Cause; Practice and Belief status of females (15-49 years old) on Female Genital Mutilation in Tigray, Ethiopia, 2020

doi:10.21203/rs.3.rs-4327410/v1

Aim: There is evidence on the cause, practice and poor status of female genital tract mitigation in Tigray, Ethiopia.

The aim of this study was to assess the cause, practice and believing status of females regarding genital mitigation in Tigray, Ethiopia.

Methods: A quantitative, community-base, cross-sectional study was conducted among reproductive aged girls and women in eastern Tigray, Ethiopia. A purposive sampling technique was used to select the study area (Atsbi District) from the Tigray Region 93 districts. A simple random sampling technique used to select four local administrations and 201 study participants. The data were collected using pre-tested structured questionnaires, and the data were entered into SPSS Version 23 for analysis. Descriptive statistics were used to describe the characteristics of the study subjects. The frequency, percentage, and graph ware used.

Result: In this study, 78 (38.8%) of the study participants had ever been circumcised, 36 (29%) had genital mutilation practiced at under 5 years of age, and 55 (44.8%) had female genital mutilation performed by traditional methods, 168(83.6%) had FGMP performed using razor blades and 102 (50.7%) had sociological and cultural causes.

Conclusion: Females’ and parents’ health education; should be strengthened, IEC/BCCmaterials should be expanded in different areas, religious leaders’ involvement in awareness creation regarding FGMPs should be strengthened, and further study should be performed.

Epidemiology

Cause

Female

Genital Mutilation

Practice

Belief

Tigray

Female genital mutilation (FGM) is the removal of external female genitalia (injury) to female genital organs for no medical purposes. The age at which FGM is performed varies across cultures but the procedure is generally performed when girls are between the ages of 0 and 15 years (WHO, 2008).

Global estimates indicate that; 100 to 140 million girls and women are at risk for FGM annually and that approximately 3 million girls are estimated to be at risk of FGM annually and that there are up to 6,000 new cases of FGM every day (UNICEF, 2016). In Africa, it is prevent and still has a high prevalence. It is estimated that 91.5 million girls and women above the age of 9 have been affected by FGM (Yoder and Khan, 2008).

FGM is widespread across Ethiopia and occurs in the majority of regions and ethnic groups, with the highest prevalence in the Afar region at a rate of 91.6% (DHS, 2005) or 87.4% (EGLDAM, 2007). Additionally, the Somali region has a percentage of 97.3% (DHS, 2005) or 70.7% (EGLDAM, 2007). The region with the lowest rate is Gambela, with a rate of 27.1% (DHS, 2005).

FGM has no health benefits and can be harmful to girls and women. According to the World Health Organization (WHO, 2008), FGM can cause immediate complications such as severe pain and bleeding, shock, tetanus or sepsis (bacterial infection), open sores in the genital region and injury to nearby genital tissue, and problems urinating and long-term consequences can include recurrent bladder and urinary tract infections, cysts, infertility, an increased risk of childbirth complications and newborn deaths, and the need for later surgeries (WHO, 2008, WHO, 2013).

Girls and women are often under strong social pressure, including pressure from their peers and risk victimization and stigma if they refuse to be cut. FGM is always traumatic (UNICEF, 2005). FGM violates human rights and is a widespread public health issue (WHO, 2008).

The aim of this study was to assess the causes, practices and beliefs regarding genital mutilation in Tigray, Northern Ethiopia which is crucial for filling the gap in current and evidence-based information regarding female genital mutilation practices and its impact on Tigray. The results of this study will enable planners and program managers, decision makers and policy makers to establish appropriate interventions for female genital mutilation practices in the region.

Study Design, Population and Setting

Descriptive community-based cross-sectional quantitative studies were conducted in the Atsbi district from February-March, 2020 among reproductive aged (15–49 Years old) girls and women. According to the 2007 GC National Population Census, the total population of Atsbi is estimated to be 137,133. A total of 31167 (4.4%) were households, and 32226 (23.5%) were girls and women of reproductive age (15–49 years old). The district is located in the eastern zone Tigray Region in the northern Ethiopia. Atsbi is bordered in the south by the Debub Misraqawi (Southeastern) Zone, in the west by Kilte Awulaelo, in the north by Saesi Tsaeda emba, and in the east by the Afar Region. The district was administratively divided into 18 local administrations (Atsbi District Health Office). Each local administration was further divided into sub-zones. The district is the basic administrative unit, and Kebele is the low-level administrative unit.

