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Corresponding author : Hanan Elzeblawy Hassan
Article Type : Research Article
Volume : 3
Issue : 10
Received Date : 29 Nov ,2022
Accepted Date : 17 Dec ,2022
Published Date : 23 Dec ,2022
DOI : https://doi.org/10.38207/JCMPHR/2022/DEC031002139
Citation & Copyright
Citation: Abd-Elhakam FH, El-Syed Ebrahim R, Mohammed MZ, Hassan HE (2022) Relationship Between Women's Intention for Female Genital Mutilation and Their Exposure to Complication and Pressure. J Comm Med and Pub Health Rep 3(10): https://doi.org/10.38207/JCMPHR/202
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Copyright: © 2022 Hanan Elzeblawy Hassan. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are
  Relationship Between Women's Intention for Female Genital Mutilation and Their Exposure to Complication and Pressure

Fatima Hosny Abd-Elhakam1, Rasha El-Syed Ebrahim1, Momen Zakria Mohammed2, Hanan Elzeblawy Hassan1*

1Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt

2Lecturer of Obstetrics & Gynecology Faculty of Medicine, Beni-Suef University

*Corresponding Author: Hanan Elzeblawy Hassan, Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt.

Abstract
Background
The most cited reasons for Female Genital Mutilation practice include a fear of being rejected by the community, preparing the girl for marriage, ensuring premarital virginity, and preventing marital fidelity, also with spiritual support and cultural tradition.

Aim: The present study was carried out to estimate the relationship between Women's Intention for Female Genital Mutilation and their Exposure to Complications and Pressure.

Subject & Methods: A Descriptive Cross-sectional study on the convenience sample at family health centers in different sitting at Beni-Suef Governorate was conducted. А Structured Interviewing Questionnaire sheet, which includes two sections: Socio-demographic data and Intention to practice Female Genital Mutilation.

Results: Around half of the participants (47.9 %) supported the continuation of Female Genital Mutilation (FGM) for young generations. Most females who experience FGM (79.3 %) have no intention of circumcision their daughter. Most females (54.6 %) of females who didn't expose to complications from FGM didn't decide yet if their will mutilate their daughter. Moreover, 8.6 % & 4.6 % who were exposed to pain and bleeding, respectively, hadn't intended to mutilate their daughters. Also, 85.9 % who did not disclose to pressure from neighbors hadn't Intention to mutilate their daughters.

Conclusion: An association between women's Intention to circumcise their daughters and the source of their information was found. There was an association between women's Intention for mutilation and the complications they have been exposed to. There was an association between women's Intention for mutilation and their exposure to pressure from family or neighbors.

Recommendations: Alleviate females' Intention toward Female Genital Mutilation should be established by improving females' resistance toward family or neighbors regarding destructive and harmful traditions.

Keywords: Relationship, Intention, Female Genital Mutilation, Complication, Pressure

1. Introduction
According to a systematic review, the prevalence of Female Genital Mutilation/Cutting (FGM/C) in Egypt from 1980 to 2018 varied between 14.7% and 100%. It also showed that FGM/C is becoming less common over time due to efforts done by both the government and non-government organizations to eradicate it, the decline in illiteracy, the prosecution of FGM/C, and other factors [1-6].

The most cited reasons for the practice include a fear of being rejected by the community, preparing the girl for marriage, ensuring premarital virginity, and preventing marital fidelity, also with spiritual support and cultural tradition [7-10]. Factors supporting the continuation of the FGM/C practice include religious requirements, traditional adherence, marriageability, moral sexuality, health benefits, social pressure, and the male role [11-15].

The FGM/C is an ancient cultural practice predating the Bible and, therefore, the Koran and has no basis in any religion [16-20]. Female Genital Mutilation is related to profound social and cultural ideas impeded in several societies regarding femininity and modesty because it is viewed as a girl's clean and delightful only after being genitally cut. FGM/C is additionally considered a protection of virginity and prevents premarital sex [21-23].

Female genital mutilation/cutting has several negative health consequences and alters the normal function of women's bodies [10]. It has physiological and psychological consequences, including short- and long-term effects [24-26]. The approach used to perform the procedure may influence the severity of the short/long-term consequences [27].

2. Aim of the Study
The present study was carried find out to estimate the relationship between Women's Intention for Female Genital Mutilation and their Exposure to Complications and Pressure.

2.1 Research Questions
1. Is there a relationship between Women's Intention for Female Genital Mutilation and their Exposure to Complications and Pressure?

