Knowledge, Attitude and Practice (KAP) of Women towards Female Genital Mutilation

Master's Thesis, 2017

119 Pages



Contents Pages








1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objectives of the study
1.4 Research Questions
1.5 Significance of the Study
1.6 Scope of the Study
1.7 Limitations of the Study
1.8 Operational Definitions
1.9 Organization of the Study

2.1 International Conventions and Declarations Relevant to FGM
2.2 National Policies, laws and Legal Framework on FGM in Ethiopia
2.3 Women’s policy in Ethiopia
2.4 Women’s Rights in Ethiopia
2.5 Human Rights and FGM
2.6 The Historical and Socio-Cultural Context of Female Genital Mutilation
2.7 Prevalence of FGM
2.8 Age and Tools used
2.9 Procedures of Female Genital Mutilation (FGM)
2.10 Reasons for Performing Female Genital Mutilation (FGM)
2.11 Gender and FGM
2.12 Sexual Morality, Marriageability and FGM
2.13 Physical, Psychological and Sexual Health Consequences of FGM
2.14 Cultural Stigma Associated with those who are not circumcised
2.15 Attitude and Knowledge Related to FGM
2.16 Conceptual Framework

3.1 Description of the Study Area
3.3 Study Population
3.4 Sampling Techniques and Procedures
3.5 Types and Methods of Data Collection
3.6 Source of Data
3.7 Methods of Data Analysis
3.8 Definition of Variables and working hypothesis for Logit model
3.9 Ethical Consideration

4.1 Socio-demographic Characteristics of Respondents
4.2 Socio-economic Characteristics of Respondents
4.3 Knowledge on the Harm of FGM
4.4 Knowledge Related to Side Effect of FGM on Health
4.5 Knowledge on Complications of FGM
4.6 Knowledge about FGM Exposes Women for HIV/AIDS
4.7 Knowledge on FGM as causes Difficulty during Delivery
4.8 Knowledge on the effect of FGM for Future Sexual Relation
4.9 Knowledge on FGM causes Excessive Bleeding
4.10 Information Related to ill Health Effect of FGM
4.11 Source of Information to Increase Knowledge related to FGM
4.12 Attitude of Respondents towards FGM
4.13 Practice of FGM towards Women
4.14 Future Plan of the Respondents for their Daughters towards FGM practice
4.15 Decision Maker of FGM in the family
4.16 The Biggest Supporter of FGM at Family
4.17 Common Reasons given why FGM practiced by the Community
4.18 Physical Consequences of FGM on Women Health
4.19 Psychosocial and Sexual problems Related to FGM
4.20 Associated Factors towards Female Genital Mutilation Practice
4.21 Binary Logistic Regression Model Analysis









Table 1: Socio-democratic characteristics of respondents

Table 2: Socio-economic Characteristics of Respondents

Table 3: Knowledge towards FGM practice

Table 4: Attitude of respondents towards FGM

Table 5: The practice of FGM towards women

Table 6: The future plan of the women for their daughters towards FGM practice

Table 7: Decision maker of FGM in the family

Table 8: The biggest supporter of FGM in the family level

Table 9: The main reasons to perform FGM

Table 10: Physical health consequences of FGM

Table 11: Psychosocial and sexual problems related to FGM

Table 12: Binary Logistic Regression Analysis


Figure 1: Conceptual frame work

Figure 2: Map of study area

Figure 3: Schematic presentation of sampling procedures

Figure 4 : Pie diagram shows that knowledge level of women towards FGM

Figure 5: Information related ill health effect of FGM

Figure 6: Source of information used to increase knowledge related to FGM practice

Figure 7: Pie diagram showing attitude towards FGM Practice


Appendix I. Survey Questionnaires

Appendix II. Logistic Regression out put


This work of research is dedicated to my mother, W/ro Eyame Arficho who selflessly dedicated her whole life to the educational betterment of her children.


Above all, my special thanks go to almighty God for giving me this opportunity and for guiding and helping me though all my life. Secondly, I extend my heartily respect and acknowledgement to my major advisor Dr.Eden Mengistu for her unlimited support, timely response and constructive comments in shaping this thesis. I would like to express my deepest gratitude to my co-advisor Dr. Tesfaye Wolitamo for his constructive advice and support during the whole process of the study.

My special thanks go to the NORAD PROJECT for the financial support provided by the government of Norwegian through coordination of Hawassa University for granting me the fund to do this research work.

Also I would like to acknowledge Angacha woreda administration office, women affairs and gender office, education sector, health sector and respective offices and administration.

Most importantly, I am deeply grateful to women and people of all interviews participants, religious leaders and health extension workers of the selected kebeles who are crucial to this thesis and graciously opened their hearts to me and shared their experience. This thesis is a product of the generosity of all the people mentioned above with their time and the information they provided to me.

Finally, I would like to express my special appreciation to all my friends’ valuable consistent support logistic support and advice they gave me during my research.


