Does Female Genital Cutting Influence Age of Initiation of Sex in Nigeria: A National Demographic Survey Data Analysis

Research Article

Austin Public Health. 2020; 4(1): 1012.

Does Female Genital Cutting Influence Age of Initiation of Sex in Nigeria: A National Demographic Survey Data Analysis

Aniwada Elias Chikee¹*, Okpoko Chinwe Catherine², Uleanya Nwachinemere Davidson³ and Aghaji Margret³

1Department of Community Medicine, University of Nigeria, Nigeria

2Department of Mass Communication, University of Nigeria, Nigeria

3Department of Pediatrics, University of Teaching Hospital, Enugu State, Nigeria

4Department of Community Medicine, University of Nigeria, Nigeria

*Corresponding author: Aniwada Elias Chikee, Department of Community Medicine, University of Nigeria, Enugu State, Nigeria

Received: September 20, 2020; Accepted: October 19, 2019; Published: October 26, 2020


Background: Female genital cutting is a harmful non-therapeutic modification of external genitalia, an ancient practice rooted in culture. Early age of exposure to sex has been associated with an increased risk of lifetime undesirable sexual outcomes. There is widely held belief that FGC influences sexual behavior and this study strives to validate or refute the assertion.

Methods: A secondary data analysis involving 2013 NDHS was done. Data on 21,747 respondents were extracted from 36,800 participants. Women aged 15-49 were studied. Data was collected using questionnaires. Chi-square test and Binary Logistic Regression were used in analysis.

Results: Of the 21,747 studied, 8,484 (39%) were circumcised. Also 4,211(49.6) circumcised and 7,892 (59.5) non circumcised had first sex at age <18 years. Female Genital Cutting (FGC) is not a predictor risk of being exposed to sex at < 18 years (AOR 1.03; 95% CI 0.99-1.07). Predictors of risk of age of exposure to sex from this study were living in southern region (AOR 1.16; 95% CI 1.10-1.23), living in rural area (AOR 0.82; 95% CI 0.78-10.85), having attained secondary education and above (AOR 0.79; 95% CI 0.76-0.84), being a Moslem (AOR 0.92; 95% CI 0.87-0.96) and belonging to richer/ richest class (AOR 0.83; 95% CI 0.79-0.88).

Conclusions: Influence of FGC on protection virginity that was propagated is largely unfounded. Legislation backed up with political will for implementation, community based anti FGC interventions and continued dialogue with religious leaders and community members are needed to discourage and finally eliminate the harmful practice of FGC.

Keywords: Female genital cutting; Age of initiation of sex; Predictors; Nigeria


Female Genital Cutting (FGC) previously referred to as Female circumcision and later Female genital mutilation was renamed in an attempt to remove the stigma associated with the term mutilation [1]. Female genital cutting is a non-therapeutic modification of external genitalia, an ancient practice that is rooted in culture [2]. According to the World Health Organization, (WHO), FGC includes all procedures that involve partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons [3]. The WHO equally classified FGC into four types namely; clitoridectomy, excision, infibulation and others [3]. The practice has been purported to have cultural significance as it manifest the sexuality of women and their reproductive role in the society.3 However, in reality it is injurious to women [4].

Female genital cutting is practiced for a variety of socio-cultural reasons and this varies from one country and ethnic group to another. In Nigeria, some major reasons for FGC include custom and tradition including passage into womanhood, peer pressure, purification, family honour, hygiene and aesthetic reasons, protection of virginity, spiritual or religious reasons as well as prevention of promiscuity [5]. Female genital cutting is performed mostly during infancy in Nigeria. Studies documented that four in five women (82%) who have been circumcised had their circumcision before their fifth birthday [2]. The long term complications are protean including difficulty in passing urine due to urethral stenosis and scarring, chronic pelvic infections which may result in infertility, recurrent urinary tract infection etc [3,4].

The practice is global though, it is presently practiced mainly in countries of Africa, Middle East and Asia. In Africa, it is performed in a total of 30 countries mostly those in the west, east and north east regions of the continent. While FGC prevalence varies across countries and communities, it is a norm in nations like Somalia, Mali, Sudan and Egypt where levels remain at approximately 90 percent. In contrast, it is rarely practiced in other countries in the same region like Uganda with only one percent prevalence rate [6]. Approximately 200 million women and girls have undergone the procedure and every year an estimated 3 million girls are at risk of undergoing the procedure.3 Female genital cutting is also practiced in Europe and North America especially among immigrant communities from countries where the prevalence is high [3]. Female genital cutting has been criticized by numerous international treaties and conventions. Likewise, most countries including 24 out of the 29 countries where it is practiced have national legislation that criminalizes FGC. Moreover, FGC violates Article 25 of the Universal Declaration of Human Rights, which expresses the sentiment that all people have the “right to a standard of living adequate for health and well-being”. Despite these treaties, the practice has persisted.

