Gender-based violence in a rural Nigerian community during the COVID-19 era: a call for policy action

Introduction: gender-based violence (GBV) is a global pandemic which is deeply rooted in culture, hence the need to contextually understand its occurrence and patterns in rural settings. The objective of this study assessed respondents´ attitude, prevalence, the perceived risk factors, patterns and predictors of GBV in Ife-Odan, Osun State, Nigeria. Methods: cross-sectional study design was used and multi-stage sampling method employed to recruit 450 consenting adults. A pretested interviewer-administered, semistructured questionnaire was used for data collection. Both descriptive and inferential statistics were carried out. Results: mean age (±SD) of the respondents was 30.73±7.0, 58.7% of them were females and 88.0% had negative attitude to GBV. Prevalence of any form of GBV was 16.2%. Predominant GBV types included intimate partner violence (IPV) (58.3%), female genital mutilation (FGM) (31.1%), Sexual violence (6.9%) and incest (3.4%). Perceived risk factors of GBV included cultural acceptance, substance abuse, lack of punishments for GBV offenders, indecent female dressing styles, social media influences, effects of COVID-19 lockdown and male dominance. However, gender (AOR=7.82; 95%CI=2.35-8.17), marital status (AOR=3.23;95%CI=1.82-3.78), religion (AOR=5.02;95%CI=1.78-9.63) and attitude (AOR=4.23; 95%CI=2.267-5.82) were the significant predictors of past GBV experiences in the study setting. Conclusion: gender-based violence (GBV) is prevalent in the study setting, with IPV being the most common. There is need for policymakers to focus on cultural transformation by designing a robust awareness campaign against GBV in rural Nigerian communities. Traditional and religious leaders should be sensitized and involved in the campaign programs using all available channels of communication. Laws prohibiting perpetration of GBV need to be fully implemented.

Female genital mutilation and male involvement: Insights of men and women in two counties in Kenya

This qualitative study, conducted in Meru and Kajiado counties in Kenya, explored the perceptions and attitudes of men and women regarding male involvement in FGM in order to inform the design of male involvement strategies in FGM abandonment. We used focus group discussions to collect the data which was then subjected to thematic analysis. Three main themes emerged from the data: i) culture and the role of men; ii) perceived awareness and knowledge of FGM among men, and iii) credible and customised education and engagement. The study found widespread agreement on the importance of male involvement in FGM abandonment. Culture played an important role in determining the extent of involvement, or lack thereof. We conclude that while culture needs to be respected it ought to be challenged to avoid the continued harm to girls. The potential of men as a collective to bring about change was evident, and policy makers and NGOs should utilise the power of male collectives to support efforts to abandon FGM

Clinical, sexual and psychopathological changes after clitoral reconstruction in a Type II Female Genital Mutilation/Cutting: a case report

Female genital mutilation/cutting (FGM/C) is a health issue associated with serious negative psychological and health consequences. However, there is little literature on the impact of FGM/C on female sexuality, mental health and genital self-image after clitoral reconstructive surgery. Our aim was to assess sexual function, psychopathology and genital self-image in a type II FGM/C patient. The patient was assessed prior to FGM/C reconstructive surgery and at a 6-month follow-up. At follow-up, she reported an improvement in sexual function and a clear improvement of the psychopathological state. However, a worsening in genital self-image was also endorsed after the surgery. Our findings uphold that FGM/C reconstructive surgery can lessen psychopathological and sexual distress, although more research is needed in order to increase awareness of the potential benefits of genital reconstruction and to perfect the surgery procedures. These results have repercussions for health practitioners and psychologists alike in terms of developing prevention strategies and treatment protocols for FGM/C women

The effect of Female Genital Mutilation on perineal injuries among women in labour in Dodoma Region, Tanzania

