Female genital mutilation/cutting refers to all procedures involving the removal of part or total female external genitalia & injuries to female external genitalia for non-medical reasons(1). World Health Organization (WHO) classified female genital mutilations/ cutting (FGM/C) in to four types: Type I is named as Sunna and Clitoridectomy. Type II (excision), Type III (infibulations) and Type IV is unclassified FGM(2).
Any type of FGM is internationally recognized as violence against human rights of girls & women which violets the right to physical integrity, right to life, the right to freedom from torture or cruel act & right to health(1, 3).
Globally, more than 125 million girls & women alive today have undergone FGM in 29 countries of Africa, Yemen, Asia & Middle East where the practice is concentrated(1). Globally, more than 70 million girls under 15 years have been cut or are at risk of FGM. More than 35 million girls under 15 years are living in Egypt, Ethiopia, Indonesia & Nigeria. Among these 3.6 million girls are at risk of FGM every year (3).
Ethiopia was classified among moderately high prevalence countries with FGM of 74% (3).According to EDHS 2016 the national prevalence of FGM among girls & women aged 15–49 years is 65.2% and in Oromia region it is 76.5% (4, 5). The prevalence of FGM in under 15 years girls in Ethiopia was 16%(4, 6) whereas study done in Habobo Guduru shows that 48% of girls under 15 years have been cut(7).
Although reasons for FGM vary from country to country, from culture to culture & from ethnic to ethnic, the commonest are girls should respect, obey cultural and social norms related to sexual control, womanhood and maturity, to controls girl’s hyper sexuality, promiscuity, preserves virginity, avoids disfigurement and unhygienic environment of female genitalia(1, 3, 8–11). In Afar & Somali, it is believed that infibulations protects rape(12).
Eradication of FGM had pertinent relation to SDGs 1&2( no poverty and zero hunger), goal 3(good health and wellbeing), goal 4(quality education), goal 5(gender equality), goal 8( economic growth) etc.(12, 13).
Perception is the process by which a person interprets and organizes sensation (see, touch, feel) to produce a meaningful experience of the world. Perception is defined as the way youthink about something, the way you notice things with your sense organs, the ability to understand or notice things quickly. It is also defined in philosophy, psychology and cognitive science as the process of getting awareness or understanding of sensory information. Perception is subjective interpretation and is one among components of attitude where attitude has components like perception/thoughts, feelings or belief/ and behavior/practice/(14, 15).
Perceiving the severity of health consequences of FGM affects health behavior practice. Individuals who well perceived the severity of FGM might have no likely hood of involving in the practice of FGM. In other word, wrong perception of respondents towards health consequences of FGM couldn’t bring attitudinal changes which in turn makes elimination of the practice of FGM difficult(12, 13).
The health extension package launched since 2003 was one of the strategy to address harmful traditional practices like FGM etc. through health education and promotion employing more than 42,000 female health extension workers(17).
Since 2016, Ethiopia also addressed FGM in Second Growth and Transformation Plan (2015/16-2019/20), National Adolescent and Youth Health Strategy (2016–2020) and refreshed its commitment to end FGM/C and child marriage by 2025(4, 10).
Ethiopia launched strategic action plan to improve awareness or perception towards the harms of FGM on economy and health of girls and women. Among activities done, awareness raising and social mobilization to bring attitudinal changes through community conversation, empowerment of girls and women through training, skill building, sharing information, religious based interventions, ‘iddir’, folksong social media to increase girls’ & women’s perception of health problems of FGM (18, 19).
But, lacking coordination among institutional structures, non-uniformity of awareness creation activities in entire country, financial or resource constraint, unsustainable intervention activities, absence or low legal support, deep rooted cultural and religious beliefs that promote FGM in many parts of the country, low level of awareness at grass root level and rural areas are the challenges to eliminate harmful traditional practices like FGM (19).
Female genital mutilation has a direct harmful effect on reproductive health of women that is an irreversible damage to female external genitalia that has immediate & long term complications(20).
Hemorrhagic and neurogenic shocks, severe pain, urine retention, infection (HIV/AIDS infection and tetanus) are some of the immediate complications. Damage to adjacent organs, pain during sex, failure of the wound to heal, formation of abscess, dermoid cyst, kelloid scar, narrowing of the opening of vagina so that difficulty in passing head of the new born, excessive bleeding during delivery, risk of caesarian section, episiotomy, and death(estimated 100, 000 teenagers death per year during child birth due to complications related from FGM etc. are the long term complications(2, 3, 21).
Degree of severity of complication depends on the type of FGM performed, cleanliness of instrument used and skill of the person who performed the procedure. Type I & II having less severe, but type III (infibulations) results in more severe complications(3).
A study conducted in Nigeria shows that 26.3% of women didn’t perceive FGM has gynecological problems (22). Other study conducted in Nigeria also shows that 47.2% 36.8%, 31.1% and 36.8% of women didn’t perceive FGM can result in dyspareunia, excessive bleeding during procedure, infection and incontinence respectively (23).
Studies conducted in West Shewa and Bale Zone of Ethiopia reveal that 11.6%, 63% of women didn’t perceive FGM has health consequences respectively(24–26). Study conducted in West Shewa shows that 40.5% of women didn’t perceive the immediate complications of FGM and study at Kersa, West Hararge shows 68.8% of women didn’t perceive any health complications of FGM(24, 26). These studies show large number of women had low perception towards health consequences of FGM.
Wrong perception towards health consequences of FGM is believed to result in attitude towards continuation of FGM which makes eliminating or ending FGM programs difficult. Studies show women’s perception towards complications of FGM was low in Ethiopia(19, 24) and as far as the knowledge of the investigator, there is no or scarce study done on similar topic. Thus this study was aimed to determine the prevalence of wrong perceptions towards health consequences of FGM and associated factors among women in Adama District.