Background of the study
The term Female Genital Mutilation (FGM), refers to the partial or total removal of the female external genitalia[1], Some people call this practice Female Genital Cutting while others use the term Female Circumcision. The practice explains all the procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons.
Globally, women are being deprived of reproductive autonomy, Exploitation, inequality, violence, coercion, and neglect of basic health services, have prevented women from having both the freedom and the empowerment to control their own reproductive lives. Many of the abuses violate women’s rights without necessarily inflicting a direct health pain on their beings[2].
Irrespective of the term used, the practice seriously endangers the health of women, as it causes them considerable pain and suffering besides threatening their lives. It is a form of human rights violation as mutilated women lose a sense of sexual desires; a fundamental right that all human beings ought to enjoy by the virtue of their humanness.
The practice is sometimes referred to as infibulation. In modern usage, infibulation is the practice of surgical closure of the labia majora (outer lips of the vulva) by sewing them together to partially seal the vagina, leaving only a small hole for the passage of menstrual blood. The legs are bound together for approximately two weeks to allow the labia to heal into a barrier. The procedure is usually done on young girls before onset of puberty, to ensure chastity. It is usually performed at the same time as removal of the clitoris. The labia minora (inner lips of the vulva) are often also removed[3].
FGM is one of the practices whose physical and psychological effects are often traumatic because of the irreversible nature of the procedures that affects women’s health and well-being, particularly sexual and reproductive health of those who undergo the procedure. As a result, some girls drop out of school, marry early and face many problems after the circumcision ritual. The girls and women who undergo the practice are predisposed to a number of health risks ranging from severe bleeding, HIV/AIDS infection, hemorrhage, and painful intercourse, obstructed labour, low sexual desire, life-long frigidity, menstrual problems, fistulae, incontinence, and a number of other permanent disabilities as well as psychological trauma and stigma.
The FGMpractice in Uganda affects approximately 5% of the women population among theSabiny of Kapchorwa District. The other Districts are Moroto and Nakapiripiritwhereby the Pokots and Tepeth tribes are affected, and the Somalis and Sabinyimmigrants and pockets of Kalenjin people in Masindi and Fort Portal.However the practice of FGM exists in Soroti and Morotodistricts, though in secrecy.
LITERATURE REVIEW
Themedical aspects of FGM depends mainly on the gravity of mutilation since FGM is illegal many people carry out FGHM in the most cruel way exposing the young girls to HIV/AIDS and other Sexually Transmitted Infections.
The deliveries of women who had undergonegenital mutilation were significantlymore likely to be complicated by caesareansection, postpartum haemorrhage and prolongedmaternal hospitalization than thoseof women who had not. Women who hadundergone the most serious form of genitalmutilation (type III) had a 30% higherrisk for delivery by caesarean section thanthose who had not had genital mutilation.Similarly, women with type III mutilation hada 70% higher risk of postpartum haemorrhagethan women who had not undergonegenital mutilation[4].
The rates of infant resuscitation and perinataldeath were higher among infants bornto women who had undergone genital mutilationthan among those born to motherswho had not, and the severity of the adverseoutcomes increased with the severityof female genital mutilation.Thus, the rate of resuscitation was 66%higher for infants of women who had undergonetype III mutilation than for thosewho had no female genital mutilation. Thedeath rates among infants during and immediatelyafter birth were higher for thoseborn to mothers with genital mutilation thanthose without, being 15% higher for womenwith type I, 32% higher for those with typeII and 55% higher for those with type III[5].
Female genital mutilation is sometimes adoptedby new groups and in new areas after migrationand displacement (Abusharaf, 2005, 2007). Othercommunities have been influenced to adopt the practice by neighbouring groups and sometimes in religiousor traditional revival movements.
Preservation of ethnic identity to mark a distinctionfrom other, non-practising groups might also be important, particularly in periods of intensivesocial change. For example, female genitalsmutilation is practised by immigrant communitiesliving in countries that have no tradition of thepractice, Female genital mutilationis also occasionally performed on women andtheir children from non-practising groups whenthey marry into groups in which female genitalmutilation is widely practised[6].