3. Subjects and Methods
3.1 Research Design: A Descriptive Cross-sectional study was used to achieve the aim of the current study.
3.2 Subjects & Setting:
3.2.1 Setting: The study was conducted in family health centers (FHCs) in different sitting at Beni-Suef Governorate

3.2.2 Sample:
3.2.2.1 Sample Type:
A Convenient sample was used.
3.2.2.2 Sample size:
The study population consisted of all females who were accepted to participate at the time of data collection (A period of six months from the start of data collection) will be included in the study.

3.3 Tools of Data Collection:
A pre-designed structured questionnaire was used to collect data. Data were collected through personal interviews. The questionnaire is divided into four sections:

Section (1): Intention to practice FGM/C for Daughters.
Section (2): Sources of information about FGM and its complication.
Section (3): Types of Complications that Participants Exposed
Section (4): Participants' Exposure to Family and Neighbor's Pressure to practice DGM.

3.4 Validity & Reliability of the Tool
Data collection tools were submitted to five maternity/obstetric nursing experts to test content validity. Their opinions were elicited regarding the tool's format layout, consistency, and scoring system. Modifications for the devices were done according to the experts' judgment on the clarity of sentences, appropriateness of the content, and sequence of items. The experts agreed on the intervention but recommended minor language skills changes that would make the information clearer and more précis.​​​​​

3.5 Ethical Considerations:
All engaged participants were informed that participation is voluntary and have the right to accept or refuse participation in the study. Everyone was informed about the objectives of the research and its benefits to obtain her acceptance to participate. The researchers reported to all of them that participation in the study is voluntary, and they have the right to withdraw from the study at any time without giving any reason, and their answers would be held confidential. Privacy and confidentiality of all the data will be secured. Informed consent was gained from those who were welcome to participate in the study.

3.6 Administrative Considerations
Necessary approvals from Beni-Suef MCHs directors were taken after issuing an official letter from the dean of the Faculty of Nursing, Beni- Suef University.

3.7 Pilot Study
A pilot study was carried out on 10.0 % of the total sample to test and ensure the clarity/applicability of all study tools and estimate the time needed to fill the questionnaire. According to the pilot study results, the necessary modifications were made.​​​​​​

3.8 Field Work
Data were gathered over six months, beginning in November 2021 and ending in April 2022. The researcher was present at the previously mentioned location until the total sample size was gathered.

3.9 Statistical Analysis
All data were collected, tabulated, and statistically analyzed using IBM SPSS 25. Data was supplied, and appropriate analysis was performed for each parameter based on the type of data obtained.

3.9.1 Descriptive Statistics data were expressed as:
1. Count and percentage: Used for describing and summarizing categorical data
2. Arithmetic means (X-), Standard deviation (SD): Used for normally distributed quantitative data, these are used as measurements of central tendency and dispersion.

3.9.2 Analytical Statistics:
A. Cronbach alpha and Spearman-Brown coefficients: The internal consistency of the generated tools was measured to assess their reliability.
B. Chi-square (χ2): used to see if there's a link between two category variables or if two or more proportions differ. For Race tables, Monte Carlo exact probability was used wherever 2 was present.

3.9.3 Graphical presentation:
A. Data visualization was done with graphs:
1. Column chart
2. Bar chart

4. Results
Table (1): Reveals the distribution of the females according to their Intention to practice FGM/C for their daughters. Around half of the participants (47.9%) supported the continuation of FGM for young generations. About 29.4% had the intention to mutilate their daughters. About 39.8% had already injured their daughters or sisters. The mutilated daughters who had complications during or after the FGM/C procedure were amounted to 6.9%.
About 28.6% of females who had mutilated their daughters were planning to mutilate their other daughters in the future. About 20.1% of females faced pressure from a family member to perform FGM/C, from their own or their husband's family, and 5.9 % faced pressure from a neighbor. About 38.8% knew someone who performed mutilation, whether a performer or a seeker of the practice.

Table (1): Intention to practice FGM/C for Daughters among the Studied Participants

Figure (1): presents Association between Participants' Exposure to Complication and their Intention to mutilate their daughters. It reveals that 54.6% of females who didn't expose to complications from FGM didn't decide yet if their will disable their daughter.

Figure (1): Association between Participants' Exposure to Complication and their Intention to Mutilate their Daughters

Figure (2): presents the Association between the types of complications that participants were exposed to and their intention to mutilate their daughters. There was an association between women's Intention for mutilation and the complications they have been exposed to. It reveals that 8.6% & 4.6% who told to pain and bleeding, respectively, hadn't intended to mutilate their daughters.

