Abstract
Background: Female genital mutilation/cutting (FGM/C) is a harmful traditional practice with severe consequences for the health and well-being of girls and women. Health care professionals are therefore expected to be aware of how to identify and manage these consequences in order to ensure that those affected by the practice receive quality health care. Moreover, their integration and legitimacy within the communities allow them to play a key role in the prevention of the practice. Nevertheless, the perception of health care professionals on FGM/C has been barely explored in African contexts. This study seeks to contribute to this field of knowledge by examining the knowledge, attitudes, and practices regarding FGM/C among health care professionals working in rural settings in The Nigeria.
Methods: A cross-sectional descriptive study was designed through a quantitative methodology, following a multiethnic approach. A pre-tested questionnaire with open and closed-ended questions was created. Forty medical students from the Community-based Medical Programme were trained to administer the questionnaire, face to face, at village health facilities in rural areas of The Edo state. A final sample of 468 health care professionals included all nurse cadres and midwives.
Results: A significant proportion of Nigerian health care professionals working in rural areas embraced the continuation of FGM/C (42.5%), intended to subject their own daughters to it (47.2%), and reported having already performed it during their medical practice (7.6%). However, their knowledge, attitudes, and practices were shaped by sex and ethnic identity. Women showed less approval for continuation of FGM/C and higher endorsement of the proposed strategies to prevent it than men. However, it was among ethnic groups that differences were more substantial. health care professionals belonging to traditionally practicing groups were more favourable to the perpetuation and medicalisation of FGM/C, suggesting that ethnicity prevails over professional identity.
Conclusions: These findings demonstrate an urgent need to build HCP’s capacities for FGM/C-related complications, through strategies adapted to their specific characteristics in terms of sex and ethnicity. A culturally and gender sensitive training programme might contribute to social change, promoting the abandonment of FGM/ C, avoiding medicalisation, and ensuring accurate management of its health consequences.
CHAPTER ONE
INTRODUCTION
1.1 Background of the study
According to the World Health Organization (WHO), Female genital mutilation (FGM) is defined as all procedures which involve partial or total removal of the external female genitalia and/or injury to the female genital organs, whether for cultural or any other nontherapeutic reasons (World Health Organization 1998). Worldwide, government and non- governmental organizations frown at FGM having seen it as an infringement on the physical and psychosexual integrity of the female child. Nigeria was said to have the highest absolute number of cases of FGM in the world, accounting for about one-quarter of the estimated 115– 130 million circumcised women worldwide (UNICEF 2001). The prevalence rate of FGM was put at 41% among adult Nigerian women (Okeke 2012). Nigeria is a country in West Africa bordering the Gulf of Guinea between Benin and Cameroon. It has an area of 923,768.00 sq kilometers with a population of 140,431,790 according to the 2006 National Population census (National Bureau of Statistics 2006). The male constituted 71,345,488 while the female were 69,086,302 (National Bureau of Statistics 2006). This study was donein a tertiary hospital in Edo State, one of the 36 states of Nigeria. Edo State has a population of 2,398,957with the female being 1,215,487and the male 69,086,302 (National Bureau of Statistics 2006). It is majorly inhabited by the Edo’s who are noted for high level of literacy in terms of formal education and is reputed to have produced the reasonable number of professors in Nigeria (Adesina 2008).The 2008 Nigeria Demographic and Health Survey showed that 30% of female surveyed between ages 15- 40years had undergone female circumcision with the Yoruba and igbo ethnic groups having the highest percentage (58.4% and 51.4% respectively) (National Population Commission 2009).Olamijulo et al., reported the prevalence of FGM among children examined at the child welfare clinic, Wesley Guild Hospital, Ilesha, Nigeria to be 66.3%.The following states in Nigeria have prohibited this act since 1999;Abia, Bayelsa, Cross River, Delta, Edo, Ogun, Osun and Rivers. However, with increasing awareness of the complication of FGM, there is a recent ban on the practice in Nigeria as a nation in year 2015. The prevalence rate is therefore expected to progressively decline in the younger age groups. FGM practiced in Nigeria is classified into four typesas follows; clitoridectomy or Type I, this involves the removal of the prepuce or the hood of the clitoris and all or part of the clitoris. Type II or “sunna” is a more severe practice that involves the removal of the clitoris along with partial or total excision of the labia minora. Type III (infibulation), involves the removal of the clitoris, the labia minora and adjacent medial part of the labia majora and the stitching of the vaginal orifice, leaving an opening of the size of a pin head to allow for menstrual flow or urine. Type IV or other unclassified types include introcision and gishiri cuts, hymenectomy, scraping and/or cutting of the vagina, the introduction of corrosive substances and herbs in the vagina, and other forms. Consequences of female genital mutilation include increased risks of urinary tract infections, bleeding, bacterial vaginosis, dyspareunia, obstetric complications, psychological problems such as depression, anxiety, post-traumatic stress disorder, low self-esteem, etc (Behrendt and Moritz, 2005), Abdulcadir and Dällenbach, 2013), Amin et al.,., 2013), Andersson et al.,., 2012), Andro et al.Female genital mutilation is classified into four major types (WHO, 1996). The most common type of the female genital mutilation is type 2 which account for up to 80% of all cases while the most extreme form which is type 3 constitutes about 15% of the total procedures(WHO, 1996; Oduro et al., 2006). Types 1 and 4 of FGM constitute the remaining 5%. The consequences vary according to the type of FGM and severity of the procedure (Onuh et al., 2006; Oduro et al., 2006). The practice of FGM has diverse repercussions on the physical, psychological, sexual and reproductive health of women, severely deteriorating their current and future quality of life (Oduro et al., 2006; Larsen, 2002). The immediate complications include: severe pain, shock, haemorrhage, urinary complications, injury to adjacent tissue and even death (Onuh et al., 2006; Oduro et al., 2006; Larsen, 2002). The long term complications include: urinary incontinence, painful sexual intercourse, sexual dysfunction, fistula formation, infertility, menstrual dysfunctions, and difficulty with child birth (Akpuaka, 1998; Okonofua et al., 2002; Oguguo and Egwuatu, 1982). The physical and psychological sequelae of female genital mutilation have been well highlighted in many literatures (Onuh et al., 2006; Oduro et al., 2006; Badejo, 1983; Klouman et al., 2005; ACHPR, 2003; Ibekwe, 2004). Recently, there has been serious concern on the increased rate of transmission of Human Immunodeficiency Virus (HIV) following this practice (WHO, 1996; Klouman et al., 2005). The practice is also a violation of the human rights of the women and girl child. FGM categorically violates the right to health, security and physical integrity, freedom from torture and cruelty, inhuman or degrading treatment and the right to life when the procedure results in death. It constitutes an extreme form of violation, intimidation and discrimination. Despite its numerous complications, this harmful practice has continued unabated, notwithstanding that Nigeria ratified the Maputo Protocols and was one of the countries that sponsored a resolution at the 46th World Health Assembly calling for the eradication of female genital mutilation in all nation (Klouman et al., 2005; ACHPR, 2003; Idowu, 2008).