Abbildung in dieser Leseprobe nicht enthalten

Knowledge, Attitude and Practice (KAP) of Women towards Female Genital Mutilation: The Case of Kembata Tembaro Zone, Angacha Woreda, SNNPRS, Ethiopia.

By: Asebe Awol (BA)

Major Advisor: Eden Mengistu (PhD): Hawassa University

Co- Advisor: Tesfaye Woltamo (PhD): Hawassa University


Female Genital Mutilation (FGM) is recognized internationally as a violation of human rights of girls and women constituting an extreme form of gender discrimination with documented health consequences. The aim of this study was to assess knowledge, attitude and practice of women towards FGM practice. A community based cross-sectional study design was applied. Both quantitative and qualitative were employed. A total of 278 women at reproductive age (15-49) were sampled for the study from six randomly selected kebeles of Angacha woreda. The survey data was analyzed by SPSS soft ware version 20. Descriptive statistics such as mean, percentage and frequency were used for analyzing data. Binary Logistic Regression Model was used to analyze determinant Associated Factors regarding FGM. In addition qualitative data were analyzed thematically and the result was presented in narration. The result showed that 55.4% of women had good knowledge about FGM practice however 44.6% had poor knowledge. The majority of the women (50.4%) had negative attitude while 49.6% of them had positive attitude towards FGM practice. Tradition and fear of marriage were the major reasons for the continuation of this practice. From study participants 92.4%of responded that FGM was being practiced in their community and 77.7% of participants were undergone themselves. This study revealed that 79.5% of women were encountered physical health problems related to FGM and 59.7% of women were encountered psychological and sexual problems related to FGM. Bivariate and Multivariate analyses were carried out to identify determinant factors of practice. Age, family income, knowledge and attitude were significantly associated factors for FGM practice. Mothers whose age range between 26-36 years were 3.2 times more likely to have FGM practice than those who were 15-25 years with adjusted odds ratio (AOR= 3.221; 95%CI= 1.057- 9.813) Similarly ,mothers who aged 37-49 years were 3.9 times more likely to have FGM practice compared to those who had age 15-25 years with adjusted odds ratio(AOR=3.9;95%CI=1.086- 14.283).Monthly income between 1001- 1500 ETB were 6.96 times more likely to have FGM practice than who did get less than 500 ETB with adjusted odds ratio (AOR= 6.967; 95%CI= 1.157- 41.951).Mothers who had good knowledge were 72% less likely to have FGM practice than those who had poor knowledge (AOR=0.281; 95%CI=.131- .600). Mothers who had negative attitude were 16% less likely to have FGM practice compared to those who had positive attitude with odds ratio (AOR=0.84; 95%CI= 0.036-0.9).Based on the findings, it was concluded that many women in this study area had poor knowledge about the health effect and almost half of them had positive attitude towards FGM practice . Yet, the prevalence of FGM was still high in the study area. Religious leaders, community leaders and government should play major role in the process of changing knowledge and attitude of the women in the entire community by arranging training, workshops, and media campaign to bring positive attitude to stop female genital mutilation.

Keywords: Knowledge, Attitude, Practice and Female Genital Mutilation


This chapter presents background, statement of the problem, objectives (general and specific objectives), research questions, significance, scope and limitations, operational definitions and organization of the study.

1.1 Background of the Study

Female Genital Mutilation (FGM) is recognized internationally as a violation of the human rights of girls and women, constituting an extreme form of gender discrimination with documented health consequences. It involves the partial or total removal of the female genital organ for non-medical reasons. The practice causes injury to female genital organ for cultural reasons (WHO, 2010).

According to Shell-Duncan et al. (2006), the term female genital mutilation (FGM) was adopted at the Third Conference of the Inter African Committee on Traditional Practices Affecting the Health of Women and Children in 1990 and is now used in the World Health Organization and other United Nations documents to emphasis the violation of human rights involved. In this context, the term female circumcision was thus predominantly replaced by the term female genital mutilation.

Worldwide about 140 million girls and women are living with the consequences of FGM. The World Health Organization (WHO) estimates that in Africa more than 3 million girls are at risk for FGM annually .The wide range of FGM distribution with in a country is closely associated with ethnicity (WHO, 2010). The practice is intertwined with ethnic identity, serving as an ethnic marker throughout the lifespan. The practice is also rooted in religio-social beliefs within a frame of psycho-sexual and personal reasons such as control of women’s sexuality and family honour, which is enforced by community mechanisms. While reasons for the practice vary across cultural groups, religious reasons rest on the belief that it is a religious requirement and socio-economic reasons include beliefs that FGM is a prerequisite for marriage or an economic necessity in cases where women are largely dependent on men (UNFPA, 2013).

A global review of FGM shows that the custom of FGM is known to be practiced in one form or on another in more than 28 countries in Africa including Ethiopia. The practice of FGM is most prevalent in the African countries such as Ethiopia, Nigeria, Sudan, and Egypt (Allen et al, 2013 and WHO, 2011).

