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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 1  |  Page : 23-27

The current situation regarding awareness about female genital mutilation among men working in schools of Benha City, Qaluobia Governorate


1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Public Health and Community, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Family Medicine, Faculty of Medicine, Banha University, Benha, Egypt

Date of Submission03-Jan-2016
Date of Acceptance07-Mar-2016
Date of Web Publication25-Jul-2017

Correspondence Address:
Fatma M Salah Eldeen
Benha Faculty of Medicine, Resident Physician of Family Medicine, Benha, 13511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_542_15

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  Abstract 


Objective
The aim of the study is to assess awareness among men regarding female genital mutilation (FGM) and practice of circumcision of their daughters.
Background
FGM is an ancient practice that constitutes an extreme form of discrimination and violation against human rights of female. The prevalence of FGM in Egypt is 91%, and the prevalence of FGM among daughters aged 15–17 years is 74%. Men have an essential role to play in the elimination of violence against women and prevention of FGM, as they play an essential role in decision making regarding circumcision of their daughters.
Participants and methods
It was a cross-section study. Men who worked in seven governmental schools represented a sample of men working in schools of Benha City, Qaluobia Governorate. Married and unmarried men were included. The sample size was calculated to be 296 males, aged 20–60 years, which was increased to 300. All participants were interviewed using predesigned questionnaire to assess their awareness about different items related to FGM and practicing of circumcision to their daughters.
Results
This study showed that all participants had heard about FGM. The majority of them had this practice in their families, and 66.7% of them supported the practice. Moreover, this study revealed that the main cause of practicing FGM is tradition. The decision of practicing FGM is made mainly by fathers, and 62% believed that there was no problem regarding uncircumcised women. Approximately half (49%) of the participants believed that men have a role regarding FGM through participation in decision-making process. Three-quarters of participants had daughters, and 63.7% of them had mutilated daughters. Nearly half of those who had no daughters intended to circumcise their future daughters.
Conclusion
Men have an important role in continuation of FGM. Therefore, program for its prevention should include men in their disciplines, as they play an important role in elimination of circumcision.

Keywords: decision makers, female genital mutilation, mutilation, violence


How to cite this article:
Shaheen HM, Kasemy ZA, Salah Eldeen FM. The current situation regarding awareness about female genital mutilation among men working in schools of Benha City, Qaluobia Governorate. Menoufia Med J 2017;30:23-7

How to cite this URL:
Shaheen HM, Kasemy ZA, Salah Eldeen FM. The current situation regarding awareness about female genital mutilation among men working in schools of Benha City, Qaluobia Governorate. Menoufia Med J [serial online] 2017 [cited 2019 Apr 25];30:23-7. Available from: http://www.mmj.eg.net/text.asp?2017/30/1/23/211520




  Introduction Top


Female genital mutilation/cutting (FGM/C) is defined by the WHO as all procedures involving partial or total removal of the external female genitalia, or injury to the female genital organs, for nontherapeutic reasons [1]. The prevalence of FGM in Egypt is at 91% [2]. The highest prevalence is in Luxor Governorate (85.5%), and the prevalence of FGM among daughters aged 15–17 years is 74% [3]. Violence against women takes a variety of forms, and FGM is one form that causes harm to women [4]. FGM is considered as an extreme form of discrimination and violation of human rights of female with immediate health consequence such as shock, hemorrhage, infections, and psychological consequences, whereas the long-term consequences being chronic pain, infections, keloids, fibrosis, primary infertility, increase delivery complications, and psychological sequela/trauma [5].

