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Sex Roles, Vol. 17, Nos. 3/4, 1987

Prevalance of Female Circumcision in Two Nigerian Communities Ehigie Ebomoyi 1 University of llorin, Kwara State, Nigeria

A study conducted to determine the prevalence of female circumcision in two Nigerian communities revealed that over 90% o f the females interviewed were themselves circumcised. The majority o f the respondents (over 50% do not support the elimination o f the practice. Their reasons for supporting female circumcision were adherence to cultural and traditional heritage, attenuation o f the sexual urges o f young females, reduction o f clitoral growth, and use as a device to enhance childbirth. Grandfathers and fathers were reported by over 36% o f the respondents to be more concerned about female circumcision. Traditional healers were the principal health care providers who perform this surgery. The strategies to eliminate this practice were discussed.

The practice of female circumcision is widespread not only in Africa but also in other continents of the world (Hathout, 1963). Its origin dates well back into history and could have originated as an initiation ceremony of young girls into womanhood (Bella, 1980). A Greek papyrus dated 163 B.C. made specific reference to female circumcision. Although female circumcision was said to be prevalent in all continents of the world, the practice was more common among the Phoenicians, Hittites, Ethiopians, Arabians, Syrians, Malaysians, Indonesians, and Africans (Baasher, 1977). Researchers have contended that no single continent was exempt from this custom of female mutilation. Currently, this practice has long been extirpated in many continents except in some of the African countries (Assaad, 1982). Sanderson

~The author gratefully acknowledges the critical comments of the anonymous reviewers. Their comments have improved the quality of this paper. This study was supported by the University of Ilorin Senate Research Grant on Primary Health Care. 139 03604~025/87/0800-0139505.00/0 © 1987 Plenum Publishing Corporation

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(1981) gives a conservative estimate of 70 million women in Africa who are affected.

Types o f Female Circumcision Female circumcision is the excision of the little hood that covers the clitoris, but the term is also used to include the partial or complete surgical removal of all or part of the female genitalia (Onad.eko & Adekunle, 1982). Infibulation refers to the removal of the hood, the entire clitoris, the labial minora, and the adjacent medial part of the labial majora. Additionally, the two sides of the vulva are sewn together by catgut sutures, making allowance for a small opening for urine and menstrual flow. (Anonymous, 1981; see Fig. 1). There are four major types of female circumcision practiced. Circumcision proper is recognized as type 1. This is the circumferential excision of the hood of the clitoris. This surgical technique is sometimes performed in the United States to redress the failure to attain orgasm by women experiencing frigidity or phimosis of the female prepuce (Rathmann, 1959). The second type involves the excision of the hood of the clitoris and the glans clitoridis, or the clitoris completely. The third type is referred to as infibulation or Pharaonic circumcision. As previously described, the entire clitoris, including the whole of the labial minora, and at least the anterior two thirds and often the whole of the medial part of the labial majora, are excised. The two sides of the vulva are then stitched together either with a silk or catgut sutures (in the Sudan), or by thorns in Somalia. This procedure obliterates the vaginal introitus except for a small orifice made posteriorly to allow for the passage of urine and menstrual blood (Cook, 1976). The fourth type, which was practiced by the Pitta-Patta ethnic group of the . ......... ~...... 7-"i '.

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Female Circumcision in Nigeria

