Discuss ways of preventing female genital mutilation.

Discuss ways of preventing female genital mutilation.

Mothers` Perspectives of Female Genital Mutilation Essay

The purpose of this study was to find out mothers perspectives on female genital mutilation (FGM) among the Maasai community in Kenya. The aim of the study can be used in utilizing the research result when planning education programs in preventing female genital mutilation. The research was carried out in co-operation with a local village which is situated in South-West Kenya, and West from Nairobi, the Kenyan capital city. Qualitative method was used to implement this study. Data was collected by interviewing four mother´s aged between 20-35 years of age, who had young daughters. The interviews were conducted between December 2010 to February 2011. The data collected was analysed by using content analysis. The results of this study revealed that the mothers interviewed have good knowledge about the effects of female genital mutilation in general and the risks involved with its practice, although afraid of losing their culture. Mothers` Perspectives of Female Genital Mutilation Essay They were also aware of the long term and short term effects to their daughters and the unborn child, which could be as serious as leading to permanent disabilities and death. The mothers interviewed had knowledge on the signs to look for after FGM infection and to determine if medical treatment was required instead of depending on natural treatment only. Most mothers admitted use of natural treatment as well as modern medicine and other treatment methods. They acknowledged other recommended alternatives to stop female genital mutilation, such as girl child education since their daughters had more knowledge and facts to prove why female genital mutilation was harmful to them. Additionally the study results indicated the willingness of the participants to work closely with health professionals who have better knowledge about FGM and its effects. They are also aware that FGM is illegal in Kenya and if they are caught, they are liable to prosecution. Further research is recommended to focus on father’s opinion. The study could also provide more knowledge to the government and policy makers in raising awareness especially to mothers who have different opinions about female genital mutilation. Mothers` Perspectives of Female Genital Mutilation Essay

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CHAPTER ONE

INTRODUCTION

Female Genital Mutilation (FGM) is defined as the practice that involves partial or total removal of the external female genitalia for cultural or religious beliefs, rather than medical reasons according to Journal of Human Rights, (2007).Types of geographical location, socioeconomic status and the ethnic background. It is not always easy to distinguish who will practice which type of female genital mutilation (Journal of Human Rights 2007, 6:392-413). Female genital mutilation has been traced back three centuries however, it has undergone cultural transformations.

It is practiced in most African, Asian and Middle East countries with an estimated three million girls at a risk of undergoing FGM yearly, which is equivalent to 8,000 girls daily (Momoh, 2010).The various reasons proposing continuation of female genital mutilations may be categorized in to socio-cultural, psychosexual, religious and hygiene purposes and the ritual is observed to mark the coming of age where-by it is accompanied by celebrations and gifts exchange (Nursing Standard 2008, 43-47). Mothers` Perspectives of Female Genital Mutilation Essay

Most of the time, victims of FGM have no knowledge about the exact day when the procedure will be carried out and sometimes they guess as the villagers may plan ceremonies the previous night. Preparations involve gifts to the girl, nourishment with food, singing songs of praise to the girls and treating her with royalty while others may have no clue. Instead they are suddenly drugged from the bed before dawn and led to a deserted area, hut, sacred tree or river (Baron & Denmark 2006, 339-355). Mothers` Perspectives of Female Genital Mutilation Essay

The interest for the above topic was drawn from observing that nursing has become an international profession, and all nurses have a responsibility to familiarize with different cultural and religious beliefs, so as to offer holistic care without discrimination or stereotyping the clients. Due to immigration, cultural diversity has increased and it can never be ignored in the nursing profession especially when health may appear to be getting compromised.

The purpose of the study is to find out the mothers` perspectives of female genital mutilation among the Maasai community in Kenya. The aim of the study can be utelised in the research results in future when planning education programs in preventing FGM.

