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ORIGINAL ARTICLE
Year : 2016  |  Volume : 29  |  Issue : 4  |  Page : 1100-1105

The current situation about female genital mutilation among circumcised and uncircumcised women in Manwahla family health unit, El-Bagour, Menofia


Department of Family Medicine, Menoufia University, Shibin Elkom, Egypt

Date of Submission11-Feb-2016
Date of Acceptance03-Jun-2016
Date of Web Publication21-Mar-2017

Correspondence Address:
Mahetab A Ali
Benha, Kalubia, 13731
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.202503

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  Abstract 

Objectives
The aim of this study was to assess the prevalence of female genital mutilation (FGM) among women attending Manwahla family health unit and compare between circumcised and uncircumcised women on their awareness (knowledge) and attitude toward FGM.
Background
FGM, circumcision, is one of the oldest and the most controversial surgical procedures performed worldwide and is almost universal. In Egypt, the practice was nearly universal until recently. FGM has no health benefits, and it harms girls and women in many ways.
Participants and methods
This study was carried out in Manwahla family health unit from 1 March 2015 to the end of May 2015; the sample included 400 married women selected from among interview attendants to Manwahla family health unit using a validated predesigned questionnaire to assess the prevalence of circumcision among them and other variables related to awareness and attitude toward FGM.
Results
The prevalence of FGM was 83%. The mean age of the studied participant was 31.1 ± 6.9 years. Approximately 53.2% of the women studied were of low socioeconomic status; the main causes for conducting mutilation were the belief that it was good for girls, 35.2%, and because it is a tradition, 33.8%. The study found that 64.3% of circumcised women had good knowledge, whereas 74.6% of noncircumcised women had good knowledge, and both circumcised and noncircumcised women had a high positive attitude, 63.4%, among circumcised women and 74.6% among noncircumcised women. The frequency of circumcision among daughters of the groups studied was 17.7% among circumcised women and 5.2% among uncircumcised women.
Conclusion
The FGM is wide spread their is no well established knowledge and negative attitudes. Maintaining the chastity of a woman and preserving tradition are the backbone causes for it's persistence.

Keywords: attitude, circumcision, female genital mutilation, knowledge


How to cite this article:
Shaheen HM, Hegazy NN, Ali MA. The current situation about female genital mutilation among circumcised and uncircumcised women in Manwahla family health unit, El-Bagour, Menofia. Menoufia Med J 2016;29:1100-5

How to cite this URL:
Shaheen HM, Hegazy NN, Ali MA. The current situation about female genital mutilation among circumcised and uncircumcised women in Manwahla family health unit, El-Bagour, Menofia. Menoufia Med J [serial online] 2016 [cited 2020 Apr 6];29:1100-5. Available from: http://www.mmj.eg.net/text.asp?2016/29/4/1100/202503


  Introduction Top


Female genital mutilation (FGM) or female circumcision is a traditional practice whose origin can be traced to ancient times [1],[2].

The WHO defines female circumcision as all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious, or other nontherapeutic reasons [3]. However, the worst types of FGM are practiced in Sudan, Egypt, Mali, Ghana, and Nigeria [4].

Various reasons have been given for the practice of FGM in different geographical and cultural settings ranging from culture, religion to superstition [5]. FGM is most often described as a rite of passage for young girls, a way to protect daughters' modesty and improve their marriage prospects, and is mainly followed across generations through women [6].

It is typically performed on girls between the ages of 8 and 14 years, preferably before the onset of puberty [7],[8].

Notably, there is an increase in its 'medicalization', where the circumcision is performed by a health professional [7]. FGM has no health benefits, and it harms girls and women in many ways, interfering with the natural functions of the bodies of girls and women. Immediate complications include severe pain, shock, hemorrhage, tetanus, sepsis, and urine retention. Long-term outcomes include recurrent bladder and urinary tract infections, cysts, infertility, and the need for later surgeries [9]. Egypt is of particular interest because the decreases in circumcision rates have been rapid. According to the estimates of the Egypt Demographic and Health Survey (EDHS), fewer than 40% of girls born in the mid-1990s are circumcised by age 13 compared with nearly 90% of girls born in the 1980s [8].


