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Prevalence of Female Genital Cutting Among Egyptian Girls

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Prevalence of Female Genital Cutting Among Egyptian Girls Prevalence of female genital cutting among Egyptian girls Mohammed A Tag-Eldin,a Mohsen A Gadallah,a Mahmoud N Al-Tayeb,a Mostafa Abdel-Aty,b Esmat Mansour c & Mona Sallem a Objective Female genital cutting (FGC) is the collective name given to traditional practices that involve partial or total cutting away of the female external genitalia whether for cultural or other non-therapeutic reasons. In Egypt, the result of the Demographic Health Survey in 2000 revealed that 97% of married women included in the survey experienced FGC. The aim of this study is to measure the prevalence of FGC among schoolgirls in Egypt. Methods Multistage random technique was applied for site selection. First, Egypt was divided into five geographical areas; Greater Cairo, Lower Egypt, Upper Egypt, Sinai and Suez Canal Region. Second, from each governorate, two educational districts were selected randomly (except Luxor). In each of the selected districts, the schools were divided into primary, preparatory and secondary schools. In each education stage, the schools were divided into rural, urban, government and private. The total number of females interviewed was 38 816. Findings The prevalence of FGC among schoolgirls in Egypt was 50.3%. The prevalence of FGC was 46.2% in government urban schools, 9.2% in private urban schools and 61.7% in rural schools. Educational levels of mother and father were negatively associated with FGC (P < 0.001). The mean age of the time of FGC was 10.1 ± 2.3 years. Conclusion FGC prevalence is lowering, yet more active education at the grass-roots level is needed to create change. Bulletin of the World Health Organization 2008;86:269–274. الرتجمة العربية لهذه الخالصة يف نهاية النص الكامل لهذه املقالة. .Une traduction en français de ce résumé figure à la fin de l’article. Al final del artículo se facilita una traducción al español Introduction Practices involving cutting of fe- Rational male genitals have been found through- Female genital cutting (FGC) is the out history in many cultures, but there The majority of existing research into collective name given to traditional is no definitive evidence documenting FGC concentrated on women of repro- practices that involve partial or total when or why this ritual began. Some ductive age. Girls exposed to FGC had cutting away of the female external geni- theories suggest that FGC might have not been studied before on a national talia whether for cultural or other non- level. Thus, the Ministry of Health and been practised in ancient Egypt as a sign therapeutic reasons.1 It is estimated that Population realized the importance of of distinction, while others hypothesize between 100 and 130 million girls and conducting this prevalence study. its origin in ancient Greece, Rome, Pre- women now alive in at least 28 African Islamic Arabia and the Tsarist Russian countries and the Middle East have Objectives been subjected to FGC.2 Federation. FGC represents a fundamental vio- In Egypt, the Demographic Our objectives were to measure the lation of women’s and girls’ rights. Eigh- Health Survey in 2000 revealed that prevalence of FGC among schoolgirls teen African countries have prevalence 97% of married women surveyed in Egypt, identify who performs FGC, 3 rates of 50% or higher. FGC has tradi- experienced FGC. Another study, and document the rate of reported com- tionally been called female circumci- carried out by the Egyptian Ministry plications. sion. Recognition of its harmful physi- of Health and Population in 2003, re- cal, psychological and human rights ported that 94.6% of married women Places of study consequences has led to the use of the had been exposed to FGC and 69.1% term “female genital mutilation” or of those women agreed to carry out Multistage random technique was ap- FGM. Many women who have under- FGC on their daughters. A pilot study plied for site selection as follows: gone FGC do not consider themselves by the Health Insurance Organization to be mutilated and have become of- showed that 41% of female students First stage fended by the term “FGM”. Recently, in primary, preparatory and second- Egypt was divided into five geographi- other terms such as “female genital cut- ary schools had been exposed to cal areas, from which nine governorates ting” have increasingly been used. FGC. were randomly selected (Table 1): a Faculty of Medicine, Ain Shams University, Abbassia 11566, Cairo, Egypt. b Health Insurance Organization, Cairo, Egypt. c Ministry of Health and Population, Cairo, Egypt. Correspondence to Mohsen A Gadallah (e-mail: [email protected]). doi:10.2471/BLT.07.042093 (Submitted: 16 March 2007 – Revised version received: 16 June 2007 – Accepted: 10 