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Female Genital Mutilation/Cutting and the Occurrences of Birth Complications Among Women of Reproductive Age in Gewane Woreda, Afar Regional State, Ethiopia

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Female Genital Mutilation/Cutting and the Occurrences of Birth Complications Among Women of Reproductive Age in Gewane Woreda, Afar Regional State, Ethiopia Cancer Research Journal 2018; 6(1): 1-9 http://www.sciencepublishinggroup.com/j/crj doi: 10.11648/j.crj.20180601.11 ISSN: 2330-8192 (Print); ISSN: 2330-8214 (Online) Female Genital Mutilation/Cutting and the Occurrences of Birth Complications Among Women of Reproductive Age in Gewane Woreda, Afar Regional State, Ethiopia Bayush Gizachew Chuluko 1, Sileshi Garoma Abeya 2, * 1Department of Public Health, Adama General Hospital and Medical College, Adama, Ethiopia 2Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia Email address: [email protected] (B. G. Chuluko), [email protected] (S. G. Abeya), [email protected] (S. G. Abeya) *Corresponding author To cite this article: Bayush Gizachew Chuluko, Sileshi Garoma Abeya. Female Genital Mutilation/Cutting and the Occurrences of Birth Complications Among Women of Reproductive Age in Gewane Woreda, Afar Regional State, Ethiopia. Cancer Research Journal . Vol. 6, No. 1, 2018, pp. 1-9. doi: 10.11648/j.crj.20180601.11 Received : November 9, 2017; Accepted : November 16, 2017; Published : January 5, 2018 Abstract: Female genital mutilation/cutting (FGM/C), one of the most deeply rooted, harmful traditional practices, is still highly prevalent in many African countries, including Ethiopia. The reproductive health complications of FGM/C include acute hemorrhage, painful sexual life, the inability-to-conceive, fistula, and death secondary to birth complications. This study was aimed to assess the magnitude, associated factors and birth outcomes of FGM/C among women of reproductive age groups (15-49 years) in Gewane, Woreda from July 4 to 17, 2016. A population-based, cross-sectional survey was conducted using quantitative data collection methods. A sample of 792 women who ever gave birth was selected using systematic random methods. Data was collected using pretested questionnaire and analyzed using SPSS Version 21. Chi-square and logistic regression models were used to analyze and find the associations between the study variables. The prevalence of FGM/C among childbearing women was 90.8%. Infibulations (WHO Type III) was the predominantly (86.1%) practiced type of FGM/C. Higher age (AOR, 11.56; 95% CI: 2.56, 48.39), Afar Ethnic group (AOR, 4.55; 95% CI: 1.95-10.61), literate (AOR, 0.35; 95% CI: 0.15, 0.81) were factors significantly associated with FGM/C. A statistically significant association (P< 0.05) was found between FGM/C and perineal lacerations, episiotomy, postpartum complications, postpartum hemorrhage, wound infection, and stillbirth. FGM/C was highly prevalent in the study area. Infibulation, WHO Type III was the most severe form of FGM/C widely practiced. Age, ethnicity and literacy were associated with FGM/C. Women with Type III FGM/C was at higher risk of having birth and postpartum complications. Education, culturally sound community awareness raising programs, and enforcing legislation are recommended to reduce the adverse outcomes associated with FGM/C. Keywords: Afar Region, Ethiopia, Female Genital Mutilation/Cutting but some reports indicate that local or general anesthetic 1. Background drugs were used in countries where health professionals are Female Genital Mutilation/Cutting (FGM/C), also known involved, such as Egypt and Indonesia in which 77% and as female circumcision is a deeply rooted traditional practice, 50% respectively of FGM/C procedures were performed by in which the external female genitalia is either partially or medical professionals as of 2008 and 2016 [3, 4]. totally removed [1]. FGM/C/ is commonly carried out by Even if the exact date and reason for the start of the practice traditional circumcisers using a blade in girls from a few days is not well known, various reasons such as socio-cultural, after birth to puberty or beyond, but usually before the first psychosexual, hygienic, aesthetic and religious, are given for birth [2]. In more than 50% of the countries for which maintaining FGM/C were mentioned by those who practice it national figures are available, most girls were cut before the [1]. The procedure differs depending on the country or ethnic age of five [2, 3]. FGM/C is usually done without anesthesia, group and it can involve the removal of the clitoral hood and 2 Bayush Gizachew Chuluko and Sileshi Garoma Abeya: Female Genital Mutilation/Cutting and the Occurrences of Birth Complications Among Women of Reproductive Age in Gewane Woreda, Afar Regional State, Ethiopia glans removal of the inner labia; and removal of both inner and FGM/C, are occurring after puberty [7, 8]. The same report outer labia and closure of the vulva by leaving a small opening revealed the highest proportion of FGM/C in several regions for