Hence, girls pass through such a procedure because it is accepted as an important part of their cultural identity. For others, it is subscribed to out of fear of being stigmatized or rejected by their community. Studies have revealed that in prominent African countries, Christians, Muslims, Animists, and several non-believers in a range of cultures embrace FGM as their religious requirement [ 19 ].
However, due to different levels of reasoning among the prominent religious bodies, it was established that a large proportion of mainstream and Protestant Christian groups were found to be against the continuation of the practice whilst Muslims are supportive of its continuation [ 20 ]. To achieve a well-coordinated and comprehensive review of this study, pieces of evidence of the best quality were systematically searched for, majorly female genital mutilation with a clear focus on the African continent.
Hence, all the studies considered in this review were selected without the restriction of type of study, including the investigation of clinical trials that are relevant to this study as well as systematic reviews and meta-analyses.
However, as the topic implies, studies selected are predominantly stratified in line with female gender but regardless of date, age, tribe, or religious belief.
Likewise, no geographical delineation or restriction was established within the confinement of the Africa continent, therefore, all studies relating to Africa in the context of the study are majorly considered. In this way, a large number of review articles involving systematic approach, case study report, and meta-analysis were realized in several languages and formats.
Of the identified articles, only those written in full-text English language and with no or significantly low level of bias were eventually prioritized. Meanwhile, the search was majorly premised on the studies involving experiences and narratives of women with female genital mutilation to ascertain whether they are victims or even beneficiaries of the act.
The aforementioned keywords showed 1 3, peer-reviewed published articles for female genital mutilation, 2 1, peer-reviewed published articles for female genital mutilation in Africa, 3 38 peer-reviewed published articles for combined keywords for experience and female genital mutilation in Africa, 4 seven peer-reviewed published articles for combined keywords for narrative and female genital mutilation in Africa, 5 six peer-reviewed published articles for combined keywords of narrative, experience and female genital mutilation in Africa, and 10 peer-reviewed published articles for combined keywords of the systematic review and female genital mutilation in Africa.
Female genital mutilation is a practice that has indeed come of age in the Africa continent. It has a strong sociocultural inclination even though it is oftentimes done secretly and as such underreported, particularly in the last two centuries.
The practice is widely embraced by all the prominent religions prevailing in the continent- Islam, Christianity, and traditional worshipers [ 20 ]. FGM is performed at different age groups: the week of birth, infancy, before the puberty stage, before the first childbirth and other periods depending on either the location or the particular reason underlying the practice in any society [ 21 ]. It is performed individually or sometimes in a group of girls or women. Thus, its extent is commonly estimated although the reported figures have been considered less of what can be observed to be the real extent.
In the early s, the first estimates of FGM prevalence were carried out on 28 African countries even though it was premised largely on subjective evidence [ 22 ]. A decade later, a more sophisticated approach was embraced, which permitted effective systemization of data collection and reporting. This was a population-based survey that gave rise to a collection of data on FGM prevalence at national and sub-national levels concerning population characteristics such as age, religion, ethnicity, residence, etc.
Some other countries like Eritrea, Sudan, and Guinea-Bissau are also characterized by a relatively high rate of prevalence following the above-mentioned ones. This generally implies that the practice of FGM is still extant in African countries. In most African countries, several perceptions are attached to the adoption of FGM at all levels.
Some conceived FGM as a traditional core practice that must be preserved while it is purely a superstitious belief to others, through which their chastity is preserved and they are considered purified [ 23 ]. These perceptions of some of the other groups are quite distinct from those as mentioned earlier. Such as a way through which their family honor is preserved, virginity is protected, promiscuity is curtailed, socio-sexual attitude and fertility are enhanced and matrimonial opportunities are increased.
Other prominent reasons in some communities are for legal reasons as an uncircumcised woman cannot inherit property and prevention of death during childbirth [ 24 ]. To this end, for further clarification, these perceptions are hereby emphasized in line with the subdivisions below.
