BioMed Research International
Volume 2021 (2021), Article ID 6675579, 6 pages
https://doi.org/10.1155/2021/6675579

Research Article

Female Genital Mutilation in Ghana: Prevalence and Socioeconomic Predictors

Abdul Rauf Alhassan¹ and John Nyaaba Anyinzaam-Adolipore²

¹Department of Surgery, Tamale Teaching Hospital, P.O. Box TL 16 Tamale, Ghana
²Department of supervision/inspectorate unit, Ghana education service, P.O. Box KA 20 Karaga, Ghana

Correspondence should be addressed to Abdul Rauf Alhassan; alhassana84@yahoo.com

Received 5 December 2020; Accepted 27 April 2021; Published 12 May 2021

Academic Editor: A.Seval Ozgu-Erdinc

Copyright © 2021 Abdul Rauf Alhassan and John Nyaaba Anyinzaam-Adolipore. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract.

Background. Each year, not less than three million women are circumcised, and more hundred million females have already been circumcised. In many African societies, the practice of female genital mutilation (FGM) is a serious cultural practice. Aim: This current study is aimed at identifying the socioeconomic predictors of female genital mutilation in Ghana. Methods. The design adopted for this study was a descriptive cross-sectional survey relying on data from the Ghana Multiple Indicator Cluster Survey (MICS) 2017/18. SPSS software was used for data analysis. Chi-square and binary logistic regression were used for associations. Results. Overall FGM prevalence, this study recorded was 11.7%. The region with the highest (50.5%) prevalence was the Upper West Region. Area of residence predicted rural (,) Upper West/western Region (, ). In terms of ethnicity, the tribes that predicted FGM when compared with the Akan tribe were Guan (, ), Gruma (, ), Mole-Dagbani (, ), Grusi (, ), Mande (, ), and other tribes (, ). Women in the richest/poorest wealth index quintile (, ). Conclusion. The study prevalence of FGM is still high in the northern part of Ghana, and the predicted factors were residence region, ethnicity, educational level, and economic status.

1. Introduction

Female genital mutilation (FGM) is defined by the World Health Organization (WHO) as the practice of cutting parts or complete removal of female external genitalia for culture medicine. It was important to classify FGM as it is significant for clinical practice, management, recording, and reporting of prevalence. FMG is categorized into four and further subdivided into subtypes [1].

In many African societies, the practice of female genital mutilation (FGM) is a serious cultural practice. FGM practice can be traced in 28 African nations, even though the use of nationality as a predictor is less significant as compared to the traditional culture. Statistics have it that each year, not less than three million women are circumcised, and more hundred million females have already been circumcised [2].

In Ghana, the magnitude of FGM practice is variable among regions and districts, but this practice is very dominant among the northern tribes [3, 4]. Even though the overall prevalence was 4%, that of the Upper East Region was 38%, and that of a district (Bawku municipality) was 82% [4]. It is believed that the higher prevalence in northern Ghana can be attributed to the variable nature of people and culture and the proximity of neighboring nations such as Mali, Togo, and Burkina Faso where the practice is widespread [5].

There are a lot of short- and long-term complications associated with the practice of FGM. Some of these short-period complications include psychological trauma, hemorrhage, shock, very severe pain, genital tissue swelling, impaired wound healing, increased exposure to blood, and transmittable infections such as human immunodeficiency virus (HIV) and hepatitis B sharing of the same knife or bladder during the procedure [6]. Moreover, among the long-term complications are chronic infections of the genital tract, reproductive tract and urinary tract, menstrual problems, and sexual performance disturbances such as pain during sexual intercourse [6–9].

Many factors have shown a significant relationship with FGM practice, and among these include demographic factors such as age, educational background, religion, culture, and economic status [10–12]. In sub-Saharan African nations, studies on economic status had a significant relation with FGM [10, 11]. Women from better economic homes were less likely to involve in FGM. And younger and well-educated women are negatively associated with FGM practice [10–13].

Additionally, a study in northern Ghana found a significant relationship between a woman’s demographic characteristics and FGM. Predictors’ factors were aged 35–49 years, no formal education or primary education, and married women [5]. This current study is aimed at identifying the socioeconomic predictors of female genital mutilation in Ghana.

