Socio-economic and demographic determinants of female genital mutilation in sub-Saharan Africa: analysis of data from demographic and health surveys
Tóm tắt
Owing to the severe repercussions associated with female genital mutilation (FGM) and its illicit status in many countries, the WHO, human rights organisations and governments of most sub-Saharan African countries have garnered concerted efforts to end the practice. This study examined the socioeconomic and demographic factors associated with FGM among women and their daughters in sub-Saharan Africa (SSA). We used pooled data from current Demographic and Health Surveys (DHS) conducted between January 1, 2010 and December 31, 2018 in 12 countries in SSA. In this study, two different samples were considered. The first sample was made up of women aged 15–49 who responded to questions on whether they had undergone FGM. The second sample was made up of women aged 15–49 who had at least one daughter and responded to questions on whether their daughter(s) had undergone FGM. Both bivariate and multivariable analyses were performed using STATA version 13.0. The results showed that FGM among women and their daughters are significantly associated with household wealth index, with women in the richest wealth quintile (AOR, 0.51 CI 0.48–0.55) and their daughters (AOR, 0.64 CI 0.59–0.70) less likely to undergo FGM compared to those in the poorest wealth quintile. Across education, the odds of women and their daughters undergoing FGM decreased with increasing level of education as women with higher level of education had the lowest propensity of undergoing FGM (AOR, 0.62 CI 0.57–0.68) as well as their daughters (AOR, 0.32 CI 0.24–0.38). FGM among women and their daughters increased with age, with women aged 45–49 (AOR = 1.85, CI 1.73–1.99) and their daughters (AOR = 12.61, CI 10.86–14.64) more likely to undergo FGM. Whiles women in rural areas were less likely to undergo FGM (AOR = 0.81, CI 0.78–0.84), their daughters were more likely to undergo FGM (AOR = 1.09, CI 1.03–1.15). Married women (AOR = 1.67, CI 1.59–1.75) and their daughters (AOR = 8.24, CI 6.88–9.87) had the highest odds of undergoing FGM. Based on the findings, there is the need to implement multifaceted interventions such as advocacy and educational strategies like focus group discussions, peer teaching, mentor–mentee programmes at both national and community levels in countries in SSA where FGM is practiced. Other legislative instruments, women capacity-building (e.g., entrepreneurial training), media advocacy and community dialogue could help address the challenges associated with FGM. Future studies could consider the determinants of intention to discontinue or continue the practice using more accurate measures in countries identified with low to high FGM prevalence.
Từ khóa
Tài liệu tham khảo
WHO, Pan American Health Organization [PAHO]. Understanding and addressing violence against women. https://www.who.int/reproductivehealth/topics/violence/vaw_series/en/. Accessed 29 Ma 2020.
WHO. Female genital mutilation. https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation. Accessed 29 Mar 2020.
WHO. Guidelines on the management of health complications from female genital mutilation. WHO Press, World Health Organization, Geneva, Switzerland. 2016. https://apps.who.int/iris/bitstream/handle/10665/206437/9789241549646_eng.pdf;jsessionid=23FBA5760C9BF5181C609DFB35BCD2A1?sequence=1. Accessed 29 Mar 2020.
Njue C, Karumbi J, Esho T, Varol N, Dawson A. Preventing female genital mutilation in high income countries: a systematic review of the evidence. Reprod Health. 2019;16(1):113.
United Nations Children’s Fund [UNICEF]. Female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change. 2013. https://www.unicef.org/media/files/FGCM_Lo_res.pdf. Accessed 29 Mar 2020.
Odukogbe ATA, Afolabi BB, Bello OO, Adeyanju AS. Female genital mutilation/cutting in Africa. Transl Androl Urol. 2017;6(2):138.
Berg RC, Underland V, Odgaard-Jensen J, et al. Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis. BMJ Open. 2014;4:e006316.
Serour GI. Medicalization of female genital mutilation/cutting. Afr J Urol. 2013;19:145–9.
Nabaneh S, Muula AS. Female genital mutilation/cutting in Africa: a complex legal and ethical landscape. Int J Gynecol Obstetr. 2019;145(2):253–7.
Cook RJ, Dickens BM, Fathalla MF. Female genital cutting (mutilation/circumcision): ethical and legal dimensions. Int J Gynecol Obstet. 2002;79:281–7.
World Bank Compendium of international and national legal frameworks on female genital mutilation. Washington DC: World Bank. 2018
Kandala NB, Komba PN. Geographic variation of female genital mutilation and legal enforcement in sub-saharan Africa: a case study of Senegal. Am J Trop Med Hyg. 2015;92(4):838–47.
United Nations Population funds [UNFPA]. Female genital mutilation (FGM) frequently asked questions. https://www.unfpa.org/resources/female-genital-mutilation-fgm-frequently-asked-questions#sthash.lLBanQT3.dpuf. Accessed 29 Mar 2020.
Karmaker B, Kandala NB, Chung D, Clarke A. Factors associated with female genital mutilation in Burkina Faso and its policy implications. Int J Equity Health. 2011;10(1):20.
