Research Article
Austin J Public Health Epidemiol. 2017; 4(1): 1056.
Gender Equity & Its Relation to Female Genital Mutilation in Rural Minia, Egypt
Mohammed ES, Seedhom AE* and Mahfouz EM
Department of Public Health and Preventive Medicine, Minia University, Egypt
*Corresponding author: Seedhom AE, Public Health and Preventive Medicine Department, Minia University, Minia 61111, Egypt
Received: December 26, 2016; Accepted: February 28, 2017; Published: March 02, 2017
Abstract
Objectives: To assess the predictors of FGM, to measure and relate Gender Equity Score (GES) to FGM future intentions.
Methods: A cross-sectional community-based study. An interview administered questionnaire was used to explore knowledge and attitude of rural people, Minia and measure GES. A systematic random sample was taken from the village. 618 males and females were included in the period from September to October 2016.
Results: FGM was performed on 76.6% of females. Complications occurred in 35.6% of circumcised females. Nearly 62% of respondents believed that this practice should be continued. FGM proponents were mostly men than women (57.0% vs. 40.2%). 76.2% of rural dwellers had low GES, 23.8% had medium or high GES. There was a significant relation between GES, supporting attitude towards FGM (p=0.0001), Knowledge that FGM is harmful (p=0.02) and future intention to undergo to their daughters (p=0.0001).
Conclusion: The strong correlation between low GES, education, social pressure and intentions to carry out FGM to their daughters means that transmission of FGM will be perpetuated among future generations unless policies are formulated to break the vicious cycle of mother-daughter transmission, by educating and protecting girls and increasing importance of values as personal wellbeing and women empowerment.
Keywords: Female genital mutilation; Gender equity; Predictors; Egypt
Abbreviations
FGM: Female Genital Mutilation; GES: Gender Equity Score; EHIS: Egyptian Health Issues Survey; EDHS: Egypt Demographic Health Survey
Introduction
World bodies have defined gender equality in terms of human rights, especially women’s rights, and economic development [1]. UNICEF describes that gender equality “means that women and men”, and girls and boys, enjoy the same rights, resources, opportunities and protections. It does not require that girls and boys, or women and men, be the same, or that they be treated exactly alike [2].
The United Nations Population Fund stated that, “despite many international agreements affirming their human rights, women are still much more likely than men to be poor and illiterate. They have less access to property ownership, credit, training and employment. They are far less likely than men to be politically active and far more likely to be victims of domestic violence [3].
Thus, promoting gender equality is seen as an encouragement to greater economic prosperity. For example, nations of the Arab world that deny equality of opportunity to women were warned in a 2008 United Nations-sponsored report that this disempowerment is a critical factor crippling these nations’ return to the first rank of global leaders in commerce, learning, and culture [4].
A large and growing body of research has shown how gender inequality undermines health and development. To overcome gender inequality the United Nations Population Fund states that, “Women’s empowerment and gender equality” requires strategic interventions at all levels of programming and policy-making. These levels include reproductive health, economic empowerment, educational empowerment and political empowerment [5].
Female genital mutilation is mostly carried out on girls between the ages of 0 and 15 years. However, occasionally, adult and married women are also subjected to the procedure. The age at which female genital mutilation is performed varies with local traditions and circumstances, but is decreasing in some countries [6].
In every society in which it is practiced, female genital mutilation is a manifestation of gender inequality that is deeply entrenched in social, economic and political structures. Such practice has the effect of perpetuating normative gender roles that are unequal and harm women. Analysis of international health data shows a close link between women’s ability to exercise control over their lives and their belief that female genital mutilation should be ended [7].
Subjects and Methods
A cross-sectional community-based study was conducted to measure gender equity score and identify its association with FGM in a rural area in Minia governorate that was chosen randomly then a systematic random sample was taken from the village (the 1st house was chosen randomly then every 5th house).