Men have conflicting views and beliefs regarding FGM. Many men support the practice, but others wish the practice to end but are unable to voice their concerns owing to social pressure and obligation within the community. In Guinea, Sierra Leone, more men than women want FGM to end [6]. A study in Egypt showed that men believed uncut women to be promiscuous and that FGM was important for good marriage opportunities and to ensure fidelity in marriage [7]. Somali men believed that FGM prevents premarital sex, and it preserves the dignity of girls and marital infidelity [8]. Men in their roles as fathers, husbands, community members, and religious leaders may play an active role in elimination of FGM through their involvement in increasing awareness about FGM in the household, including among young men and boys, or by outreach in schools. Group discussions among men at work, in sports clubs, and during social and religious events talk about FGM as a harmful practice and its health consequence may eliminate FGM [1]. Education empowerment improves the knowledge and attitude of men toward FGM, so it helps men to change their behavior, beliefs, and deep-rooted traditions and to take proper decisions regarding FGM as men are the ultimate decision makers in practicing FGM to their daughters, wives, or sisters [2].

Objective

The aim of the study is to assess awareness among men about the causes of FGM, its consequences, their beliefs, and the practice of mutilation in their families.


  Participants and Methods Top


This was a cross-sectional study. It was conducted in Benha City, Qaluobia Governorate. Men aged 20–60 years were the target of the study. The participants were selected from men working in schools, whether married or not. The sample size has been calculated at power of 0.80 and 95% confidence interval. It was estimated to be 296 males, which was increased to 300 for a round figure. It was estimated according to the total number of males aged 20–60 years recorded in Benha City, which was 197 782 men.

Men were selected from governmental schools in Benha City. Of the 196 schools in Benha City, seven governmental schools were selected through simple random technique. They fulfilled the calculated sample. The study was conducted from the beginning of January 2015 till the end of October 2015.

All participants (300) were interviewed using predesigned questionnaire to assess the awareness among men about the causes of FGM, its consequences, and their beliefs. The questionnaire contained personal and sociodemographic data, questions about hearing of FGM, person who performs FGM, person who makes decision regarding FGM, age of practicing FGM and its causes, adverse effects of FGM, beliefs about uncircumcised women, men's role, supporting FGM, thinking that FGM is violation of human rights or that it has an effect on reproductive health, needing its continuation, wanting circumcised wives, and circumcision of daughters/future daughters.

The study was approved by the Ethical Committee of the Faculty of Medicine, Menoufia University. An official permission letter was obtained from the authorities. Informed consent was obtained from the local education authorities in Benha City as well as from all the participants after explaining the aim of the study.

Results were collected, tabulated, and statistically analyzed using an IBM personal computer and statistical package SPSS version 17 (SPSS Inc., Chicago, Illinois, USA). Qualitative data were represented as number and percentage. Quantitative data were represented as mean and SD.


  Results Top


The result of the present study showed that the age of the studied participants was 42.1 ± 10.1 years, with range of 20–60 years. Married men represented 96% of the studied group. Regarding occupation, 88.3% were teachers and 11.7% were workers. The illiterate/basic education participants accounted for 7.3% of the group, whereas those of secondary and high education were 35.7 and 57.0%, respectively. Men from urban area represented 76.7% of the sample [Table 1].
Table 1 Sociodemographic characteristics of studied group

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Approximately 72% of the participants stated that FGM was performed by a physician, and 56.4% stated the decision regarding FGM was made by fathers [Table 2].
Table 2 Distribution of participants regarding their awareness about person performing or making female genital mutilation decision

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All participants had heard about FGM, and 98.3% of men had the practice of FGM in their families, with the average age of practicing FGM being at 9.95 ± 1.35 years. The revealed causes showed that 56.0% were because of tradition and 27.0% to decrease female sexual desire. Adverse effects confined mainly to hemorrhagic shock (18.7%) and psychological problems (9.4%), with most stating no problem (57.3%) [Table 3].
Table 3 Distribution of participants regarding their awareness about different items related to circumcision's process

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A high percentage of studied participants (62.0%) held a belief that there was no problem regarding an uncircumcised female; men's role in prevention or continuation of FGM was mainly through participation in decision making (49.0%). Approximately two-thirds (66.7%) of the studied participants supported continuation of FGM. Moreover, 84.0% of the studied participants thought that there is no effect on reproductive health. Approximately76.0% of men did not think that FGM is a violation of human rights [Table 4].
Table 4 Participants' opinion and beliefs regarding female genital mutilation