Ethiopia has been also one of the countries with the highest rates of Female Genital Cutting in Africa, according to the UN Secretary General’s report on violence against children (UN, 2012). A recent study by Bellemare and Steinmetz (2013) shows that factors at village level only account for 15% of the relationship between whether a woman has undergone FGM and her support for the practice, while 85% is attributed to individual and household level factors. Wagner (2011) demonstrates that ethnic and religious identity foster this health-destructing practice and that being cut increases marriage prospects by almost 40%.

Apart from being a signatory of major conventions that protects women from discrimination and other, the Ethiopian Government has also expressed its commitment to gender equity and equality by issuing a national Policy on Ethiopian Women. Two articles (16 and 35) in specifically protect women (Federal Negarit Gazetta, 2000).

In the FGM practicing societies in Ethiopia, uncircumcised women are recognized as unclean and are not allowed to touch food and water. FGM remains a serious concern in Ethiopia and has affected 23.8 million women and girls, making it the second highest country in Africa by affected numbers (Roman, 2014).

From the total Of 66 Ethiopia’s largest ethnic groups 46of them carry out FGM. FGM is therefore practiced by over half of Ethiopia’s ethnic groups (EGLDAM, 2007). According to the Demographic Health Survey (DHS), the estimated prevalence of FGM in girls and women (15-49 years) in Ethiopia is 74.3% and it also says 60% of Ethiopian women support the practice (DHS, 2005).

SNNPR is the home of many nations, nationalities and peoples with different cultures and languages. Most of the peoples (over 85%) live in rural areas with low access to health, education and other social services. Female genital mutilation(FGM) and other harmful traditional practices performed in this diversified ethnic groups. Among the ethnic groups Kembata people of SNNPR is one that high rate of FGM it may be due to negative attitude and lack of awareness and knowledge (Sintayehu, 2012). Still perception exist, especially in Kembata uncircumcised woman is referred to as ‘unclean, uncontrolled, unmanageable because of this she broke materials and equipments in the home offensively translated as the uncut one. In Kembata female sexuality is viewed mainly as a potential threat to family honour and the practice is called “cutting off the dirt.” To keep girls from promiscuity and ruin, the clitoris and often the labia are cut off to deaden sexual sensation. FGM is traditionally believed to ensure hygiene and preserve a girl's chastity and fertility. Hence, the practice is considered beneficial to girls, but also as a prerequisite for an honourable marriage.

In the study area, very few studies have been conducted on women population to determine the current knowledge status, attitude about FGM and their involvement in the eradication of the practice.

1.2 Statement of the Problem

Female Genital Mutilation is one of the serious human right issues with adverse health and social implications. It violates women rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death (WHO, 2011). In Ethiopia prevalence and practice of the FGM seems set to continue within several families and communities. FGM is a practice deep-rooted social convention as a norm. It is widely practiced in different ethnic groups of Ethiopia and it is one of the major socio-economic development problems of the country. The negative health implication of this practice increases the chance of maternal mortality during childbirth (Mohamed, 2015).

At the same way in SNNPR, Angacha Woreda FGM practiced within families and communities and recently its prevalence is widely spreading in community. According to the KMG (2014), annual report, the practice of FGM is performing Kembata ethnic group in secret way by keeping the information from the people who teaches about female genital mutilation and other harmful traditional practices. The practice was performed at night time. Because of this, many young girls were dropped out the school, achieve low result because of absenteeism and they were exposed to health problems in the study area. This practice is against human reproductive health rights with many serious consequences in physical, mental, social and psychological makeup of girls in the community. There have still been gaps between the desired levels of change to be brought about FGM.

There are a number of institutions that are engaged in the fight against FGM in Ethiopia generally and particularly in Kembata. These institutions have joined hands by establishing networks against FGM. Despite this, the persistence of FGM is believed to be associated with individual, social and cultural factors, interventions were not particularly focused. This may also affected the whole effort of stopping the practice of FGM. Various strategies have been employed to curb the practice of (FGM). Community dialogues focusing on FGM and other harmful traditional practices; establishment of girls clubs to protest against FGM and proclaim their rights; staging of special events such as public weddings of uncircumcised girls; screening of videos showing the practice of cutting and testimonies of circumcised girls and women; and the like, have been among the major strategies, especially employed by the KMG and government to curb the practice of FGM.

Despite all the efforts have been made to reduce the practice of FGM practice in the area, still it has been widely practiced. Limited study has been done on FGM in Angacha Woreda to determine the attitude and knowledge of women towards FGM .This implies that lack of understanding of the determinant factors of the FGM practice in the study area may be one of the causes for the prevalence of the problem.

Thus, this study attempts to examine the prevalence of FGM, determinant factors of FGM, knowledge about the ill health effects of FGM and attitude of women towards FGM is timely in order to recommend to the concerned bodies.

1.3 Objectives of the study

1.3.1 General Objective

The general objective of this study was toassess knowledge, attitude and practice of women towards FGM in Kembata Tembaro Zone, Angacha Woreda

1.3.2 Specific Objectives

The specific objectives of this study were to:

1. Analyze knowledge level of women related to ill health effects of FGM in the study area.
2. Analyze the attitude of women towards FGM practice in the study area.
3. Explore the prevalence of FGM in study area.
4. Analyze determinant factors associated with FGM practice in the study area.