Introduction: Female Genital Mutilation (FGM) is widespread in Tanzania and poses a risk when women give birth.Objective: To determine the association between FGM and perineal injury among women in labour in DodomaMethods: A matched case-control study of 364 randomly selected consenting women in labour was conducted in Dodoma Region between January 2017 and June 2018. Controls (no perineal injury) were matched to the cases (with perineal injury) based on maternal age at a ratio 2:1 making a sample of 243 controls and 121 cases. FGM and perineal injury was directly observed during labour using WHO guidelines. Data were analysed by using SPSS version 20 for Window (SPSS Inc., Chicago, IL, USA). Frequency tables were generated and bivariate analyses were conducted. The association between FGM and perineal injury was determined using chi-squared statistics.Results: Of the 364 women were investigated 40.4% (n=147) were circumcised and 59.6% (n=217) were not. There was a significant association between FGM and perineal injury (p=0.001).Conclusion: The FGM rate was high. FGM (total and Type II) was significantly associated with perineal injury

Labor, delivery and postpartum complications in nulliparous women with female genital mutilation admitted to Karamara hospital

Objectives:To assess labor, delivery and postpartum complications in nulliparous women with FGM/C and evaluate the attitude of mothers towards elimination of FGM.Methods:A prospective hospital based study using structured questionnaire was conducted between January to March 2015 at Karamara hospital, Jijiga, Ethiopia. All nulliparous women admitted for labor and delivery were included. Data were collected regarding circumcision status, events of labor, delivery; postpartum and neonatal outcomes as well as attitude of mothers towards elimination of FGM/C. Results:Two hundred sixty four (92.0%) of the women had FGM/C with most (93.0%) undergoing Type III FGM. The mean age of the women was 22 yr. Failure to progress in 1st stage and prolonged 2nd stage of labor occurred in 165 (57.0%) and189 (65.6%) of the cases respectively. Caesarean section was performed in 17.0% and instrumental delivery in 23.0%. 64.5% required episiotomies, 83.3% had an anterior episiotomy, 29 % had perineal tears, 25.7%% experienced post-partum hemorrhage and 24% postpartum infection. Among the newborns, there were 6.4% perinatal deaths; 18.8 % low birth weight and 1.5% birth injuries. Almost all complications were more frequently seen in circumcised compared to non-circumcised women. Conclusions: The prevalence of FGM is high and it substantially increases the risk of many maternal complications. Health professionals should be aware of these complications and support/care of women with FGM should be integrated at all levels of reproductive health care provision. Capacity building of responsible health professional should be initiated in the area with intensification of FGM eradication activities

Determinants of female genital mutilation practices in East Gojjam zone, western Amhara, Ethiopia

Background: Female genital mutilation is one of the harmful traditional practices among women and girls. More than 130 million girls and women live today who have undergone female genital mutilation. In Ethiopia, a high prevalence (74.3% national and 68.5% in Amhara region) has been reported. This study was aimed to identify determinant factors of female genital mutilation practices in East Gojjam Zone, Western Amhara, Ethiopia. Methods: A community based cross sectional study was conducted among 730 women aged 15-49 years and having children < 5 years old in September, 2014. Data were collected using a pretested interviewer administered questionnaire. Descriptive statistics were used to describe study objectives, and bivariate and multivariate analysis to identify determinant factors to female genital mutilation.Results: 718 women and 805 daughters participated in the study. FGM prevalence was 689 (96%) and 403 (49%) among women and daughters< 5 years of age, respectively. Type1 and type 2 FGMs were common and daughters <1 years of age exhibited 91% female genital mutilation. Daughters' age, parent education level, residence, women circumcision history, culture, health education, frequent health extension workers follow up and participation in anti FGM interventions were risk factors to female genital mutilation practice.Conclusions: Female genital mutilation practices continues to be a major problem to women and daughter <5 years of age in the study area. A number of factors were associated with FGM practices including daughters' age, parent education level, residence, health education, culture, mothers circumcision history, frequent health extensions workers follow up and participation in anti FGM interventions were determinants to higher FGM practices

Female genital mutilation/cutting: Knowledge, practice and experiences of secondary schoolteachers in North Central Nigeria

