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The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria

BJOG. 2002 October; 109(10): 1089–1096

The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria

Okonofua FE, Larsen U, Oronsaye F, Snow RC, Slanger TE

ABSTRACT

Objective To examine the association between female genital cutting and frequency of sexual and gynaecological symptoms among a cohort of cut versus uncut women in Edo State of Nigeria.

Design Cross sectional study.

Setting Women attending family planning and antenatal clinics at three hospitals in Edo State, South–south Nigeria.

Population 1836 healthy premenopausal women.

Methods The sample included 1836 women. Information about type of female genital cutting was based on medical exams while a structured questionnaire was used to elicit information on the women’s socio-demographic characteristics, their ages of first menstruation (menarche), first intercourse, marriage and pregnancy, sexual history and experiences of symptoms of reproductive tract infections. Associations between female genital cutting and these correlates of sexual and gynaecologic morbidity were analysed using univariate and multivariate logistic regression and Cox models.

Main outcome measures Frequency of self-reported orgasm achieved during sexual intercourse and symptoms of reproductive tract infections.

Results Forty-five percent were circumcised and 71% had type 1, while 24% had type 2 female genital cutting. No significant differences between cut and uncut women were observed in the frequency of reports of sexual intercourse in the preceding week or month, the frequency of reports of early arousal during intercourse and the proportions reporting experience of orgasm during intercourse. There was also no difference between cut and uncut women in their reported ages of menarche, first intercourse or first marriage in the multivariate models controlling for the effects of socio-economic factors. In contrast, cut women were 1.25 times more likely to get pregnant at a given age than uncut women. Uncut women were significantly more likely to report that the clitoris is the most sexually sensitive part of their body (OR = 0.35, 95% CI = 0.26–0.47), while cut women were more likely to report that their breasts are their most sexually sensitive body parts (OR = 1.91; 95% CI = 1.51–2.42). Cut women were significantly more likely than uncut women to report having lower abdominal pain (OR = 1.54, 95% CI = 1.11–2.14), yellow bad-smelling vaginal discharge (OR = 2.81, 95% CI = 1.54–5.09), white vaginal discharge (OR = 1.65, 95% CI = 1.09–2.49) and genital ulcers (OR = 4.38, 95% CI = 1.13–17.00).

Conclusion Female genital cutting in this group of women did not attenuate sexual feelings. However, female genital cutting may predispose women to adverse sexuality outcomes including early pregnancy and reproductive tract infections. Therefore, female genital cutting cannot be justified by arguments that suggest that it reduces sexual activity in women and prevents adverse outcomes of sexuality.

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Impact of a communication programme on female genital cutting in eastern Nigeria

Trop Med Int Health. 2006 Oct; 11(10):1594-1603

Impact of a communication programme on female genital cutting in eastern Nigeria

Babalola S, Brasington A, Agbasimalo A, Helland A, Nwanguma E, Onah N

ABSTRACT

Objectives  This study describes a female genital cutting (FGC) elimination communication programme in Enugu State and assesses its impact in changing relevant knowledge, attitudes and behavioural intentions.

Methods  The FGC programme combined a community mobilization component with targeted advocacy and mass media activities. Data for assessing the impact of the programme derived from baseline and follow-up surveys in three intervention local government areas (LGA) in Enugu State and three comparison LGAs in Ebonyi State. An ideation model of behaviour change guided the analyses of the impact of the programme on personal advocacy for FGC, perceived self-efficacy to refuse pressure to perform FGC, perceived social support for FGC discontinuation, perceived benefits of FGC, perceived health complications of FGC and intention not to perform FGC on daughters. The analytical methods include comparing change in pertinent outcome variables from baseline to follow-up in the two study states and using logistic regression on follow-up data for the intervention state to assess the link between programme exposure and the relevant outcome indicators.

