Determinants of Support for Female Genital Mutilation and its Practice on Young Girls in Northern Iraq

doi:10.21203/rs.3.rs-5297115/v1

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Determinants of Support for Female Genital Mutilation and its Practice on Young Girls in Northern Iraq

https://doi.org/10.21203/rs.3.rs-5297115/v1

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Introduction: Female genital mutilation (FGM) is a widespread practice that affects millions of girls and women worldwide, violating their human rights and posing significant health risks. This study aims to explore the determinants of support for FGM and its practice on young girls in Northern Iraq.

Methods: A cross-sectional study was conducted in three cities, and data were collected from 348 women who had undergone FGM and had at least one daughter. The study employed logistic regression analysis to identify the factors influencing agreement with performing FGM and having a daughter undergo FGM.

Results: Approximately 10% of women agreed with performing FGM, and 7% reported that their daughters had undergone the procedure. However, among those whose daughters had undergone FGM, a small subgroup expressed disagreement and held strong beliefs against its future occurrence. Religious recommendations and traditional practices were the main reasons cited by women for supporting FGM. Age, education status, marital status, and age of the daughter were found to be significant determinants. Notably, women with daughters above 10 years old and illiterate women exhibited higher odds of supporting FGM. Additionally, women with illiterate husbands were more likely to support the practice.

Discussion: This study highlights the persistence of FGM in Northern Iraq and identifies key determinants associated with its practice. Efforts to eradicate FGM should focus on addressing sociocultural factors, promoting education and awareness, and engaging religious leaders and communities. By understanding the motivations behind FGM and targeting interventions accordingly, progress can be made towards achieving the Sustainable Development Goals and advancing gender equality.

Female genital mutilation (FGM)

Determinants

Northern Iraq

Female genital cutting, also known as female genital mutilation (FGM), encompasses all procedures involving the partial or complete removal of external female genitalia or other forms of injury to the female genital organs for non-medical reasons. It is a widespread issue affecting over 200 million girls and women worldwide [1], each year, 3 million women and girls are added [2]. FGM is practiced by numerous ethnic groups in 27 African countries, as well as in Iraq, Yemen, Indonesia, and among migrant populations from communities where FGM is prevalent [3]. The United Nations and WHO recognize FGM as a violation of human rights, and its eradication is an integral part of the Sustainable Development Goals (SDGs) [4]. Therefore, eradication of FGM by the end of 2030 is a critical objective within the framework of SDGs. This endeavor serves as a significant stride towards advancing gender equality [5]. FGM is associated with different health consequences and even death. The practice can result in pain, bleeding, infection, and urinating problems as immediate health consequences. Chronic infections, cysts, chronic pain, birth complications, and sexual and emotional suffering are examples of long-term consequences of FGM [6].

Although there has been a gradual decline in the practice of FGM, it continues to pose a considerable threat to the health and overall well-being of individuals in diverse communities [7]. Motivations for FGM vary across different contexts and individuals, but they are predominantly driven by sociocultural factors. FGM is often believed to ensure virginity before marriage, promote sexual restraint, enhance marriage prospects, improve fertility, and prepare girls for their roles as wives and mothers [8, 9]. Despite predating major religions, FGM continues to be perpetuated in some religious communities. The physical and psychological consequences of FGM are significant, yet in communities where it is practiced, these consequences are often disregarded, disconnected from the practice itself, or considered outweighed by perceived benefits [10].

FGM is a global phenomenon, but its prevalence is primarily concentrated in certain regions of Africa and Asia. Additionally, FGM is practiced in specific areas of Iraq, where approximately 7.4% of girls undergo circumcision annually [11]. In the Kurdistan region of Iraq, an autonomous region in northern Iraq, the prevalence of FGM is notably higher, with an estimated prevalence rate of approximately 40–58% [12].

Examining the perspectives and experiences of women who have undergone FGM is crucial for gaining insights into the impact of this practice, formulating effective strategies to eradicate it, and updating the existing knowledge base regarding FGM in Sulaymaniyah.