1.4 Research Questions

The following basic questions were raised and answered by this study.

1 To what extent do respondents know about the effects of FGM?
2 What is attitude of women towards FGM?
3 How much is FGM practiced in study area?
4 What are the determinant factors for the practice of FGM?

1.5 Significance of the Study

Female genital mutilation (FGM) is a deeply rooted tradition in many communities in Ethiopia, and is a problem that matters a lot and that needs to be studied and understood. The findings of this study, therefore, would be vital for the victims of the practice of the FGM, girls and women who were considered most at risk of undergoing FGM and other community members, who were prone to the complications of FGM either directly or indirectly. The study was hopefully be a valuable contribution in the ongoing to bring behavioral change (on knowledge and attitude) and fight against ending FGM practices in Kembata Tembaro Zone in general and in Angacha Woreda in particular.

The study also used for planning purpose for future work and also very important for capacity building for health professionals, Anti-FGM clubs, peer educators and teachers. Moreover, it would be also a vital reference for governmental or non- governmental organizations who work to fight FGM, researchers and others involved in social services, teaching and child right protection.

In addition, this study used to show some important mechanisms and direction for policy makers, health sectors, health professionals, and government organs of the country regarding how to control and prevent FGM among women and to create awareness and mobilize the information of FGM problem.

1.6 Scope of the Study

This study was confined mainly to the case at Angacha Woreda of Kembata Tembaro Zone Southern Nations, Nationalities and People’s Regional Government (SNNPRS). Besides, among several harmful traditional practices (HTPs), the study was delimited to investigate the issue of knowledge, attitude and practice of women towards Female Genital Mutilation (FGM).The study only focused on women. A comprehensive data was required and gathered from the target population of the six selected kebeles from the total of 20 kebeles of Angacha Woreda. These include: Donkorcho, Gubena, Bucha, Kaelama, Bondena and Kerekcho kebeles. The study covered 278 women who are in reproductive age (15-49) from selected kebeles.

1.7 Limitations of the Study

With regard to the limitations of the study, inadequacy of the financial sources, unwillingness of the target population especially the focus group discussants to attend the discussion meetings on FGM scheduled by the researcher, they were not open on practice part and few women were response refusal or omission of the responses. Also the nature of the study and questions are sensitive to women of this society. These were the supposed constraints on the findings of this study. Nevertheless, every effort was made to limit the limitations.

1.8 Operational Definitions

Female genital mutilation: All procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons (WHO, 2010).

Prevalence: Proportion of household who circumcised their daughter in the past years.

Knowledge: is a range of information and understanding stored in the memory concerning FGM. It is the fact or condition of knowing something with familiarity, gained through experience or association.

Attitude: refers either positive or negative view of FGM practice. Feelings toward FGM, as well as any preconceived ideas they may have towards it.

Practice: a habit or an overt behavior of women towards FGM practice.

1.9 Organization of the Study

In order to show a clear picture of the study, the study was organized under several headings: background of the study; statement of the problem; objectives of the study (general and specific objectives); research questions; significance of the study; scope and limitations of the study; and organization of the study, that constitute chapter one. Concepts pertaining to validity and findings of previous scholarly works relevant to the present study were reviewed briefly in chapter two. Chapter three was dealt with the methodology of the study. This was also further presented under the following headings: description of the study area; research design, study population, sapling techniques and procedures, sources of data; methods of data collection and methods of data analysis. In Chapter four described result and discussion and finally in Chapter five presented conclusion and recommendation.


Concepts pertaining to validity and findings of previous scholarly works relevant to the present study are reviewed briefly in this chapter. These are presented as follows:

2.1 International Conventions and Declarations Relevant to FGM

According to (Tang,2000) FGM is a new rights issue in the sense that it doesn’t appear in the major human rights conventions, and attention to it as a human rights issue is fairly recent. In this vacuum, advocates have drawn from exact rights such as the right to health, the rights of women and the rights to children to construct an argument against the practice.FGM has relentlessly been condemned by the U.N. and the international community.

According to the 2004 World Bank and United Nations Population Fund’s report on Female Genital Mutilation, FGM was denounced by the U.N. in 1952, at a World Health Organization Regional meeting in Khartoum, in 1979, and in a 1984 conference in Senegal, which was attended by members from 20 African countries.

Moreover, a number of conventions and declarations provide for the promotion and protection of the health of the child and the woman; some specifically provide for the elimination of FGM according to WHO, 2001. These are as follows:

The Universal Declaration of Human Rights (1948) proclaims the right of all human beings to live in conditions that enable them to enjoy good health and health care.

- The International Covenant on Civil and Political Rights, and the International Covenant on Economic, Social and Cultural Rights (1966) condemns discrimination on the grounds of sex and recognized the universal right of all persons to the highest attainable standard of physical and mental health.