  Participants and Methods Top


This was a cross-sectional study. The study was carried out over a time frame of 3 months (from the beginning of March 2015 to the end of May 2015). The study was carried out in the Manwahla family health unit, El-Bagour district, Menofia governorate.

The sample size was estimated according to the total number of females in the child-bearing period (15–45) years in Manwahla village, which were 2743 according to the last residential census [10]. With a confidence level of 95% and a 5% margin of error, the sample size was 338 females, with 10% added to cover dropouts and to round out the results [11]. The cases were selected from among the attendees of the family health center seeking treatment, follow-up, or accompanying a patient.

All women were interviewed using a validated predesigned questionnaire that included questions on sociodemographic characteristics, and knowledge of and attitude toward FGM including the following: 13 questions on sociodemographic characteristics, three of them focused on personal history and nine focusing on sociodemographic data [11]. Seven questions focused on circumcision to assess knowledge of circumcision, types, steps, complications, and sources of information. Six questions focused on assessment of attitudes toward circumcision and motives behind female circumcision.

Statistical analysis of the result was carried out; the data were collected, tabulated, and statistically analyzed using the SPSS version 20 (SPSS Inc., Chicago, Ilions, USA) software program. Two types of statistical tests were used, descriptive and comparative types, where quantitative data were summarized as mean and SDs, whereas qualitative data were summarized as numbers and percentages.

A comparison were made using a paired Student t-test in case of quantitative data and the c2-test in case of qualitative data. Results were considered significant if the P value was 0.05 or less.

The response for the knowledge questions involved yes or no. The responses were scored and good knowledge was indicated by a total score of more than 60% and poor knowledge was indicated by a total score of less than 60%. Attitude scoring was performed for attitude questions and a positive attitude was indicated by a score of more than 60% and a negative attitude was indicated by a score of less than 60%.

Ethical consideration

The aim and method of the study was explained to the women. They were assured that their data would be anonymized. The medical ethical committee of the Menofia Faculty of Medicine approved the study.


  Results Top


The prevalence of FGM among women in Manwahla family health unit was 83% and only 17% had not been circumcised.

Among circumcised women, the age range was 15–45 years, with a mean age of 31.1 ± 6.9 years, whereas among noncircumcised women, the mean age was 26 ± 6.8 years. It was noted that circumcised women had income that meet routine expense and emergency whereas in non-circumcised women they had income meet routine expense only ([Table 1]).
Table 1 Comparison between circumcised and noncircumcised married women in terms of sociodemographic data

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Socioeconomic status: low socioeconomic status was high among circumcised women (53.2%) compared with noncircumcised women (7.5%); this was statistically significant ([Table 2]).there was a statistical difference regarding knowledge among the studied groups regarding the complication, procedure and prohibition. Thirty-four percent had incomplete answers; 35.7% of these were circumcised and 25.4% were uncircumcised. The participants studied depended mainly on the media as a source of their knowledge (64.2%) ([Table 2]).
Table 2 Awareness (knowledge) of circumcision among the women studied

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Attitudes and motives: About 40.8% of the circumcised women mentioned chastity of girls (good for girl) as the main motive for performing circumcision, whereas about one-half of the noncircumcised women mentioned keeping tradition as the main motive for performing circumcision, 47.8%. Among all of the noncircumcised women, 100% refused circumcision, whereas among circumcised women, 41.1% refused. Most of the circumcised women, 29.7%, were not aware of their husbands' attitude toward circumcision, and 28.2% of husbands favored circumcision and only 17.7% were against it. Among noncircumcised women, 32.9% were not aware of their husbands' attitudes; 24.9% favored circumcision and 20.4% were against it.

Protection of girls was the most frequent reason for the support provided by circumcised women, 53.2%. Among noncircumcised women, the most frequent reason provided was protection of girls, 80%. The fear of complications was the most important reason for opposing the practice, 24.3%, reported by circumcised women; this was reported by 45% of noncircumcised women. Most of the women studied opposing the practice, 65.2%, and 34.8% supported the practice; the main reason for supporting the practice was maintaining female chastity, 53.8%, whereas the main reasons for opposition were fear of complications and the belief that this was not important (both 21.2%). Maintaining a girl's chastity was the main motive reported by the interviewed women, 35.2%, for the continuation of this practice, followed by maintaining traditions, 33.8% ([Table 4]).
Table 4 Differences in knowledge and attitudes among the group studied

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  Discussion Top


This study aimed to study female circumcision in Manwahla village, El-Bagour, Menofia. In this study, a systematic random sample of 400 married women in the child-bearing period (15–45 years) was selected among the attendees of the Manwahla family health unit.