FGM has no health benefits. It involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls’ and women’s bodies. Traditional excisers use a variety of tools to perform FGM, including razor blades and knives, and do not usually use anaesthetic. Anestimated 18% of all FGM is done by health-care providers, who use surgical scissors and anaesthetic (8). All forms of FGM can cause immediate bleeding and pain and are associated with risk of infection; the risk of both immediate and long-term complications increases with the extent of the cutting. A WHO-led study of more than 28 000 pregnant women in six African countries found that those who had undergone FGM had a significantly higher risk of childbirth complications, such as caesarean section and postpartum haemorrhage, than those without FGM. In addition, the death rate for babies during and immediately after birth was higher for mothers with FGM than those without. The risks of both birth complications and neonatal death increased relative to the severity of type of FGM (9). Sexual problems are also more common among women who have undergone FGM. They are 1.5 times more likely to experience pain during sexual intercourse, have significantly less sexual satisfaction and are twice as likely to report a lack of sexual desire (10).
Sexual abuse and protection from physical and mental harm and neglect; the right of disabled child to special treatment and education; protection of children affected by armed conflict; child prostitution; and child pornography. Under Article 43 of the Convention, the Committee
on the Rights of the Child was established to monitor the implementation of the Convention by state parties.
FGM is a potential financial burden to health systems. A study based on data from six African countries found that costs associated with the medical management of obstetric complications resulting from FGM were equivalent to 0.1–1% of total government spending on women of reproductive age (13). The cost to families is largely unknown; a study from Nigeria estimated the cost of treating post-FGM complications in a paediatric clinic to be US$120 per girl (14). A recent study from the Gambia found that one out of three gynaecological complications women sought help for was the direct result of FGM. In many cases, surgery was required, indicating that FGM complications are a significant cost for gynaecology services (15)
A major trend is that health-care providers, such as physicians, nurses and midwives (21,22), are increasingly providing FGM in place of traditional excisers, a phenomenon known as ‘medicalization’ (8,24). FGM is still carried out primarily by traditional excisers in most countries, but, for example, survey data suggest that girls in Egypt are three times more likely to undergo FGM at the hands of a health-care provider than did their mothers (25).
Parents may go to health practitioners instead of traditional excisers because they believe it will reduce the risk of harm from FGM (24). Some medical providers do indeed use clean equipment and drugs to reduce pain, bleeding and infection. However, medical FGM cannot eliminate immediate risks, as illustrated by media reports of deaths resulting from the practice[7].
The procedure of FGM is practiced indisputably in numerous countries all over in the world. Its highest prevalence is in African countries, but it is also common in the southern part of the Arab peninsula along the Persian Gulf, in the Middle East and among of the Muslim population of Indonesia and Malaysia.According to WHO the term Female Genital Mutilation (FGM) covers all forms of female genital cutting and female circumcision. The term FGM was agreed upon as an appeal to use the term in the 6th general assembly of Inter-African Committee (IAC).
Female genital mutilation is one of the most dangerous practices that cause torture and death among those who undergo the procedure. Without much knowledge for those practicing female genital mutilation, meaning the practitioners of the practice and those, undergoing the practice. The girls and women do not know much about the human rights. On the one hand, the ones who do not practice FGM tend to identify it as violating the human rights of women and young girls in many ways[8].
WHO estimates that up to 140 million women worldwide have undergone this procedure and that every year about three million girls are at risk to undergo, The traditional practice of cutting a girls genitilia still marks the transition to woman hood among the pokot in the north-eastern Ugandan region of karamojong, despite growing fears that the ritual is spreading HIV/AIDS. This crude procedure uses very crude procedure to cut off female Genitilia from the young girls, this is performed the women elder in the community who are not medically trained to perform surgeries but the are well conversna t with the community practices. The practice is performed because it is believed that it is an initiation into woman hood so it is made specifically to make the young girls change from girls to women mature women of the community.
1.2 Statement of the Problem
Female genital mutilation is one of the old practices that is found among the Hittites, Ethiopians and Egyptians.