Female genital cutting is practiced in 28 African nations, including some in which the
practice has been outlawed.
1
Female genital cutting is longstanding and has been in practice
for millennia in some places.
2
As with many longstanding traditions, it may be argued that the
procedure holds strong ties within the community. In fact, women from the communities who
must undergo female genital cutting and advocate for its continuance do not see the procedure
as a violation or “aberration”. Mothers` Perspectives of Female Genital Mutilation Essay
3
For many young girls and women who face female genital
cutting, the person holding the knife is another woman, which presents an interesting question:
why would women continue the practice of a procedure that causes pain and potential health
risks that could lead to serious injury or death? The answer is as difficult to accept as it is
simple in statement: culture. For these women, participating in female genital cutting translates
into conforming to the standards for the role of a woman.
4
In these communities, the practice
of cutting continues without scientific need or widespread international approval.
However, this does not mean that the international community has accepted the practice
as a meaningful cultural expression. Indeed, it seems that the majority of people living outside
of these communities condemn the practice from hearing the name alone. Many people cite
international disapproval of the practice, with much support from international organizations,
such as the United Nations. In pushing their ideals, critics of female genital cutting run the risk
of imposing their beliefs upon the women closest to the communities that adhere to the
practice. Advocates for the discontinuation of female genital cutting turn to international
norms and the constitutional texts of some of the nations that have outlawed the practice with
communities that clandestinely continue it. Mothers` Perspectives of Female Genital Mutilation Essay
5
Caught between culture and international scrutiny, the women in these communities are
often forced to choose between tradition and gender rights. If they choose to stand with
tradition, they risk appearing “backward” by international human rights standards enforced by
Western ideology. Yet, if they choose to adhere to the changing landscape of women’s rights,
led by the White elite, they chance weakening the cultural bonds that have existed for centuries.
From this viewpoint, this paper will discuss the multiple levels of legal framework that discuss
female genital cutting, both domestically and internationally, focusing on four nations on the
African continent: Kenya, Senegal, Egypt, and Sierra Leone. The discussion will illustrate the
struggle African women face in their attempt to form a cohesive voice with which to advocate
on their own behalf. Mothers` Perspectives of Female Genital Mutilation Essay

The World Health Organization [1] defines female genital mutilation as any procedure that cuts or harms female genitalia without medical indication. As of 2014, there are about 130 million women living in one of the 29 countries of Africa and the Middle East who have experienced female genital mutilation; it is believed that in the next decade, a further 30 million girls, mostly living in Africa and Asia, are in danger of undergoing this harmful practice [2,3]. Although the rate of FGM is slowly diminishing worldwide, the prevalence of FGM in different parts of the world continues at a rate ranging from 0.6% to 98% [3]. FGM can have serious adverse effects on the physical and mental health of women in both the short and long terms, especially since it is often done in unsanitary conditions by relatives, neighbors and elderly women [4,5]. In the short term, severe pain, hemorrhage and abscess from unsterile instruments are the most common problems associated with female genital mutilation. The long-term physical effects of FGM include recurrent infections, keloids, fistulas, pain during sexual intercourse, menstrual problems and even infertility [4,6]. Furthermore, FGM is often associated with serious psychological and emotional difficulties including anxiety, depression, stress, insomnia, eating disorders and impaired cognition [4,7–9]. Consequently, FGM has been recognized as a violation of human rights [7,10] and is considered a public health problem [11]. Mothers` Perspectives of Female Genital Mutilation Essay

FGM is mainly carried out on young girls under the age of 15 years old who often have little choice in the matter [7]. FGM is often deeply embedded in the culture and traditions of the people, which influence mothers to want to have their daughters undergo this surgery [12]. The main reasons given for the practice of FGM are prevalent social norms [13,14], the suppression of female sexuality [2,15–17], aesthetic preferences [13], social cohesion [18] and religion [3,16]. The attempt to stop FGM is not easy [19,20]. Previous studies on the practices of female genital mutilation have concluded that the development and implementation of legislation as a sole strategy against FGM is not an effective way to reduce its prevalence [21,22]. Although laws signal a country’s disapproval of FGM and send a clear message of support to those who abandon the practice [23], their deterrent effect has not been confirmed [24]. For instance, in a systematic review on practices of FGM in seven different African countries, it was found that only study participants from Burkina Faso mentioned legal prohibition as a reason for not performing FGM. Burkina Faso, however, is the only country in which people who break the law are commonly prosecuted [25]. Participants from nearly all other African countries consistently argued that FGM was simply a cultural tradition and, therefore, must continue [24]. A more effective way to reduce FGM involves community education and awareness. Successful community strategies that have been documented include mutilation-free rite-of-passage ceremonies and collective declarations in which villages pledge not to mutilate their daughters [25]. Furthermore, several studies have argued that educational interventions that emphasize the negative consequences of FGM, that correct faulty knowledge or that provide educational knowledge that is missing can trigger changes in beliefs [24]. In these intervention programs, various people should be targeted, including parents, health workers, religious leaders and other key people Mothers` Perspectives of Female Genital Mutilation Essay