Results  The data show that while the pertinent ideational factors and the intention not to perform FGC either worsened or remained stagnant in Ebonyi State, they improved significantly in Enugu State. The logistic regression results show that programme exposure is associated with the expected improvements in all the pertinent indicators.

Conclusion  The multimedia communication programme has been effective in changing FGC-related attitudes and promoting the intention not to perform FGC.

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Female genital cutting in southern urban and peri-urban Nigeria: self-reported validity, social determinants and secular decline

Trop Med Int Health. 2002 Jan; 7(1): 91-100

Female genital cutting in southern urban and peri-urban Nigeria: self-reported validity, social determinants and secular decline

Snow RC, Slanger TE, Okonofua FE, Oronsaye F, Wacke RJ

ABSTRACT

Despite growing public resistance to the practice of female genital cutting (FGC), documentation of its prevalence, social correlates or trends in practice are extremely limited, and most available data are based on self-reporting. In three antenatal and three family planning clinics in South-west Nigeria we studied the prevalence, social determinants, and validity of self-reporting for FGC among 1709 women. Women were interviewed on social and demographic history, and whether or not they had undergone FGC. Interviews were followed by clinical examination to affirm the occurrence and extent of circumcision. In total, 45.9% had undergone some form of cutting. Based on WHO classifications by type, 32.6% had Type I cuts, 11.5% Type II, and 1.9% Type III or IV. Self-reported FGC status was valid in 79% of women; 14% were unsure of their status, and 7% reported their status incorrectly. Women are more likely to be unsure of their status if they were not cut, or come from social groups with a lower prevalence of cutting. Ethnicity was the most significant social predictor of FGC, followed by age, religious affiliation and education. Prevalence of FGC was highest among the Bini and Urhobo, among those with the least education, and particularly high among adherents to Pentecostal churches; this was independent of related social factors. There is evidence of a steady and steep secular decline in the prevalence of FGC in this region over the past 25 years, with age-specific prevalence rates of 75.4% among women aged 45–49 years, 48.6% among 30–34-year olds, and 14.5% among girls aged 15–19. Despite wide disparities in FGC prevalence across ethnic, religious and educational groups, the secular decline is evident among all social subgroups.

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Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries.

Lancet. 2006 Jun 3;367(9525):1835-41.

Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries.

WHO study group on female genital mutilation and obstetric outcome, Banks E, Meirik O, Farley T, Akande O, Bathija H, Ali M.

National Centre for Epidemiology and Population Health, Australian National University, ACT 0200, Australia. FGMStudyGroup@who.int

Comment in Lancet. 2006 Jun 3;367(9525):1799-800.

Lancet. 2006 Aug 12;368(9535):579.

BACKGROUND: Reliable evidence about the effect of female genital mutilation (FGM) on obstetric outcome is scarce. This study examines the effect of different types of FGM on obstetric outcome.

METHODS: 28 393 women attending for singleton delivery between November, 2001, and March, 2003, at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan were examined before delivery to ascertain whether or not they had undergone FGM, and were classified according to the WHO system: FGM I, removal of the prepuce or clitoris, or both; FGM II, removal of clitoris and labia minora; and FGM III, removal of part or all of the external genitalia with stitching or narrowing of the vaginal opening. Prospective information on demographic, health, and reproductive factors was gathered. Participants and their infants were followed up until maternal discharge from hospital.

FINDINGS: Compared with women without FGM, the adjusted relative risks of certain obstetric complications were, in women with FGM I, II, and III, respectively: caesarean section 1.03 (95% CI 0.88-1.21), 1.29 (1.09-1.52), 1.31 (1.01-1.70); postpartum haemorrhage 1.03 (0.87-1.21), 1.21 (1.01-1.43), 1.69 (1.34-2.12); extended maternal hospital stay 1.15 (0.97-1.35), 1.51 (1.29-1.76), 1.98 (1.54-2.54); infant resuscitation 1.11 (0.95-1.28), 1.28 (1.10-1.49), 1.66 (1.31-2.10), stillbirth or early neonatal death 1.15 (0.94-1.41), 1.32 (1.08-1.62), 1.55 (1.12-2.16), and low birthweight 0.94 (0.82-1.07), 1.03 (0.89-1.18), 0.91 (0.74-1.11). Parity did not significantly affect these relative risks. FGM is estimated to lead to an extra one to two perinatal deaths per 100 deliveries.

