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 [
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 [
In Ghana, the magnitude of FGM practice is variable among regions and districts, but this practice is very dominant among the northern tribes [
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 [
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 [
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 [
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.
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
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
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% |
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
Prevalence of female genital mutilation in Ghana.
Circumcised | |||||
---|---|---|---|---|---|
No | Yes | ||||
Region | Western | 992 | 95.8% | 44 | 4.2% |
Central | 897 | 99.1% | 8 | ||
Greater Accra | 1087 | 97.5% | 28 | 2.5% | |
Volta | 654 | 99.2% | 5 | 0.8% | |
Eastern | 812 | 99.1% | 7 | ||
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 | ||
Total | 9564 | 88.3% | 1272 |
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 (
Association socioeconomic characteristics and female genital mutilation in Ghana.
Circumcised | Df | |||||
---|---|---|---|---|---|---|
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 |
Area of residence predicted FGM, and those from rural were more likely 2.3 times to engage in FGM compared to those from urban (
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 (
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 |
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 [
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 (
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 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. [
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 [
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.
All data related to the findings of this study are available from the Multiple Indicator Cluster Survey (MICS) website upon request.
There is no conflict of interest with this submission.
Funding for this study was completed by the authors without any external funding.