- The Convention on the Elimination of All Forms of Discrimination against Women (1979) can be interpreted as obliging States to take action against female genital mutilation which is: to take all appropriate measures, including legislation, to modify or abolish existing laws, regulations, customs and practices which constitute discrimination against women (Art. 2. f) and to modify the social and cultural patterns of conduct of men and women, with a view to achieving the elimination of prejudices, and customary and all other practices which are based on the idea of the inferiority or superiority of either of the sexes or on stereotypes for men and women (Art. 5. a).

- The Convention on the Rights of the Child (1990) protects the right to equality irrespective of sex (Art. 2), to freedom from all forms of mental and physical violence and maltreatment (Art.19.1), to the highest attainable levels of health.
- The Vienna Declaration and the Programme of Action of the World Conference on Human Rights (1993) expanded the international human rights agenda to include gender-based violations which include female genital mutilation.
- The Declaration on Violence against Women (1993) states that violence against women must be understood to include physical and psychological violence occurring within the family, including female genital mutilation and other traditional practices harmful to women.
- The Programme of Action of the International Conference on Population and Development (ICPD, 1994) included a recommendation on female genital mutilation which commit governments and communities to: “urgently take steps to stop the practice of female genital mutilation and to protect women and girls from all such similar unnecessary and dangerous practices”.
- The Platform of Action of the Fourth World Conference on Women (1995) included a section on the girl-child and urged governments, international organizations and nongovernmental groups to develop policies and programmes to eliminate all forms of discrimination against the girl child, including female genital mutilation.

2.2 National Policies, laws and Legal Framework on FGM in Ethiopia

Ethiopia is a signatory of global agreements on women rights such as Convention on Elimination of all forms of Discrimination against Women (CEDAW) which guarantees women equal right and protection from discrimination (PMO, 2004).

The FDRE Constitution of Ethiopia has also made the provisions of this convention an integral part of the law of the land. It further ensures that all fundamental rights granted are to be interpreted in conformity with the principles of the signed conventions and declarations. Apart from being a signatory of major conventions that protects women from discrimination and other, the Ethiopian Government has also expressed its commitment to gender equity and equality by issuing a national Policy on Ethiopian Women. Two articles in particular, 16 and 35, specifically protect women .In May 2005, Ethiopia’s new Criminal Code came into effect and further acknowledged the grave injuries and suffering caused to women and children by harmful practices. The provisions have been included on FGM and other domestic violence’s. The Code includes penalties and punishments for those who are accomplices, as well as those who are directly responsible for the crime (Federal Negarit Gazetta, 2000).

2.3 Women’s policy in Ethiopia

National policy on Ethiopian women has been formulated to address women's strategic gender needs through improving their access to resources and their decision-making power. Rural women's affairs departments have been set up in the relevant line ministries as well as in the prime minister's office. The Federal Democratic Government of Ethiopia has declared its unequivocal commitment to the development of women with the announcement of the National Policy on Women in 1993 (referred to as women’s policy), and the promulgation of the new constitution in 1995. In other words, Ethiopia has demonstrated its firm commitment to the equitable socio-economic development of women. The women’s policy primarily aims to institutionalize the political, economical and social rights of women by creating an appropriate structure in government offices and institutions so that the public policies and interventions are gender-sensitive and can ensure equitable development for all Ethiopian men and women (UNDP, Cherinet and Mulugeta, 2003; Ogato,2009; Ogato,2011; Ogato,2013).

Ethiopia has developed national constitution to protect the fundamental rights of women and their interest of access and control over resource. Accordingly, Ethiopian women are entitled to remedial and affirmative measures to enable them to compete and participate on the basis of equality with men in political, economic and social life. New policies and programmes have been formulated and adopted with increased gender consideration and equity. As regards property and land rights, the constitution states that women shall acquire, administer, control, use and transfer property. With respect to use, transfer, administration and control of land women have as equal access as men to benefit this (UNDP, 2003; Ogato, 2011; Ogato, 2013).

According to MOWA (2006), following the Beijing conference of 1995, Ethiopia had identified the following seven priority areas that need to be tackled in order to ensure gender-equitable development: Poverty and Economic Empowerment of Women and Girls; Education and Training of Women and Girls; Reproductive Rights, Health and HIV/AIDS; Human Rights and Violence against Women and Girls; Empowering Women in Decision Making; Women and The Environment; and Institutional Mechanisms for the Advancement of Women (MOWA). The government of Ethiopia is committed to the implementation of Agenda 21 in relation to gender empowerment for sustainable development. It has been making significant efforts in empowering women in decision-making processes. The establishment of the Women’s Affairs Office and issuance of a National Policy on Ethiopian Women which entitles and ensures a woman’s rights to property, employment and a pension could be mentioned as important milestones for the commitment of the current regime towards the realization of gender issue and mitigation measures in Ethiopia (United Nations, 2002; Ogato, 2011; Ogato, 2013 Ministry of Women’s Affairs (MOWA), 2006).

