INTRODUCTION

The term Female Genital Mutilation (FGM) describes procedures of total or partial removal of external female genitalia or other intentional injury to the female genital organs for non-medical reasons (Fried et al., 2013). FGM is a practice which is thought to have existed for thousands of years. It is most commonly practiced in countries in sub Saharan Africa, in the Sahel region, in the horn of Africa and Egypt, but it is also found amongst women and families migrating to European countries and the United States of America (USA) from these locations. Globally it is estimated that between 100-140 million women are thought to have undergone FGM and 3 million girls annually are thought to be at risk (Karmaker et al, 2011).

In 2010, the European Parliament estimated that up to half a million women living in Europe had been subjected to FGM, with a further 180,000 at risk. According to United Nations High Commission for Refugees (UNHCR), nearly 20,000 women from FGM/C practicing countries applied for asylum to the European Union (EU) including, France, Italy , Sweden, United Kingdom of Great Britain, Belgium, Germany, Netherlands , Finland, Greece, Ireland, Spain and Malta in 2011with an estimated 8,809 female applicants aged 14-64 years likely to be affected by FGM. In addition to those coming to the European countries who have already been subjected to FGM, there is anecdotal evidence supported by criminal prosecutions, particularly in France and Sweden, that suggests that FGM is conducted in the European countries. This has led to the implementation of FGM elimination campaigns in the European countries (Brown, Beecham, & Barrett, 2013).

FGM is also common in countries like Iraq, Kurdistan, Malaysia, Indonesia, Europe, USA and Australia among many other countries where migrants carry along their culture (Kaplan, 2013).

In Africa, FGM is most prevalent in 27 countries whereby 67.7 million girls and women aged 15-49 years are affected. This number rises to 85.9 million in women aged 50 and older who have undergone FGM in 27 African countries (Bjalkander et al., 2013).

Nigeria has the highest prevalence of 97% of FGM in the world. Nigeria is characterized by decades of civil war that propelled approximately 25% of its people to migrate to Western countries such as Norway, (Gele, Bo, & Sundby, 2013a). Data on prevalence of FGM in Nigeria is scarce but WHO estimated it to be approximately 98% in 2006. About 90% of these cases had undergone infibulation (Fried et al., 2013). Nigeria has the highest global prevalence (98%) of FGM and despite a long history of abandonment efforts, it is not clear whether or not these programs have changed people’s attitudes toward the practice (Gele, Bo, & Sundby, 2013b).

There are a growing number of studies which demonstrate a significant association between FGM and various gynecological and pregnancy complications. World Health Organization (WHO) reports (2000) concluded that FGM has negative implications for women’s health, with women who have undergone FGM more likely than others to have adverse obstetric outcomes. FGM has no health benefits and harms girls and women both physically and mentally. These impacts occur at the time of the procedure as well as adulthood, particularly motherhood. All forms of FGM have psychological effects, particularly related to female sexuality and sexual relationships. The UN regards FGM as a violation of female reproductive rights (United Nations Population Fund [UNFPA], 2007), and thus the ending of FGM is of relevance to all health professionals. Understanding the issues associated with preventing FGM is particularly relevant to health professionals who work with FGM affected and at risk women and girls. This is because they are in a position to communicate directly with affected community members and may also be linked with organizations which engage in prevention as well as obstetric and gynecological treatment of FGM complications. Some of the popular interventions that have been employed are; health risk information, conversion of exercisers, training of health professionals as change agents, alternative rites programs, and community led approaches, public statements and legal measures (Ahmadu, 2007).

FGM is associated with a series of health risks and consequences. According to Yasin et al. (2013) immediate consequences are pain and bleeding; difficulty in passing urine; infections including the Human Immunodeficiency Virus (HIV); death caused by hemorrhage or infections; unintended labia fusion; and psychological consequences. Long term health risks include chronic pain, keloid formation, reproductive tract and sexually transmitted infections, poor quality of sexual life, birth complications and psychological consequences. Type three FGM bears additional complications like need for later surgery, urinary and menstrual problems, painful sexual intercourse and infertility (Yasin et al., 2013).

Several studies have demonstrated a significant association between FGM and various gynecological and pregnancy complications. Yet, women, who bear these consequences, continue with the FGM practice. According to WHO reports, there is evidence that FGM has negative implications for women’s health, with women who have undergone FGM more likely than others to have adverse obstetric outcomes (WHO, 2012). The impacts of FGM occur at the time of the procedure and at adulthood, particularly motherhood ((Brown, Beecham, & Barrett, 2013). All forms of FGM have psychological effects, particularly related to female sexuality and sexual relationships.

In a study by Gele, Bo, & Sundby (2013a) which involved 215 randomly selected persons, both men and women carried out from July to September 2011, in Nigeria, revealed that 97% of the study’s participants were circumcised with no age differences and that of this 81% were subjected to Type 3, while 16% were subjected to Type 1 and 2 and only 3% were left uncircumcised. Approximately 85% of the women had intention to circumcise their daughters, with 13% planning the most radical form of FGM. In conclusion the researchers showed that the persistence of the practice was profoundly high in Nigeria.