1.2
STATEMENT OF THE PROBLEM
The practice of Female Genital Mutilation (FGM) is regrettably persistent in many parts of the world. This occurs commonly in developing countries where it is firmly anchored on culture and tradition, not minding many decades of campaign and legislation against the practice (Onuh et al., 2006; WHO, 2008). Female genital mutilation comprises any procedure involving partial or total removal of the external female genitalia or other injury to the female genital organs for cultural, religious or other non-therapeutic reason (WHO, 2008; WHO, 1996). The World Health Organization (WHO) estimates that between 100 and 140 million girls and women worldwide are presently living with female genital mutilation and every year about three million girls are at risk (WHO, 2008). It is in view of this that the researcher intends to assess the effect of female genital mutilation.
1.3
OBJECTIVE OF THE STUDY
The main objective of the study is on an assessment of female genital mutilation in Nigeria with emphasis on Edo state. But to aid the completion of the study, the researcher intends to achieve the following sub-objective;
1. To determine health care professionals’ awareness of female genital mutilation and its health consequences
2. To determine the Knowledge of FGM/C among Nigerian health care professionals
3. To examine the Attitudes of Nigerian health care professionals towards FGM/C
1.4
RESEARCH QUESTIONS
To aid the completion of the study, the following research hypotheses were formulated by the researcher
1. What is the level of health care professionals’ awareness of female genital mutilation and its health consequences
2. What is the level of Knowledge of FGM/C among Nigerian health care professionals
3. What is the Attitudes of Nigerian health care professionals towards FGM/C
1.5
SIGNIFICANCE OF THE STUDY
At the completion of the study, it is believed that the study will be of great important to the federal ministry of women affair and the house committee on women affairs as the study will help them formulate policy that will help prohibit or eliminate the archaic and orthodox practice of female genital mutilation, the study will also be of great importance to every parent as the study seek to expose the dangers of female genital mutilation among female. The study will also be of great importance to student who intend to embark on a study in similar topic as the findings of the study will serve as a pathfinder to them. Finally the study will be of great importance to students, teachers and the general public as the finding will add to the pool of existing literature.
1.6
SCOPE AND LIMITATION OF THE STUDY
The scope of the study covers an assessment on female genital mutilation in Nigeria, with emphasis on Benin City. But in the cause of the study, there were some factors which limited the scope of the study
a) AVAILABILITY OF RESEARCH MATERIAL: The research material available to the researcher is insufficient, thereby limiting the study.
b) TIME: The time frame allocated to the study does not enhance wider coverage as the researcher has to combine other academic activities and examinations with the study.
c) FINANCE: The finance available for the research work does not allow for wider coverage as resources are very limited as the researcher has other academic bills to cover
1.7 DEFINITION OF TERMS
Female
Female is the sex of an organism, or a part of an organism, that produces non-mobile ova (egg cells). Barring rare medical conditions, most female mammals, including female humans, have two X chromosomes.
Female genital mutilation
Female genital mutilation (FGM), also known as female genital cutting and female circumcision, is the ritual cutting or removal of some or all of the external female genitalia. The practice is found in Africa, Asia and the Middle East, and within communities from countries in which FGM is common
Reproductive health
Within the framework of the World Health Organization's (WHO) definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene, addresses the reproductive processes, functions and system at all stages of life. Reproductive health implies that people are able to have a responsible, satisfying and safer sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. One interpretation of this implies that men and women ought to be informed of and to have access to safe, effective, affordable and acceptable methods of birth control; also access to appropriate health care services of sexual, reproductive medicineand implementation of health education programs to stress the importance of women to go safely through pregnancy and childbirthcould provide couples with the best chance of having a healthy infant.
1.8 ORGANIZATION OF THE STUDY
This research work is organized in five chapters, for easy understanding, as follows. Chapter one is concern with the introduction, which consist of the (background of the study), statement of the problem, objectives of the study, research questions, research hypotheses, significance of the study, scope of the study etc. Chapter two being the review of the related literature presents the theoretical framework, conceptual framework and other areas concerning the subject matter. Chapter three is a research methodology covers deals on the research design and methods adopted in the study. Chapter four concentrate on the data collection and analysis and presentation of finding. Chapter five gives summary, conclusion, and recommendations made of the study.
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Item Type: Project Material | Size: 54 pages | Chapters: 1-5
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