Female genital mutilation: a dilemma in child protection

Female genital mutilation and sexual behaviour by marital status among a nationally representative sample of Nigerian women

Background

Female Genital Mutilation (FGM) is believed to have a negative effect on sexual and reproductive health but the evidence from nationally representative sample in high-burdened countries like Nigeria is scarce. This study explored the association between FGM and sexual behaviour in a nationally representative sample of Nigerian women.

Methods

A secondary data analysis was conducted using the Nigeria Demographic Health Survey conducted in 2013 and 2018 among women aged 15–49 years. The descriptive summaries of respondent characteristics by marital status were presented using frequencies and percentages. The proportion and 95% Confidence Interval (CI) of circumcision by sexual behaviour characteristics were computed. A multivariable log-binomial logistic regression was used to determine the association between sexual behaviour and female circumcision while adjusting for other covariates. All analyses were performed using Stata 15.1 (StataCorp, College Station, TX, USA) at the 0.05 level of significance.

Results

The proportion of circumcised women was 38.6% among those who were ever-married and 32.4% among those unmarried. There were no statistically significant relationship between circumcision status and sexual behaviour among women who were unmarried. However, circumcised women who were ever married had 18% higher risk of having contracted sexually transmitted disease in the last 12 months preceeding the survey and 10% higher risk of engaging in pre-marital sex compared to ever married women who were uncircumcised after adjusting for other covariates. However, the risk of having multiple sexual partners in the last 12 month among uncircumcised ever married women was lower (aRR = 0.80; 95% CI: 0.66–0.97) in the adjusted model.

Conclusion

Circumcision is not associated with positive sexual behavioural outcomes including delay in sexual debut, virginity and marital fidelity, although there exists some perception behind increasing FGM in Nigeria including prevention of premarital sex and ensuring marital fidelity. While we strongly discourage FGM in all its form, we assert the need for alternative health promoting community measures to address these inherent sexual perceptions toward eliminating FGM and improving sexual and reproductive health across population groups.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-022-01379-w.

Female genital mutilation (FGM) recognized internationally as a violation of human right, refers to all procedures that involve partial or complete removal or other injury to the female genital organs for non-medical reasons. About 200 million girls and women in 30 countries mainly in Africa, Middle East and Asia have been subjected to FGM. Almost 22% of the estimated 68 million girls and women that are at the risk of being cut between 2015 and 2030 will be Nigerians.

FGM is deeply entrenched within socio-cultural beliefs around preserving a girl's purity, and controlling women's sexuality or chastity. It is also believed that FGM protects girl’s virginity, prevents marital infidelity and is necessary to ensure male partners and/or husbands get better sexual satisfaction. However, studies on the association between women sexual behaviour (sexual debut, pre-marital sex, multiple sexual partners, STDs, lifetime sexual partner, number of unions) and FGM is limited in countries where FGM is prevalent. This study utilized pooled datasets from the Nigerian Demographic Health Survey conducted in 2013 and 2018 to explore the association between FGM and sexual behaviour among women of reproductive age.

The findings revealed that there is no association between sexual behaviour and FGM among unmarried women. Circumcised ever-married women were more likely to contract sexually transmitted diseases and engage in pre-marital sex than those who were not circumcised. However, circumcised ever married women were less likely to have multiple sexual partner in the last 12 months preceding the survey. This study disproves the assertion that FGM could control women’s sexual behaviour.

Male Circumcision: A Gender Perspective

The practice of routine medical circumcision of newborn male infants remains the norm in the United States, occurring to more than one million baby boys annually. This article examines the history and continuing debate surrounding this surgery, and places it within the context of gender identity. The rise of the activist anti-circumcision movement is described, as medical, moral, psychological, and legal issues surrounding this controversy are identified. The continuing practice of male circumcision is framed as an abusive wounding of males, which holds lifelong implications. A differentiation is made between the conventional medical amputation of the foreskin, from that which is solely ritual, religious-based. Further, a societal double standard is noted between the moral outcry against female circumcision and the relative silence toward male circumcision.

Promotion of children's rights and prevention of child maltreatment

In medical literature, child maltreatment is considered as a public-health problem or an issue of harm to individuals, but less frequently as a violation of children's human rights. Public-health approaches emphasise monitoring, prevention, cost-effectiveness, and population strategies; protective approaches concentrate on the legal and professional response to cases of maltreatment. Both approaches have been associated with improvement in outcomes for children, yet maltreatment remains a major global problem. We describe how children's rights provide a different perspective on child maltreatment, and contribute to both public-health and protective responses. Children's rights as laid out in the UN convention on the rights of the child (UNCRC) provide a framework for understanding child maltreatment as part of a range of violence, harm, and exploitation of children at the individual, institutional, and societal levels. Rights of participation and provision are as important as rights of protection. The principles embodied in the UNCRC are concordant with those of medical ethics. The greatest strength of an approach based on the UNCRC is that it provides a legal instrument for implementing policy, accountability, and social justice, all of which enhance public-health responses. Incorporation of the principles of the UNCRC into laws, research, public-health policy, and professional training and practice will result in further progress in the area of child maltreatment.