She adds that in ancient Egypt traces of infibulations are still found on the Egyptian mummies. She further argues that in the 19th century FGM was practiced by gynaecologists in the UK and USA to cure from insanity and masturbation, however the practice of female genital multilation is one of the most protected practices and cultures of the people of pokot , this is because most of the elder women in the community believe that without their daughters going through this practice will make their daughter not to be respected and accepted in the community and above all the women in the community who donot under FGM donot get married as they are seen as social outcasts.
However despite of the popularity of the practice in these communites the equipments used by the elder women in circumcision are not of good quality and the traditional surgeons use one knife for all the girls in the process, therefore this study intends to investigate into the Medical implications of female genital mutilation among the pukot community in amudat district.
1.4 Objective of the study
- To determine the influence of female genital mutilation on the spread of HIV/AIDS in POKOT.
- To assess the techniques of female genital mutilation by the communities of pokot
- To assess the medical challenges faced by the communities of pokot
1.5 Research Questions
- What is the influence of female genital mutilation on the spread of HIV/AIDS in POKOT.
- What are the techniques of female genital mutilation by the communities of pokot
- What are the medical challenges faced by the communities of pokot.
CHAPTER THREE
METHODOLOGY
3.0 Introduction
This section presents the methodology which consists of the research design, area of study, study population, sample population and selection, sampling technique, data collection method, data quality control, data collection procedures and limitations of the study.
3.1 Research design
Qualitative and quantitative purposive, random, research designs will be used. The researcher will use the above methods because many aspects will be covered in the study, Qualitative research method will be used because it collects information within a short time while quantitative will be through interview to cross check what has been given.
3.2 Study Area and population
The study will be carried out inPOKOT and the study will involve a total population of 120 people who will consist of health professional, local women, local leaders and men.
3.3Sample Size, determination and sampling procedure
Mugenda and Mugenda (2003), argue that it is impossible to study the whole targeted population and therefore the researcher took a sample of the population. A sample is a subset of the population that comprises members selected from the population. Using Krejcie and Morgan’s (1970) table for sample size determination approach, a sample size of 92 respondents will be selected from the total population of 120.
Sampling involves selecting a sample of the population in such a way that samples of the same size have equal chances of being selected[9].
The respondents will be selected using purposive sampling techniques. Purposive sampling is where the researcher chooses the sample based on what they think would be appropriate for the study. A Purposive sampling technique will be used because it’s cheap.
3.4Data type and source
The type of data will be both primary and secondary, Primary data will be obtained from the questionnaires administered on the target respondents to gain opinions and practices on the topic of the study. Secondary data is data which has been collected by individuals or agencies for purposes other than those of a particular research study. It is data developed for some purpose other than for helping to solve the research problem at hand. This will comprised of literature related to the study. Secondary data will be sourced because it yields more accurate information than obtained through primary data, and it is also cheaper.
3.5 Data Collection Instruments
The major instrument for data collection will be questionnaires. Surveys will be just one part of a complete data collection and evaluation strategy. The major method of data collection for the study will be the survey, which will be done using selected instruments like questionnaires. The questionnaire will provide respondents with ample time to comprehend the questions raised and hence, they will be able to answer factually.
3.5.1 Questionnaires
The questionnaire will be used to collect quantitative data. The researcher will administer the questionnaires to respondents in different respondents, which will be designed basing on study objectives and questions. Respondents will read and write the questionnaires themselves. The questionnaires will be close ended and will be considered convenient because they will be administered to the literate and its anonymous nature will fetch unhindered responses.
A five point Likert ordinal scales ranging from; strongly agree was assigned 5, strongly Agree, 4 agree, Not Sure assigned 3, Disagree allocated 2 and strongly disagree allotted 1 to obtain responses on the variables. The Likert ordinal scale has been used by numerous scholars who have conducted similar studies.
3.7Data collection procedures
Upon receiving the University permission to carry out research, the area of study will be visited for purposes of familiarization. The researcher will seek permission from staff and once allowed to proceed with research, questionnaires will be issued and interviews will be carried out with the selected respondents.
3.8Quality control of data instruments
The instrument will be taken to the supervisor to check its correctness there after pilot study will be carried out to find out if it measured what it is meant for.
3.9 Data processing, presentation and analysis
The raw data will be coded, edited, and arranged ready for analyzing only completed raw data will be analyzed using statistical packages like excel and SPSS.
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