The government of Ethiopia has started empowering and strengthening women’s participation in decision-making, guaranteeing their rights to access to credit schemes, and creating a conducive environment for civic societies. Victimization of Ethiopian women by gender-based oppression and exploitation in all spheres of life; lack of adequate recognition and economic valuation of their contribution; denial of their right to have access to and control over means of production and their major share of the category of the poorest of the poor are the basic reasons why the government of Ethiopia has given due consideration to the multi-faceted problems of Ethiopian women (United Nations, 2002; Kabeer , Cherinet and Mulugeta, 2003; Ogato,2011; Ogato,2013). MOWA (2006) affirms that inequalities prevailing in Ethiopia represent violations of women's human rights. MOWA (2006) further contend that women are subjected to violence unique to their sex that are widely prevalent; and which include female genital mutilation affecting many women and girls nationally.

2.4 Women’s Rights in Ethiopia

Ethiopia has ratified both the UN Charter adopted in 1948 and the Universal Declaration of Human Rights (UDHR) of 1949. Both these international instruments prohibit the negative discrimination of women based on their sex. The UDHR identifies targets and requires the promotion and protection of civil, political, economic, and social rights of people. Though the UDHR prohibits all forms of discrimination based on sex, an additional instrument was necessary, to accommodate the special situation and needs of women, and accelerate the process of closing the gap between men and women (Ministry of Women’s Affairs (MOWA), 2006). Accordingly the Convention on the Elimination of All forms of Discrimination against Women (CEDAW) was adopted in 1981. Ethiopia ratified the convention in the same year. Many of the risks to women’s sexual and reproductive health are caused by failure to respect the full equality of women, by attitudes and by practices which reinforce women’s subordinate status. Issues such as forced marriage, early pregnancy, sexual violence, trafficking, female genital mutilation, and others, have negative consequences for sexual and reproductive health. The constitution of 1995 FDRE expresses the right of women in article 35 and its sub articles. In article 35 the Rights of Women in the Federal Democratic Republic of Ethiopia constitution of 1995 expressed as follows:

1. Women shall have equal rights with men in the enjoyment of the rights and protections guaranteed by this Constitution to all Ethiopians.
2. Women shall, as prescribed by this Constitution, have equal rights with men in respect to marriage.
3. Considering that women have traditionally been viewed with inferiority and are discriminated against, they have the right to the benefit of affirmative action undertaken for the purpose of introducing corrective changes to such heritage. The aim of such measures is to ensure that special attention is given to enabling women to participate and compete equally with men in the political, economic and social fields both within public and private organizations.
4. The State has the duty to guarantee the right of women to be free from the influence of harmful customary practices. All laws, stereotyped ideas and customs which oppress women or otherwise adversely affect their physical and mental well-being are prohibited.
5. (a) Women shall have the right to maternity leave with full remuneration. The duration of maternity leave shall be determined by law having regard to the nature of the work, the woman's health and the welfare of the child and its family.
(b) Maternity leave may, by law, be made to include pregnancy leave with full remuneration.
6. Women shall have the right to demand that their opinions be heard on matters of national development policies, on plan and project implementation, and in particular, on projects affecting their interests.
7. Women shall have the right to acquire, administer, control, enjoy and dispose of property. They shall, in particular, have equal rights with men regarding the use, transfer, administration and control of land. They shall enjoy the same rights with men with respect to inheritance.
8. Women shall have the right of access to education and information on family planning and the capability to benefit thereby so as to protect their good health and prevent health hazards resulting from child birth. But still in Ethiopia there are many traditional practices that affect woman’s health and their human rights in many parts of the society (Ogato, 2011; Ogato, 2013).

2.5 Human Rights and FGM

According to (Amnesty international, 2013) female genital mutilation was first recognized in the agenda of the United Nations in 1948 within the context of the universal declaration of human rights (UDHR). It was seen as a harmful tradition practice in the 70s and 80s, during the United Nation´s year for women 1975-1989. Efua Dorkenoo (2002) states female genital mutilation is a clear demonstration of gender-based human rights violation, which intends to control women’s sexuality and freedom. Internationally the practice is recognized as a form of torture and violence against women and girls (Clifford, 2009). Some of the international agencies, WHO consider FGM as a violation of human rights include; World Health Organization (WHO), United Nation Children Education Fund(UNICEF), World Medical Association and the United Nations Population Fund. For example, WHO (2011) made an effort in fighting FGM by officially opposing the practice on FGM and classifying it as a violation of human rights. Authors like Rahman and Toubia (2000) in their work they have listed the following as human rights that FGM violates.

2.5.1 The right to be free from all forms of discrimination against women

According to Convention on Elimination of all forms of Discrimination Against Women (CEDAW) article1, of the women’s convention “Discrimination against women” based on sex FGM fits within this definition because it is a practice carried on women and girls that has the effect on their sexual desire and enjoyment of their fundamental rights. The pain it causes and not being able to be sexually satisfied is violating the rights.