Although the government has banned the practice, female circumcision has been a tradition in Egypt since the Pharaonic period [12]. The prevalence of female circumcision among the studied group was found to be 83.2%. However, the EDHS 2008 reported that the prevalence of female circumcision is widespread in Egypt; 91% of all women aged 15–49 years have been circumcised [12]. The result of this study is in agreement with the result obtained in Menofia governorate by Badr [13]; the prevalence of circumcision was 99.3%.

An estimated 130 million girls and women worldwide have been subjected to some form of FGM. FGM is mainly practiced in 28 countries of Africa [9].

Knowledge of female circumcision

It was noted that 66% of the studided group had good knowledge and gave sufficient answer. In all, 64.3% of circumcised women had good knowledge, whereas only 74.6% of noncircumcised women had good knowledge. More than half of the studied women depended on the visual mass media (television), 64.2%. This result is in agreement with the 2008 EDHS: around seven in 10 women in the 15–49 years age group. In terms of the sources of information on circumcision, television was the primary source of information for 96% of the women [14]. However, in another comparative cross-sectional study carried out among physicians at the faculties of medicine, Benha, and October 6 universities carried out by Hamdy [15], it was found that 40% of the studied physicians' knowledge came from audio visual aids.

Attitude toward circumcision

It was found that most of the women among the studied groups, 65.2%, were strongly against the practice, whereas 34.8% supported it. The most commonly given reasons for supporting the practice was the belief that it maintained chastity, 35.2%, followed by the belief that it was a good tradition, 33.8%. The main causes of refusal of FGM were to avoid complications and the belief that it was not important, 21%, respectively. This in agreement with the study carried out by Al Hinai on FGM in the sultanate of Oman in 2014; 55% of the female participants in the survey supported this practice compared with 37 who did not support it; 5% remained neutral and 3% preferred not to answer. They rather considered female circumcision as a tradition or a ritual. A number of participants asserted that female circumcision is a crime and should be forbidden [16]. EDHS 2008 had showed that nearly half of all women aged 15–49 years believes that female circumcision is a religious requirement and just over half believed that the practice of circumcision should continue. This may be explained by the strong social pressure of the society favoring this practice [14].

These results were in agreement with the 2014 EDHS on exposure to information on female circumcision and the channels through which they received information on circumcision during the 6-month period before the survey. Around seven in 10 women in the 15–49 years age group had received information on female circumcision before the survey. In terms of the sources of information on circumcision, television was the primary source of information, Among women, 96% received information on female circumcision on television, 22% had received information from their husbands, other relatives, or friends and neighbors, and 14% cited other mass media as a source of information on circumcision [17].[Table 3]
Table 3 Attitude and motives toward undergoing this operation among circumcised and noncircumcised women

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Reasons behind the performance of female genital mutilation

On asking the studied participants about the possible motives or reasons behind the performance of FGM, the highest percentage reported maintenance of chastity as the main motive for performing it, followed by traditions, hygienic, religious, and cosmetic motives.

This is in agreement with a cross sectional study carried out in faculties of medicine, Benha, and October 6 universities carried out by Hamdy [15], 51% believed that the most important motive was traditions (compared with 33.8% in our study), followed by those who believed that there was a religious benefit in performing FGM, 20% (compared with 4.2% in our study).


  Conclusion Top


The prevalence of FGM is wide spread and the negative attittude increasing.

The main motive behind its persistence in the Egyptian community is to maintain the chastity of women, preserving tradition, and considering it as a religious requirement.

There is a lack of knowledge of FGM even among educated women despite mass media participation, which is not sufficient.