Study Design and Setting:

This cross-sectional study was conducted in 2024 in three cities of Halabja, Chamchamal, and Rania in Iraq. The study population consisted of women with a history of FGM who had at least one daughter. The sample size included 360 participants, with 120 women selected from each city through convenience sampling among women attending healthcare centers. These women were then asked about their history of FGM, and those who had undergone the procedure and expressed willingness to participate were included as study samples. Data for this study were collected using a researcher-developed checklist and completed through interviews with women with a history of FGM, conducted by three midwives. The checklist included questions about women's attitudes towards FGM, reasons for its practice, and necessary strategies for eradicating FGM.

Statistical Analysis:

Descriptive statistics were used to summarize the demographic characteristics of the participants, including age, education status, and marital status. The prevalence of agreement with performing FGM and having a daughter undergo FGM was calculated. Logistic regression analysis was conducted to identify the determinants of agreement with performing FGM and having a younger daughter undergo FGM. Crude odds ratios (ORs) with 95% confidence intervals (CIs) were calculated initially. Adjusted odds ratios were obtained by removing variables with little effect on the dependent variable in the adjusted models.

Ethics statements

All procedures performed in studies involving human participants were approved by the Ethics Committee of the Sulaimani Polytechnic University under the ethics code No. 139.24. Also, informed consent was obtained from all subjects or legal guardian/Legally authorized representatives of illiterates.

The study included 348 women who had undergone FGM, all of whom had at least one daughter (Table 1). Among them, 46.3% (161 individuals) fell within the age range of 40 to 45 years. Interestingly, the majority of the youngest daughters, comprising 52.9% (184 individuals), were older than 10 years. Additionally, it was observed that 12.1% (42 individuals) of the women were unable to read or write, and an equal proportion of 12.1% (42 individuals) had illiterate spouses. Furthermore, a notable 16.7% (58 individuals) of the women were widowed and living independently.

Table 1

Descriptive statistics of demographic variables of the women who had underwent FGM and had at least one daughter (n = 348)
		No	%
Age
	40>	111	31.9
	40–45	161	46.3
	45–50	76	21.8
Age of Daughter
	10≥	164	47.1
	10<	184	52.9
Education status
	Illiterate	42	12.1
	Primary	96	27.6
	Middle school	113	32.5
	High school and Diplom	60	17.2
	Academic	37	10.6
Husbands' education status
	Illiterate	27	7.8
	Primary	106	30.5
	Middle school	111	31.9
	High school and Diplom	67	19.3
	Academic	37	10.6
Marital Status
	Married	290	83.3
	Widow	58	16.7
FGM: Female genital mutilation

Table 1.

10% (34 individuals) of women who underwent FGM expressed agreement, with the majority citing religious recommendation (85%) and traditional practices (82%) as the main reasons supporting FGM (Fig. 1).

Figure 1

Based on Fig. 2, within the group of women who had undergone FGM, a total of 7% (25 individuals) reported that their daughters had also undergone FGM. Out of these 25 individuals, 4 belonged to women who held opposing views regarding the practice for their daughters. It is noteworthy that among this subgroup, 8 individuals expressed their disagreement with FGM and held strong beliefs against its future occurrence.

Figure 2

Table 2 presents the determinants of agreement with performing FGM and having a smaller daughter undergo FGM in both crude and adjusted models. In the crude model, the majority of variables were found to be significant determinants of agreement with performing FGM and having a smaller daughter with FGM (p < 0.05). For instance, females in the 45 to 50 age group had 3.7 times higher odds (p = 0.003, 95% CI: 1.58–8.72) of agreeing with performing FGM and 4.84 times higher odds (p = 0.002, 95% CI: 1.74–13.46) of having a smaller daughter undergo FGM compared to females below 40 years of age. Additionally, for women whose youngest daughters were above 10 years old, the odds were 22.1 times higher (p < 0.001, 95% CI: 12.19–43.67) for agreement with performing FGM and 6.61 times higher (p < 0.001, 95% CI: 2.22–19.69) for having a smaller daughter with FGM. Illiterate women also showed significantly higher odds, 12.78 times (p = 0.018, 95% CI: 4.56–43.60) for agreement with performing FGM and 6.61 times (p = 0.025, 95% CI: 3.36–32.80) for having a smaller daughter with FGM. Also, mothers who were agree with performing FGM were more likely to have a daughter subjected to FGM (p > 0.05).