July 2007 – Published online: 30 January 2008 ) Bulletin of the World Health Organization | April 2008, 86 (4) 269 Research Female genital cutting among Egyptian girls Mohammed A Tag-Eldin et al. 1. Greater Cairo (Cairo) Table 1. The prevalence of FGC among female students in selected governorates in 2. Lower Egypt (Sharkia, Demiatta, Egypt Dakahlyia and Alexandria) 3. Upper Egypt (Bani Suif, Assuit and Governorates Total no. of females Females with FGC Luxor city) interviewed 4. Sinai (North Sinai) No. Percentage 5. Suez Canal Region (Port Said) Cairo 7 696 2 811 36.5 Alexandria 4 597 1 800 39.2 Although it is a small city, Luxor is Sharkia 4 487 3 314 73.9 considered as a governorate due to its Dakahlyia 4 240 2 111 49.8 cultural and historic importance. It has Demiatta 3 415 735 21.5 only one health district which was in- Port Said 1 989 356 17.9 cluded in our study. Bani Suif 4 135 3 024 73.1 Assuit 4 508 3 389 75.5 Second stage Luxor city 1 761 1 506 85.5 From each governorate, two educational North Sinai 1 988 503 25.3 districts were selected randomly. In each of the selected districts, the schools Total 38 816 19 543 50.3 were divided into primary, preparatory FGC, female genital cutting. and secondary schools. In each educa- tion stage, the schools were divided into rural, urban, government and private before its use. The questionnaire in- Discussion (Table 2). cluded data pertaining to age, place of residence in the last 5–10 years, educa- FGC has remained a common practice in the countries where it has tradi- Third stage tional level of girl, her mother and father, 4 age at time of FGC, reasons given to tionally been performed. The most Representative schools were selected common forms of FGC still widely randomly. support and reject the practice, who per- formed the FGC, consequences of FGC, practised throughout Egypt are type and the decision-maker. Interviews of I (commonly referred to as clitoridec- Sample size the female students were conducted by tomy) and type II (commonly referred to as excision).5 In Africa, the most The assumption in calculating the female physicians working in the school common type of FGC is type II (exci- sample size in each governorate depends sector of the National Health Insurance sion of the clitoris and the labia minor) on a decrease by 5% in the current Organization. which accounts for up to 80% of all prevalence of FGC. Using a level of cases.6 It is of note that there is no doc- significance at 0.05 and the power of the Statistical analysis trinal basis for this practice in either test of 80%, the sample size (with the the Islamic or Christian faiths. calculated sample size in parentheses) Data entry and coding was performed In recent years, the laws regard- in each selected governorate and Luxor using Microsoft Excel 2000. First, sim- ing FGC have changed. In 1995, a city was as follows: ple frequency, mean, standard deviation and range were calculated. Thereafter, ministerial decree forbade the practice Cairo = 7696 (6900) comparisons were made using Pearson’s and made it punishable by fine and Alexandria = 4597 (4200) χ² test for categorical variables. All imprisonment. A series of later min- Sharkia = 4487 (4200) statistical analyses were performed us- isterial decrees allowed certain forms Dakahlyia = 4240 (4200) ing the Statistical Package for Social but prohibited others. Doctors were Demiatta = 3415 (4200) Science (SPSS) version 11.0 (SPSS Inc. prohibited from performing the pro- Port Said = 1989 (2200) Headquarters, Chicago, Illinois, United cedure in government health facilities Bani Suif = 4135 (4000) States of America). Level of significance and non-medical practitioners were Assuit = 4508 (4200) was set at P £ 0.05. forbidden from practising any form. In Luxor city = 1761 (1600) 1996, a ministerial decree prohibited all North Sinai = 1988 (1800) Results medical and non-medical practitioners from performing FGC in either public The total sample size was 38 816 girls. The total number of females inter- or private facilities, except for medi- viewed was 38 816. The prevalence of cal reasons certificated by the head of Time of field study was from March to FGC among schoolgirls was 50.3%. a hospital’s obstetric and gynaecology May 2005. The prevalence of FGC was 46.2% in department. Perpetrators can lose their government urban schools, 9.2% in pri- medical license and be subjected to 7 Method vate urban schools and 61.7% in rural criminal punishment. schools. Educational levels of mother Most of the girls and women who A cross-sectional study was conducted and father were negatively associated have undergone FGC live in 28 African in all selected governorates. An inter- with FGC (P < 0.001). The mean age countries, although some live in Asia view questionnaire with 20 questions of the time of FGC was 10.1 ± 2.3 and the Middle East.
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