Background. Despite global efforts at eradicating female genital mutilation/cutting (FGM/C), the act continues to be performed globally. Objective. To determine the experience of schoolteachers about FGM/C and their possible role in contributing to its eradication. Methods. A prospective cross-sectional survey involving secondary schoolteachers from 18 secondary schools in Ilorin, North Central Nigeria, was undertaken during October and November 2014. All consenting participants completed a self-administered questionnaire on FGM/C. Statistical analysis was with SPSS version 20.0 with χ2 and logistic regression; a p-value of <0.05 was considered significant. Results. There were 371 participants (113 males (30.5%) and 258 females (69.5%)). More females than males were aware of FGM/C (205 v. 94; χ2 41.2; p=0.001); 180 women (69.8%) and 81 men (71.7%) wanted awareness and the implications of FGM/C to be taught in schools, while 46 women (17.8%) and 23 men (20.4%) had previously educated students about FGM/C. Also, 109 (42.3%) of the female teachers had been mutilated (mean (standard deviation) age 4.76 (4.86) years), and 49 mutilations (45.0%) had been performed by traditional circumcisers. Of the teachers, 44.0% of men and 24.5% of women had subjected their daughters to FGM/C (p=0.029), mostly for religious reasons. The men initiated the majority of their daughters' mutilations, while the mothers-in-law were the main initiators among the women; 44 (17.0%) women and 23 (20.4%) men held the opinion that females should be circumcised, while the majority considered education and legislation to be the most important interventions to encourage its eradication. Predictors of the likelihood to support discontinuation of FGM/C include awareness of government policy about FGM/C and having a mutilated daughter. Conclusion. Education, reorientation and motivation of teachers will position them as agents for eradicating FGM/C

Attitudes to female genital mutilation/cutting among male adolescents in Ilorin, Nigeria

Background. The central role of males in female reproductive health issues in patriarchal societies makes them an important group in the eradication of female genital mutilation/cutting (FGM/C).Objective. To determine knowledge about and attitudes to FGM/C among male adolescents; and their preparedness to protect their future daughters from it.Methods. A cross-sectional survey among male adolescent students in Ilorin; Nigeria. Participants completed a self-administered questionnaire after consent had been obtained from them or their parents. Statistical analysis was with SPSS version 20.0 (IBM; USA). A p-value of 0.05 was taken as significant.Results. Of 1 536 male adolescents (mean age 15.09 (standard deviation 1.84) years; range 14 - 19); 1 184 (77.1%) were aware of FGM/C; 514 (33.5%) supported female circumcision; 362 (23.6%) would circumcise their future daughters; 420 (27.3%) were of the opinion that FGM/C had benefits; mostly as a necessity for womanhood (109; 7.1%); and 627 (40.8%) perceived it as wickedness against females; 546 (35.5%) were aware of efforts to eradicate FGM/C; and 42.2% recommended education as the most important intervention to achieve thisConclusion. Education and involvement in advocacy may transform male adolescents into agents for eradication of FGM/C

Reflections on female circumcision discourse in Hargeysa, Somaliland: purified or mutilated?

In communities where female circumcision is carried out, increasingly large segments of the population have been exposed to strong arguments against the practice. This study aimed to explore diverse discourses on female circumcision and the relationship between discourses and practice among informants who have been exposed both to local and global discourses on female circumcision. A qualitative study was carried out in 2009/10 in Hargeysa, Somaliland, employing interviews and informal discussion. The main categories of informants were nurses, nursing students, returned exile Somalis and development workers. The study findings suggest that substantial change has taken place about perceptions and practice related to female circumcision; the topic is today openly discussed, albeit more in the public than in the private arena. An important transformation moreover seems to be taking place primarily from the severe forms (pharaoni) to the less extensive forms (Sunna). (Afr J Reprod Health 2014; 18[2]: 22-35)