In the adjusted models, the independent variables that had little effect on the dependent variable were removed to obtain the desired model. Women whose youngest daughters were above 10 years old had 36.9 times higher odds (p < 0.001, 95% CI: 8.13–67.93) for agreement with performing FGM and 10.1 times higher odds (p < 0.001, 95% CI: 3.16-32.00) for having a younger daughter undergo FGM. Illiterate women had 49.0 times higher odds (p = 0.010, 95% CI: 5.39–84.24) for agreement with performing FGM and 28.9 times higher odds (p = 0.002, 95% CI: 3.28–74.65) for having a younger daughter undergo FGM. Women with illiterate husbands had 10.3 times higher odds (p = 0.036, 95% CI: 1.16–25.38) for agreement with performing FGM (Table 2).

Table 2

Table 2

logistic regression results for determinants of Agree with performing FGM and Having a smaller daughter with FGM
		Agree with performing FGM`				Having a smaller daughter with FGM
		OR (95% CI)	P-value	AOR (95% CI)	P-value	OR (95% CI)	P-value	AOR (95% CI)	P-value
Age
	40>	1.00				1.00
	40–45	1.33 (0.52–03.39)	0.547			1.79 (0.59–5.32)	0.332
	45–50	3.71 (1.58–8.72)	0.003			4.84 (1.74–13.46)	0.002
Age of Daughter
	10≥	1.00		1.00		1.00		1.00
	10<	22.06 (12.19–43.67)	< 0.001	36.96 (8.13–67.93)	< 0.001	6.61 (2.22–19.69)	0.001	10.05 (3.16-32.00)	0.001
Education status
	Academic	1.00				1.00
	Illiterate	12.77 (4.56–43.60)	0.018	49.02 (5.39–84.24)	0.010	11.25 (3.36–32.80)	0.025	28.89 (3.28–74.65)	0.002
	School Education	3.21 (0.42–15.52)	0.262	6.64 (0.56–31.23)	0.070	1.98 (0.252–15.48)	0.517	3.58 (0.45–28.38)	0.227
Husbands' education status
	Academic	1.00				1.00
	Illiterate	6.26 (1.66–20.57)	0.111			10.29 (1.16–25.38)	0.036
	School Education	4.09 (0.54–30.98)	0.172			2.44 (0.32–18.80)	0.393
Marital Status
	Widow	1.00				1.00
	Married	0.51 (0.23–1.17)	0.112			1.05 (0.35–3.19)	0.926
Agree with performing FGM
	No	…				1.00		…
	Yes	…	…			125.19 (37.53-217.59)	< 0.001	…	…
AOR: The stepwise regression method by adding or removing predictor variables to obtain the most parsimonious model

The current study results indicate that 10% of women subjected to FGM consented to the procedure. The majority attributed their agreement to religious recommendations and traditional practices as the main reasons. In Egypt, this percentage was around 30%, with religious and social reasons being the major factors [13]. In Ethiopia, 48% of respondents favored continuing FGM, and 47% stated that they would have it performed on their children due to issues related to traditions, culture, and community values [14]. Another study conducted in Egypt reported that 82% of participants mentioned social and cultural reasons [15]. In another study conducted in Djibouti, tradition and culture were identified as the primary factors [16].

The findings of this research demonstrate that the attitudes towards FGM and the likelihood of subjecting their daughters to FGM are influenced by various factors. Among the factors investigated, the age of the youngest daughter, and the literacy levels of women and their husbands play a significant role. Women whose youngest daughters are over 10 years old are more than 36 times more likely to consent to FGM. Additionally, women's illiteracy increases the likelihood of FGM consent by more than 49 times. Studies conducted in African countries indicate that higher education among women has contributed to a reduction in the prevalence of FGM [17]. These findings are also consistent with a study conducted in rural communities in Nigeria, where participants without formal education are more likely to accept and engage in FGM [18]. Studies in Ethiopia have similarly shown that higher maternal education is associated with a lower likelihood of FGM among women [19]. This result aligns with a study conducted in a Sudanese village, which revealed that a woman's education level plays a significant role in her decision-making and attitude towards this practice [20]. This finding is consistent with a study conducted in Sudan, reporting a higher prevalence of FGM/C among the impoverished population [21]. Poverty restricts individuals' access to education and, as a result, can be a major obstacle for women to become aware of the harmful effects of FGM or gain knowledge about it. In other words, educated women are more likely to evaluate the advantages and risks of FGM before making a decision [22].