141

Australian aborigines, necessitates the enlargement of the vagina orifice at puberty by surgiciaUy tearing it downwards or splitting the perineum with a locally fashioned stone knife (Cook, 1976; Melly, 1935). In Nigeria, the practice of female circumcision varies among different ethnic groups and the type of operation depends on the religious and traditional beliefs of the people. In southern Nigeria, where Christianity and Animism are the predominant faiths, the procedure commonly employed among the Ibos is the surgical removal of the clitoris with or without the labia minora (Agugua & Egwuatu, 1982). Among the Edo and Yoruba ethnic groups of southern Nigeria, clitoridectomy is the type widely practiced. Among the former ethnic group, the traditional healer is labeled as a quack if he or she tampers with either the labia minora or the labia majora. In northern Nigeria, only the partial excision of the clitoris is employed and the same procedure is adopted in the north of Ghana (Ebomoyi, 1985). Several medical complications are regularly experienced with infibulation and the fourth type that necessitates the splitting of the perineum with a stone knife. The adverse consequences include septicaemia, partial labial fusion, implantation dermoid, introital stenosis, urinary tract infection, and hemorrhage (Agugua & Egwuatu, 1982; Asuen, 1977; Dareer, 1983; Ebomoyi, 1985). This study was conducted in the northwestern area of Nigeria where the majority of female children are circumcised in early infancy. However, the age and period at which female circumcision is performed varied according to the ethnic group. The Yorubas in Oyo State, Urhobo, and the Edo ethnic groups of Bendel State in southern Nigeria, perform this practice in infancy and early childhood. The Isoko ethnic group of Bendel State and the Hausas in the northern states circumcise their females just before marriage. The Igbos in Abakaliki celebrate this ritual at puberty, and the Ogbaru ethnic group in Anambra State and the Igbomina-Ekiti ethnic group in Kwara State circumcise their females at the third trimester of first pregnancy (Adetoro & Ebomoyi, 1986; Iregbulem, I980; Mustapha, 1966). The present study was designed to assess the prevalence of female circumcision in two communities in Kwara State, Nigeria. Also assessed were the factors underlying the practice of female circumcision, the willingness of respondents to circumcise their daughters, and the effective approach to eliminate this harmful practice.

METHODS

Questionnaire interviews were conducted at two communities in the outskirts of Ilorin, the capital of Kwara State, Nigeria, which has a population

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of about 400,000 (Watts, 1984). The two study sites were Shao and Okelele. Using the "de jure" technique, the population census conducted in Shao by the writer revealed that there were 434 houses with 3,756 females and 3,510 males. The village contained two primary health care (PHC) centers and three outpatient medicine stores. The census of Okelele reported by Watts (1984) revealed that there were 328 houses at Okelele inhabited by 1,733 females and 1,808 males. The community contains a PHC center and over five patient medicine stores. In each of the two communities, males and females of childbearing age made up over 58°70 of the total population. Since each of the two communities was relatively small, every house was visited and a stratified random sampling technique was used to select an equal number of male and female respondents. A total of 2,300 respondents were interviewed in the two communities. Every house was visited, 575 men and the same number of women of reproductive age were interviewed, and information on age, sex, marital status, religion, ethnic group, occupation, and state of origin was noted. The respondents were asked to explain their knowledge of and attitudes toward female circumcision. Inquiry was also made into the sociocultural rationales underlying the practice of female circumcision and the suitable strategy to eliminate this practice.

FINDINGS A total of 1150 men and 1150 women were interviewed at the two communities on the outskirts of Ilorin. Over 90°7o of the female respondents were themselves circumcised in their childhood. In the two communities, females were generally circumcised in their infancy when they were 7-10 days old. However, the circumcision of a sickly child is postponed to a much later period, but it must be performed before she attains puberty. Table I. Rationales Underlying the Practice of Female Circumcision at Shao and Okele, Kwara State, Nigeria Rationales Tradition and cultural heritage Circumcision can prevent female promiscuity Circumcision can prevent clitoral growth Circumcision enhances female fertility Circumcision enhances the cleanliness of the vagina Circumcision prevents the clitoris from infection

Okelele N = 1150 (100%) 58.6

Shao N = 1150 (100%) 69.3

13.3

8.4

10.5

7.6

3.5

6.0

3.5

0.3

0.8

0.8


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Table I1. Attitude of Respondents Toward the Circumcision of One's Daughter Agree

Okelele Disagree

Total

Shao Disagree

Agree

Total

Respondents

No.

(%0) No.

(%)

No.

(%)

No.

(%)

No.

(%)

No.