Koukoui S, Hassan G, Guzder J. The mothering experience of women with FGM/C raising ‘uncut’ daughters, in Ivory Coast and in Canada. Reprod Health. 2017;14(1):51.
Yoder PS, Wang S, Johansen E. Estimates of female genital mutilation/cutting in 27 African countries and Yemen. Stud Fam Plann. 2013;44(2):189–204.
United Nations. Transforming our world: the 2030 agenda for sustainable development, Geneva. 2015
Ronsmans C, Holtz S, Stanton C. Socioeconomic differentials in caesarean rates in developing countries: a retrospective analysis. Lancet. 2006;368(9546):1516–23.
Joshi C, Torvaldsen S, Hodgson R, Hayen A. Factors associated with the use and quality of antenatal care in Nepal: a population-based study using the demographic and health survey data. BMC Pregnancy Childbirth. 2014;14(1):94.
Amo-Adjei J, Aduo-Adjei K, Opoku-Nyamah C, Izugbara C. Analysis of socioeconomic differences in the quality of antenatal services in low and middle-income countries (LMICs). PLoS ONE. 2018;13(2):e0192513.
Inner City Fund (ICF). Demographic and Health Surveys Standard Recode Manual for DHS7. The Demographic and Health Surveys Program. Rockville: ICF; 2018.
Gajaa M, Wakgari N, Kebede Y, Derseh L. Prevalence and associated factors of circumcision among daughters of reproductive aged women in the Hababo Guduru District, Western Ethiopia: a cross-sectional study. BMC Women’s Health. 2016;16(1):42.
Setegn T, Yihunie Lakew KD. Geographic variation and factors associated with female genital mutilation among reproductive age women in Ethiopia: a national population based survey. PLoS ONE. 2016;11(1):e0145329.
Achia TN. Spatial modelling and mapping of female genital mutilation in Kenya. BMC Public Health. 2014;14:276. https://doi.org/10.1186/1471-2458-14-276PMID:24661558;PubMedCentralPMCID:PMC3987694.
Andro A, Lesclingand M, Grieve M, Reeve P. Female genital mutilation. Overview and current knowledge. Population. 2016;71(2):217–96.
Fikrie Z. Factors associated with perceived continuation of females’ genital mutilation among women in Ethiopia. Ethiop J Health Sci. 2010;20(1).
Plo K, Asse K, Sei D, Yenan J. Female genital mutilation in infants and young girls: Report of sixty cases observed at the general hospital of abobo (Abidjan, Cote d’ivoire, West Africa). Int J Pediatr. 2014. https://doi.org/10.1155/2014/837471.
Afifi M. Women’s empowerment and the intention to continue the practice of female genital cutting in Egypt. Arch Iran Med. 2009;12(2):154–60.
Oyefara LJ. Female genital mutilation (FGM) and theory of promiscuity: myths, realities and prospects for change in Oworonshoki Community, Lagos State, Nigeria. Genus. 2014;70(2–3).
Temin M, Montgomery MR, Engebretsen S, Barker KM. Girls on the move: adolescent girls and migration in the developing world. New York: PopulationCouncil.UNICEF; 2013. Female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change. New York: UNICEF; 2013. https://www.unicef.org/cbsc/files/UNICEF_FGM_report_July_2013_Hi_res.pdf. Accessed 29 Mar 2020.
Mackie G. Ending footbinding and infibulation: A convention account. Am Sociol Rev. 1996;999–1017.
Mackie G. Female genital cutting: the beginning of the end. Female" circumcision" in Africa: culture, controversy, and change. Boulder: Lynne Rienner; 2000. p. 253–82.
Hicks EK. Infibulation: female mutilation in Islamic Northeastern Africa. New Brunswick: Transaction Publishers; 2011.
Freymeyer RH, Johnson BE. An exploration of attitudes toward female genital cutting in Nigeria. Popul Res Policy Rev. 2007;26(1):69–83.
Williams-Breault BD. Eradicating female genital mutilation/cutting: human rights-based approaches of legislation, education, and community empowerment. Health Human Rights. 2018;20(2):223.
Andersson C. Female genital mutilation—a complex phenomenon [in Swedish]. Lakartidningen. 2001;98(20):2463–8.
United States Department of State. Prevalence of the practice of female genital mutilation (FGM): laws prohibiting FGM and their enforcement; recommendations. 2001
WHO Female genital mutilation: a joint WHO/UNICEF/ UNFPA statement. Geneva: World Health Organization; 1997. https://www.childinfo.org/files/fgmc_WHOUNICEFJointdeclaration1997.pdf.
Masho SW, Matthews L. Factors determining whether Ethiopian women support continuation of female genital mutilation. Int J Gynecol Obstetr. 2009;107(3):232–5.
Ashimi A, Aliyu L, Shittu M, Amole T. A multicentre study on knowledge and attitude of nurses in northern Nigeria concerning female genital mutilation. Eur J Contracept Reprod Health Care. 2014;19(2):134–40.
Babalola S, Brasington A, Agbasimalo A, Helland A, Nwanguma E, Onah N. Impact of a communication programme on female genital cutting in eastern Nigeria. Trop Med Int Health. 2006;11(10):1594–603.