Similarly, high levels of FGM were observed in Sudan and Sierra Leone for each age group, indicating a significant prevalence of FGM among women in these countries [21, 23]. Furthermore, mothers at older ages were found to have a higher likelihood of being affected by FGM in 19 Sub-Saharan African countries [24]. The present study also revealed that women with younger daughters over the age of 10 were more inclined to support the circumcision of girls. It is presumed that younger respondents are more likely to have received education, which increases their exposure to FGM education and the associated harmful effects, thereby influencing their decisions [25].

Furthermore, the results of this study indicate that women whose youngest daughters are over 10 years old are 10 times more likely to subject their daughters to FGM. Additionally, women with low literacy levels are more than 29 times more likely to practice FGM on their daughters. Similarly, women whose husbands have low literacy levels are also more than 10 times more likely to consent to FGM. Higher education among mothers in African countries [9, 24] and the Eastern Mediterranean region [26, 27] has been shown to decrease the likelihood of families opting for FGM for their daughters [21]. Similarly, in West Africa, women without formal education were over 4 times more likely to subject their daughters to FGM in the future [25]. In Nigeria, a significant proportion of women in rural areas expressed the intention to perform FGM on their daughters in the future. It is expected that women in rural areas have lower educational levels and limited access to information and media compared to women living in urban areas [19].

Furthermore, we found that there is a correlation between fathers' lower education levels and mothers' positive attitudes towards FGM, as well as the practice of FGM on their daughters. Similarly, studies indicate that a significant portion of fathers in families had involvement in the decision-making process regarding FGM, and therefore, a higher education level of fathers played a protective role against FGM [28, 29], although in some studies, no association between fathers' education and FGM was found [2]. Ultimately, as the results showed, mothers who had a positive attitude towards FGM were highly likely to have a daughter subjected to FGM. Similar studies also demonstrated that mothers who had a positive attitude towards the continuation of FGM were more likely to have their daughters exposed to FGM [27, 30].

The present study has some limitations, including the limited scope of identifiable variables considered. Additional factors such as wealth, religion, occupational status and employment, knowledge of FGM, village/urban residency, and other related factors could have potentially enriched the study's findings and analysis.

Several determinants of agreement with performing FGM and having a younger daughter undergo FGM were identified. Factors such as age, education status, age of the youngest daughter, and husband's education status were found to have influential associations with support for FGM. Efforts should focus on addressing sociocultural norms, promoting education and awareness, and engaging religious and community leaders to challenge the misconceptions and harmful beliefs associated with FGM. Additionally, empowering women and girls through education and providing alternative opportunities can contribute to changing attitudes and behaviors related to FGM.

Financial support and sponsorship

This study did not receive any kinds of funding resources.

Conflicting Interest (If present, give more details):

The authors declare that they have no conflicts interests.

Author Contribution

Authors Contributions Conceptualization: Farman Zahir Abdullah and Azad Shokri.Data curation: Bakhtiar Piroozi and Farman Zahir Abdullah.Formal analysis: Azad Shokri. Methodology: Bakhtiar Piroozi and Azad ShokriSupervision: Farman Zahir AbdullahWriting: Bakhtiar Piroozi, Farman Zahir Abdullah and Azad ShokriAll authors have read and approved the final version of the manuscript

Acknowledgments

The authors of this article would like to thank all the participants who took part in this study.

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No competing interests reported.

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Determinants of Support for Female Genital Mutilation and its Practice on Young Girls in Northern Iraq

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Introduction

Materials and Methods

Statistical Analysis:

Ethics statements

Results

Discussion

Conclusion

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Author Contribution

Acknowledgments

References

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