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The present study took place in Ravansar, a county in Kermanshah Province in Iran. A recent study conducted by Pashaei [12] found that the prevalence of FGM in the region is approximately 58% and that 96% of the genital mutilations are performed by traditional midwives and old women. Moreover, the same study revealed that FGM is always done based on a mother’s request. In other words, mothers allow others to genitally mutilate their daughters. This indicates that FGM is deeply embedded in the culture and traditions of the people, which makes the reduction and elimination of the practice of FGM very challenging [4]. Understanding the factors associated with FGM behavior might help in the designing of appropriate intervention strategies to change this behavior. Therefore, the aim of this study is to test a clinically relevant and theoretical framework to explain and predict mother’s intentions to have their daughters undergo FGM; the reason for this approach is that intention is a very strong determinant of actual behavior [27]. One such framework that has proved to be successful is the theory of planned behavior (TPB) [27,28]. To date, TPB is one of the most thoroughly tested and robust of the social psychological models for understanding, predicting and changing health-related behaviors [29–33]. To the best of our knowledge, no study has applied this framework to predict mothers’ intentions to make their daughters undergo female genital mutilation. Mothers` Perspectives of Female Genital Mutilation Essay

The theory of planned behavior (TPB) proposes that behavior can be predicted by the strength of an individual’s intention to behave in a particular way. Behavioral intention is predicted by three variables: attitude toward the behavior, subjective norms and perceived behavioral control over the behavior [28]. Attitude refers to people’s positive or negative evaluation of the behavior. A subjective norm is defined as the perceived social pressure to perform or not to perform the behavior. Perceived behavorial control refers to the level of ease or difficulty the individual experiences when attempting to perform the behavior [27]. As a general rule, the more favorable the attitude and the subjective norm and the greater the perceived behavioral control, the stronger is the person’s intention to engage in the behavior [27,28]. The stronger the person’s intention, the more that person is expected to try, and hence, the greater the likelihood of the person demonstrating the behavior [34]. Except with regard to behaviors that are largely out of the person’s behavioral control, the intention to engage in a particular behavior is the strongest predictor of the actual behavior [28,35]. Based on the TPB-literature, we derive three hypotheses (H): There is a positive association between mothers’ attitudes (H1), subjective norms (H2) and perceived behavioral control (H3) and their intention to allow their daughters to undergo FGM. Mothers` Perspectives of Female Genital Mutilation Essay

In sum, the present study was conducted in Ravansar, a county in which FGM is still a common practice. The purpose of the study was to gain a better understanding of mothers’ intentions to allow their daughters to undergo FGM. We therefore examined the predictive value of attitudes, subjective norms and perceived behavioral control in relation to mothers’ intentions to allow their daughter to undergo FGM. The findings of this study may help policy makers design appropriate interventions to prevent the practice of FGM among the new generation of females in Iran. Mothers` Perspectives of Female Genital Mutilation Essay

Material and Method
Procedure and participants
Data were collected with the help of five trained midwives who worked in health centers located in both urban and rural areas of Ravansar, a county in western Iran. Ravansar is a region in Iran in which FGM is practiced fairly commonly [36]. Almost 100% of the population in Ravansar has a Kurdish background (i.e., an ethnic minority in Iran) [36]. To identify potential study subjects, the midwives reviewed the existing medical records of mothers who had been referred to the health centers in 2011. In Iran, each family has a medical file at a health center located in the region in which they live. Mothers were eligible if they (a) had experienced female genital mutilation, (b) had at least one daughter younger than seven years old and (c) had no daughter(s) above seven years old. The age criteria were chosen because a recent study [12] found that approximately 54% of the women in Ravansar are mutilated before they are seven years old. All eligible women (n = 323) were called by the midwives and were informed about the purpose of the study. All of the contacted women had a medical record at the health center. Therefore, they were asked by phone to come to the health center. In the correspondence with the participants, the Kurdish language was used because it is the ethnic language of Ravansar and is known by all the citizens in the region. Mothers` Perspectives of Female Genital Mutilation Essay

The midwives were trained by the first author in how to contact the mothers. The trained midwives asked the subjects whether they agreed to participate in the study. It was made clear that the respondents were under no obligation to participate and that their responses would be treated anonymously and confidentially. Furthermore, the mothers were assured that their decision to refuse would not deprive them of any health services at the health centers. Mothers who were willing to participate received an introductory letter explaining the purpose and procedure of the survey. Each participant also received a plain-language statement and a written informed-consent form. If women were illiterate, the midwives helped the mothers to fill in the paper-and-pencil questionnaire. No compensation was given to the respondents. The study protocol was approved by the ethics committee of the Tehran University of Medical Sciences. Mothers` Perspectives of Female Genital Mutilation Essay

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