In Africa, studies and observations have established the fact that the justifications linked to the practice of FGM are quite numerous and in some jurisdictions, compelling. Noteworthy is that the practice varies among several communities, although they are hinged on some common themes such as family honor sake, health, marriageability, and women's status in the communities, among others [ 25 , 26 , 27 ]. On many occasions, these justifications are presented in a positive manner while less credence is lent to its consequences in order to emphasize its advantages in line with the social-cultural perspective [ 25 ].
In fact, in numerous practicing communities and tribes in Africa and the Middle East, FGM is considered a requisite for marriage, and any uncircumcised girl has no chance of being married. Studies have revealed that FGM in Africa is broadly connected with social status and how girls and their families would be respected in the community [ 26 ]. This is evidenced in Sierra Leone culture where it is strictly required to undergo FGM else it will lead to social exclusion and being ousted from the society in general.
In this regard, parents are left with no practical choice than to subject their daughters to this act in order to safeguard their images and that of their families. Therefore, the consent of these parents earns them the status of honorable members in the community and their families will be well recognized [ 26 ]. Furthermore, among the FGM practicing groups, the cutting is conceived to be a mark of social and tribal distinction which affords their women and families a social status and value in the society [ 22 ].
This corroborates Arusha and Chagga culture in Tanzania, which makes the bride price of circumcised girls higher than their counterparts [ 28 ]. This is traceable to Nigeria, where FGM serves as the sign which is usually verified by mothers-in-law to ascertain the virginity status of the bride before the wedding [ 29 ]. Similarly, another justification for FGM is protecting the sexual emotions of girls thereby leading to the preservation of their dignity, morality, and chastity in society.
More so, in countries like Somalia and Sudan, bodily cleanliness and beauty are considered as the major reasons why infibulation is carried out on girls. In a plethora of studies and scholarly articles, it has been established over time that FGM is of no religious ground, although this fact is partially defeated due to its adoption by few Islamic sects although regarded it as a Sunna-type FGM.
However, it has been revealed that no text in the Koran supports the circumcision of the external genitalia of female, thus its prevalence is more apparent among the Sudanese or Nubian Muslims because of its existence in their culture before Islam [ 30 ]. In short, the majority of Muslims across the globe do not embrace FGM. Most especially, there is no traceable evidence of it among Saudi Arabians and some parts of African-Islamic nations like Tunisia, Morocco, Libya, and Algeria.
Below are the views of religious leaders with respect to FGM practice as truncated through an interview, cited in [ 31 ]:. Hence, those who violate or deprive them of these rights has indeed committed a major sin. Further, it is morally, practically, and medically groundless. When God created the human being, he made everything good: each organ has its designated function and role. The constant campaign against the widespread practice of FGM is not a matter of subjectivity but a result of adverse effects that have been recorded over the years.
In essence, the consequences are beyond health-inclined ones, as the majority of the victims' mental and psychological stability are often equally disturbed. Medically, the extent of health complications arising from FGM is largely dependent on the method adopted for the practice [ 33 ]. For instance, unsterilized equipment and no medical prescription against adverse effects can potentially cause primary infections like urinary tract infections, staphylococcus, hemorrhaging, and excessive and uncontrollable pains [ 34 ].
Specifically in this regard, Type 3 mutilation compared with other types has been revealed to have a propensity of exposing the circumcised women to severe infection such as HIV, clostridium tetani, HSV 2, Chlamydia trachomatis, and others [ 34 ].
Consequently, the manifestation of these short-term complications will increase the mortality rate due to limited health care available in some African countries. Although the actual mortality data of girls that have undergone FGM are currently unknown, at least one out of every FGM results in death, even though the general belief in some African societies that FGM protects their girls against sexually transmitted diseases has been debunked by a case-control study carried out in Sudan [ 34 ].