Figure (2): Association between Types of Complication that Participants Exposed to and their Intention to Mutilate their daughters

Table (2): presents the distribution of females according to their source of knowledge regarding FGM/C. About 71.3% of females mentioned that the basis of their information about FGM/C was their personal experience, 36.2% from friends or neighbors, 22% from TV or radio, 22.1% from the internet, 5.1% mentioned religious leaders,10.3% from doctors, and nurse, 8% from the lecture about FGM and 0.03% of females read about FGM/C health consequences in books.

Table (2): Sources of information about FGM and its complication among the Studied Participants

Figure (3): Shows an association between women's Intention to the circumcision of daughters and the source of their information. Most females who experience FGM (79.3%) have no intention of circumcision their daughter. Moreover, 9.4% of females take information from religious leaders planning for the circumcision of their daughter, and 9.2% didn't decide yet, while 10.1% of females who carry a lecture about FGM aren't planning for the circumcision of their daughter.

Figure (3): Association between Participants' Source of Information and their Intention to Mutilate their daughters

Figure (4): presents association between participants' exposure to family pressure and their intention to mutilate their daughters. There was an association between women's Intention for mutilation and their exposure to pressure from family. It reveals that most females (85.9%) who were not exposed to stress from neighbors didn't intend to mutilate their daughters.

Figure (4): Association between Participants' Exposure to Family Pressure and their Intention to Mutilate their daughters

Figure (5): presents Association between Participants' Exposure to Neighbor Pressure and their Intention to mutilate their daughters. It reveals that many females (96.7%) who were not exposed to pressure from neighbors didn't intend to disable their daughters.

Figure (5): Association between Participants' Exposure to Neighbors Pressure and their Intention to Mutilate their daughters

Discussion
In 1997, nearly 95% of women had undergone FGM/C. In 2002, El- Gibaly et al. found 84.9% prevalence. Another study from 2006 found an 84.9% prevalence of FGM/C, indicating that the regulation is ineffective. [28] According to a 2020 study, 74.2% of women and girls aged 15 to 49 had been subjected to FGM [21]. Among girls and women aged 15 to 49 years, nearly 9 in 10 have undergone FGM; within many governorates, a minimum of 7 in 10 girls and women have experienced the Practice [29].

Regarding Participants' Opinion supporting the Continuation of FGM for Young Generations, and their intention to practice FGM/C for their daughters, the results revealed that around half of females support the continuation of FGM for young generations. Moreover, they had the intention to mutilate their daughters. This is attributed to the fact that most of the studied females were from rural residences with culture, customs, and traditions supporting performing FGM/C as a religious requirement and decreasing the sexual desire of females. Also, their intention related to the fact that she did not expose to complications or their rationale that doctors would perform it. These reasons were comparable to Allam et al. (2001) and Abdou, et al., (2020) in Egypt [21,30].

Regarding females' exposure to side effects and health consequences of FGM/C, the results of the present study revealed that some of the participants' daughters were exposed to complications. However, their mothers still intended to repeat the procedure for other daughters or sisters. This may reflect the results of the present study, which revealed that those females expose to pressure. There was an association between women's intention for mutilation and their exposure to pressure from family, as found by the results of the current study. WHO reported that Female genital mutilation/cutting has no benefits; on the contrary, it has both physiological and psychological consequences, including short-term and long-term effects [24]. The approach used to perform the procedure may influence the severity of the short-term consequences [27]. In the present study, about one-fifth of females were facing pressure from a family member to perform FGM/C, from their own family or their husband's family, and the minority was facing pressure from a neighbor. One of the leading causes of the intention to mutilate daughters was family pressure, according to research done in Upper Egypt to assess how women felt about the prohibition of Female Genital Mutilation/Cutting. [31].

There was an association between women's intention for mutilation and the complications they have been exposed to. It revealed that daughters who told to bleeding, their mothers hadn't intended to mutilate their daughters again. This is expected as bleeding is life threaten. Shabila, et al., (2019) reported hemorrhage occurs when the arterial blood supply to the genital organs is severed. The hemorrhage can happen right after the procedure or later due to a clot sloughing over the blood supply due to the infection. The management of the bleeding related to excision is the same as any other type of bleeding [32]. Berg, (2018) added that severe bleeding after an FGM/C operation could decrease the volume of circulating blood in the body, leading to hemorrhagic shock. If the female does not receive the emergency help, she requires, she may die soon. [33].