The Nigeria’s Provisional Constitution defines FGM as “torture” in Article 15 (4) – “Circumcision of girls is a cruel and degrading customary practice, and is tantamount to torture. The circumcision of girls is prohibited.” However, there is no specific law against female circumcision, and the practice remains widespread in both rural and urban areas in this Horn of Africa nation (Abdirahman, 2015). Moreover, after nearly four decades of campaigning against FGM, there is still a rather slow decline in prevalence of FGM which raises questions about the effectiveness of interventions to eliminate the practice. Some of the popular interventions that have been employed include; health risk information; conversion of exercisers; training of health professionals as change agents; alternative rites programs; community led approaches; public statements; and legal measures. Evidence on the effectiveness of these interventions is insufficient, particularly whether they have led to an actual decline in the incidence or prevalence of FGM. This study sought to find out the prevailing women’s knowledge and attitude towards FGM in Delta State.

Despite the fact that people are aware of the health risks and human rights violations associated with FGM, they still support the continuation of the practice. This shows that the over 30 years of campaigns have limited progress in eradication of the practice. This study aimed at assessing FGM practice and its effects on women’s’ reproductive health in Delta State, Nigeria.

1. What are the socio demographic characteristics that influence FGM in Delta State, Nigeria?
2. What is the knowledge and attitude of the women’s health in Delta State, Nigeria on the risks associated with FGM

• What are the effects of socio cultural and religious beliefs on the health programs targeting the elimination of FGM in Delta State, Nigeria?

1. What are the health complications that women experienced when they have undergone FGM in Delta State, Nigeria?

1. FGM practice has no effect on the women’s health.
2. Women’s knowledge and attitude towards FGM has no association with the practice of FGM.

• Socio demographic characteristics among women have no influence on

1. Socio cultural and religious beliefs have no effect on the health programs targeting the elimination of

General objective

The main objective of the study was to assess FGM practice and its effects on women’s health in Delta State, Nigeria.

Specific Objectives

1. To determine the socio-demographic characteristics that influence FGM practice in Delta State, Nigeria
2. To establish women’s knowledge and attitudes on FGM risks and eradication programs in Delta State,

• To determine the effects of socio cultural and religious beliefs on FGM eradication programs in Delta State,

1. To determine the reproductive health complications associated with FGM and how they are managed in Delta State,

This study contributed to the existing information/ literature about the effects of FGM on women in Delta State, Mogadishu. This study was significant for it provided more information on FGM hence, contributing to knowledge on attitudes and effects of FGM.

Furthermore, this assisted the stakeholders including internal partners (Local NGOs), donors, Nigeria Government, UN agencies, humanitarian aid workers and Somali community to know the existing socio cultural and religious beliefs and their effects on the health programs targeting the eradication of FGM.

This study was significant to a number of sectors. The findings of the study helped policy makers and legislators to develop a comprehensive health policy targeting elimination of FGM due to its health consequences which the victims undergo.

The findings of the study was also be beneficial to the Nigeria Government in promoting anti-FGM campaigns among the Nigeria community based on the health matters associated with FGM which reduces productivity of the women as well as the community. The findings of the study also helped other scholars understand the dynamics of FGM in Nigeria and possibly they may be interested to carry out other studies in other regions of Nigeria or any other country or community.

The security situation was of a concern during data collection however there were insecurity incidences witnessed.

The scope of the study was limited by finances and time and also detailed data collection was limited by sensitivity of some research questions.

Attitude: is an expression of favor or disfavor toward a person, place, thing, or event.

Clitoris: A small mass of erectile tissue in the female that is situated at the anterior apex of the vulva, near the meeting of the labia majora (vulva lips).The clitoris is the human female’s most sensitive erogenous zone.

Culture: Culture is the sum of the learned behavior of a group of people that are generally considered to be the tradition of that people and are transmitted from generation to generation.

FGM: Female Genital Mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.

Knowledge: is a familiarity, awareness or understanding of someone or something, such as facts, information, descriptions, skills, which is acquired through experience or education by perceiving, discovering, or learning.

Tradition: is a belief or practice passed down within a group or society with symbolic meaning or special significance with origins in the past

Type 1 (Sunna): is the removal of the clitoral prepuce, with or without excision of part or the entire clitoris.

Type 2 (Sunna kabir): is where the prepuce, clitoris and all or part of the labia minora is removed.

Type 3 (Infibulation or Pharaonic): involves the excision of part or all the external genitalia and then, through infibulations, stitching the vulva closed, leaving only a small opening for urination and menstruation. The most severe form and often repeated after each childbirth

Type 4: includes unclassified procedures such as cauterization of the clitoris, cutting of the vagina and the introduction of corrosive substances or herbs into the vagina for the purpose of tightening or narrowing it.

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