(%)

Female Male Total

566 569 1135

98.4 99.0 49.3

1.5 1.0 0.7

575 575 1150

100 566 100 569 50 1135

98.4 99.0 49.3

9 6 15

1.6 575 1.0 575 0.7 1150

100 100 50

9 6 15

Summarized in Table I are the stated rationales underlying the practice of female circumcision in the two communities. The main justification for female circumcision given by over 58% of the respondents from each community was that the practice constituted part of their cultural heritage. From Table II it can be observed that well over 90% of the persons interviewed agreed that they will circumcise any daughter born to them. As shown in Table III, the significant others whose views were highly respected in the practice of female circumcision included grandfathers, fathers, grandmothers, and mothers. In Nigeria, grandparents are the custodians of culture and morality. Among the various age cohorts, respondents willing to circumcise any daughter born to them were over 500/0 (Table IV). Presented in Table V is the educational status of respondents by their willingness to circumcise a daughter. Again, respondents willing to circumcise a daughter at each educational level was over 50%. In both communities well over 50% of the persons interviewed did not feel female circumcision should be discouraged on any of the following grounds: pain, severe bleeding, interference with orgasm, permanent emotional trauma, tetanus infection, and complication of childbirth (Table VI). On the suggested strategies to eliminate female circumcision (Table VII), over 46% of the persons interviewed did not feel eradication of the practice

Table III. Significant Others Who Care More For Female Circumcision in the Family Significant others Grandfathers Fathers Mothers Grandmothers Brother siblings Sister siblings Total

Okelele No. (%0) 690 (60) 420 (36.5) 29 (2.5) 11 (1.0) . . . 1150

100

Shao No. (%o) 609 (53) 466 (40.5) 35 (3) 29 (2.5) 11 (1.0) . 1150

100

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Table VII. Percentage Distribution of Suggested Strategies to Eradicate Female Circumcision by Sex

Suggested strategies Health education Government legislation Eradication of the practice is unnecessary

Okelele (N = 1150) Male Female Total (%) (%) (%) 36.5 48 42.25 13.5 1.5 7.5

S h a o ( N = 1150) Male Female Total (%) (%) (%) 38.1 51.0 44.5 9.5 2.5 6.0

50.0

40.5

52.4

46.5

49.5

100.0

100.0

100.0

100.0

100.0

50.25 100.0

is necessary. However, over 36% of the respondents in each community suggested health education, and over 9% recommended government legislation against female circumcision.

DISCUSSION The findings from this study revealed that the majority of the female respondents in the two communities surveyed were not only circumcised but supported the practice of female circumcision. Although over 58.0% of the respondents agreed that female circumcision is part of the traditional and cultural heritage in the two communities surveyed, the view that female circumcision can prevent female promiscuity ranks second of all the reasons advanced for their desire to continue the practice. That female circumcision can prevent clitoral growth and that it will enhance childbirth were ranked as third and fourth salient rationales. (Table I). As elicited from the study sample, the circumcision of female children in the two communities is performed about seven days after delivery of the infant. For the sickly female infant, circumcision can be postponed but must be performed before she attains puberty. For this category of female children, they can be exposed to both physical and psychological trauma. In situations where female circumcision is performed by the unskilled traditional healer, who works under septic conditions and without prior hematological problem-related consideration, several complicaions can ensue. These include genital sepsis, septicaemia, patial labia fusion, hemorrhage, implantation dermoid, deep scarred tissues, apareunia dyspareunia, and tetanus (Adetoro & Ebomoyi, 1986; Taba, 1980). The two uniovular twins, who are the traditional healers performing circumcision in the study area, opined that the complications associated with female circumcision occur when done by unskilled traditional healers. Their

