Female genital mutilation and intimate partner violence in the Ivory Coast

Female genital mutilation (FGM) – defined by the World Health Organization (WHO) and the United Nations (UN) agencies as “the partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons” is a deeply rooted tradition in many communities in 28 countries in Africa and in some countries in Asia and the Middle East [1], ranging from 0.6% to 98% of the female population [WHO 2011]. Across countries in western Africa the prevalence of Female Genital Cutting (FGC) was 94%, 79%, 74% and 72% in Sierra Leone, Gambia, Burkina Faso and Mauritania, respectively, whereas in Ghana, Niger and Togo prevalence was less than 6% [2]. In Ivory Coast a comparison between Multiple Indicator Cluster Survey (MICS) 2000 and MICS 2006 revealed that between 2000 and 2006 the national prevalence of FGM among women aged 15-49 decreased from 44% to 36.4% [3]. Various short-term and long term negative physical and psychosocial health consequences of FGM have been reported [1, 4]. Some examples of these health consequences include adverse effects on women’s reproductive health (prolonged labour, obstetric lacerations, instrumental delivery, obstetric hemorrhage, and difficult delivery) [4] and negative psychological consequences (have a psychiatric diagnosis, suffer from anxiety, somatisation, phobia, and low self-esteem) [5].

According to WHO [6] the global prevalence of physical and/or sexual intimate partner violence among all ever-partnered women was 30.0%, with the highest in the WHO African, Eastern Mediterranean and South-East Asia Regions, where approximately 37% of ever-partnered women reported having experienced physical and/or sexual intimate partner violence at some point in their lives [6]. From the 2005 Demographic and Health Survey in Ivory Coast it was found that past 12 months physical and/or sexual violence from an intimate partner or non-partner was 12% [7].

Two previous studies in Egypt and Mali have shown a positive association between FGM and intimate partner violence (IPV) [8, 9]. Salihu et al. [8] propose that a possible explanation of the association between FGM and IPV is that women with previous exposure to violence are more likely to experience violence later in life. Women with physical and sexual trauma during childhood are more likely to experience violence, including IPV in later life [10]. Likewise, women who experience FGM as a form of violence in early childhood may be vulnerable to IPV [8]. Childhood abuse, including FGM may interfere with normal development of interpersonal relatedness and affect regulation leading to a “higher threshold of tolerance” for coercive or forceful sexual advances [11]. The aim of this study was to determine if FGM is associated with IPV, using data obtained from the Demographic and Health Survey (DHS) 2012 in Ivory Coast.

Overall, 5005 women were administered the domestic violence and female genital cutting modules of the 2012 Ivory Coast DHS. Their demographic characteristics are provided in Table 1. The lifetime prevalence of physical violence was 24.8%, sexual violence, 5.7% and emotional violence, 19.0%, and the prevalence of any lifetime IPV was 32.1%. In all, 40.6% reported female genital cutting or mutilation (FGM). Among women with FGM the median age of circumcision was 4 years (SD = 5.4). The proportion of women with FGM was highest among those with no education (55.8%), those belonging to the Catholic religion (71.8%), and women in polygynous marriage (59.5%) (see Table 1).

The adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) for the association between FGM and IPV are shown in Table 2. Women reporting FGM were two times as likely to experience sexual IPV (AOR: 1.96, CI: 1.29-2.98), while other subtypes of IPV were higher in women reporting FGM but they were not significant. Of the socio-demographic covariates, urban residence and having a primary education were associated with most subtypes of IPV, while being a Muslim seemed protective from any type, sexual and emotional IPV, and having been exposed to two or three types of IPV. Having seen the father beating the mother was positively associated with most IPV subtypes, and having been diagnosed with a sexually transmitted infection (STI) in the previous 12 months was associated with physical and sexual IPV (see Table 2).

The lifetime prevalence of IPV and its subtypes in the Ivory Coast seem lower than the average in the WHO African region [6]. The prevalence of FGM found in this survey (40.6%) seems to show an increase compared to 36.4% in 2006 [3].

The study findings show that FGM was only partially associated with IPV, namely with sexual violence only, while having witnessed interparental violence in childhood was found to be associated with most IPV subtypes; the latter was also found in a DHS survey in Bolivia [14]. Therefore, our results are only partially consistent with previous research that links childhood exposure to physical or sexual trauma (e.g. FGM) to subsequent IPV [8, 13, 15, 16]. Previous studies found that FGM women had higher marital and sexual relationship dissatisfaction than non-FGM women [17]. Further research is needed to explore the reasons for the identified association between FGM and sexual violence in this study.

Further, the study found that having been diagnosed with a sexually transmitted infection (STI) in the previous 12 months was associated with physical and sexual IPV. IPV has been identified to increase the risk of HIV/STI [6]. Of the socio-demographic covariates studied, urban residence and having a primary education were associated with most subtypes of IPV, while being a Muslim seemed protective from any type, sexual and emotional IPV and multiple types of IPV. These findings seem to be in agreement with other studies in terms of urban residence [14] and better education [13]. Further, our analysis of the correlates of IPV showed that physical, psychological and sexual violence had a number of common risk factors, as also found by Meekers et al. [14] among Bolivian women.

Significant rates of FGM and IPV were found among this sample of Ivorian women calling for the need for multiple strategies to reduce FGM and IPV.