 2006). Prevalence and type of FGC varies among ethnic and regional groups, with the practice being most common in the eastern parts of the country (Table 1), home to the Afar and Somali groups. Religion is used by many as the basis for their justification in performing these procedures, despite the fact that there is no doctrinal basis for this practice in Islam, Christianity or Judaism. FGC is a deeply rooted tradition reinforced by customary beliefs that it ensures hygiene and preserves a girl’s chastity and fertility, thus making her a more valuable potential wife as well as securing family honour. In most communities, women who have not undergone FGC are considered likely to be promiscuous and, therefore, unworthy of marriage. Hence, the practice is regarded not only as a positive experience that is beneficial to girls but also as a prerequisite for an honourable marriage. Among communities performing FGC in girls at older ages, it is usually seen as a rite of passage and, therefore, is thought of positively, granting a girl respect within a village by making her a woman.
In order to gather information as to what extent FGC is practised in Ethiopia, questions related to the practice were included in the 2005 Ethiopia Demographic and Health Survey (2006). The current report analyses data gathered in the women residing in the Oromia region. The analysis presents the reported prevalence of FGC in women of reproductive age and examines socio-economic factors and personal characteristics that may have an influence on the attitudes of women towards FGC. Specifically, the objective of the study was to elucidate which factors are associated with support for the discontinuation of FGC in women and to explore preventative factors that could be useful in future educational programmes in Oromia communities. As rapid abandonment of FGC is unrealistic, while understanding and development of sensitive approaches will help managers addressing future goals. Along these lines, the following hypothesis was tested: a women’s feeling of self-empowerment is proportional to the degree to which she takes a stance against the practice.
Section snippets
Materials and methods
The Ethiopia Demographic and Health Survey (2006) sample is a stratified, two-stage clustered sample of some 14,000 Ethiopian households. It includes a representative survey of women of reproductive age (15–49 years). The current paper investigates interview data gathered from women residing in Oromia region (n = 2230). Data used here include socio-economic information such as age, residence, educational status (years of schooling, educational level achieved), religion (Christian, Islamic), ethnic
Results
The original sample contained 2230 women, of whom nine did not know their status; their data were deleted. The data set thus included 2221 women of reproductive age (15–49 years), with a median age of 25 years. Overall, 84% (1853) identified themselves as belonging to the ethnic group of Oromo, while 10.3% (228) were Amhara, 1.3% (28) Gurarge or Gedeo, and 99 women belonged to one of the other ethnic groups. Fourteen percent of the respondents lived in an urban environment, while 86% resided in
Discussion
As a result of its representative design, the Ethiopia Demographic and Health Survey provides an authoritative picture of the population in Oromia region, Ethiopia. It therefore offers an extremely useful tool that allows the characterization of the population and examination of the factors that are associated with a variety of outcomes; it can also be used to understand women’s perceptions and how certain factors might affect their behaviour. However, there are some methodological limitations:
Acknowledgements
The contribution of Jesse Jacobs at University of California, Berkeley is gratefully acknowledged. Thanks are extended to P Greiner, without whose constantly encouraging efforts this work would never have been done. Parts of this publication were presented at the Sixth European Congress on Tropical Medicine and International Health, 6–10 September 2009, Verona, Italy.
In line with our finding, another study conducted in Ethiopia showed that the community still supports the continuation of FGM [7]. On the contrary, this finding is different from the finding of other studies conducted in Ethiopia that showed a growing resistance and decline of FGM [54, 55]. Therefore, community based health education should be delivered thoroughly.
Female genital mutilation affects the social, psychological, spiritual and physical well-being of women. In Ethiopia, studies regarding the female genital mutilation were conducted in various settings and years.
This systematic review and meta-analysis was aimed to summarize the prevalence of female Genital Mutilation in Ethiopia.
A systematic search of articles was conducted in PubMed, African Journals Online (AJOL), Excerpta Medica database (EMBASE), SCOPUS, Web of Science, and JSTOR. Data were extracted using a standardized data extraction format prepared in Microsoft Excel. The data were analyzed using STATA version 11 software. Cochrane Q statistic was used to assess the presence of significant between-study heterogeneity. I2 was used to quantify between-study heterogeneity. A leave-one-out sensitivity analysis and subgroup analysis based on a study period and setting were done. The funnel plot and Egger's regression tests were used to measure the presence of substantial publication bias. The pooled estimated prevalence of female genital mutilation was conducted using a DerSimonian and Laird random effects model.