urine and menstrual flow and later on opening the vagina of the country [8]. The Afar National, Regional State for intercourse and childbirth [5]. (ANRS) of Ethiopia is one of the regions that practice the FGM/C is often associated with recurrent infections, most severe forms of FGM/C is highly prevalent [4]. difficulty in urinating and passing menstrual flow, chronic Reports have demonstrated the increased risk of pain, development of cysts, painful intercourse, inability to occurrence of birth complications among women with conceive, complications during childbirth and fatal bleeding FGM/C [9-14]. A study in Jigjiga town of the Somali region depending on the type of the procedure done. There are no in Ethiopia showed an increased risk of postpartum known health benefits [6]. According to the WHO, there are haemorrhage, and stillbirth in mutilated women [10]. more than 40 million women with FGM/C globally, with 92 However, no similar studies were found from the ANRS million in Africa. The same report indicates around 3 million despite the high prevalence of FGM/C. This study was girls are at risk of FGM/C in Africa every year [1]. Despite conducted to demonstrate the type of FGM/C and its its harmful effects, violation of reproductive rights of girls association with birth complications among women who ever and women and the various efforts to tackle it, the practice is gave birth in the study area. still prevalent in 27 countries in Africa, Indonesia, Iraqi Kurdistan, and Yemen, with a prevalence rate ranging from 2. Methods and Materials 80 to 98% among reproductive age women (RAW) in Djibouti, Egypt, Eritrea, Somalia, and Sudan. Recent reports 2.1. Study Area also show the practice in other parts of Asia, the Middle East and among Diaspora communities around the world [4]. The study was conducted in Gewane Woreda (the lower Ethiopia outlawed FGM/C in 2004 and practitioners could level of administration in the government structure) of ANRS be penalized with a minimum of three months to life in of Ethiopia from July 4 to 14, 2016. The ANRS is found in prison or monetary fines; however, the practice is deeply the Northern east part of Ethiopia and mainly a home for a rooted and almost universal with a national prevalence of rural pastoralist population of 1.4 million [15]. The region 74% among RAW [4]. Ethiopia was among the countries has two hospitals, 14 health centers, 42 clinics and 78 health with high prevalence of FGM/C with 23.8 million women posts. Gewane Woreda is found in Zone three in the region and girls underwent the procedure [7]. Reports showed the around 400 km east of Addis Abeba (the capital of Ethiopia). prevalence rates of 81% among women ages 35 to 39, 62% The Woreda is divided into 11 rural Kebeles (the lowest level among women ages 15-19, and only 24% of girls under 14, of administrative unit in government structure). The Woreda which could indicate either behavioral change or that has three health centers and six Health posts (Figure 1). Source: http://www.ocha-eth.org/Maps/downloadables/AFAR. pdf. Figure 1. Map of Afar National Regional State (ANRS), Ethiopia, July 2016. Cancer Research Journal 2018; 6(1): 1-9 3 2.2. Study Design [Z ∂ 2 *] P()1− P A community based cross-sectional study design was n = 2 *2+10% ()2 conducted using quantitative data collection method. All d reproductive age women in Gewane Woreda were the source 2 ()− population, while, the study population was all reproductive = 15.0*]96.1[ 5.0 n 2 *2+10% age women who are residing in the selected Kebeles . All ()05.0 reproductive age women (15-49 years) who ever gave birth and live for at least 6 months before the survey within the n = (384 *2)+10%=845 study area were included, while those who were mentally ill, unable to communicate or those who never gave birth were 2.3.2. Sampling Procidure excluded from the study. To select the sample two stage sampling procedure was used. Gewane Woreda is composed of one urban and 10 rural Kebeles . 2.3. Sample Size Determination and Sampling Procidure In the first stage one urban and five out of 10 rural Kebeles were selected by lottery method. These Kebeles were Gewane 01, 2.3.1. Sample Size Determination Meteka, Egile, Gelila Dura, Gebayabora and Urafita. All the The optimum sample size was determined using single selected Kebeles were almost equally populated thus equal population proportion formula with the assumption of the proportion of the sample size was allocated for each of them prevalence of FGM/C (p) of 50%, 95% of confidence level (141 subjects per Kebele ). In each of the selected Kebeles the and margin of error between sample size and population eligible women in the household were selected until the required parameter of 5%. Considering the 10% non-response rate and sample size was achieved. In case there were two or more design effect of two. The following formula was used to eligible in the same household only one was included randomly calculate the required sample size: to control intra-household correlation (Figure 2).
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