INTERPRETATION: Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive FGM.

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Abuja declaration calls for action against hazardous traditional practices.

Newsl Inter Afr Comm Tradit Pract Affect Health Women Child. 1990 May;(9):13-4.

Abuja declaration calls for action against hazardous traditional practices.

[No authors listed]

ABSTRACT

PIP: The UN Economic Commission for Africa organized a conference in Abuja, Nigeria, last November to review the “Role of Women in Africa in the 1990s” as a follow-up of the “Arusha Strategies” of 1984. Among topics examined were harmful traditional practices, such as early marriage and pregnancy, female circumcision, nutritional taboos, inadequate child spacing and unprotected delivery, which are still found to be current realities in many African countries. These practices often inflict permanent physical, psychological, and emotional damage, even death, and little progress has been achieved in the abolition, the Declaration states. The lives of women in Africa are dominated by traditions. Certain attitudes, structures, and traditional practices, such as female circumcision and nutritional taboos that have harmful effects on the health of women and children, have rarely been officially surveyed. They have not been fully acknowledged by policy makers and opinion leaders, nor have effective steps to stop them been given precedence in health development planning. There is need for action at national as well as subregional and regional levels. Action at the national levels means that: national research institutes should undertake in-depth research on various traditional practices and their effects on women; functional literacy campaigns should sensitize parents and disseminate information on the harmful effects of circumcision, childhood marriage and early pregnancy; guidance and counseling should be provided to adolescent girls as well as to parents to make them understand the harmful physical, social, and mental effects of some traditional practices; religious leaders, traditional rulers, women’s organizational, professional bodies and others should act as pressure groups in promoting efforts against harmful practices through traditional and modern means of communication, dissemination of information, and other appropriate ways of communication; and legislative and administrative measures to eradicate harmful practices should be introduced and implemented urgently and expeditiously. At the subregional and regional levels: established subregional and regional structures should give priority attention in their development programs to the issues of female circumcision and other harmful traditional practices; action should be taken to ensure that women’s issues are addressed within national programs; and policies on data development by gender specifications should be advocated so as to make data more relevant and useful. [Full Text Modified]

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NGO Girl´s Power Initiative

Girl´s Power Initiative is an NGO based in Benin City, Nigeria.

According to their website, GPI “ is a Nigerian non-governmental, not-for-profit youth development organization founded in 1993 by Bene Madunagu and Grace Osakue to address the challenges facing girls in the Nigerian society and equip them with information, skills and opportunities for action to grow into self actualised young women”.

Outreach activities. The GPI outreach programmes aims to:

  1. Provide avenues to reach out to adolescent girls who cannot physically come to the centres (in Calabar, Uyo, Benin and Asaba) due to distance, lack of funds, parental consent, time, poverty, etc….
  2. Enlighten and educate more adolescent girls on gender, sexuality issues (including HIV/AIDS, and Female Genital Mutilation) and personal empowerment.
  3. Reduce teenage pregnancies, school drop-out rates, violence against girls and sexual exploitation through passage of information, education and skills development.
  4. Increase the number of girls who would in turn impact on their peers and communities to meet the long term social goal of gender equality.

GPI has published “Know This Series: Hiv/Aids, Moods, & Female Genital Mutilation”

Some articles found in the cloud about the labour of advocacy against FGM of NGO GPI:

Female Genital Mutilation – a life-threatening health and human rights issue LINK

NGO Seeks End to Female Circumcision LINK

Nigeria acts to eradicate female genital mutilation LINK

This is the LINK of Girl´s Power Initiative