The pooled prevalence estimate of FGM was 77.28% (95% CI: 55.81, 98.76). The pooled prevalence was higher in studies conducted from 2013-2017 (78.39%, 95%CI: 48.24, 108.54) and studies conducted in Hospital (92.02: 95%CI: 55.81, 98.76).
The prevalence of Female Genital Mutilation is high. Therefore, interventions that are focused on health education, social support and advocacy are recommended.
2016, International Journal of Gynecology and Obstetrics
Citation Excerpt :
However, a bad experience might lead women to disfavor FGM on their daughters. One study [15] found that personal FGM experience was significantly associated with favoring a discontinuation of the practice. In the present study, only 4.5% of mothers had a positive perception of genital mutilation of daughters.
To assess the practice of female genital mutilation (FGM) among mothers and daughters, and to investigate sociodemographic factors influencing the practice of FGM in Harar, Ethiopia.
A community-based cross-sectional study was conducted among women aged 15 years or older who had at least one living daughter younger than 12 years via the Harar Health and Demographic Surveillance System 2013. Data were collected through face-to-face interviews. The practice of FGM was compared between mothers and their daughters. Whether the daughter had undergone FGM was included as an outcome variable in bivariate and multivariate analyses.
Among 842 mothers, 669 (79.5%) reported that they had undergone FGM themselves, and 160 (19.0%) that their daughter had undergone FGM. Traditional practitioners were said to be the major performers of FGM by 151 (94.4%) mothers. Mothers whose daughter was mutilated mentioned social acceptance (144 [90.0%] women) and better marriage prospects (96 [60.0%]) as the major benefits. Genital mutilation of daughters was significantly associated with maternal age, education to grade 1–4, and FGM experience. Amhara ethnic origin was significantly associated with a reduced likelihood of FGM among daughters.
Over one generation, the incidence of FGM has reduced. Increasing advocacy against FGM and enforcement of law should be emphasized.
However, because FGC tends to occur before formal education has begun, many argue that education of a mother is a more meaningful variable for assessing the relationship between FGC and education. Education of a child's mother remains an important predictor of completion of FGC in young girls, with several studies reporting that the higher level of education attained by a woman or her partner, the lower the prevalence of FGC in daughters18,22 and the higher the level of support for its discontinuation.23 Social tradition and a belief that religion requires FGC are major reasons for the continuation of FGC.
The United States has more than 1.5 million immigrants from countries in Africa and the Middle East where female genital cutting (FGC) is known to occur. Often, FGC occurs in infancy and childhood in the countries where it is practiced, but patients of any age can present with complications. Lack of understanding of this common problem can potentially alienate and lower quality of care for this patient population. We provide an introduction to the practice of FGC and practice guidelines for the primary care physician. We reviewed original research, population-based studies, and legal research from PubMed, Scopus, CINAHL plus, PsycINFO, and Legal Trac. The terms searched included female genital cutting, female genital circumcision, and female genital mutilation alone and with the term complications or health consequences; no limit on date published. Legal databases were searched using the above terms, as well as international law and immigration law. Editorials and review articles were excluded. This review discusses the different types of FGC, important cultural considerations for physicians caring for patients with FGC, the common early and late medical complications and their management, and psychosocial issues associated with FGC. Current laws pertaining to FGC are briefly reviewed, as well as implications for patients seeking asylum status in the United States because of FGC. Finally, the article presents evidence-based, culturally sensitive approaches to discussions of FGC with girls and women for whom this is an issue.
Dr Yilma Melkamu is a medical doctor with specialization in public health. He has been working both as a medical practitioner and public health expert in Ethiopia for the last 15 years, at the Ministry of Health and national and international and NGOs, both in urban and rural settings. From 2004 to 2008, Dr Yilma worked as an assistant professor in Public Health at Addis Ababa University. Recently, he joined the International Planned Parenthood Federation Africa Regional Office in Nairobi as a Technical Advisor. His main expertise and research interests are safe motherhood, family planning and HIV/AIDS.