Community-based study of circumcision practices in Nigeria

Background: Circumcision practice around the world has various implications and has generated a lot of debate about the pros and cons of the practice. Nigeria is one of the countries where male and female circumcision practice still occurs however, there has been claim of reduction in female genital cutting. Congregational or 'group' circumcision prevails in some communities as a means of upholding traditions and commemoration of festive period. Objective: To determine the pattern of circumcision practice and identify factors affecting the practice in Ilorin community. Materials and Methods: The study was a descriptive, cross sectional study conducted among parents of under-5 children of both the sexes using pre-tested, semi-structured questionnaires, which were administered to the respondents by trained research assistants over a six-week period. Clinical examination of genital area in index child of each respondent was done by a pediatric surgeon, who was the principal investigator. Results: Three hundred and ninety three (93%) respondents completed the questionnaire and the same number of index children's external genitalia was examined by the pediatric surgeon. The mean age of respondents was 33.2±9.3 years, and the main source of family income was private enterprises and civil services. The circumcision status of fathers was 100%, mothers, 65.6%, and overall female-child circumcision rate was 46.7%. Though, most of the index children were delivered at health centers (72.3%), the circumcisions were performed at almost equal frequencies by traditional circumcisionists (39.8%) and doctors (39.2%), with more than half of the circumcision being done outside the hospital. The mean age at circumcision was 22 ±0.69 months, with 73.9% of girls as against 91.7% boys being circumcised by the age of five years. Family choice was the main determinant of the age at circumcision and the circumcisionist. Female circumcision was done by traditional circumcisionist, nurses, and doctors in 1 in 4, 1 in 5, and 1 in 10 cases of circumcision, respectively. Traditional open (classical) circumcision technique was mostly used (40.4%), followed by Plastibel TM (ring type) (32.6%), and 'group' circumcision was practiced among 41.2% of respondents. Post-circumcision complications were seen in 116 (33.7%) of circumcised children examined. Conclusion: Circumcision practice in Ilorin is still higher among the traditional circumcisionists, despite of high hospital delivery. Female circumcision and 'group' circumcision were also being practiced, using mainly the traditional open circumcision technique. The high rate of circumcision complications indicate the need for proper enlightenment and retraining of health care providers and traditional circumcisionists on the safe methods available. The government should involve the religion and opinion leaders in the community to assist in the prevention of negative and harmful traditional practices including female circumcision

Health workers' knowledge of and experience with female genital cutting in Southwestern, Nigeria

Female genital mutilation with its attendant complications has been a harmful traditional practice that is difficult to eliminate despite all efforts by various government and non-governmental agencies in Nigeria. The aim of this study is to assess the experience and the knowledge of the health workers practicing in our environment on Female genital cutting (FGC). Two hundred and fifty were interviewed with self-administered structured questionnaire. Their mean age was 35.2±8.3 years. Type I 82(66.6%) was the commonest FGC seen by the health workers, type II 31(25.2%), type III 9 (7.3%) and type IV constituted 0.8%. Two hundred and two (202) (80.0%) of the respondents admitted to having sufficient knowledge in preventing FGC while 42 (16.8%) did not have. One hundred and twenty one (121) (48.4%) had been asked to perform FGC. It was concluded that female genital cutting is still a major health problem in Nigeria. There is need for all concerned to step up efforts in the elimination of the practice

Female genital mutilation among Edo people: the complications and pattern of presentation at a pediatric surgery unit, Benin City

This prospective study on female genital mutilation among Edo people was based on female children and parents who presented on account of it at the University of Benin Teaching Hospital, Benin City, Nigeria, between January 2002 and December 2007. During the period, 51 female children aged 10 days and 18 years presented with complications following genital mutilation. Twenty-nine were brought by their parents for mutilation while 67 parents interviewed believed strongly on female genital mutilation with 47 mothers mutilated. Religio-cultural and superstitious beliefs were the main indications and the type of mutilation ranged from excision of clitoridal tip in 10 (19.6%) children to complete excision of the clitoris, labia minora and inner layer of majora in 7 (13.7%). Complications ranged from clitoridal cyst formation in 21 (41.2%) to life threatening infections with one mortality due to tetanus infection (Afr J Reprod Health 2009; 13[1]:17-25)

Les séquelles de la circoncision et de l'excision traditionnelles

De 1985 a 1993; 22 enfants ages de 3 mois a 11 ans ont ete vus a notre consultation pour des sequelles de la circoncision et de l'excision traditionnelles. Parmi ces 22 enfants; on comptait 6 filles dont 4 avaient une stenose partielle du vagin et de l'uretre; une avait une stenose complete du vagin; et la derniere avait une cicatrice hypertrophique du clitoris : chez les 16 garcons; il y avait 3 cas de phimosis cicatriciels; 4 cas de fistules uretrales; 4 cas d'hypospadias iatrogenes; 3 cas d'amputations du gland; un cas d'amputation partielle du scrotum et un cas de granulome du sillon balanopreputial. Cinq filles et 11 garcons ont ete traites avec des resultats fonctionnels satisfaisants