The study stressed that, even after the healing of the cutting, the victims often suffer psychological, physiological, and childbirth complications. Therefore, the consequences attached to the act are far beyond what could be overemphasized [ 34 , 35 ]. In line with health consequences, a study carried out in Djibouti, Somalia, and Sudan on women during pregnancy, childbirth, and postpartum revealed unhealthy complications arising from FGM had increased both mortality and morbidity among those women [ 32 ].
Likewise, in Gambia, Sudan, Egypt, Somali, Nigeria, and other parts of Africa, studies have revealed that high prevalence of FGM has posed several health challenges such as bacteria vaginosis, herpes simplex virus, Neisseria gonorrhea, Chlamydia trachomatis or treponema pallidum, trichomonas, Candida albicans, Pseudomonas pyocyanin, vaginalis Staphylococcus aureus, HSV-2, prolonged labor, obstructed labor, cesarean section and fetal outcome, obstetrics complication, perineal tear, postpartum blood loss, chronic pelvic infection, and sexual difficulties [ 32 , 33 , 34 , 35 , 37 , 45 , 50 ].
Concerning long-term complications, perhaps the most severe one is the forming of keloid scar tissue over the cut area which often leads to anxiety and shame for the victim [ 38 ]. Resultantly, neuromas may equally submerge as a result of the entrapped nerves around the scar, thereby leading to pain, especially in the process of intercourse [ 38 ].
For instance, there has been a long record of mortality rate for infibulated women due to the complications that usually arise during childbirth [ 32 ].
Similarly, the reviewed studies equally established that FGM entails psychological, psychosocial, and psychosexual effects, although there is a few quality evidence to adequately back it [ 49 ].
Some studies identified effects such as anxiety, post-traumatic disorder, and depression, perhaps as a result of shame arising from social victimization [ 38 ]. In the study of Behrendt and Moritz, where the mental health status of 47 Senegalese women was sampled via clinical interview, it was established that 23 among them had undergone FGM. Thus, a high prevalence of psychiatric problems such as memory loss Therefore, the prevalence of problems associated with mental health in circumcised women was statistically significant.
More so, FGM has also been traced to sexual dysfunction as the clitoris may be removed in the process. However, studies on sexual function post-FGM are relatively few and frequently devoid of standardized and appropriate questionnaires and control groups, which could serve as reliable evidence for valid inference. In a study comprising Sudanese women on the sexual experience and marital adjustment of the female with FGM, it was revealed that mental and emotional effects glaringly manifest in the lives of those clitoridectomized women [ 38 ].
This study commensurates the findings from a narrative review of psychosexual consequences and a meta-analysis study on Nigerian women based on their psychosocial analysis. The former posited that women with FGM are more prone to developing psychological disorders such as phobia, anxiety, somatization, self-esteem, and post-traumatic stress disorder and equally physiological problem in respect to being sexually stimulated, while the latter revealed that FGM creates psychological problems, sexual abnormalities, and unhappiness in marriage [ 48 , 49 ].
Like other studies, this study has limitations. First, taking full consideration and premising the review on the whole of African nations, even regardless of credence being duly lent to the prominent parts, is a concern although measures were taken to achieve all-inclusiveness.
Still, some parts of the nation or ethnic groups might not have been adequately taken into account. More so, the review focused mostly on the adverse effects of FGM on health, psychosocial, and psychological areas with little indication to the solution in a real sense. However, one can hope that the statutory prohibition on FGM will catalyze its de-legitimation as with other related harmful practices.
However, the review captured narratives and experiences of mutilated women from several germane studies with in-depth analysis and extensive coverage. Towards harnessing the feelings and thoughts of African women about the practice of FGM in their respective territory, the findings, which hinged on the cultural, social, and partly religious ideology about the practice, are indicative of the likely rationale behind the continued practice of FGM in all African regions.
Little wonder the practice persists despite the ongoing global campaigns against it. Unfortunately, mothers, who are responsible for protecting their children, are in good faith subjecting their daughters to this detrimental practice for fear of being victimized or ousted from the community. Therefore, it is important to ensure that culture, myths, and misconceptions associated with the practice are dismissed, and proper enlightenment is sufficiently channeled because women are consistently victims of this barbaric practice.
