CHAPTER ONE: INTRODUCTION
Background to the Study … … … … … … … 1
Statement of the Problem … … … … … … … 3
Purpose of the Study … … … … … … … 4
Objective of the Study … … … … … … … 4
Research Question … … … … … … … … 5
Significance of the Study … … … … … … … 6
Scope of the Study … … … … … … … … 7
Operational Definition … … … … … … … 7
CHAPTER TWO: LITERATURE REVIEW
Conceptual Review … … … … … … … 8
Concept of Female Genital Mutilation … … … … 8
Types of Female Genital Mutilation … … … … … 10
Reasons for Female Genital Mutilation … … … … 13
Theoretical Review… … … … … … … … 17
Empirical Review … … … … … … … … 21
Summary of Literature Review … … … … … … 29
CHAPTER THREE: RESEARCH METHODS
Research Design … … … … … … … 31
Study Area … … … … … … … … … 31
Population of Study … … … … … … … 32
Sample … … … … … … … … … 32
Sampling Procedure … … … … … … … 33
Inclusion Criteria … … … … … … … … 34
Instrument for Data Collection… … … … … … 34
Validity of Instrument … … … … … … … … 35
Reliability of Instrument … … … … … … … 35
Ethical Consideration … … … … … … … 35
Procedure for Data Collection … … … … … … 36
Method of Data Analysis … … … … … 37
CHAPTER FOUR: RESULTS
Results … … … … … … … … … 38
Summary of Results … … … … … … … 48
CHAPTER FIVE: DISCUSSION OF FINDINGS
Discussion of Major Findings … … … … … … 49
Summary of the Study … … … … … … … 54
Implication of the Study for Nursing Practice … … … 56
Conclusion … … … … … … … … … 57
Recommendations … … … … … … … … 59
Limitation of the Study … … … … … … … 60
ABSTRACT
The study examined the socio-cultural factors that still preserve female genital mutilation practice among women in selected rural communities of Enugu State. Five objectives and two null hypotheses were raised to guide the study. The study adopted the descriptive survey design. A sample of 419 women aged 15-49 years were drawn from estimated 145,905 women in rural communities in Enugu East Local Government Area of Enugu State using convenient sampling technique. Data were collected using researcher-developed 36-item questionnaire. Statistical analysis was done using statistical package for social sciences (SPSS) Version 17. Major findings revealed that high percentage of women almost half of the women studied 46.3% still practice female genital mutilation in the studied rural communities. The strongest social factors that preserves the practice of female genital mutilation were the belief that it controls sexual desires and promiscuity among women – mean =3.23 and SD = 6.14); 157 (52.3%) strongly agreed. The most strongly agreed cultural factors preserving the practice of female genital mutilation were that it is done in order to initiate girls into womanhood strongly agreed by 138 (46%); mean = 3.02 SD = 4.72. The study concluded that many women still practice female genital mutilation in the rural communities studied and actually they encourage its continuity. They study recommends more sensitization campaign on the social structures supporting the practice. Efforts of stakeholders in health should be geared towards planning and implementing aggressive programmes aimed at creating more awareness on the negative effects of female genital mutilation and its practice
CHAPTER ONE
INTRODUCTION
Background to the Study
Female genital mutilation (FGM) commonly known as female circumcision comprises all procedures involving partial or total removal of the external female genitalia either for cultural or other non-therapeutic reasons (Wright, 2006). Whatever the purpose, FGM is a dangerous and potentially life-threatening procedure that causes unspeakable pain and suffering to the victim. According to Black (2000), it is declining in many western worlds but it is still being practiced in many African countries. It continues to be one of the most persistent, pervasive and silently endured human rights violations in the developing world.
An estimated 140 million females in the world today have undergone some form of female mutilation. At the current rates of population increase and with the slow decline in these procedures, it is estimated that each year a further 2 million girls are at risk from the practice, and the women and girls affected live in 28 African countries and a few in the Middle East and Asia (World Health Organization (WHO), 2002).
Recently, it has been identified as a very vital public health problem (Uwasomba, 2003). Referring to female genital mutilation as female circumcision is misleading because it implies that the procedure is similar to male circumcision, which is necessary and simply involves the removal of piece of the foreskin of the genital organ (WHO, 2004). The procedure is far more invasive and dangerous as a large portion of healthy sensitive tissues of the female external genital organs are normally excised.
In Africa, the practice exists today in about thirty two out of the forty eight African countries among them are Sudan, Egypt, Mali, Niger, Nigeria to mention but a few (Bashir, 1997). In Nigeria, female genital mutilation is noted to be practiced among different tribes, for example the Igbos, Efiks, Ishans, Edo’s, Urhobos, Yorubas, Nupes, Hausas, Idomas and many others (Bardie, 1995).
There are 3 main types of female genital mutilation although some other forms have been identified. They are: Type 1 (Clitoridectomy), Type 2 (Excision) and Type 3 (Infibulations). Clitoridectomy involves removal of the tip of the prepuce, with or without excision of part or all of the clitoris, Excision involves removal of the clitoris along with some part or all of the labia minora while in infibulations most of all the external genitalia is removed, and the vaginal opening is then stitched leaving only a small opening for the flow of urine and menstruation. The procedure can be carried out during infancy, about the eight day of delivery, childhood, at time of marriage or even during first pregnancy depending on the cultural dictates of the area. The operation is often performed by practitioners with little or no formal knowledge of human anatomy and physiology and in most cases under unhygienic conditions without the use of anaesthetic or sterile instruments. The immediate medical consequences according to Black (2000), include, difficulty in passing urine, urine retention, haemorrhage, infection, fever, stress, shock and damage to the genital organs.