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Moreover, two-thirds (66.3%) of the participants preferred a circumcised wife, 63.7% of the participants had circumcised their daughters, 75.6% intended to circumcise uncircumcised daughters, and 55.4% of those who had no daughters intended to circumcise their future daughters [Table 5].
Table 5 The practice of circumcision among men's families

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  Discussion Top


FGM/C is defined by the WHO as all procedures involving partial or total removal of the external female genitalia, or injury to the female genital organs, for nontherapeutic reasons [1]. Men have conflicting views and beliefs regarding FGM. Many men support the practice but others wish the practice to end but are unable to voice their concerns owing to social pressure and obligation within the community. In Guinea, Sierra Leone, more men than women want FGM to end [6].

The present study showed that 100% of the participants had heard about FGM. This was higher than that reported in Egypt Demographic and Health Survey (EDHS) [2], which stated that only 50% of men had heard about FGM. This may be because of increased awareness about FGM through media and health campaigns. The practice of FGM in participants' families was 98.3%; this result was higher than that reported by Kaplan et al. [9] who reported that the practice of FGM in families was 70.8%. The major revealed cause of FGM was tradition (56%); this was in agreement with a study conducted in Coted'lvoire by UNICEF [10] which reported tradition at 54.4% among causes of FGM. The mean age of practicing FGM was 9.95 ± 1.35 years; this is in agreement with a study by Naguib [11] in Qaluobia, who reported that the mean age of the practice was 9.5 years. Adverse effects confined to majorly to hemorrhage as stated by18.7% of participants; this disagrees with the finding by Kaplan et al. [9], who stated that bleeding as complication was reported to be 54.1%.

Regarding the person who makes decision regarding FGM, 56.4% of participants were of the opinion that it was the father; this is in agreement with Bjalkander [12], who reported that 30.75% of the respondents believed that the final decision was made by father. However, this result disagrees with that obtained by Kaplan et al. [9] who reported that only 8% of men made the final decision of FGM, and it appeared as a women's choice. This may be because the decision-making process is not a simple one-way process, and it is made by multiple involved actors including women, men, and relatives. Overall, 71.7% stated that FGM was performed by a physician, which indicates that there is a tendency toward medicalization of the practice (FGM carried out by health professional); this may be because of the lack of knowledge among medical staff and also out of the mistaken social belief that the practice is necessary. This result is in agreement with the study by Naguib [11] in Qaluobia, who reported that medicalization rate was 74.7%. Moreover, UNICEF [6] reported that 72% of FGM in Egypt were done by physicians. On the contrary, this result disagrees with that obtained by Bjalkander [12] in a study in Sierra Leone, which reported that only 13.2% of FGM were done by physicians.

Men's role in prevention or continuation of FGM was mainly through participation in decision making (49.0%); this is in agreement with Kaplan et al. [9] who reported that men had a role at 80.5%. Men who support the practice of FGM was 66.7% [Table 4]; this in the line with EDHS [2] which reported that men who support the practice was 57%.T his result disagreed with that reported by Sudan House Hold Survey [13] which stated that only 28% of the men in Sudan support the practice; this may be because of the practicing of the severe forms of FGM in Sudan which affect the sexual life as that reported by men. Men who thought that FGM affects reproductive health was 16% [Table 4]; this was less than that reported by Kaplan et al. [9] who stated that only 44.4% of men thought that it may cause difficulty during delivery. Moreover, 24% of men thought that FGM is a violation of human rights [Table 4]; this is in disagreement with Kaplan et al. [9] who reported that 95% of men thought it is a violation of human rights. This finding may be because of a lack of educational messages about human rights in Egypt.