This victimization can be viewed from the angles of gynecological, psychological, psychosocial, and psychosexual implications which were realized to be dangerous to the existence of the circumcised women. Thus, FGM is an outdated practice that perpetuates gender inequality in society and endangers women by exposing them to disabling consequences and complications.
In line with this, as revealed by past studies, proper awareness about FGM's consequences and, most notably, female empowerment through girl-child education beyond peripheral will have potential in reducing female circumcision. Currently, there is a need for a collective effort at all levels to deal with this disabling cultural practice. This could be achieved by criminalizing the practice, providing both adequate medical and psychosocial aids for its victims, and encompassing traditional and religious heads in campaigns against the practice and anti-FGM initiatives.
More so, to curtail the prevalence of FGM in a real sense, the approaches have to be holistic, community-based, and feature human rights education at all levels. Resultantly, there would be a drastic social transformation among individuals and families in African communities, which will potentially end FGM and quickly motivate the remainder of the intermarrying population.
With these, there would be a drastic reduction in the prevalence of FGM in Africa and the narratives will change in years to come. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional.
Do not disregard or avoid professional medical advice due to content published within Cureus. The authors have declared that no competing interests exist.
National Center for Biotechnology Information , U. Journal List Cureus v. Published online Sep 4. Author information Article notes Copyright and License information Disclaimer. Corresponding author.
By clicking the "I accept" button, you consent to the use of these cookies. Although progress towards ending FGM is not moving fast enough attitudes are changing, new analysis shows. Female genital mutilation FGM will take centuries to eradicate despite world leaders promising to end the practice by , according to United Nations data released on Thursday.
Estimated to affect at least million girls and women globally, FGM causes multiple mental and physical health problems. A year-old girl recently died in Egypt after undergoing FGM.
Female genital mutilation hurts economies, says WHO. FGM typically involves the partial or total removal of the external genitalia. Sometimes the vaginal opening is sewn up. Although no high prevalence country is on track to meet the goal, Cappa said attitudes were changing in many places.
In countries affected by FGM, seven in 10 women think the practice should end, and half of women who have themselves been cut would like to see it stop, according to the report published on International Day of Zero Tolerance for FGM. This is derived from self-reports.
In most surveys, eligible respondents are all girls and women aged 15 to The second indicator used to report on the practice measures the extent of cutting among daughters of girls and women of reproductive age 15 to If the eldest daughter was reportedly not cut, respondents were asked if they intended to have their daughter cut. This was followed by questions about the procedure type, age at cutting and practitioner for the daughter most recently cut.
As a result, prevalence estimates can be obtained for girls aged 0 to Therefore, the data on prevalence for girls under age 15 is actually an underestimation of the true extent of the practice. Since age at cutting varies among settings, the amount of underestimation also varies.
That said, these data must be analysed in light of the extremely delicate and often sensitive nature of the topic. First, women may be unwilling to disclose having undergone the procedure because of the sensitivity of the topic or the illegal status of the practice in their country.
However, even these data need to be interpreted with a degree of caution. Despite this, considerable challenges arise when examining trends, particularly when establishing a connection between programmatic activities and changes in prevalence levels over time. First, prevalence can be compared from surveys in the same country from two or more points in time. Several important factors should be considered when examining trends in the practice:.
Female genital mutilation FGM August All topics. At least million girls and women alive today living in 30 countries have undergone FGM. Prevalence Available data from large-scale representative surveys show that the practice of FGM is highly concentrated in a swath of countries from the Atlantic coast to the Horn of Africa, in areas of the Middle East such as Iraq and Yemen and in some countries in Asia like Indonesia, with wide variations in prevalence.
Is the practice changing? Read more. Build your own dataset Build and download your own customizable dataset on female genital mutilation fgm data.
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