The questionnaires were administered, face to face. The sample size was calculated using EP Info version 2000. A total of 578 male and female rural dwellers, aged >18 years were participated in this study.
The study was conducted in the period from October to December, 2016. A pilot study was performed on 50 persons and the questionnaire was further validated through a review panel process where each item was considered for appropriateness.
GES was used. The 2006 Victorian Survey identified that the strongest predictor for holding violence-supportive views about violence against women was an individual’s “gender equity score [17]. This gender equity score or GES was constructed by asking respondents a series of attitudinal statements about women and their role in society. As with the 2006 Victorian Survey, the 2009 National Survey asked participants to respond to the same series of attitudinal statements relating to gender equity adapted from [18]. Responses to these statements were based on a likert scale where 1 =“strongly agree’ and 5= “strongly disagree’. The questions were:
On the whole, men make better political leaders than women.
When jobs are scarce men should have more right to a job than women.
- A university education is more important for a boy than a girl
- A woman has to have children to be fulfilled
- It’s OK for a woman to have a child as a single parent and not want a stable relationship with a man (reversed scored)
- In the 2009 survey additional three statements were included:
- Discrimination against women is no longer a problem in the workplace
- Men should take control in relationships and be the head of the household
- Women prefer a man to be in charge of the relationship
The gender equity scale and associated scores were calculated and summed to give a score out of 100. Participants were required to respond to eight statements on a scale of 1 (strongly agree) to 5 (strongly disagree).
The eight statements were summed to give the respondent a score out of 40. The score was then multiplied by 2.5 to give the respondent a score out of 100. The score out of 100 was then categorized as “high GES’ (>90), “medium GES’ (75–90) or “low GES’ (<75).
Those who scored closest to 100 gave answers to the statements which indicated they supported gender equity – women should not only have equal rights and opportunities but be treated fairly and justly in the distribution of benefits and responsibilities between women and men. Those who scored lower on the gender equity scale expressed views that indicated less support for women being treated equally and fairly [8].
Statistical analysis
The Statistical Program SPSS for windows version 20 had been used in data analysis. Statistical significance was set at p < 0.05.
Ethical considerations
The study protocol had been approved by the standard ethics of Minia University ethical committee for human studies. Interviews were held in strict privacy, mainly in the respondents’ homes, with no one able to overhear the conversation. The participants were informed about their possibility to withdraw at any point during the research phase and gave written informed consent to participate.
Results
The study highlighted the key characteristics that either foster or discourage the continuation of the practice. A total of 618 rural dwellers were included in the present study with only 0.3% non response rate. Respondents’ average age was 31.8±14.6 years. 90.3% were moslems in religion and 67.6% were women. 342 (55.3%) were married (Table 1).
Percentage
Frequency
Socio-demographic variables
Sex
31.1
180
Male
68.9
398
Female
Age
18-74 (30.7±12.4)
Range (Mean±SD)
Educational level
17.3
100
Illiterate
9.3
54
Read and write
10.7
62
1ry education
28.4
164
2nd education
34.3
198
University
Religion
89.6
518
Moslem
10.4
60
Christian
Marital status
36.7
212
Single
59.2
342
Married
0.6
4
Divorced
3.5
20
Widow
100
578
Total
Table 1: Socio-demographic profile of studied population, rural Minia, Egypt.
Table 2 showed that 451 (78.03%) of rural dwellers had low GES, 100 (17.3%) had medium and 27 (4.67) had high GES.
GES
No.
%
Low
451
78.03
Middle
100
17.3
High
27
4.67
Table 2: Gender equity score among the studied sample.
Table 3 showed that there was a significant relation between GES and sex, marital status and education. Also, there was a significant relation between GES and attitude that FGM is a good practice (p=0.0001), Knowledge that FGM is harmful (p=0.02) and agreement with FGM performance to daughter in the future (p=0.0001).
