Intergenerational attitude change regarding female genital cutting in Yoruba speaking ethnic group of southwest Nigeria: a qualitative and quantitative enquiry.

Author:Alo, Olubunmi Akinsanya


Female genital cutting (FGC) is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between sexes, and constitutes an extreme form of discrimination against women. The practice also violates a person's rights to be free from torture, cruel, inhuman or degrading treatment and the right to life when the procedures result in death (WHO, 2010). Female genital cutting has been widely condemned by International Organizations and Feminist Groups all over the world due to the health outcomes it has for women, and because it is an abuse of the women's Fundamental Human Rights (Alo and Adetula, 2005). A worldwide consensus was reached at the International Conference on Women and Development (ICWD) held in Cairo in 1994 where the practice was recognized as a set back on women's rights and major life long risk to women's heath.

Female genital cutting consists of all procedure that involve partial or total removal of the external genitalia, or other injury to the female genital organs for non-medical reasons. It is estimated that between 100-140 million girls and women worldwide are currently living with the consequences, while in Africa an estimated 92 million girls and women have undergone female genital cutting (WHO, 2010). The practice is most common in the western, eastern and north eastern regions of Africa, in some countries in Asia and the Middle East and among certain immigrant communities in North America and Europe (Okumepira, 2010). It has also been reported to occur in individual tribes in South America and Australia (WHO, 1999). To a lesser degree female genital cutting is practiced in Indonesia, Malaysia, Pakistan, India, New Zealand and United States (WHO, 2009).

In the mid 1990's, World Health Organization and many other groups adopted the term genital mutilation to describe the cutting of female genitalia. Some other interventionist groups have adopted female genital surgeries (Obermeyer, 1999). A number of specialists have objected to the term mutilation, because the term is judgmental and implies disrespect (Elias, 1996), USAID recommended a neutral term 'Female genital cutting' and this is preferred by an increasing number of researchers. This is the position adopted in this article. Female genital cutting (FGC) is used in this article to refer to all forms of female circumcision, female genital mutilation and the removal of any part of the female genitals at whatever age.

The types of FGC vary from a simple pricking of the clitoris, to removal of all the female genitalia, and almost complete closure of the virginal area (infibulations). Based on the classification of Toubia (1994), WHO categorized the practice into the following four types:

* Total or partial removal of the clitoris (Clitoridectomy).

* Removal of the clitoris and part of the labia manora (Excision).

* Removal of the clitoris, the labia minora, and the labia majora, with tighter

* closing of the vaginal opening (Infibulations).

* Any variant of the above.

FGC is carried out using various types of unsterilized instrument which include special knives, scissors, scalpels, and pieces of glass or razor blades. The procedures are usually carried out by an elderly woman of the village who has been specially designated for this task or by traditional attendants. It has been documented that FGC has very serious health implications on the reproductive, physical and emotional health of girls and women. The immediate physical health consequences include: severe pain, heavy bleeding, shock, acute urinary infection, pelvic inflammatory diseases, risk of contacting HIV and Hepatitis B; while the long term consequences include difficulty passing urine, recurrent urinary tract infection, and infertility, loss of normal sex function, cysts and abscess on genitals, painful intercourse, problems in child birth, painful and difficult labour, etc. (Alo and Adetula, 2005).

A recent study by WHO (2010) has shown that women who have had FGC are significantly more likely to experience difficult child birth and that their babies are more likely to die as a result of the practice. Serious complications during child birth include the need to have caesarian section, dangerously heavy bleeding after the birth of the baby and prolonged hospitalization after the birth. The psychological effects of FGC are less easily measured than medical complications. Among the effects documented by researchers are: anxiety, depression, trauma, frigidity, and marital conflict (WHO, 1996a). FGC sharply reduces a woman's capacity for sexual fulfillment (Toubia, 1995:16), and it may also leave a woman with damaged nerve and scar tissue that makes intercourse extremely painful (WHO, 1996b). World Health Organization has compiled a list of possible health consequences of FGC and divided them into three categories; short term medical, long term medical, and sexual, marital and social consequences (WHO, 1996c).

FGC is a common practice in many societies of Africa. In a few societies, the procedure is carried out when a girl is a few weeks old and in some others, it occurs latter in childhood or adolescence. In the case of the later, FGC is often part of a ritual initiation into womanhood that includes a period of seclusion and education about the rights and duties of a wife. The practice of FGC is wide spread in Nigeria and varies from one cultural setting to another. A 1996 United Nations Development Systems Study reported that 32.7 million women have undergone FGC in Nigeria; the average reported rate for southwest Nigeria is 66 percent (United Nations, 1996). Toubia (1994) provided an estimate of 50% prevalence rate for Nigeria. This estimate prompted Gruebaun (2001:8) to postulate that nearly 1/3 of the cases in Africa are in Nigeria, not because of high prevalence but because of the large population; Nigeria accounts for 30.6 million of the 114.3 million cases for Africa as a whole. DHS estimated for Nigeria a prevalence rate of 25% for 1999 (NPC, 2000), 19% for 2003 (NPC, 2004) and 30% for 2008 (NPC, 2009). DHS (2003) further reported that about 60% of females have undergone that procedure in all the six geopolitical zones in the country, and that Southwest Nigeria is ahead in the practice with 56.9% prevalence rate. In 1999 Snow et al conducted a cross sectional study of reproductive health among woman aged 15-49 attending antenatal and family planning clinic in three hospitals in Edo state of Nigeria and reported a prevalence rate of 46% (Snow et al, 2002).

In 1994, Nigeria joined other members of the 47th World Health Assembly in a resolution to eliminate FGC-WHA 47.10 (Mandara, 2004). Steps taken so far to achieve this include establishment of Multicultural Technical Working Group on Harmful Traditional Practices (HTPS), conduct of various studies and national surveys on HTPS, launching of a regional plan of action, formulation of national policy and plan of action which was approved for the elimination of FGC in Nigeria by the federal executive council. In 1997, WHO issued a joint statement with the United Nations Children Fund (UNICEF), and the United Nation Population Fund against the practice of FGC (WHO, 1998). A new statement with wider United Nations support was issued in February 2008 to support increased advocacy for the elimination of FGC (UNFPA, 2010). The United Nations declares February 6 of every year as International day of zero tolerance to female genital cutting. The Nigeria National Assembly, Nurses and Mid Wives Association of Nigeria, the Nigerian Medical Association, and Nigerian Female Medical Association have all made concerted efforts towards the elimination of a FGC in Nigeria. The Houses of...

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