Ebomoyi

148

contention was that this practice cannot be wiped out in their lifetime because of the traditional essence of the practice. The practice of female circumcision is ethnically linked in Nigerian communities. There are quite a few ethnic groups where the practice is not acceptable to the general public. These include the Egbas and Ijebus of Ogun State, the Itshekiris of Bendel State, and some calabarians of the Cross River State of Nigeria. Earlier researchers in Senegal have observed similar ethnic differences where the Fula and Toucoulese women circumcise their daughters, and the Wolofs refrain from circumcision (Onadeko & Adekunle, 1985). From Table II, it can be observed that the majority of the respondents (over 90%) were willing to circumcise any daughter born to them. However, 99% of the males in the two communities were willing to have any of their daughters circumcised. As presented in Table III the majority of the significant others who cared more for female circumcision were grandfathers and fathers in the two communities. This observation was confirmed by Dareer (1983) who maintained that fathers generally play a passive role that really amounts to indirect approval and that "they do in the fact participate in the subjection of their daughters and sisters to the ordeal." (Dareer, 1983; p. 143).

Control o f Women's Illicit Sexuality and Reproduction Shao and Okelele have a family system in which a female can have only one husband while the male is free to be polygamous. As a result, there is a strong need in this male-dominated society to restrict women's sexuality. Viewed from the materialistic perspective, because marriage is an event that both fathers and daughters look forward to, efforts are made by fathers to protect their daughters' virginity and their reputation for virginity until marriage. In communities such as Okelele and Shao, where both polygamy and the extended family system are in evidence, it is little wonder that the fraternal interest group is strong and there is overwhelming support for the fathers' motives. In these Yoruba communities, circumcision is also adopted as a form of contraceptive for the potential mother. Because it is widely believed sperm can easily contaminate a nursing mother's milk and thereby harm the baby (Oni, 1986), during the nursing period, the mother has to abstain from sexual intercourse for the 18 months that she needs to breast-feed her baby. It is locally believed that, because she was circumcised it is easier for her to endure a sexless life for the period she nurses her baby. (Anonymous, 1981). In many African societies where marriage and childbearing are essential for women, those who are uncircumcised are stigmatized as uncouth and may not be able to attract a husband. So excision is performed to attenuate


149

sexual desire and make women less vulnerable to illicit sexual behavior before or after marriage (Epelboin & Epelboin, 1979). In the two communities studied, respondents who were generally willing to circumcise any daughter born to them were the older and less literate persons. As can be observed from Table V over 55070 of the respondents who supported the circumcision of their daughter were illiterate. Those of them with primary education who supported female circumcision were less than 21o70. The preponderance of activists who oppose female circumcision are educated women and concerned learned males (Onadeko & Adekunle, 1985; Women In Nigeria, 1977). The main justification for female circumcision given by 58.6°7o and 69.3°70 of those interviewed at Okelele and Shao, respectively, was that the practice was part of their cultural heritage. In both communities, well over 66070 of the persons interviewed did not feel female circumcision should be discouraged on any on the following grounds: pain, severe bleeding, interference with orgaism, tetanus infection, and complication of childbirth. The contention by a prominent African leader (Kenyata, 1959) has been that, by eradicating female circumcision, a fundamental African tradition will be destroyed or extirpated. The practice is harmful, and just as facial marks and scarifications have been allowed to disappear, female circumcision should be abolished. Home visitors and PHC workers should assist women to identify and solve their most important problems. The issue of female circumcision can be effectively tackled by multidisciplinary teams in which women are motivated to be leaders. The rights of women are not only a question of justice but also of social progress. Collaboration with enlightened African women organizations such as the Association of African Women for Research and Development can invest efforts in launching and supporting programs aimed at reducing or eliminating the excessive control that African men currently exert over their women counterparts. Additionally, nongovernmental organizations such as the World Health Organization, UNICEF, and other international organizations in Europe and America, have prominent roles to play in enhancing the status of women in most African societies. In traditional and homogenous cultural settings such as Okelele and Shao, the ability to bear children is highly revered. Quite often housewives engage in intrafamilial competition in terms of the number and sex of children they are able to bear. Generally males are preferred, owing to property rights and the perpetuation of family names. So it is a fulfillment of the women's life to have children-without children she is nothing at all (Alausa, Ebomoyi, Parakoyi, Omonisi, Alade, 1985; Hosken, 1976). The respondents in this study were of the opinion that the practice of female circumcision was aimed at promoting sexual morality among women