Recommendations

In view of the findings of the present study, the following recommendations can be made:

  • Health education of the public to make them aware of all the different dimensions of this tradition and its potential hazards, which can be disseminated through:
    1. Mass media
    2. Open discussions
    3. Illiteracy eradication programs
    4. Ministry of education to the young children
  • Plan for training programs for all health service providers, particularly nurses, mid wives, traditional birth attendants, and circumcisers, besides physicians, to provide them with appropriate knowledge
  • Make the religious opinions about FGM known to the public. This may be done by the religious leaders in each village and supported by family physicians (to spread awareness of the complications such as bleeding, infection, and other health hazards)
  • Allowing autonomy for the FGM decision by the-female her self not the guardians.
  • Special support programs for FGM victims provided by parents or family physicians or psychiatrists [Figure 1] and [Figure 2].
Figure 1: Women's attitude toward female genital mutilation (FGM).

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Figure 2: Husbands' attitude toward female genital mutilation (FGM).

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Aziz FA. Gynecologic and obstetric complications of female circumcision. Int J Gynaecol Obstet 1980;17:560–563.  Back to cited text no. 1
    
2.
Shah G, Susan L, Furcroy J. Female circumcision: history, medical and psychological complications, and initiatives to eradicate this practice. Can J Urol 2009;16:4576–4579.  Back to cited text no. 2
    
3.
Obermeyer CM. Female genital surgeries: the known, the unknown, and the unknowable. Med Anthropol Q 1999; 13:79–106.  Back to cited text no. 3
    
4.
Odoi AT. Female genital mutilation. In: Kwawukume EY, Emuveyan EE, editors. Comprehensive gynaecology in the tropics. Accra: Graphics Packaging Ltd; 2005; 268–278.  Back to cited text no. 4
    
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Gruenbaum E. Is female circumcision a maladaptive cultural pattern? In: Edited by Shell-duncan B, Hernlund Y. Female 'circumcision' in Africa: culture, controversy, and change. Boulder: lynne Rienner Publishers; 2000:41–54.  Back to cited text no. 6
    
7.
UNICEF: female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change. New York; 2013. Available from: http://www.unicef.org/media/files/FGCM_lo_res.pdf. [Last accesse don last accessed 2015 May].  Back to cited text no. 7
    
8.
The population council: survey of young people in Egypt: final report, Cairo; 2011. Available from: http://www.popcouncil.org/pdfs/2010PGY_SYPEFinalReport.pdf. [Last accessed 2015 May].  Back to cited text no. 8
    
9.
WHO: media center, factsheet no. 241, updated on February 2014. Available from: http://www.int/mediacenter/factsheets/fs241/en. [Last accessed 2015 May].  Back to cited text no. 9
    
10.
Residential census in Manwahla family health unit, El-Bagour district, 2015  Back to cited text no. 10
    
11.
Online sample size calculator. Available at: http://www.raosoft.com/samplesize.html. [Last accessed on 2015 Aug].  Back to cited text no. 11
    
12.
A. Elgelany, A Wehadi, M Elwasefy. Updating and validation socioeconomic status scale for health referral Egypt. EMHJ 18:962–968.  Back to cited text no. 12
    
13.
Badr SA. 1998: Study of female circumcision in Menofia governorate, Faculty of Medicine, Menofia University; discussion p: 133  Back to cited text no. 13
    
14.
El-Zanaty, F, A Way. Egypt Demographic and Health Survey 2008. Cairo, Egypt: Ministry of Health, El-Zanaty and Associates, and Macro International; 2009.  Back to cited text no. 14
    
15.
Hamdy YM. 2011; Thesis in knowledge, attitude and practice of physicians regarding female genital mutilation, result and discussion p: 87:100  Back to cited text no. 15
    
16.
Al Hinai H. 2014: A research study, female genital mutilation in sultanate Oman, results p: 14. Oman report on the official website of WADI (a German human rights organization who launched an international campaign against female circumcision 'Stop FGM Middle East')  Back to cited text no. 16
    
17.
Ministry of Health and Population [Egypt], El-Zanaty and Associates [Egypt], and ICF International. Egypt Demographic and Health Survey 2014. Cairo, Egypt and Rockville, Maryland, USA: Ministry of Health and Population and ICF International. 2015.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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