2. Materials and Methods

The design adopted for this study was a descriptive cross-sectional survey relying on data from the Ghana Multiple Indicator Cluster Survey (MICS) 2017/18. The survey was conducted from October 2017 to January 2018 by the Ghana Statistical Service with collaborator partners such as the Ministry of Health, Ministry of Education, Ministry of Sanitation and Water Resources, Ministry of Gender, Children, and Social Protection, Ghana Health Service, and the Ghana Education Service as part of the Global MICS Programme and technical support from the United Nations Children’s Fund (UNICEF), with government funding and financial support from UNICEF, KOICA, UNDP, USAID, and the World Bank through the Statistics for Results Facility–Catalytic Fund (SRF-CF).

The sampling frame assumed was from the Ghana 2010 Population and Housing Census (PHC). This encompassed all women (10,840) aged 15-49 years who were permanent occupants of selected households or visitors who stayed in selected households the night before the survey.

2.1. Statistical Analysis

SPSS version 20 (IBM Corp., 2011, and NY) was used for the analysis. Categorical variables results were presented using frequencies and percentages in tables. The association between dependent and independent variables was done using chi-square. The binary logistic regression model was used to identify the predictor variables of FGM. Statistical significance was set at a value of <0.05.

3. Results

3.1. Socioeconomic Characteristics of Respondents

The majority (56.6%) of the women were from rural, and dominant (15.6%) of them were from the Ashanti region and in terms of ethnicity, about 37.2% of them were from the Akan tribe. Most (73.1%) of them first got married when they were between 15 and 24 years. About 37.8% of them had a preprimary educational level or no education. Health insurance coverage was 55.6% among the respondents, and 29.7% of them were in the poorest wealth index quintile. The majority (88.8%) of them had no functional difficulty (Table 1).

Table 1: Socioeconomic characteristics of the respondents.

Frequency
Percentage

Area
Urban
4703
43.4%

Rural
6137
56.6%

Region
Western
1036
9.6%

Central
905
8.3%

Greater Accra
1117
10.3%

Volta
659
6.1%

Eastern
820
7.6%

Ashanti
1693
15.6%

Brong-Ahafo
914
8.4%

Northern
1151
10.6%

Upper East
1146
10.6%

Upper West
1399
12.9%

Age at first marriage
Below 15
1237
11.9%

15-24
7611
73.1%

25-34
1435
13.8%

35 years and above
128
1.2%

Ethnicity
Akan
4035
37.2%

GA/Dangme
666
6.1%

Ewe
900
8.3%

Guan
362
3.3%

Gruma
458
4.2%

Mole Dagbani
2976
27.5%

Grusi
460
4.2%

Mande
67
0.6%

Other
910
8.4%

Educational level
Preprimary or none
4101
37.8%

Primary
1994
18.4%

JSS/JHS/middle
3370
31.1%

SSS/SHS/secondary
939
8.7%

Higher
434
4.0%

Have health insurance
Yes
6030
55.6%

No
4810
44.4%

Functional difficulties (age 18-49 years)
Has functional difficulty
1214
11.2%

Has no functional difficulty
9607
88.8%

Wealth index quintile
Poorest
3217
29.7%

Second
1791
16.5%

Middle
1878
17.3%

Fourth
1909
17.6%

Richest
2045
18.9%

3.2. Female Genital Mutilation Prevalence in Ghana and Associated Factors

Overall FGM prevalence, this study recorded was 11.7%. The region with the highest (50.5%) prevalence was the Upper West Region, and the lowest (0.9%) prevalence was recorded in the central and eastern regions (Table 2).

Table 2: Prevalence of female genital mutilation in Ghana.

Circumcised

No
Yes

Region
Western
992
95.8%
44
4.2%

Central
897
99.1%
8
0.9%

Greater Accra
1087
97.5%
28
2.5%

Volta
654
99.2%
5
0.8%

Eastern
812
99.1%
7
0.9%

Ashanti
1617
95.6%
75
4.4%

Brong-Ahafo
876
95.8%
38
4.2%

Northern
1065
92.5%
86
7.5%

Upper East
871
76.0%
275
24.0%

Upper West
693
49.5%
706
50.5%

Total

9564
88.3%
1272
11.7%

Chi-square analysis revealed a significant relationship between FGM and socioeconomic characteristics such as area of residence, the region from, age at first marriage, ethnicity, educational level, health insurance coverage, functional difficulty, and wealth index quintile () (Table 3).