Men who wanted their wives circumcised represented 66.3%; this result is in agreement with EDHS [2] which reported that 60% of men wanted their wives circumcised. This may be because of the wrong belief that circumcision preserves virginity and cleanliness of women. The present study showed that 75.6% of men intend to circumcise their daughters in the future, which in the line with Kaplan et al. [9] who reported that 60.7% of men intend to circumcise their daughters in the future. On the contrary, this result disagrees with Sudan House Hold Survey [13], which reported that only 27% of men intend to circumcise their daughters in the future.


  Conclusion Top


The main cause of practicing FGM is the tradition. Men influence the decision regarding FGM, as results revealed that more than half of fathers are final decision makers. This is an important result as it assures their role as positive actors if they become involved in prevention of FGM.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO, OHCHR, UNAIDS, UNFPA, et al. Eliminating female genital mutilation. An interagency statement; 2008. pp. 153–154. Availableat: http://whqlibdoc.who.int/publications/2008/9789241596442eng.pdf. [Last accessed on 2015 Jan 15].  Back to cited text no. 1
    
2.
El-Zanaty and Associates: Egypt demographic and health survey. 2008. Available at: http://www.dhsprogram.com. [Accessed June 2015].  Back to cited text no. 2
    
3.
Tag-Eldin MA, Gadallah MA, Al-Tayeb MN, Abdel-Aty M, Mansour M, Mona S. Prevalence ofFGCamong Egyptian girls. Bull World Health Organ 2007; 86:269–274.  Back to cited text no. 3
    
4.
International Planned Parenthood Federation (IPPF). Elimination of violence against women. Med Bull 2009; 43:1–4.2  Back to cited text no. 4
    
5.
Dare FO, Oboro VO, Fadiora SO Orji EO, Sule-Odu AO, Olabode TO. Female genital mutilation: an analysis of 522 cases in South-Western Nigeria. J Obstet Gynaecol 2004; 24:281−283.  Back to cited text no. 5
    
6.
UNICEF. Female genital mutilation/cutting July report: a statistical overview and exploration of the dynamics of changea; United Nations Children's Fund (UNICEF), July 2013. Available from: https://www.unicef.org/publications/index_69875.html. [Last accessed on 2015 Jun 15].  Back to cited text no. 6
    
7.
Abdelshahid A, Campbell C. Should I circumcise my daughter? Exploring diversity and ambivalence in Egyptian parents' social representations of female circumcision. J Community Appl Soc Psychol 2015; 25:49–65.  Back to cited text no. 7
    
8.
Gele AA, Sundby J. Have we made progress in Somalia after 30 years of interventions? Attitudes toward female circumcision among people in the Hargeisa district. BMC Res Notes 2013; 6:122.  Back to cited text no. 8
    
9.
Kaplan A, Cham B, Njie L, Seixas A, Blanco S, Utzet M. Female genital mutilation/cutting: the secret world of women as seen by men. Obstet Gynecol Int 2013; 2013:1–11.  Back to cited text no. 9
    
10.
UNICEF. Changing aharmfulsocial convention: female genital mutilation/cutting, Innocenti Digest. Florence: UNICEF; 2005. Available at: http://www.unicef-irc.org/publications/pdf/fgm_eng.pdf. [Last accessed 2015 May 05].  Back to cited text no. 10
    
11.
Naguib K. The effect of social interactions on female genital mutilation: evidence from Egypt. 2012. pp. 1–35. Available from: https://scholar.google.com/citations?user=QB8Gtv0AAAAJ&hl=en. [Last accessed 2015 Apr 07].  Back to cited text no. 11
    
12.
Bjälkander O, Grant DS, Berggren V, BathijaH, Almroth L. FGM in Sierra Leone. Obstetr Gynecol Int 2013; 2013:1–116.  Back to cited text no. 12
    
13.
UNFPA. Sudan House Hold Survey (SHHS) by UNFPA. A situational assessment of health sector role/interventions in FGM in Khartoum state, Sudan. UNFPA; 2011. p. 1–77.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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[Pubmed] | [DOI]



 

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