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Female Genital Cutting 13 FEMALE GENITAL CUTTING 13 Female genital cutting (FGC), also known as female circumcision or female genital mutilation (FGM) in Tanzania, is a common practice in many societies in the northern half of sub-Saharan Africa. Nearly universal in a few countries, it is practiced by various groups in at least 25 African countries, in Yemen, and in immigrant African populations in Europe and North America (Yoder et al., 2004). In a few societies, the procedure is routinely carried out when a girl is a few weeks or a few months old (e.g., Eritrea, Yemen), while in most others, it occurs later in childhood or adolescence. In the case of the latter, FGC is typically part of a ritual initiation into womanhood that includes a period of seclusion and education about the rights and duties of a wife. The Tanzanian Special Provision Act, a 1998 amendment to the penal code, specifically prohibits FGC. However, while the practice has been outlawed, it is still occurring in many areas. FGC is considered compulsory in some communities whereas in other communities, women may have options about being cut. The 2004-05 TDHS collected data on the practice of female circumcision from women age 15-49. The 1996 TDHS also collected data on female circumcision from women in the same age group. The 2003-04 Tanzania HIV/AIDS Indicator Survey (TACAIDS, NBS, and ORC Macro, 2005) included only one question on circumcision for male and female respondents: whether the respondent was circumcised. In this chapter, topics discussed include knowledge, prevalence, and type; age at circumcision; person who performed the circumcision; and attitudes towards the practice. The terms FGC and female circumcision are used interchangeably in this chapter. 13.1 KNOWLEDGE OF FEMALE GENITAL CUTTING Table 13.1 presents data on women’s and men’s knowledge of female circumcision. About three-quarters (74 percent) of Tanzanian women have heard of the practice. Although differences by marital status are minimal, there are noticeable variations in knowledge of female circumcision by residence, region, education, and ethnicity. About nine out of every ten women in urban areas have heard of female circumcision, compared with only two-thirds of women in rural areas (91 and 67 per- cent, respectively). Knowledge of female circumcision among women is higher in Zanzibar than in the Mainland (86 and 73 percent, respectively). Almost all women in the Northern, Central, and Eastern zones have heard of the practice, compared with between half and two-thirds in other zones. The variations by zone and residence are a reflection of ethnic differentials and advocacy campaigns. In the Northern zone, where the Maasai and Chagga tribes are located, and in the Central zone, where the Gogo and Nyaturu tribes are the primary residents, women have greater knowledge of female circumcision than ethnic groups in the Southern zone. The Eastern zone, which includes the city of Dar es Salaam, has higher awareness compared with the Southern Highlands, Lake, and Western zones because the Eastern zone is more urban and is where most advocacy groups at the national level are based. With regard to education differentials, the table reveals that awareness of the practice is highest (97 percent) among women with at least some secondary education, and gradually decreases with level of education to 58 percent among women with no education. Differentials by wealth quintile are very similar to the differentials by education. The percentage of women who are aware of female circumcision ranges from 95 percent for the highest quintile to 59 percent for the lowest quintile. By religion, knowledge of FGC is highest among Muslims (85 percent) and lowest among those who report that they have no religion (48 percent). Female Genital Cutting | 247 Table 13.1 Knowledge of female circumcision Percentage of women and men who have heard of female circumcision by background characteristics, Tanzania 2004-05 Percentage of Percentage of women who men who have heard have heard Background of female Number of of female Number of characteristic circumcision women circumcision men Age 15-19 64.4 2,245 64.9 637 20-24 73.8 2,007 82.6 493 25-29 