Table 3: Association socioeconomic characteristics and female genital mutilation in Ghana.

Circumcised

Df
value

No
Yes

Area
Urban
4548
151
582.021
1
≤ .001

Rural
5016
1121

Region
Western
992
44
2770.331
9
≤ .001

Central
897
8

Greater Accra
1087
28

Volta
654
5

Eastern
812
7

Ashanti
1617
75

Brong-Ahafo
876
38

Northern
1065
86

Upper East
871
275

Upper West
693
706

Age at first marriage
Below 15
964
273
158.316
3
≤ .001

15-24
6722
885

25-34
1339
96

35 years and above
118
10

Ethnicity
Akan
4021
14
1963.652
3
≤ .001

GA/Damgme
662
2

Ewe
897
3

Guan
353
9

Gruma
444
14

Mole Dagbani
2073
902

Grusi
325
135

Mande
46
21

Other
737
172

Educational level
Preprimary or none
3060
1041
1217.089
4
≤ .001

Primary
1859
135

JSS/JHS/middle
3299
67

SSS/SHS/secondary
913
26

Higher
431
3

Have health insurance
Yes
5420
608
35.802
1
≤ .001

No
4144
664

Functional difficulties (age 18-49 years)
Has functional difficulty
1063
151
.608
1
.436

Has no functional difficulty
8482
1121

Wealth index quintile
Poorest
2384
833
990.454
1
≤ .001

Second
1574
217

Middle
1761
115

Fourth
1857
51

Richest
1988
56

3.3. Predictors of FGM in Ghana

Area of residence predicted FGM, and those from rural were more likely 2.3 times to engage in FGM compared to those from urban (, ). Women from all regions except the Upper West Region when compared to those from the western region were protected from FGM (). Women from the Upper West Region were more likely 1.8 times to engage in FGM compared to those from the western region (, ). In terms of ethnicity, the tribes that predicted FGM when compared with the Akan tribe were Guan (, ), Gruma (, ), Mole-Dagbani (, ), Grusi (, ), Mande (, ), and other tribes (, ).

The history of FGM was less likely 0.8 times among women with a marriage age of 15-24 years when compared to those with marriage age before 15 years (, ). Women with educational level primary and above were less likely to engage in FGM compared to those with preprimary or none (). Women from the richest wealth index quintile were more likely 1.8 times to engage in FGM compared to those from the poorest wealth index quintile (, ) (Table 4).

Table 4: Multiple regression for predictors of female genital mutilation in Ghana.