Age at first intercourse is an indicator and a summary measure of the average age at which adolescents become sexually active [7]. Early age of exposure to sex has been associated with an increased risk of having lifetime multiple sexual partners, unprotected sex, acquiring Sexually Transmitted Infections (STIs), unwanted pregnancy, [8-12] and undesirable sexual outcomes, such as problems with orgasm and arousal [12]. Recent studies have found that early sexual intercourse is associated with psychosocial problems including; depression and low self-esteem [13-15]. Established risk factors for early sexual intercourse include low parental educational level, household income, being raised by a single parent, poor parent-adolescent relationship, religion and religious group affiliation, reproductive health knowledge and sex education [16-23]. According to the classic ecological model, many other environmental factors like leisure time activities may also affect adolescents’ sexual development including early sexual intercourse initiation [24].

In light of the widely held belief among perpetrators of FGC that it influences sexual behavior and initiation, this study (strives) aims to ascertain the validity of the assertions. The understanding of this may contribute to and improve the prevention and intervention strategies to curb or eradicate the practice of FGC and help in the development of policies against it.

Materials and Method

Study Area: Nigeria is in sub-Saharan Africa. It is grouped into six geo-political zones including North-west, North-east, North-central, South-east, South-west and South-south zones. Administratively, Nigeria is divided into 36 states and Abuja, the Federal Capital territory. Each state is made up of a number of Local Government Areas (LGAs). There are 774 LGAs in Nigeria. Each LGA is divided into autonomous communities. There are widely varied regional health and educational indices with southern region being better than the northern region. Nigeria’s urbanization growth rate is estimated at 5.3% per year.13 Nigeria consists of many tribes and languages.

Study Design: This is a secondary data analysis involving 2013 Nigeria Demographic and Health Survey (NDHS). The NDHS is a cross sectional survey executed by the National population commission (NPC) with the main objective to provide updated estimates of basic social, demographic, economic and health indicators covering human reproductive health, maternal and child health; awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections; violence against women as well as age of exposure to sex.

Sampling Technique and Sample Size: The Primary Sampling Unit (PSU) used in the survey was defined on the basis of Enumeration Areas (EAs) from the 2006 census. During the 2006 national population census, Local Government Areas were divided into localities and each locality was further subdivided into census enumeration areas and then clusters for convenience. Household enumeration and mapping in the selected clusters was done to produce a list of households which made up the sampling frame. The final sample size was 36,800 households selected with a minimum target of 950 completed interviews per state. A stratified, 2 stage cluster designs that uses Probability Proportional To Size (PPS) technique was used to identify clusters within the EAs and choose households randomly within the clusters, achieving a nationally representative sample that appropriately include both rural and urban residents as well as both upper, middle and lower Socio Economic Status (SES) groups. In the first stage a total of 888 clusters (PSU), 286 in urban and 602 in rural areas were selected by systematic sampling using the PPS technique. In the second stage an average of 41 households were selected by equal probability systematic sampling in each cluster from list of all private households.

Study Population/Participants: All women aged 15-49 who were either permanent residents of the households or visitors were studied.

Study Instruments: Data collected for the 2013 NDHS involved use of questionnaires (Household Questionnaire, Women’s Questionnaire and the Men’s Questionnaire). However, women data was analyzed for this study. It was pretested and a standard protocol observed in administering them. These questionnaires were adapted to collect information on relevant demographic, social and economic factors, and health status/indicators including age of exposure to sex. It was translated from English into three major Nigerian languages of Hausa, Igbo and Yoruba. The questionnaires were interviewer administered through face to face interview to all eligible participants.

Data Analysis: Data on 21,747 respondents were extracted from 36,800 participants in the 2013 NDHS data. The extracted data was cleaned for missing observations in the outcome variable. Data were summarized using frequency and percentages. Chi-square test of statistical significance was used to verify associations of characteristics of respondents with age of exposure to sex, while Binary Logistic regression model was used to identify predictors of risk of age of exposure to sex. The level of statistical significance was determined by a p value ≤ 0.05.


The mean age of the respondents was 30.1±9.6 years. Respondents have similar distribution of age (about 30%) and region (50%). A higher proportion of respondents (54.7%) attained primary education and below, resides in urban areas (54.4%), were Christians (53.0%), belong to richer/richest class (47.4%), in union (87.7%), never used contraceptives (78.1%), were not circumcised (61.0%) and have incorrect knowledge of ovulation (75.1%). Table 1.

Citation: Chikee AE, Catherine OC, Davidson UN and Margret A. Does Female Genital Cutting Influence Age of Initiation of Sex in Nigeria: A National Demographic Survey Data Analysis. Austin Public Health. 2020; 4(1): 1012.