IMPACT OF COMMUNITY BASED EDUCATION ON FGM IN A RURAL ETHIOPIANCOMMUNITY 131st Annual Meeting and...

131st APHA Annual Meeting and Exposition

IMPACT OF COMMUNITY BASED EDUCATION ON FGM IN A RURAL

ETHIOPIANCOMMUNITY

131st Annual Meeting and Exposition of the American Public Health Association

San Francisco, CANovember 17, 2003

Gabremaskal Habtemariam Ph.D.

Senait Tibebu M.Sc.

Yeshewamebrat Ejigsemahu M.Sc.

PATHFINDER INTERNATIONAL


Female Genital Mutilation (FGM)DEFINITION: “All procedures involving partial or total removal of the female external genitalia or other injury to female genital organs whether for cultural or other non-therapeutic reasons.” - WHO

TYPES:Type I: Excision or removal of the clitoral hood with or without excision of part or the entire clitoris.Type II: Excision or removal of the clitoris together with partial or total excision of the labia minora.Type III: Infibulation or removal of part or all of the external genitalia and stitching/narrowing of the vaginal opening, leaving a small hole for urine and menstrual flow.


Historical Origin of FGM It was recorded as early as the fifth century BC and

practiced in Egypt for at least 2000 years. Slave traders sold infibulated women for higher prices,

as their services were not interrupted by child bearing. In Ethiopia, female circumcision is believed to precede

the introduction of Christianity in the 4th century. It is a cross-cultural and cross religious practice. It is known by different names, including female

circumcision, female genital cutting, and female genital mutilation.

In the Oromo Culture, where this assessment was undertaken, girls are circumcised just before marriage. Other ethnic groups in the area practice female child circumcision.


Relevance of FGM to Reproductive HealthIMMEDIATE EFFECTS: Pain, shock, bleeding, urine retention,

infection, and injury to neighboring organs

LONG TERM EFFECTS: Labial fusion, scarring, keloid formation, cyst

formation, PID, HIV/AIDS, Dysmenorrhea, and Dyspareunia

OBSTETRIC: Delayed labor and perenial laceration

PSYCHOSOCIAL: Decreased sexual enjoyment


Interventions to Mitigate Female Circumcision

IEC by community-based RH agents (CBRHAs)Education by women promotersSupport by local administrationSupport by the “Geda” systemSupport by Project Advisory Committee (PACs)

“Geda” is a system of social regulation and culture among the Oromo ethnic group.


A Survey was Undertaken to Determine the Effects of Community-Based Educational on FGM The Survey Included:

– Interview of parents whose daughters married in the past six years before the survey

– Qualitative assessment with different groups including:• Men’s group• Women’s group• Uncircumcised women’s group• CBRHA’s group• Project Advisory Committee Members• Case studies


Educational Activities Against FGM Undertaken in

the Community

Mothers

(%)

Fathers

(%)

Parents reporting that they had information on FGM.

69.6 74.0

Major Sources of Information on FGM?

CBRHAsHealth WorkersMediaCommunity Animators

63.022.2 8.0

6.8

60.221.1 8.110.6


Other Reasons Mothers and Fathers Gave for Practicing FGM

Mothers %

Fathers %

Respect for tradition 73.4 80.8

Avoid shame and stigmatization

14.7 10.6

Religious commitment 8.4 5.8

Better hygiene 1.4 0.0

Community pressure 1.2 1.9

Suppress woman’s sexuality

0.6 1.0


% with Knowledge of Other Major Harmful Traditional Practices Discussed at the

Community Level

TOPICS Mothers Fathers

Marriage by Abduction

41.1 49.0

Early Marriage 40.2 48.1

Uvulectomy 27.8 34.6

Milk Teeth Extraction 21.9 29.8

Applying Cow Dung on New Born Umbilical Cord

10.1 14.4


Other Reasons Mothers and Fathers Gave for Not Practicing FGM

Mothers %

Fathers %

Not required by tradition

53.1 47.2

It is harmful 23.9 25.0

Advised not to practice it

22.1 26.4

Community pressure

0.9 1.4


Mothers and Fathers Attitudes Towards FGM

Mothers (%)

Fathers (%)

Is FGM harmful? YesNoDo not know

70.4 2.427.2

83.3 1.015.7

Should FGM be stopped? YesNo

Do not know

Undecided

68.64.7

13.613.0

82.54.92.99.7


Mothers and Fathers Attitudes Towards FGM (continued)

Mothers (%)

Fathers (%)

Will your unmarried daughter be circumcised?

Yes No

Do not know Undecided

22.755.8 6.514.9

21.457.311.7 9.7


Harmful Effects of FGM Identified by Respondents

Mothers (%)

Fathers (%)

BleedingDifficulties During DeliveryPainInfectionDecreased Sexual SatisfactionHIV/AIDS TransmissionMarriage ProblemDeath

61.555.617.211.811.8 6.5 4.7 1.8

76.963.523.111.713.513.510.6 8.7


Focus Group Findings There was a case of one circumciser who had her

first daughter circumcised, but decided not to have her second daughter after receiving education. She is now educating against the practice of FGM.

Some of the uncircumcised girls said that they would now refuse to let their parents have them circumcised.

Educating on the negative health impacts tends to work better than other approaches (including regulations)s

Young unmarried men have said that they would not want their wives to be circumcised.

The community has promised the “Geda” elders that they would stop FGC.


Trends in Female Circumcision in Shashamene Area of Oromia

Region, Ethiopia-2003

0

10

20

30

40

1998 1999 2000 2001 2002 2003Year of Marriage

% Uncircumcised


Conclusion The trend shows a decrease in the proportion of girls

circumcised during the three years before the survey, which coincides with the starting of a community based reproductive health project in the area.

WHAT CAUSED THE REDUCTION OF FGM? Education by CBRHAs appears to have initiated other

actions by the community. Formal and informal support from community leaders. Opposition by authoritative “Geda” leaders reinforced

educational initiatives. Winning over circumcisers. Some parents have

refused to allow their daughters to be circumcised.


Recommendations Education on the effects of FGM and other

harmful traditional practices requires an understanding of local customs and traditions.

Collaboration among all community level actors.

Using health risk approach to fight FGC.

Raising awareness and gaining the support of young male and female stakeholders.

Involving and winning over local circumcisers is an effective way.


For more information, please contact:

Pathfinder International HeadquartersNine Galen Street, Suite 217Watertown, MA 02472 USA

Phone: (617) 924-7200Fax: (617) 924-3833

Web: http://www.pathfind.org

or

Pathfinder/EthiopiaBole Sub-City, Kebele 02

House No. 2446Phone: (2511) 613330

Fax: (2511) 614209Email: [email protected]

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