Sample Size Determination and Sampling Procedure

Because of the relatively high Female Genital Mutilation/FGM practices, the district and its four local administrations (Enda Silasie, Hayk Meshal, Michael Amba and Adi Mesanu) were selected purposively; According to the administration of the Atsbi Wemberta district, the population of women in the four kebeles had 15,998 of these women: Enda Silasie 5,437, Hayk Meshal 2,112, Michael Amba 4,158 and Adi Mesanu had 4,291 people. Thus, Yamane’s (1967:886) simplified formula used to determine the sample size is:

where; n = the sample size

N = is the population size, and e is the level of precision.

A totally 201 people were included, and the sample size of the study was determined.

The study samples were proportionally allocated to the women population residing in the selected 4 local administrations. Then, households were randomly selected, one woman was randomly selected from each selected household, and replacement was made for absences on the first visit.

Table 1

Quota sampling for each selected local administration
S,N	Kebeles	Population	Sample size
1	Enda silasie	5,437	68
2	Hayk meshal	2,112	27
3	Michael amba	4,158	52
4	Adi mesanu	4,291	54
Total		15,998	201

Study Variables

The dependent variables for this study were cause, practice and beliefs of females on female genital mutilation, and the independent variables were sociodemographic variables (age, sex, religion, residence, marital status and educational status); and decision-making for female genital mutilation practice.

Data collection tool and procedure

The data were collected using an interviewer-administered structured questionnaire adapted from the literature. The survey included information on socio demographic characteristics, knowledge, cause, practice and beliefs of females on female genital mutilation. The questionnaire was initially prepared in English, translated into the local language Tigrigna, back translated into English, and checked for consistency.

Data collection instrument and quality management

A standardized data collection instrument was used to maintain data quality. Training was provided to the data collectors and supervisors on the objectives of the study, interview techniques, informed consent and confidentiality. Moreover, 5% of the questionnaire was pretested and necessary amendments were made. During the data collection period, completeness and consistency were checked by the investigators immediately and daily. Owing to the sensitive nature of the questions, the interviewers were of the same sex.

Data analysis and processing analyses

The data were entered into Epi-Data software version 3.1 and then transferred to the Statistical Package for Social Sciences (SPSS) version 23 for analysis. Data cleaning and editing were performed before the analysis. Descriptive statistics such as frequency distribution tables and graphs were used to present the findings.

Socio demographic characteristics of the study participants

In this study, 201 respondents participated, for a response rate of 100%. Most of the respondents were aged 94 (25–35) years, with a minimum of 15 years and a maximum of 46 years. Overall, 100% of the respondents; were females, were in the Tigraway Ethnic group, and lived in rural areas. Of the 201 participants, 137 (68.2%) were Orthodox Christian followers. Regarding marital status, 135 (67%) of them were married. The majority of the respondents (67, 33.3%) were unable to write or read (Table 2).

Table 2

Socio demographic status
Socio demography characteristic	Frequency	Percentage
Sex
Male	0	0
Female	201	100
Total	201	100
Marital status
Single	30	15
Married	135	67
Divorced	13	7
Widowed	23	11
Total	201	100
Age
15–24	26	12.9
25–35	94	46.8
36–45	38	18.9
46+	43	21.4
Total	201	100
Residence
Rural	201	100
Town	0	0
Total	201	201
Religious
Orthodox	137	68.2
Catholic	0	0
Muslim	61	30.3
protestant	3	1.5
Total	201	100
Ethnicity
Tigraway	201	100
Erob	0
Afar	0	0
Others specify	0	0
Total	201	100

Socio demography characteristic	Frequency	Percentage
educational status
unable to write and read	67	33.3
able to write and read	40	19.9
Elementary(1–8) school	41	20.4
Secondary(9–10) and preparatory(11–12) school	41	20.4
College and above	12	6
Total	201	100
Source: field Data

Awareness about Genital Mutilation, Eastern Zone, Tigray

Of the 201 study participants, 174 (86.6%) had heard about FGMP, and 175 (87.1%) of the participants were aware of it. The study revealed that 163 (81.1%) of the participants had Knowledge of the presence of policy and legal frameworks to mitigate the impact of FGMPs, and 103 (51.2%) understood about FGMP harmfulness from the age of 11–20. This study revealed that for 162 (51%) participants, female genital tract mitigation practices were needed. Regarding the effect of FGMPs, 66 (32.8%), 63 (31.3%), 45 (22.4% ) and 19 (9.5%) participants indicted that FGMPs had fertility problems, problems during giving birth, problems during sex and ministration, respectively (Table 3).