2.5.2 The right to life and physical integrity including freedom from violence

Female Genital mutilation affects the right to life in situations when death occurs resulting from the mutilation procedure. What comes to the right to physical integrity, the practice violates the right to liberty and security of women and girls because they are subjected to FGM unwillingly before they have reached the age at which they can decide for themselves if they need to be mutilated. Also in cases when some communities believe that the women’s body needs to be, altered implying it is ugly (Hodges F. and Milos M,2000).Then respect for women’s dignity in this case implies acceptance of their physical qualities that is the natural look of their genital and their normal sexual function. According to WHO, 2014 FGM violates the following rights and freedom of children and women: The right of the child, Right to health, and Rights to religious freedom.

2.6 The Historical and Socio-Cultural Context of Female Genital Mutilation

The precise origins of the practice of FGM are unclear. However, according World Organization it predates the rise of Christianity and Islam. There is mention made of Egyptian mummies that display characteristics of FGM. Historians such as Herodotus claim that in the fifth century the Phoenicians, the Hittites and the Ethiopians practiced FGM. The practice of FGM is most prevalent in the African countries such as Ethiopia, Nigeria, Sudan, Egypt, and some area of the Middle East. It is not restricted to any ethnic, religious or socioeconomic class. An overwhelming factor for its justification is the cultural influence and traditions, social acceptance within the community, and ensuring chastity and fidelity by attenuating sexual desire (WHO, 2011 and WHO, 2013).

There are a number of different terms used to refer to the practice of Female Genital Mutilation, the most common ones being: female circumcision, female genital cutting (FGC), female genital surgeries, female genital alteration, female genital excision, and female genital modification. Female genital mutilation (FGM) is, therefore, defined by the World Health Organization (WHO) as all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.

The procedures known as FGM were referred to as female circumcision until the early 1980s, when the term "female genital mutilation" came into use. According to the evidence from the well known website, the Wikipedia, the term was adopted at the third conference of the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children in Addis Ababa, Ethiopia, and in 1991 the WHO recommended its use to the United Nations. It has since become the dominant term within the international community and in medical literature. The practice is primary found in area where there is high poverty, child mortality, illiteracy, poor sanitation and access to modern health care facilities. Religion, tradition, poor economic and social status of women are among the most common factors reported to play a role for the practice to continue and exist (WHO,2014).

Although the damage to female sexual organ and their function is extensive and irreversible, yet the true magnitude of the problem is still underestimated due to limited information and mystery of the practice. The practice is considered as one of major international and national problem as it does not only affect the physical, mental and social life of women but also socio-economic development of many Countries (UNICEF, 2005; UNDP et al., 2008).

2.7 Prevalence of FGM

The term "prevalence" is used to describe the proportion of women and girls now living in a country who have undergone FGM at some stage in their lives. This is distinct from the incidence of FGM which describes the proportion of women and girls who have undergone the procedure within a particular time period, which could be contemporary or historical. FGM is practiced in Africa, the Middle East, Indonesia and Malaysia, as well as some migrants in Europe, United States and Australia. It is also seen in some populations of South Asia. The highest known prevalence rates are in 28 African countries, in a band that stretches from Senegal in West Africa to Ethiopia on the east coast, as well as from Egypt in the north to Tanzania in the south (Roman, 2011)

According to the Demographic Health Survey (DHS), the estimated prevalence of FGM in girls and women (15-49 years) in Ethiopia is 74.3% (DHS, 2005). Rahlenbeck and Mekonnen (2009) reported that in 2005, the prevalence of FGM in women of reproductive age in the Amhara region of Ethiopia was 69%, while 64% of mothers with daughters had a circumcised daughter. Nearly four out of five (77%) women with ages between 45 and 49 years were affected and about the same rate (79%) in this age group had daughters on whom she had let the procedure be performed. Their finding suggests that the practice was still widely approved of thirty years ago, as women in this age group began to have their first daughters.

2.8 Age and Tools used

The age at which mutilation is carried out on the girls varies among ethnic groups. In Amhara, Tigray and Afar FGM take place between the ages of 7-10th days of the birth of the baby. In Somali FGM takes place between the ages of seven and eight years, and in some ethnic groups of SNNPR it is commonly performed at puberty age, after the official wedding, but some weeks before first sexual intercourse (Wakjira Mekonnen, 2009).Research findings revealed that, only one instrument was used for all the girls without fear of transmitting diseases such as HIV/AIDS and hepatitis B. The instruments are traditionally improvised and no medication is used (Parekh, 2005).

2.9 Procedures of Female Genital Mutilation (FGM)

FGM is carried out using special knives, scissors, razors, or pieces of glass. On rare occasions sharp stones have been reported to be used (e.g. in eastern Sudan), and cauterization (burning) is practiced in some parts of Ethiopia. Finger nails have been used to pluck out the clitoris of babies in some areas in the Gambia. The instruments may be re-used without being cleaned .As the evidences from the WHO also suggest that the operation is usually performed by an elderly woman of the village specially designated to this task, who may also be a traditional birth attendant (TBA). An aesthesia is rarely used and the girl is held down by a number of women, frequently including her own relatives. The procedure may take 15 to 20 minutes, depending on the skill of the operator, the extent of excision and the amount of resistance put up by the girl. The wound is dabbed with anything from alcohol or lemon juice to ash, herb mixtures, porridge or cow dung, and the girl’s legs may be bound together until healing is completed(WHO, 2011, Getnet and Wakgari ,2009).