Conclusion
An association between women's intention to the circumcision of daughters and the source of their information was found. There was an association between women's preference for mutilation and the complications they have been exposed to. There was an association between women's intention for mutilation and their exposure to pressure from family or neighbors.

Recommendations
1. Alleviate females' intention toward Female Genital Mutilation should be established through educational programs.
2. Alleviate females' intention toward Female Genital Mutilation should be established by improving females' resistance toward family or neighbors regarding destructive and harmful traditions.

References

  1. Hassan H., Abd-ELhakam F., Ebrahim R., Mohammed M. Prevalence of Female Genital Mutilation in Northern Upper Egypt. American Journal of Nursing Research, 2022; 10(3)
  2. Abd-ELhakam F., Ebrahim R., Mohammed M., Hassan H. Relationship between Socio Demographic Data and Female Genital Mutilation. Archives of Medical Case Reports and Case Study, 2022; 6(4)
  3. Ebrahim R., Mohammed M., Hassan H., Abd-ELhakam F. Relationship between Personal Characteristics and the Person Performing Female Genital Mutilation. Journal of Community Medicine and Public Health Reports, 2022
  4. Mohammed M., Abd-ELhakam F., Hassan H., Ebrahim R. Study Females' Intention to practice Female Genital Mutilation for their Daughters at Beni-Suef. Public Health Open Access, 2022; 6(2): 1-8
  5. Abd-ELhakam F., Hassan H., Ebrahim R., Mohammed M. Relationship between Females' Intention of Mutilating Their Daughters and Demographic Characteristics, Journal of Psychology and Neuroscience, 2022; 4(3)
  6. Hassan H. Evidence-Based Practice in Midwifery and Maternity Nursing for Excellent Quality of Care Outcomes. American Journal of Nursing Research, 2020; 8(6): 606-607. doi: 10.12691/ajnr-8-6-3.
  7. World Health Organization (WHO). Female genital mutilation Geneva: WHO; 2020 https://www.who.int/news-room/fact- sheets/detail/female-genital-mutilation.
  8. Hassan H., Ebrahim R., Mohammed M., Abd-ELhakam F. Prevalence and Determinants of Female Genital Mutilation at Beni-Suef. Journal of Gynecology and Women’s Health, 2022, 24(3): 1-10. DOI: 10.19080/JGWH.2022.23.556138
  9. Hassan H., Abd-ELhakam F., Ebrahim R., Mohammed M. Call for Change Enhancement Upper Egyptian Females' Knowledge Regarding Effect of Female Genital Mutilation. American Journal of Public Health Research, 2022; 10(5)
  10. Abd-ELhakam F., Ebrahim R., Mohammed M., Hassan H. Female Genital Mutilation: Females' Related Knowledge. Biomedical Research and Clinical Reviews, 2022; 2022,7(2)
  11. El-Gibaly, O., Ibrahim, B., Mensch, B. S., & Clark, W. H. The decline of female circumcision in Egypt: evidence and interpretation. Social Science & Medicine, 2002; 54(2): 205-220. https://doi.org/10.1016/s0277-9536(01)00020-x.     
  12. Abd-ELhakam F., Ebrahim R., Mohammed M., Hassan H. Female Genital Mutilation: Relationship Association between Upper Egyptian Females' Knowledge and Attitude. American Journal of Medical Case Reports, 2022; 10(12)
  13. Ebrahim R., Abd-ELhakam F., Hassan H., Mohammed M. Relationship between Females' Knowledge and Attitude and Intention of Female Genital Mutilation. Research in Psychology and Behavioral Sciences2333-438X, 2022; 10(1)
  14. Hassan H., Abd-ELhakam F., Ebrahim R., Mohammed M. Female Genital Mutilation: Females' Intention in Northern Upper Egypt. Journal of Obstetrics Gynecology and Reproductive Sciences, 2022; 6(4)
  15. Hassan H. The Impact of Evidence-Based Nursing as The Foundation for Professional Maternity Nursing Practices. Open Access Journal of Reproductive System and Sexual Disorder, 2019; 2(2): 195-197. OAJRSD.MS.ID.000135. DOI: 10.32474/OAJRSD.2019.02.000135.
  16. Abd El Salam S., Hassan H., Kamal K., Ali R. Sexual Dysfunction of Women’s Associated with Cervical Cancer. Journal of Applied Health Sciences and Medicine, 2021; 1(2): 12-27.