Table 3

Awareness, Knowledge and beliefs about Criminality of the FGMP
Response	Frequency	Percentage
Have you ever heard of female genital mutilation?
Yes	174	86.6
No	17	13.4
Total	201	100.0
Response	Frequency	Percentage
Aware
Yes	175	87.1
No	26	12.9
Total	201	100.0
Knowledge on the presence of policy and legal frame works to mitigate the impact of FGMP
Yes	163	81.1
No	38	18.9
Total	201	100
Female understanding about harmfulness of FGMP
before 10 years old	15	7.5
11–15	43	21.4
16–20	60	29.8
21–25	51	25.4
26–30	32	15.9
Total	201	100
believe/stand on eradication of FGMP
Yes	162	81
No	39	19
Total	201	100
Option on FGNP
Need Continued	18	9
Need discontinued	183	91
Total	201	100
Knowledge of the effect of FGMP
Menstrual problem	19	9.5
Problem during sex	45	22.4
Fertility Problem	66	32.8
Problem during giving birth	63	31.3
I do not know	8	4
Total	201	100
Source: field Data

Female Genital Mutilation Practice, Eastern Zone, Tigray

Of the total 201 participants, 78 (38.8%) practiced female genital mutilation. Fifty- two (42%) genital mutilations practiced by females were circumcised at the infant’s age, and 55 (44.8%) female genital mutilations were performed by Traditional methods (Table 4).

Table 4

Female genital mutilation practice s
Are you circumcised?
Yes	78	38.8
No	123	61.2
Total	201	100
If yes, how old were you when you were circumcised?
Under 5 year	52	42
I do not Know	71	58
Total	123	100
Who performed the circumcision?
Traditional	55	44.8
I do not Know	68	55.2
Total	123	100
Source: Field Data

The study findings showed, that 102 (50.7%), 50(24.9%), 37 (18.4%) and 12 (6%) FGMPs had sociological and cultural causes, Hygiene and Aesthetic causes, Religious and Psychosexual causes, and 168 (83.6%) FGMPs had been performed using razor blades (Table 5).

Table 5

Reasons and instruments used to perform FGMP
Response		Frequency		Percentage
Reason for FGMP
Sociological and Culture		102		50.7
Hygiene and Aesthetic		50		24.9
Religious		37		18.4
Psychosexual		12		6
Total		201		100
Instrument used to perform FGMP
Special Knife	4		2
Scissors	22		10.9
Pieces of Glass	7		3.5
Razor Blades	168		83.6
Total	201		100
Source: field Data

The study findings revealed; that 38.8% of the participants practiced female genital mutilation. This percentage was lower than 65% in Ethiopia (Ethiopia, 2016), Afar region (88%) (Ethiopia, 2016), the Amhara region (50%) (Ethiopia, 2016), Somalia (95%) (Ethiopia, 2016), and the Beneshangul Gumuz Region (43%) (Ethiopia, 2016) and higher than that in Gambela region (24%) (Ethiopia, 2016), Kenya (21%) (Ethiopia, 2016), Uganda (0.3%) (Ethiopia, 2016), and Tanzania (10%) (Ethiopia, 2016) and similar to that in Addis Ababa (39%) (Ethiopia, 2016). This discrepancy could be due to differences in the study period, sample size, and socio cultural factors.

In the study area, 52% of genital mutilations occurred in individuals under the age of 5 years. These findings were greater than those in Ethiopia (44%) (Ethiopia, 2016), Harari (10%) (Ethiopia, 2016), Somalia (21%) (Ethiopia, 2016), and SNNPR (22%) (Ethiopia, 2016), and lower than in Amhara (96%) (Ethiopia, 2016), Afar (84%) (Ethiopia, 2016), Addiss Abeba (65%) (Ethiopia, 2016), and Benishangul Gumuz (83%) (Ethiopia, 2016). This difference could be due to socio cultural factors, access to media and educational reasons.