B
S.E.
Wald
Sig.
AOR
95% C.I. for AOR

Lower
Upper

Residence (rural/urban)
.831
.138
36.408
≤ .001
2.296
1.753
3.007

Western

403.536
≤ .001

Central
-.852
.424
4.039
.044
.426
.186
.979

Greater Accra
-.317
.301
1.115
.291
.728
.404
1.312

Volta
-1.762
.544
10.489
.001
.172
.059
.499

Eastern
-1.746
.440
15.784
≤ .001
.174
.074
.413

Ashanti
-.692
.232
8.917
.003
.500
.318
.788

Brong-Ahafo
-1.193
.265
20.245
≤ .001
.303
.180
.510

Northern
-1.569
.229
46.909
≤ .001
.208
.133
.326

Upper East
-.513
.212
5.846
.016
.599
.395
.907

Upper West
.608
.206
8.700
.003
1.836
1.226
2.750

Below 15

9.009
.029

15-24
-.284
.095
8.845
.003
.753
.624
.908

25-34
-.247
.158
2.429
.119
.782
.573
1.066

35 years and above
-.062
.435
.020
.887
.940
.401
2.206

Akan

246.865
≤ .001

GA/Dangme
-.038
.772
.002
.961
.963
.212
4.373

Ewe
.364
.660
.304
.581
1.439
.395
5.240

Guan
2.188
.472
21.465
≤ .001
8.919
3.534
22.509

Gruma
1.864
.407
20.988
≤ .001
6.447
2.905
14.310

Mole Dagbani
3.640
.299
148.010
≤ .001
38.100
21.195
68.489

Grusi
3.813
.314
147.261
≤ .001
45.302
24.470
83.869

Mande
4.228
.408
107.642
≤ .001
68.576
30.853
152.421

Other
3.379
.306
122.185
≤ .001
29.328
16.111
53.388

Preprimary or none

136.214
≤ .001

Primary
-.712
.111
40.934
≤ .001
.491
.395
.610

JSS/JHS/middle
-1.363
.148
84.693
≤ .001
.256
.191
.342

SSS/SHS/secondary
-1.211
.232
27.142
≤ .001
.298
.189
.470

Higher
-2.625
.606
18.773
≤ .001
.072
.022
.238

Health insurance
.109
.075
2.077
.150
1.115
.962
1.293

Poorest

14.105
.007

Second
.079
.104
.568
.451
1.082
.882
1.327

Middle
-.019
.143
.018
.892
.981
.741
1.298

Fourth
-.223
.194
1.329
.249
.800
.547
1.169

Richest
.587
.211
7.718
.005
1.799
1.189
2.722

4. Discussion

Overall FGM prevalence, this study recorded was 11.7%. The region with the highest (50.5%) prevalence was the Upper West Region, and the lowest (0.9%) prevalence was recorded in the central and eastern regions. There is a decline in national prevalence when compared to an earlier study using MICS data, which recorded a prevalence of 15.9%. In this same study, the prevalence was high among women of the Upper West Region [14]. This confirms other results that in Ghana, the magnitude of the practice of FGM is variable among regions and districts, and that this practice is very dominant among the northern tribes [3, 4]. Even within the regions, it is variable among districts in a study through the overall prevalence was 4%, and that of the Upper East region was 38%, and that of a district (Bawku municipality) was 82% [4]. The variation of prevalence across the regions of Ghana can be attributed to the variable cultural practices, and this confirms the fact that using nationality as a predictor is less significant when compared with using traditional culture [2]. It is believed that the higher prevalence in northern Ghana can be attributed to the variable nature of people and culture and the proximity of neighboring nations such as Mali, Togo, and Burkina Faso where the practice is widespread [5].

This is the first of a few epidemiological studies on FGM with an effort of shedding light on etiology and predictors. This study was not without limitations as not all variables significantly related to the study topic were studied, for example, religious affiliation. Two variable analyses revealed a significant relationship between FGM and socioeconomic characteristics such as area of residence, the region from, age at first marriage, ethnicity, educational level, health insurance coverage, functional difficulty, and wealth index quintile (). These factors were significantly related to FGM in other studies [10–12].

Area of residence predicted FGM, and those from rural were more likely 2.3 times to engage in FGM compared to those from urban. Women from the regions except the Upper West Region were protected from FGM when compared to those from the western region (). Women from the Upper West Region were more likely 1.8 times to engage in FGM compared to those from the western region. In terms of ethnicity, the tribes that predicted FGM when compared with the Akan tribe were Guan, Gruma, Mole-Dagbani, Grus, Mand, and other tribes. This confirms similar study results in which FGM practice is highly predominant among women in the Upper West Region and the Mole/Dagbani [14]. Ethnicity brings cultural variation, and it is believed the variable nature of people and their culture contributes to the ethnic variations [5].

Women with at least a primary educational level were less likely to engage in FGM compared to those with no education; meaning, lack of formal education was a predictive factor for FGM. Additionally, women from the richest wealth index quintile were more likely 1.8 times to engage in FGM compared to those from the poorest wealth index quintile. In sub-Saharan African studies, economic status had a significant relation with FGM, and not in line with this current study, women from better economic homes were less likely to involve in FGM. [10, 11]. However, in line with this current study, well-educated women were less likely to practice FGM [10–13].

The history of FGM was less likely 0.8 times among women with a marriage age of 15-24 years compared to those with marriage age below 15 years. The implication of this is that child marriage below 15 years was more likely among those with FGM practice history, and this is in line with other earlier studies or works that FGM had a significant relation with child marriage below 18 years [15, 16].

5. Conclusion

The study prevalence of FGM is still high in the northern part of Ghana, and the predicted factors were residence region, ethnicity, educational level, and economic status.

Data Availability

All data related to the findings of this study are available from the Multiple Indicator Cluster Survey (MICS) website upon request.

Conflicts of Interest

There is no conflict of interest with this submission.

Acknowledgments

Funding for this study was completed by the authors without any external funding.

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