Pupil’s perspectives on female genital cutting abandonment in Harari and Somali regions of Ethiopia

Female Genital cutting (FGC) is a harmful traditional practice which affects the physical and mental health of girls and women [1]. FGC affects girls’ schooling and limits their capacity [2]. It is an issue in both the development and governance, and therefore ending all forms of FGC is the interest of families, communities, and nations [3].

It is estimated that more than 200 million girls and women alive today have undergone female genital cutting in the countries where the practice is concentrated [1]. Furthermore, there are an estimated 3 million girls at risk of undergoing female genital mutilation/cutting every year. FGC has been documented in 30 countries, mainly in Africa, as well as areas in the Middle East and Asia [1]. Some forms of FGC have also been reported in certain ethnic groups in South America [1]. Moreover, FGC has been practiced by migrants living in Europe, Australia, and North America [1]. Even if the worldwide decline in FGC is maintained at current rates, population growth means that about 196 million girls would be cut by 2050 [4].

World Health Organization (WHO) classified FGC into four groups. Type I,Sunna/clitoridectomy, which is the partial or total removal of the clitoris and/or the prepuce. Type II or excision involves the partial or total removal of the clitoris and the labia minora with or without excision of the labia majora. Type III or infibulation involves in narrowing of the vaginal opening through the creation of a covering seal. Type IV includes all other harmful procedures to the female genitalia for non-medical purposes [5, 6]. Some studies revealed that there was a low level of awareness towards the types of FGC practice, and there had been an opinion that some types are not harmful [7, 8].

Although the numbers of girls and women affected by FGC, is distressing, a recent report by United Nation Children’s Fund (UNICEF), indicates that there has been a slow decline in the overall prevalence of FGC over the past decades. Moreover, the same report shows that younger women, in 28 African countries, are less likely than older women to have experienced any form of FGC, indicating a generational shift towards ending the practice [9]. Despite the progress made in some countries, many girls are still at risk of FGC, due to its association with marriageability, religion, chastity, female honor, beauty, and aesthetics.

This study examined pupil’s perspectives toward the abandonment of FGC in Somali and Harari regions of eastern Ethiopia. The findings of this study provide important information, on the opportunities for intervention and to formulate efficient FGC programs in regions with high prevalence of FGC in Ethiopia. According to the study result, participants who got information only from one source were less likely to support the abandonment of FGC when compared to those who have received information from different sources (AOR = 0.567, 95% CI = 0.333–0.967). This implies that the more people are exposed to different sources of information, the higher the probability of knowing the harmful effect of FGC, and change their attitudes toward the practice. This study is supported by a study on FGC in the United States, Ghana, Gambia, and Kenya, which stated that mass media were the main source of information which influences the process of understanding about the practice among the general public as well as policymakers [18]. Other studies have also supported our findings by stating that people who are aware of the negative health consequences of FGC are more likely to support the discontinuation of FGC [14, 18, 19].

Surprisingly, this study shows that most of the girls reported that they were not circumcised, and the majority of them were from the Harari region. While 15.8% of girls at Harar were circumcised, over half of the girls in the Somali region, have experienced FGC. The high number of circumcisions in the Somali region might be due to the deep-rooted culture, whereby the family is the decision maker for circumcisions, and the practice is considered as the criteria for marriage. This finding was supported by the qualitative study done in Somali and Harari regions, where the majority of women discussants noted that they perform the procedure due to fear of the stigma and discrimination by the community, and to prepare their daughter for a proper marriage [20]. Another study also supported by stating that the family is the one who decided for circumcision. Which was seen as the cut status of a mother is associated with the cut status of her daughter [21].

The high number of uncircumcised girls may be due to the awareness creation at the school level, at the community level and the information which they (the girls) got from multiple sources may help them to recognize the harmful effect of FGC. This study is supported by other studies which stated that the prevalence of FGC among girls is declining and the decision to send girls to school (for education) plays a great role in changing the positive attitude of girls toward FGC [22‐24]. UNICEF reported that FGC prevalence rates among girls aged 15 to 19 have declined in some African countries, and FGC should end. There has been an overall decline in the prevalence of the practice over the last three decades among girls and women, but not all countries have made progress, and the pace of decline has been uneven [25, 26]. These indicated that there must be the subsequent legislation against FGC, and providing convincing reasons to abandon the practice, by strengthening a partnership among governments, religious leaders, an influential people, young people, and the schools, to transfer knowledge about the harmful effects of FGC to end the practice.

The present study also shows that Participants with primary level education and those with lower age group (16 years) were less likely to support the abandonment of FGC when compared to those with secondary level education and with a higher age group (17–22 years) respectively. This indicated that children in the lower age are more influenced by their parents than their peers. Decision-making processes for FGC are often led by older female relatives, including mothers and grandmothers, as they have the sole responsibility of making this happen as a sign of fulfilling their social responsibility. In the Ethiopian context, where there is respect for families, it is extremely difficult for younger children to influence those decisions. This study is supported by WHO fact sheet, which stated that FGM/C is mainly carried out on young girls under the age of 15 years old who often have little choice in the matter [27]. Another study also stated that older mothers had more positive attitudes toward female genital mutilation, felt more social pressure and had a greater intention to allow their daughters to undergo FGM/C [27]. Nell Williams (2014), wrote about Ethiopian girls and women about FGM/C, which stated “every mother wants to keep her children close, under her care, the high school is far away. If they send her, she might get abducted” [28].

