Female genital cutting : findings from the demographic and health surveys program

This report presents findings of surveys on female genital cutting conducted between 1989 and 1996 in the Central African Republic (CAR), Ivory Coast, Egypt, Eritrea, Mali, northern Sudan, and Yemen. All told, more than 55,000 women and 1,000 men were surveyed. Results are as follows. (1) Genital cutting is nearly universal in Egypt, Eritrea, Mali, and northern Sudan. It is less common, though widespread, in the CAR and the Ivory Coast. (2) Prevalence levels are constant, irrespective of women"s education or residence, but are often higher among Muslim women. (3) Many women have a substantial amount of genital tissue (e.g., part or all of the clitoris and labia minora) removed during the cutting, which is mostly commonly performed by traditional practitioners, although medical professionals are also common providers in Egypt and Sudan. Women commonly report health problems related to the cutting, e.g., hemorrhage and difficulties in child delivery and in sexual relations. (4) Despite medical risks and international censure, support for the practice among most women in high-prevalence countries appears widespread and enduring. Eritrea is an exception, with relatively high levels of opposition and dissatisfaction among women and men. Support levels are higher among Muslims, sometimes because of support from Islamic leaders, as is the case in Egypt, than among those of other faiths. Support in the CAR and the Ivory Coast is concentrated in particular regions that may strongly oppose change. (5) In terms of ethnicity, attitudes towards cutting vary considerably in the CAR, less so in Mali. No other countries provided data on ethnicity. (6) Tradition or custom are the most common reasons given by women for supporting the practice. Egypt is the only country where women support the practice for hygienic and religious reasons. Medical complications are the reasons most often given for opposing the practice. (7) No major decrease in prevalence levels is evident across generations, except in the CAR, where younger women seem nearly as likely to undergo the practice as did their mothers. However, the less favorable personal attitudes expressed by urban and educated women (especially in Egypt) may make the daughters of these women less likely than others to undergo the practice. At the same time, personal attitudes may not necessarily translate into lower prevalence. Fear of social criticism and the insistence of older women are powerful forces against change. Educational campaigns were suggested by Egyptian and Sudanese women opposed to the practice as the best strategy for eradicating it. (8) The role of men in furthering female genital cutting is ambiguous.