Child maltreatment: a global issue

PURPOSE

This article explains why children with speech and language impairments are at increased risk for having experienced abuse, neglect, and trauma and how maltreatment may vary across cultures.

METHOD

International literature on maltreatment is reviewed in order to provide frameworks for identifying what constitutes maltreatment across cultures; how cultural variations in discipline practices impact maltreatment; and professionals' roles in treatment when they encounter children who have experienced abuse, neglect, or trauma.

CONCLUSION

Speech-language pathologists and audiologists are required to document and report any instance of suspected child abuse. To intervene effectively with children and families from diverse cultures who experience maltreatment, professionals must understand when a practice causes harm and be able to modify childrearing practices in culturally acceptable ways.

Female genital mutilation: analysis of the first twelve months of a Southeast London specialist clinic

OBJECTIVES

To analyse the sources and reasons for referral of women who have undergone genital mutilation to a recently established specialist clinic, and to determine the consequences of the genital mutilation procedure.

DESIGN

Retrospective descriptive case series.

SETTING

The maternity units of Guy's and St. Thomas's Hospital, London.

POPULATION

One hundred and sixteen women attending the clinic over a one-year period.

MAIN OUTCOME MEASURES

(1) sources and reasons for referral to the specialist clinic; (2) characteristics of the women attending the clinic; (3) acute and chronic complications of the genital mutilation procedure; (4) attitudes towards female genital mutilation.

RESULTS

Complete case records were available for 108 women. Of the 86 women who could remember the procedure, 78% were performed by a medically unqualified person, usually at home (71%), at a median age of seven years. Acute and chronic complications were each present in 86% of women with Type III genital mutilation. Most women (82%) were referred by their midwife because they were pregnant, of whom 48% were primigravid. Eighteen non-pregnant women also attended the clinic to request either defibulation or for advice. None of the 89 pregnant women requested re-infibulation after delivery, but almost 6% were seriously considering having their daughter undergo genital mutilation outside the United Kingdom. In addition, fewer than 10% of the women refused to continue the tradition of female genital mutilation.

CONCLUSIONS

During its first year, the recently established African Well Woman Clinic has provided specialist care for 116 women with genital mutilation. Such women may attend with a variety of common medical or psychiatric conditions and often do not volunteer that they have undergone the procedure. Doctors and midwives in particular, should enquire specifically about genital mutilation when caring for women from high risk countries, and offer the services of specialist clinics for female genital mutilation.

Female circumcision

The practice of female genital mutilations is widespread in many developing countries, yet health care professionals typically know little about the care of circumcised women. With the influx of immigrants and refugees from developing countries into Western cultures, it's important for nurses to understand some of the customs, beliefs, and traditions surrounding female circumcision (Calder, et al., 1993; McCleary, 1994). It's estimated that approximately 2 million procedures are performed annually (WHO, 1997).

Ritualistic female genital mutilation: current status and future outlook

Ritualistic sexual mutilation of females dates back to the fifth century B.C. This traditional practice is a social as well as a health issue that affects the physical and mental well being of the women who undergo it. Although practiced mostly in African countries north of the equator and the Middle-East, concern has recently been expressed that female genital mutilation is also being practiced in the U.S., Europe, and other western countries by immigrants from these countries. This review describes the various types of female genital mutilation and presents the historical and cultural background of the tradition, outlines the medical, psychological and sexual problems, and discusses the current status and future outlook for this tradition, emphasizing social, medical, and legislative aspects.

Meeting the needs of minority ethnic communities

Concentrating on exotica and cultural differences merely allows commissioners and providers to ignore general health needs and blame the communities themselves when they receive poor quality services. We now have to move forward if we are to achieve an improvement in their health care. We are not talking of an insignificant minority, but nearly one in 10 of all children. Clearly real differences in health needs do exist, for example haemoglobinopathy associated illness; these need to be addressed and adequate provision made. It is in meeting the general needs of minority ethnic children that we face the greatest challenge. These are no different to those of the white ethnic majority. However, meeting them may require different--sometimes radically different--response strategies on behalf of both purchasers and providers of health care to children, supported by appropriate training, audit, and research.

Female genital mutilation in Britain

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