On the other hand, children with the higher age (young people) are more influenced by their peers and exposed to multiple media like Facebook and the internet, to learn the ill effect of FGC. On top of this, education plays a great role, and powerful, in changing the attitude of young people (particularly of young girls). Moreover, the training at the school level and awareness at the community level enable them to identify the harmful effect of FGC. This study is supported by a study done in Burkina Faso which stated that education plays a better role for girls and women, to understand the negative health consequences associated with FGC [29]. Another study in Egypt stated that women living in the urban areas, having a higher level of education/literacy, and those who were working, were more likely to support the discontinuation of FGC [14]. Other studies also stated that literate, better educated and employed women are more likely to oppose FGC [30, 31]. These imply that there is a need to work on women’s education and empowerment to change their positive attitude towards the practice for the abandonment of FGC.

One of the major findings of this study is that the majority of the young study participants supported the abandonment of FGC (82%). This could be due to the result of different awareness-raising campaigns in the regions, and the provision of FGC education in schools as compared to the previous times. Furthermore, school based awareness which emphasized FGC health complications, may contributed to the young people to support the abandonment of the practice. This study is supported by the study done among school boys and girls in the Somali and Harari regions which stated that, FGC cause problem during delivery (63.4%), cause infection (55.3%), cause pain during sexual intercourse (64.3% ), cause bleeding (44.7%) [32], and the majority (86%) of the respondents, condemned the continuation of the practice (FGC). Another study also reported that FGC causes bleeding, shock, genital tissue swelling, fever, infections, and problems with urination and wound healing [33]. This implies that FGC awareness based on its health complications may have potential power to facilitate the abandonment of FGC. The abandonment of FGC requires the effort of the entire community, to create an enabling environment for change [34]. Therefore, efforts to end the practice need a collective approach to address the entire communities in ways that can decrease the social expectations to perform FGC [31]. To promote community-wide abandonment of FGC, community-led programs based on participatory methods, and women empowerment is curtailed [34]. The result of this study is in line with the study by UNICEF which stated that a moment of public affirmation of commitment is required to abandon the practice, so that each individual is assured that other community members are willing to end FGC, and leads Families able to change their social status of cutting and protect their daughters from harm [35]. Another study also supported the abandonment of FGC by stating that information gained from multiple sources might help the participant to internalize the problem and make an attitudinal change to design FGC abandonment [36]. To bring FGC abandonment to reality, the approaches should be based on holistic, community-based, and human rights education, to promote the social transformation among individuals, families, and to the entire community, who would forever end FGC, and quickly motivate the remainder of the intermarrying population [11, 37].

In contrast, the qualitative study done in the Somali and Harari regions/Ethiopia stated that women living in the Somali region were more likely to support the continuation of FGC. As expressed by a 52- year-old female from Somali, “We Somali women know the harmful effect of FGC. We are suffering throughout our life. Despite this all, no Somali mother wants her daughter left unmarried due to this existing culture, “Marriageability” that is why we support the continuation of FGC.” [20]. There are varies studies which support the continuation of FGC, such as the study done in Egypt, which stated that up to 82% of the women supported the continuation of FGC [30]. Studies done in Hargeisa district/Somalia also stated that although people are aware of the harmful effect of FGC, they support the continuation of the practice and there is a strong resistance towards the abandonment of the practice [35, 36]. Other studies in Ethiopia stated that families are forced to practice FGC, due to fear of stigma and discrimination by the community. The study further stated that the practice is extremely common among illiterate, rural resident, and Muslim religion, due to strongly and personally held beliefs for deviating from community norms, and fear of GOD’s punishment, if not cut their daughters [24, 31, 37, 38]. The aforementioned studies, however, targeted the attitudes toward the practice among adult people, while our study focused on young people, who are students, which implies a high level of literacy and potential exposure to social media among participants in our study.

The present study has limitations. The self-reported answers might have been to some extent in social desirability bias. Moreover, the study participants were students where 17.1% and 45.4% of females were literate in Somali and Harari regions respectively [39], while the majority of the people in the two regions are illiterate. Therefore, the generalization of the result of this study to the people in Somali and Harari regions should be avoided.

The study result shows that multiple information channels that include school-based awareness campaigns were found to be the best way to support the abandonment of FGC. That means information from different sources is the powerful tool to disseminate the harmful effect of FGC among the study population. This was reflected in the study by the high proportion of support toward the abandonment of FGC, and the high number of Female study participants who didn’t experience circumcision. Although the study result demonstrates an increased perspective towards the abandonment of FGC among the study subjects, FGC abandonment is the unfinished agenda which is highly linked and reinforced by societal norms. Thus, to quicken the perpetuation of FGC in the stated Regional States, awareness creating campaigns that change the attitudes of youths towards the practice should be delivered through various sources. In this regard, school-based education, school mini-media, and social media could play significant roles in changing the pupils’ attitudes towards the practice. More importantly, using the co-curricular activities to uncover the danger of this harmful practice could make students change their attitudes towards it (FGC).