Over time, circumcised women may also develop menstrual complications, urinary tract infections, chronic pelvic infection and low fertility or infertility. With all these medical complications prevalent among the circumcised female, the obnoxious practice is still common especially in some rural areas in most developing countries like Nigeria. A lot of campaigns by government and non-governmental organizations highlighting the risks associated with FGM have been mounted, yet the practice is still prevalent in some rural settings in Nigeria (Jerry, 2000). This raises the question, “what could be the factors that are still preserving the continuing practice of FGM?”
Seeking answer to the question prompted the need to examine the socio-cultural perspectives of FGM in rural communities of Enugu State in other to provide evidence-based health education information.
Statement of the Problem
A study of a community in Ekwusigo LGA of Anambra State showed that the incidence of this practice increased from 150 in 1990 to 350 in 2006 despite the numerous teachings about the medical complications of FGM, as well as other health campaigns against this unacceptable practice (Amadigwe, 1999). These medical complications according to WHO (2003) include: bleeding, infection, prolonged labour, lacerations and sometimes death. The procedure negatively affects the psychological and social health and well being of women. Despite the ban by the Enugu State House of Assembly, some communities are still neck deep in the practice. Also, all the efforts in sensitizing the people through other government and non-governmental agencies highlighting the medical complications of FGM, the practice is still flourishing in some rural communities and one wonders what could be the problems and the factors that seem to preserve such practice. That has many negative effects on the health of the women.
In the rural communities of Enugu East LGA despite the efforts of national and international organizations advocating and campaigning for the abolition of the practice of FGM not much success seems to have been achieved. An eight-day old baby girl died from post circumcision bleeding at Ugwuogo Nike as was observed by the Enugu State Maternal, Newborn and Child Health (MNCH) team while on one of their monitoring visits (Health System Development Project 2008, HSDP2). Thus the study to assess the socio-cultural factors that may contribute to the continued practice of this FGM is deemed necessary.
Purpose of the Study
The purpose of the study is to examine the socio-cultural factors that still preserve the continued practice of female genital mutilation among women in selected rural communities of Enugu State.
Objectives of the Study
Specifically, the objectives of this study include to:
- determine social factors that still preserve the practice of FGM in this rural communities studied.
- identify social structures that preserve the practice of FGM in these rural communities.
- 3. determine cultural beliefs that support FGM practice in these rural communities.
- determine the association between social structures and continued practice of FGM.
- determine the relationship between cultural beliefs and continued practice of FGM.
Research Questions
- What are the social factors that promote the practice of FGM in these communities?
- What are the social structures that preserve the practice of FGM in the rural communities under study?
- 3. What are the cultural beliefs that support FGM practice in these rural communities?
- What are the association between social factors that preserve continued practice of FGM and religion?
- What are the relationship between cultural beliefs that preserve continued practice of FGM and religion?
Null Hypotheses
Ho1: Social structures of communities that practice FGM will not significantly differ from those that do not
Ho2: Cultural belief of communities that practice FGM will not significantly differ from those that do not
Significance of the Study
The study will benefit the common man and woman in the community, the healthcare professionals, the academic, the media, the policy makers and the entire nations as a whole since FGM for what ever purpose it is practiced, the demerits outweighs the supposed benefits and its elimination will overall reduce maternal newborn and infant morbidity and mortality as a result of FGM practice.
The community members will be aware of the demerits of FGM continued practice thereby changing their attitude, the healthcare providers will have an indebt knowledge of the importance of discontinuing FGM practice, document their evidence based findings as a result of FGM practice the effect on women during labour and delivery, the academia will increase their research and library and step it down to all their beneficiaries especially students, the media will increase their campaign and sensitization on the effect of FGM continue practice, the policy makers will institute policies that will enhance the total elimination of the ugly practice.
The benefits will be realised when all the social and cultural beliefs and other factors still preserve FGM practice is eliminated thereby reducing the unacceptable maternal and infant mortality as a result of FGM practice.
Findings of this study therefore, identified social structures and cultural beliefs that still preserve the practice of FGM in rural areas so provide evidence based information for health education. Result of the study revealed the reasons behind the continued practice of FGM in such communities so that appropriate interventions may be instituted. The findings also will help in the changing of some cultural beliefs and practice through health education, community mobilization, sensitization and community dialogue since culture is dynamic. The findings will equally add to the existing body of knowledge in the area of study. Also much work have been done on FGM, mostly on physical and psychosocial but not much have been done on socio-cultural perspectives especially in rural communities in Enugu hence the relevance of this study.
Scope of the Study
The study is delimited to women of child bearing age in 10 rural communities in of Enugu East Local Government Area of Enugu State. The study variables are delimited to social factors, social structures and cultural beliefs that still preserve continued practice of FGM.
Operational Definition
Social factors are family status, decision making pattern of the family, educational level, women status in the communities.
Social structures in this study refer to women associations “umuada”, women leaders in Igwe’s cabinet, age grade and cultural groups.
Cultural beliefs: Refers to people’s beliefs about uncircumcised females such as being promiscuous, being dirty (so needs purification through circumcision), and prone to late marriage.
Rural communities: Refers to groups of people living within an underdeveloped area lacking most of the social amenities such as good road network, electricity, water supply and basic health facilities. Most of them are poor, illiterate, ignorant, farmers, peasants and are tied to tradition.