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      Knowledge and Attitude on Obstetric Effects of Female Genital Mutilation among Maasai Women in Maternity Ward at Loitokitok Sub-County Hospital, Kenya

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          Abstract

          Background

          Female genital mutilation (FGM) is one of the most harmful traditions still practiced in many parts of the developing world, including Kenya. The practice leads to permanent and irreversible health damages; however, knowledge and attitude of women towards its obstetric effects is scarce.

          Aim

          The objective of this study was to determine knowledge and attitude of women towards obstetric effects of FGM among Maasai women.

          Methods

          A hospital-based cross-sectional study was conducted at Loitokitok Sub-County Hospital among 64 Maasai women who had undergone FGM. Systematic sampling was employed to identify the respondents. Data were collected using a pretested semistructured questionnaire and analyzed through Statistical Package for the Social Sciences (SPSS) version 20.0 based on frequencies and percentages. Qualitative data were coded and categorized and thematic analysis was done.

          Results

          Half of the women were knowledgeable on obstetric effects of FGM. Majority of them, 81% ( n=52), sustained perineal tears during childbirth while 53% ( n=34) had postpartum hemorrhage. Majority of the respondents, 81% ( n=51), had negative attitude towards FGM and 87% ( n=31) would not encourage their daughters to be circumcised. Most of them, 64% ( n=23), disagreed that circumcision made one a respectable woman.

          Conclusion

          Obstetric effects of FGM were fairly known and there was negative attitude towards FGM practice.

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          Most cited references17

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          Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries.

          Emily Banks, Olav Meirik, Tim Farley … (2006)
          Reliable evidence about the effect of female genital mutilation (FGM) on obstetric outcome is scarce. This study examines the effect of different types of FGM on obstetric outcome. 28 393 women attending for singleton delivery between November, 2001, and March, 2003, at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan were examined before delivery to ascertain whether or not they had undergone FGM, and were classified according to the WHO system: FGM I, removal of the prepuce or clitoris, or both; FGM II, removal of clitoris and labia minora; and FGM III, removal of part or all of the external genitalia with stitching or narrowing of the vaginal opening. Prospective information on demographic, health, and reproductive factors was gathered. Participants and their infants were followed up until maternal discharge from hospital. Compared with women without FGM, the adjusted relative risks of certain obstetric complications were, in women with FGM I, II, and III, respectively: caesarean section 1.03 (95% CI 0.88-1.21), 1.29 (1.09-1.52), 1.31 (1.01-1.70); postpartum haemorrhage 1.03 (0.87-1.21), 1.21 (1.01-1.43), 1.69 (1.34-2.12); extended maternal hospital stay 1.15 (0.97-1.35), 1.51 (1.29-1.76), 1.98 (1.54-2.54); infant resuscitation 1.11 (0.95-1.28), 1.28 (1.10-1.49), 1.66 (1.31-2.10), stillbirth or early neonatal death 1.15 (0.94-1.41), 1.32 (1.08-1.62), 1.55 (1.12-2.16), and low birthweight 0.94 (0.82-1.07), 1.03 (0.89-1.18), 0.91 (0.74-1.11). Parity did not significantly affect these relative risks. FGM is estimated to lead to an extra one to two perinatal deaths per 100 deliveries. Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive FGM.
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            A Tradition in Transition: Factors Perpetuating and Hindering the Continuance of Female Genital Mutilation/Cutting (FGM/C) Summarized in a Systematic Review

            Rigmor Berg, Eva Denison (2013)
            Understanding the forces underpinning female genital mutilation/cutting (FGM/C) is a necessary first step to prevent the continuation of a practice that is associated with health complications and human rights violations. To this end, a systematic review of 21 studies was conducted. Based on this review, the authors reveal six key factors that underpin FGM/C: cultural tradition, sexual morals, marriageability, religion, health benefits, and male sexual enjoyment. There were four key factors perceived to hinder FGM/C: health consequences, it is not a religious requirement, it is illegal, and the host society discourse rejects FGM/C. The results show that FGM/C appears to be a tradition in transition.
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              Long term health consequences of Female Genital Mutilation (FGM)

              Dan Reisel, Sarah. M. Creighton (2015)
              Female Genital Mutilation (FGM) comprises various procedures which remove or damage the external female genital organs for no medical reason. FGM has no health benefits and is recognised to cause severe short and long term damage to both physical and psychological health. Although FGM is primarily performed in Africa, Asia and the Middle East, migration of FGM practising communities means that the health complications of FGM will have a global impact. It is important that health professionals world wide are aware of the damage FGM causes to long term health. In some cases it may be possible to offer interventions that will alleviate or improve symptoms. However whilst there is some high quality research on FGM and pregnancy outcomes, little is known about the effects on gynaecological, psychological and sexual function. Research is hampered by the problems of data collection on such a sensitive topic as well as the practical difficulties of analysis of studies based mainly on retrospect recall. Well planned hospital based studies of the impact of FGM on physical and psychological health are urgently need but are currently absent from the medical literature. Such studies could generate robust evidence to allow clinicians to benchmark clinical effectiveness and high quality medical care for survivors of FGM.
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                Author and article information

                Contributors
                Keddy Wanjiru Muchene:
                ORCID: http://orcid.org/0000-0002-0250-4398
                Journal
                Journal ID (nlm-ta): Obstet Gynecol Int
                Journal ID (iso-abbrev): Obstet Gynecol Int
                Journal ID (publisher-id): OGI
                Title: Obstetrics and Gynecology International
                Publisher: Hindawi
                ISSN (Print): 1687-9589
                ISSN (Electronic): 1687-9597
                Publication date Collection: 2018
                Publication date (Electronic): 1 August 2018
                Volume: 2018
                Electronic Location Identifier: 8418234
                Affiliations
                1Loitokitok Sub-County Hospital, P.O. Box 28-00209, Loitokitok, Kenya
                2School of Nursing Sciences, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya
                Author notes

                Academic Editor: Curt W. Burger

                Author information
                http://orcid.org/0000-0002-0250-4398
                Article
                DOI: 10.1155/2018/8418234
                PMC ID: 6093056
                SO-VID: 22503b41-0b61-4eac-9f3e-7ceb9f4d8727
                Copyright © Copyright © 2018 Keddy Wanjiru Muchene et al.
                License:

                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.

                History
                Date received : 9 December 2017
                Date revision received : 1 May 2018
                Date accepted : 10 June 2018
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Obstetrics & Gynecology
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology

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