While the method of FGM carried out is vary from country to country and from one cultural, ethnic or religious group to another. All forms of FGM violate a range of human rights of girls and women, including the right to non-discrimination, to protection from physical and mental violence, to the highest attainable standard of health, and, in the most extreme cases, to the right to life (UNFPA, 2013).

2.10 Reasons for Performing Female Genital Mutilation (FGM)

In communities where it is practiced, FGM is not viewed as a dangerous act and a violation of rights, but as a necessary step to raise a girl ‘properly’, to protect her and, in many instances, to make her eligible for marriage (UNICEF, 2010).The most common reasons for the FGM to continue according to WHO (20013) were psychosexual, socio-cultural, spiritual and religious and for hygienic and aesthetic purposes. These are elaborated further as follows:

2.10.1 Cultural Reasons

One justification of FGM is the sociological aspect which presents the operation as a transition in life stages as an initiation rite of passage rite. It was performed at puberty on girls 12 to 18 years old, or just before the onset of menstruation and just before marriage. FGM as an initiation rite emphasizes the transition in age status from girlhood to womanhood and to marriageable age. In FGM practicing countries, an uncircumcised girl has no chance of having a suitor; the operation is a signal for her readiness for marriage and availability. Before initiation through mutilation individually or in group, the girls are kept in seclusion for a period of time (at least 3 weeks) and given instructions on morality, tribal law, social codes, being a good wife, etc. Some communities believe that unless a girl’s clitoris is removed, she will not become a mature woman, or even a full member of the human race. She will have no right to associate with others of her age group, or her ancestors. Some communities believe that a woman’s external genitalia have the power to blind anyone attending to her in childbirth; to cause the death of her infant or else physical deformity or madness; or to cause the death of her husband(WHO,2013).

2.10.2 Hygienic and Aesthetic Reasons

In FGM practicing communities, it is believed that a woman’s external genitalia are ugly and dirty, and will continue to grow ever bigger if they are not cut away. Removing these structures makes a girl hygienically clean. Therefore, FGM is believed to make a girl beautiful (WHO, 2013).

2.10.3 Spiritual and Religious Reasons

One of the biggest misconceptions about FGM is that it is sanctioned by religion of Christianity or Islam. There is no possible connection between FGM and religion as it precedes both of them. In the FGM risk countries it is practiced by followers of all denominations: Christians, Moslems, animists and non-believers and followers of indigenous (traditional) religion. The practice seems to be very extensive among the Muslim population in the FGM practicing countries and as such has acquired a religious dimension (WHO, 2013). In Ethiopia and Egypt, for example, both Christians and the Muslims practice FGM (Population reference Bureau, 2010). FGM is more common in Muslim communities than in other religious institutions. For example, in Sudan and Somalia, where the majority of people are Islamic, 80% of Muslim women versus 18 % of Christian women are mutilated. Muslim practitioners have linked FGM by reflecting it to “SUNNA” in the Koran (Parekh, 2005).

2.10.4 Psycho-sexual Reasons

The uncircumcised girl is believed to have an overactive and uncontrollable sex drive so that she is likely to lose her virginity prematurely, to disgrace her family and damage her chances of marriage, and to become a menace to all men and to her community as a whole. The belief is that the uncut clitoris will grow big and pressure on this organ will arouse intense desire. It is also believed that the tight vaginal orifice of an infibulated woman, or a woman who has had chemicals placed in the vagina in order to narrow it, will enhance male sexual pleasure, in turn preventing divorce or unfaithfulness. In some communities it is believed that excising a woman who fails to conceive will solve the problem of infertility, as the World Health Organization suggests in advance(WHO, 2013).Research conducted by Nahid Golafshani (2003) on women’s enjoyment of sex indicates that female genital mutilation does affect women’s enjoyment during intercourse. Another study conducted by Amnesty international (2010), among the mutilated women indicates that 90% of the women, who had undergone female genital mutilation disclosed having experienced an orgasm. Therefore, the element that influences sexual enjoyment and having orgasm are misunderstood. Momoh (2005) adds that some factors such as the type of female genital mutilation, the quantity of tissues taken away, extent of scarring, experience of the initial procedure, cultural and social expectations are reported to have impact on sexual functioning of those who have undergone the procedure of female genital mutilation.


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Knowledge, Attitude and Practice (KAP) of Women towards Female Genital Mutilation
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Asebe Awol (Author), 2017, Knowledge, Attitude and Practice (KAP) of Women towards Female Genital Mutilation, Munich, GRIN Verlag,


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