Female genital mutilation/cutting (FGM/C) according to United Nations Children’s Fund (UNICEF) is any procedure that involves partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious, or other nontherapeutic reasons [
The prevalence of FGM/C ranges from 90 percent to as low as 5 percent in practicing countries and among different ethnic groups. Approximately 3 million girls are at risk of being mutilated/cut each year [
FGM is practiced for a variety of reasons, sometimes at a certain age or alternatively as a rite of passage, often at puberty which is a time of vulnerability and change. Despite the fact that FGM has been illegal in Kenya for the last 12 years, it is still widely practiced. The Kenyan government estimates that 28 percent of all women between the ages of 15 and 49 in more than half the country’s districts have undergone FGM with North Eastern region having the highest prevalence (97.1%) [
FGM has both immediate and long-term complications [
At Loitokitok Sub-County Hospital maternity ward, out of an average of 128 women admitted every month, about 50% are women who are admitted with FGM-related complications. According to the health records, there is an increase in admissions to maternity ward due to the government policy of offering free maternity services and also the establishment of community strategy whereby the community units through the Community Health Workers (CHWs) encourage all pregnant women to deliver in health facilities under the care of skilled birth attendants. This increase has made the obstetric complications of the women subjected to FGM more evident owing to increased utilization of skilled birth attendance among the Maasai women. In the hospital, the number of incidences of FGM-related complications rose from 29 to 60 women in the months of April to September 2013, respectively (Table
Obstetric complications incidences from April to September 2013 in Loitokitok Sub-County Hospital.
Type of complication | Month | |||||
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April 2013 | May 2013 | June 2013 | Jul 2013 | Aug 2013 | Sept 2013 | |
Perineal tears | 3 | 4 | 3 | 5 | 4 | 6 |
Postpartum hemorrhage | 4 | 3 | 4 | 5 | 6 | 7 |
Prolonged labor | 5 | 7 | 8 | 10 | 12 | 13 |
Obstructed labor | 7 | 8 | 9 | 10 | 10 | 11 |
Episiotomy | 5 | 7 | 9 | 10 | 13 | 15 |
Anemia secondary to postpartum hemorrhage | 5 | 6 | 5 | 7 | 7 | 8 |
The aim of the study was to review existing knowledge and identify knowledge gaps and attitudes with regards to the obstetric effects of FGM among Maasai women so as to facilitate understanding and take appropriate action towards abolishing the unhealthy practice.
This was a descriptive cross-sectional study carried out in Loitokitok Sub-County hospital, Kajiado County, Kenya. Loitokitok is located at the southern tip of Rift Valley province in Kajiado County and is categorized among arid and semiarid districts in Kenya. It borders the Republic of Tanzania to the west, Taveta district to the southeast, Kajiado Central to the northwest, and Kibwezi to the east. The inhabitants of the region are mostly the Maasai community. The inclusion criteria were Maasai women who had undergone FGM and admitted for delivery to maternity ward and also willing to participate in the study. The sample size of the study was 64 women, which was obtained based on the average number of women who had undergone FGM admitted in the hospital’s maternity in one month. This sample was calculated using Fischer’s and Yamane’s formulae. Systematic sampling technique was used where every 2nd woman in order of arrival to the maternity ward and met the inclusion criteria was interviewed. To get the sampling interval the target population was divided by the desired sample size. The researchers aimed to interview at least four respondents per day. Four pieces of paper were written and shuffled in a container. There was a random start for the first respondent where the nursing officer in-charge picked a number from pieces of paper written one to four.
A researcher-administered semistructured questionnaire which contained closed and open-ended questions was used to collect data. Data collection process took three weeks. Quantitative data were analyzed using Statistical Package for Social Sciences (SPSS) version 20.0 where percentages and frequencies were generated. Qualitative data generated through open-ended questions were coded and categorized into emerging patterns which were later grouped into emerging themes. Three themes emerged: knowledge of FGM, experience of FGM, and attitude towards FGM arose from the open-ended questions. A key score was developed to assess the level of knowledge of obstetric effects among the respondents. The variables indicating the obstetric effects were listed, and a respondent scored one if they mentioned an obstetric effect while they scored a zero if they did not mention any effect. A total of three correct responses was considered knowledgeable. Presentation of the findings was done using tables, bar graphs, and pie charts besides narrative descriptions. Ethical approval to carry out the study was obtained from Kenya Methodist University, Ethics Committee. Informed consent was sought from the participants after explaining about the study and the method of interview.
A total of 64 respondents admitted to maternity ward were interviewed on their knowledge of obstetric effects of FGM and their attitude towards the practice.
Most of the respondents, 53% (
Sociodemographic characteristics.
Characteristic | Frequency ( |
Percentage (%) |
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14–20 | 34 | 53.1 |
21–30 | 18 | 28.1 |
31–40 | 10 | 15.6 |
41–49 | 2 | 3.2 |
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Rural | 50 | 78 |
Urban | 14 | 22 |
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None | 36 | 56 |
Primary | 12 | 19 |
Secondary | 14 | 22 |
Postsecondary | 2 | 3 |
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Married | 51 | 80 |
Single | 11 | 17 |
Separated | 2 | 3 |
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Formal employment | 9 | 14 |
Self–employment | 4 | 6 |
Farmer | 14 | 22 |
Casual laborer | 9 | 14 |
Housewife | 23 | 36 |
Student | 5 | 8 |
During admission, a pelvic examination was carried out, and it was evident that all the respondents had undergone FGM; however, the type varied. Most of them, 73% (
Irrespective of their experience on FGM, half of the respondents, 50% (
Knowledge of obstetric effects of FGM.
The 50% (
The study’s findings established that majority of the respondents, 81% (
Teenage pregnancy is itself is a risk factor of pregnancy-related complications. This situation is worsened with the presence of female genital mutilation (FGM). A factor contributing to teenage pregnancy is early marriage. The findings of the study indicated that half of the respondents were aged between 14 and 20 years and most of them were already married. These findings agree with those of the Kenya Demographic Health Survey (KDHS) which indicated a high prevalence of FGM among teenage mothers in the Maasai community [
The study established that half of the women had knowledge on obstetric complications of FGM which is in agreement with Nasteha et al. who reported that 80.3% of Somali women had knowledge of FGM and its complications [
The FGM scar predisposes pregnant women to perineal tears during childbirth. The study revealed that majority of the women had perineal tears during childbirth and slightly more than half had postpartum hemorrhage. These findings are in agreement with a WHO study which established that perineal tears are a cause of obstetric hemorrhage [
The perception of FGM practice is dependent on the values and beliefs held by the community and also the knowledge on its effects. The study established that majority of the women felt that FGM did not make a woman feel more acceptable as a respectable woman or feel happier. Similar findings were established in a review study which found out that female circumcision is not a religious requirement and neither changed the behavior of women [
Majority of women believed the practice should be stopped and reported that they would not have their own daughters circumcised. Similar findings were reported by various studies assessing the knowledge and attitude of women on FGM [
Based on the study findings, the respondents were fairly knowledgeable on the obstetric effects of FGM. Additionally, most of the respondents had negative attitude towards FGM despite the practice being a rite of passage in the Maasai culture.
There is need for the health-care providers therefore to increase knowledge of the community on obstetric effects of FGM through health education sessions. The community elders who are the law-makers of the community need to be empowered through education to embrace nonharmful cultural practices.
The authors declare that there are no conflicts of interest.
The authors acknowledge the Loitokitok hospital administration and the participants on the study for willingly sharing the information.