The findings revealed that 44.8% of female genital mutilation in this study area was performed by traditional practitioners. This percentage is greater than that in Jijjiga (5%) (Jigjiga Town, Eastern Ethiopia, 2013); and lower than in Ethiopia (44%) (Ethiopia, 2016), the SNNPR (90%) (Ethiopia, 2016), Eritrea (92%) (Africa, 2015), and Djibouti (94%) (Africa, 2015). Regarding the reason for the FGMP in the study area, 50.7% of the FGMPs had sociological and cultural causes, which is higher than that of Hadiya (25%) (Hadiya, Ethiopia, 2013); and lower than that of Bale (74.8%) (Bale Zone, Ethiopia, 2014). This discrepancy could be due to socio cultural differences.

In the study area, 86.6% of the study participants had heard about FGMP, and (87.1%) of the participants were aware of it. This finding is lower than that in Jijiga (91.3%) (Jigjiga Town, Eastern Ethiopia, 2013); and higher than that in Amhar (56.6%) (Amhara regional state, Northwest Ethiopia, 2018); and Tanzania (56.51%) (Tanzania, Charlotte H. Mwanja1, Patricia Z. Herman1* and Walter C. Millanzi1, May, 2022). This difference could be due to the period of study, sample size and socio cultural differences.

Fifty-one percent of participants in the study area needed to stop female genital mitigation practices. This percentage is lower than that in Ethiopia (87%) (Ethiopia, 2016), and Amhara (54.2%) (Amhara regional state, Northwest Ethiopia, 2018); and higher than that in Egypt (44%) (Egypt, 2018); and Tanzania (31.2%) (Tanzania, Charlotte H. Mwanja1, Patricia Z. Herman1* and Walter C. Millanzi1, May, 2022). The difference could be due to the study period, sample size, educational status and access to media.

Limitations and Strengths of the Study

The data were exclusively dependent on self-reports of female genital mitigation practices; thus, there may be a social bias, and because the study was cross sectional, it may not be strong enough to demonstrate direct causes. Furthermore, it was performed in one district and selected local administrations, and the results did not show the entire Tigray. However, this study provides evidence that females in rural areas, benefit program managers, service providers, decision and policy makers, and stakeholders.

The study findings showed that; the magnitude of female genital mutilation is high among females in the Atsbi district, which is the eastern zone of the Tigray region in, northern Ethiopia. Therefore, strengthening female and parent health education, expanding IEC/BCC materials in different areas, strengthening religious leaders’ involvement in awareness creation regarding FGMPs, and further study should be performed.

FGMP, Female Genital Mitigate Practice Youth Friendly Service; HIV, Human Immuno deficiency Virus; IEC, Information Education Communication; IRB, Institutional Review Board; SPSS, Statistical Package For Social Science;

Acknowledgments

We would like to extend our appreciation to the Regional Women Affairs and Atsbi Wemberta Women Affairs office, who have contributed in diverse ways to ensuring the successful completion of this work during the study. We would like to acknowledge the ethical clearance of the Mekelle University institute of population studies and Tigray Health Research Institute researchers for providing valuable comments and suggestions for conducting this study.

Author Contributions

All authors made significant contributions to the study conception, study design, execution, acquisition of data, analysis and interpretation of the data; participated in drafting , revising or reviewing the article critically; gave final approval of the version to be published; agreed on the journal to which it would be submitted; and agreed to be accountable for all aspects of the work.

Funding

The study had no funding

Disclosure

The authors declare that they have no competing interests.

Ethical consideration

Ethical approval was sought and granted from the Mekelle University Institute of Population Studies Ethical Clearance Committee with reference number 204/MUIP-6/20. The clearance letter was summited to the Atsbi Wemberta Woreda Association Office, and then the cooperating letters were taken from the office. It was distributed to concerned bodies and district health office experts to gain access and collaboration. The respondents were informed of the objective of the study and verbal consent was obtained from each respondent. They were also informed that they were free to decline or withdraw from the study at any time. Privacy and confidentiality were ensured during the interviews.

Data Sharing Statement

The dataset analyzed in the current study is available from the corresponding author upon reasonable request

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The authors declare no competing interests.

Cause; Practice and Belief status of females (15-49 years old) on Female Genital Mutilation in Tigray, Ethiopia, 2020

Status:

Version 1

Abstract

Introduction

Methods and Materials

Study Design, Population and Setting

Sample Size Determination and Sampling Procedure

Study Variables

Data collection tool and procedure

Data collection instrument and quality management

Data analysis and processing analyses

Results

Socio demographic characteristics of the study participants

Awareness about Genital Mutilation, Eastern Zone, Tigray

Female Genital Mutilation Practice, Eastern Zone, Tigray

Discussion

Limitations and Strengths of the Study

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1