150

Ebomoyi

and enhancing safe delivery among women. Additionally, the practice was said to ensure infantile survival. Public health efforts directed at discouraging the practice of female circumcision must provide precise information capable of invalidating the erroneous views currently upheld about the essence of female circumcision, not only in Nigeria but also in most developing African societies. The various dangers associated with the practice must be made known. Sex education of women can assist in reducing the unwanted physical, psychological and social torture inflicted upon women as a result of this practice. Legislation can also be adopted if people are sufficiently made aware of the dangers associated with female circumcision. Legislation should be the last resort, but the education of men, women, and traditional healers should create an awareness that would enable people to give up the practice of female circumcision in order to enhance the general health status not only of women but also of the community at large.

REFERENCES Adetoro, O. & Ebomoyi, E. Health implications of traditional female circumcision in pregnancy. Asia-Oceania Journal of Obstetrics and Gynaecology, 1986, 12, (4), 489-492. Agugua, N. & Egwuatu, V. Female circumcision management of urinary complication. Journal of Tropical Pediatrics, October 1982, 28, 248-252. Alausa, O. K., Ebomoyi, E., Parakoyi, B. D. Omonisi, K., & Alade, I. The health needs of people. An International Journal of Health Development World Health Forum, 1985, 6 (4), 348-349. Anonymous. The battle against female circumcision. New African, 1981, 168, 42. Assaad, F. The sexual mutilation of women. An International Journal of Health Development World Health Forum, 1982, 3 (4) 391-394. Asuen, M. Maternal septicaemia and death after circumcision. TropicalDoctor, October 1977, 7, 177-178. Baasher, T. Psychological aspects of female circumcision. WHO Eastern Mediterranean Region, 1977. Bella, H. Female circumcision. African Health, 1980, 2, 31-32. Cook, R. Damage to physical health from pharaonic circumcision (infibulation) of females. A Review of medical literature. WHO/EMRO Tech. Publ. Vol.2, 1976, 138-144. Dareer, A. Attitudes of Sudaness people to the practice of female circumcision. International Journal of Epidomiology, 1983, 12, 138-144. Ebomoyi, E. Female circumcision: An inhuman practice. A n International Journal of Health Development World Health Forum, 1985 6 (3). 236-237. Epelboin, S., & Epelboin, A. Female circumcision., People, 1979, 24-29. Hathout, H. M. Some aspects of female circumcision. JournalofObstetrics Gynaecology, 1968 79, 505-507. Hosken, F. P. Female circumcision and fertility in Africa. Women and Health, 1976, 1 (6) 3-11. Iregbulem, L. M. Post circumcision vulval adhesions in Nigeria. British Journal Plastic Surgery, 1980, 33, 83-86. Kenyata, J. Facing Mount Kenya. London: Secker and Warburg, 1959. Melly, J. M. Infibulation. Lancet, 1935, 2, 1272.


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Mustapha, A. Z. Female circumcision and infibulation in the Sudan. Journal of Obstetrics and Gynaecology, 1966, 73, 302-306. Onadeko, M. O., & Adekunle, V. L. Female circumcision in Nigeria: A fact or farce? Journal of Tropical Pediatrics, 1985, 31, 180-184. Oni, G. A. Contraceptive use and breast feeding: Their inverse relationship and policy concern. East African Medical Journal, 1986, 63 8, 522-529. Rathmann, W. G. Female circumcision. Indications and new techniques. General Practitioners, 1959, 20, 115-120. Sanderson, L. P. Against the mutilation of women: the struggle against unnecessary suffering. London: Ithala Press, 1981. Taba, H. A. Female circumcision. Tropical Doctor, 1980, 10, 21-23. Watts, S. J. "Marriage migration, A neglected form of long-term mobility. A case study from Ilorin, Nigeria. ~ International Migration Review 1984, 17, 682-698. Women In Nigeria, New female circumcision. Lexington, MA, 1977.