78.8 1,885 90.9 405 30-34 78.1 1,542 90.8 387 35-39 77.6 1,053 91.0 278 40-44 75.6 834 89.7 265 45-49 69.4 763 91.4 170 Marital status Never married 72.1 2,371 74.0 1,100 Married or living together 73.9 6,950 89.6 1,401 Divorced, separated, or widowed 74.4 1,007 88.0 135 Residence Urban 91.1 2,935 94.5 716 Rural 66.6 7,394 78.7 1,919 Mainland/Zanzibar Mainland 73.1 10,016 82.8 2,556 Total urban 91.0 2,885 93.4 716 Dar es Salaam city 97.4 969 94.3 267 Other urban 87.8 1,916 92.8 450 Total rural 65.9 7,131 78.7 1,840 Zanzibar 86.1 313 89.0 79 Unguja 93.3 216 93.2 53 Pemba 70.0 97 80.3 26 Zone Western 50.7 1,880 59.8 468 Northern 98.3 1,496 85.7 362 Central 93.1 799 94.3 212 Southern highlands 55.3 1,440 81.0 358 Lake 63.9 1,865 89.5 448 Eastern 95.4 1,670 93.0 462 Southern 66.6 866 83.5 245 Region Dodoma 96.0 468 92.8 113 Arusha 98.6 391 94.9 82 Kilimanjaro 98.5 380 79.0 104 Tanga 96.9 431 78.7 94 Morogoro 93.0 449 91.9 127 Pwani 92.0 253 90.0 68 Dar es Salaam 97.4 969 94.3 267 Lindi 78.5 221 86.3 65 Mtwara 67.2 346 88.1 98 Ruvuma 57.0 299 76.0 83 Iringa 80.2 412 69.3 102 Mbeya 53.0 712 91.2 170 Singida 89.1 331 96.1 99 Tabora 51.3 520 55.3 127 Rukwa 28.2 316 75.1 87 Kigoma 39.6 499 55.7 127 Shinyanga 56.8 861 64.8 215 Kagera 32.0 545 90.1 122 Mwanza 68.2 939 85.8 229 Mara 98.9 381 97.3 98 Manyara 99.5 293 92.9 83 Zanzibar North 88.3 48 87.4 11 Zanzibar South 93.3 26 85.0 6 Town West 95.0 143 96.4 36 Pemba North 67.7 52 87.8 13 Pemba South 72.5 45 72.2 12 Education No education 57.7 2,503 71.4 312 Primary incomplete 68.7 1,855 70.0 646 Primary complete 79.1 5,086 88.4 1,381 Secondary+ 96.6 885 98.2 296 Continued... 248 | Female Genital Cutting Table 13.1—Continued Percentage of Percentage of women who men who have heard have heard Background of female Number of of female Number of characteristic circumcision women circumcision men Religion Muslim 85.0 3,095 86.9 798 Catholic 72.1 2,944 83.2 755 Protestant 74.2 3,000 87.0 739 None 47.5 1,284 64.7 342 Wealth quintile Lowest 59.0 1,840 71.2 484 Second 62.9 1,944 78.4 504 Middle 65.1 1,943 80.3 516 Fourth 77.8 2,004 87.5 517 Highest 94.7 2,597 94.5 615 Total 73.5 10,329 83.0 2,635 Note: Total includes 3 women and 1 man with “other” religion. Table 13.1 indicates that knowledge of female circumcision is higher among men than women. More than four-fifths of men know about the practice. The differentials by background characteristics for men generally follow the same pattern as noted above for women. Among zones, men in the Western zone are least likely to have heard of female circumcision (60 percent). Knowledge of FGC is higher in urban areas than rural areas, and awareness increases with men’s educational level and wealth quintile. However, the differentials for men are generally not as pronounced as for women. 13.2 PREVALENCE OF FEMALE GENITAL CUTTING Table 13.2 shows the prevalence of female circumcision by background characteristics. The prevalence of FGC in the country seems to have dropped slightly from 18 percent reported in the 1996 TDHS and the 2003-04 THIS to 15 percent in the 2004-05 TDHS, although the difference is not statistically significant. It is clear that prevalence level and level of knowledge of circumcision are not always related. For example, knowledge is higher among urban women and men but prevalence of FGC is more than double in rural areas than in urban areas. The proportion of women who were circumcised at the time of the survey was the highest in the Northern and Central zones (Manyara, Dodoma, Arusha, and Singida regions). The high prevalence of female circumcision in Manyara (81 percent) and Dodoma (68 percent) is largely explained by ethnic differentials in the practice. Women age 15-19 are less likely to report being circumcised than their older cohorts (Fig- ure 13.1). It is difficult to know the real reason for a lower percentage of younger women circumcised. The differences by age may be the result of a real decline in the practice or may be underreporting of the practice because it is now prohibited by law. Although Arusha region shows a sharp decline in FGC prevalence (81 percent in 1996 compared with 55 percent in 2004-05), the data should be interpreted with caution.
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