  17. Sabry, H. A., & Elamir, R. Y. Knowledge, Attitude and Intention to Future Practice of Female Genital Mutilation among Medical Students, Egypt. The Egyptian Family Medicine Journal, 2020; 4(2): 7-21.
  18. Said S., Hassan H., Sarhan A. Effect of an Educational Intervention on Women's Knowledge and Attitude Regarding Cervical Cancer. American Journal of Nursing Research. 2018; 6(2): 59-66. doi: 10.12691/ajnr-6-2-4.
  19. Hassan H., Saber N., Sheha E. Comprehension of Dyspareunia and Related Anxiety among Northern Upper Egyptian women: Impact of Nursing Consultation Context Using PLISSIT Model. Nursing & Care Open Access Journal. 2019; 6(1): 1-19. DOI: 10.15406/ncoaj.2019.06.00177
  20. Hassan H., Abd-ELhakam F., Zakria M., El-sayed R. Female Genital Mutilation in Northern Upper Egypt: Prospects of Reasons for Performing and Refusing. International Journal of Nursing Science, 2022; 12(1)
  21. Abdou, M. S., Wahdan, I. M., & El-Nimr, N. A. Prevalence of Female Genital Mutilation, and Women’s Knowledge, Attitude, and   Intention to   Practice   in   Egypt:   A   Nationwide Survey. Journal of High Institute of Public Health, 2020; 50(3): 139-145.
  22. Hassan H., Ebrahim R., Mohammed M., Abd-ELhakam F. Female Genital Mutilation: Impact on Knowledge, Attitude, Sexual Score Domains and Intention of Females in Northern Upper Egypt. Archives of Medical Case Reports and Case Study, 2022; 6(4)
  23. Hassan H., Mohammed M., Abd-ELhakam F., Ebrahim R. Female Genital Mutilation: Study Sexual Issues. American Journal of Nursing Research, 2023; 11(1)
  24. Young, J., Nour, N. M., Macauley, R. C., Narang, S. K., Johnson- Agbakwu, C., & Committee on bioethics. Diagnosis, management, and treatment of female genital mutilation   or cutting   in girls. Pediatrics, 2020; 146(2).
  25. Hassan H., Abd-ELhakam F., Ebrahim R., Mohammed M. Study Females' Attitude toward Female Genital Mutilation. Journal of Gynecology and Women’s Health, 2022, 24(3): 1-9 DOI: 10.19080/JGWH.2022.24.556137
  26. Abd-ELhakam F. Prevalence of Female Genital Mutilation at Beni-Suef Governorate, Egypt. [Master's Disseration, Beni-Suef University]. Beni-Suef, Egypt. 2022
  27. Klein, E., Helzner, E., Shayowitz, M., Kohlhoff, S., & Smith- Norowitz, T. A. Female genital mutilation: health consequences and complications-a short literature review. Obstetrics and gynecology international, 2018, Article id 7365715, 7 pages,  2018.  https://doi.org/10.1155/2018/7365715,1-8.
  28. Amin, T., Moety, A. M. A., & Sabry, H. A. Female genital mutilation: Egypt in Focus. Eur J Forensic Sci.Jan-Mar, 2017; 4(1): 24.
  29. UNICEF Data. Female Genital Mutilation: A New Generation Calls for Ending an Old Practice. 2020. Available online:https://data.unicef.org/resources/female-genital-mutilation-a-new-generation-calls-for-ending-an-old-practice/(accessed on 2 January 2021).
  30. Allam, M. F., de Irala-Estevez, J., Navajas, R. F. C., del Castillo,A. S., Hoashi, J. S., Pankovich, M. B., & Liceaga, J. R. Factors associated with the condoning of female genital mutilation among university students. Public health, 2001; 115(5): 350-355.
  31. Hassanin, I. M., & Shaaban, O. M. Impact of the complete ban on female genital cutting on the attitude of educated women from Upper Egypt toward the practice. International Journal of Gynecology & Obstetrics, 2013; 120(3): 275-278. https://doi.org/10.1016/j.ijgo.2012.10.010
  32. Shabila, N. Geographical variation in the prevalence of female genital mutilation in the Kurdistan region of Iraq. Eastern Mediterranean Health Journal, 2019; 25(9): 630-636. https://doi.org/10.26719/emhj.19.009.
  33. Berg, R. C., Taraldsen, S., Said, M. A., Sørbye, I. K., & Vangen, S. The effectiveness of surgical interventions for women with FGM/C: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology, 2018; 125(3): 278-287.
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