X2
Total
Low GES
High and medium GES
(n=127)
p value
(n=578)
(n=451)
Sex
24.3
398 (67.6)
333 (72.8)
65 (51)
Females
0.0001
180 (32.4)
118 (27.2)
62 (49)
Males
Age
2.4
286 (49.5)
215 (47.8)
71 (55.1)
Less than 25 year
0.1
292 (50.5)
236(52.2)
56 (44.9)
More than 25 year
Marital status
8.4
232 (40.8)
167 (37.6)
65 (51)
Never married
0.004
346 (59.2)
19 (62.4)
62 (49)
Ever married
Education
48.4
218 (38.5)
137 (31.2)
81 (61.9)
University
0.0001
144 (26.5)
136 (31)
8 (12.2)
Secondary education
32 (8.4)
30 (8.5)
2 (8.2)
Primary education
44 (10.4)
42 (11)
2 (8.2)
Read and write
100 (16.2)
86 (18.3)
14 (9.5)
Illiterate
Attitude that FGM is a good practice
17.5
262 (45.6)
227 (50.3)
35 (30.6)
Yes
0.0001
316 (54.4)
224 (49.7)
92 (69.4)
No
Knowledge that FGM is harmful
5.1
304 (52.4)
225 (49.9)
79 (60.5)
Yes
0.02
274 (47.6)
226 (50.1)
48 (39.5)
No
Agree to perform FGM to his daughter in the future
Yes
31.7
315 (54.2)
275 (60.5)
40 (34)
No
0.0001
263 (45.8)
176 (39.5)
87 (66)
Table 3: Relation between GES and socio-demographic variables and some factors related to FGM, rural Minia, Egypt.
Discussion
FGM has gained increased attention in policy and research over the last decades due to its impact on women’s health, including severe violation of human rights [9,10]. Studies on FGM in the general population in Egypt have reported that almost all Egyptian women (97%) have been subjected to FGM [11,12].
About 78.03% of rural dwellers had low GES, this result was less than what was found by Hassan et al. who found that 90.5% of respondents’ scores fell within the low range of support for gender equity, 8.6% fell within the medium range of support. This difference may be explained by that, our study sample included males and females, while in the other study, the participants were males only and this emphasize that women in poor agricultural villages in Upper Egypt were still considered to be inferior to males and to their husbands [13].
Behaviour change will become more likely when people are not only ready to change, but willing and able as well. Such interpretation is consistent with social convention theory. Social conventions require social support. To change social conventions, role models (such as individuals or families in good social standing) may introduce new behaviours [14].
In an analysis to EDHS, 2008 in Egypt, unlike mother’s education; father’s education as well as father employment status had no association with FGM. In addition, the parent’s preference for daughter circumcision decreased over time [15].
According to the results of a previous study, higher educated mothers were less likely to have circumcised daughters than for medium and low educated women when other factors as family and community factors were held constant. Past experience of women about FGM was also consistently related to decision to mutilate their daughters since mutilated women were more likely to have their daughters circumcised too. Women who believed that hygiene and cleanness were benefits for girls who undergo FGM were more likely to mutilate daughter. Family approval, achievement of community status and tradition and sexual control, assurance of eligibility for marriage and male pleasure were other factors that might contribute to fostering the FGM practice [16].
Limitations of the Study
1. This cross-sectional study allowed studying associations but not causality.
2. Some women and men refused to participate in the study. Applying patience and diplomacy the researchers had to work for long hours.
3. The possibility of recall bias or reporting bias.
Conclusion and Recommendations
The overall results gave important inputs to policy makers. Educating and protecting girls and increasing importance of values as personal wellbeing, health care and women empowerment which could help to fight acceptance of FGM.
Acknowledgement
We are grateful for all the women and men of Burgaia village, Minia, Egypt, for their participation in the study.
Ethical Consideration
This research took approval from the research ethical committee of the university. All participants gave consent to participate in the study.
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