Survey of female circumcision in Ibadan, Nigeria Nigeria is the largest black African country situated in the west coast of Africa and is bounded on the west by Togo, on the east by Cameroon, in the south by the Atlantic Ocean and in the North by Niger.
Nigeria is an extremely diverse and heterogeneous country in terms of ethnic groups, culture and language, and has a population of 87 million. Literacy rate is 34%, GNP/capita per annum is low - approximately 450 U.S. Dollars. Maternal mortality rate is 3 to 6 per 1,000 total births (that is 5 to 10 times the rates reported in Europe and North America), and infant mortality rate is 150 to 200 per, 1,000 live births (that is 10 to 20 times the rates reported from the developed countries like U.K., U.S.A. and Sweden).
In Nigeria there is a lack of accurate data with regard to the current practice of female circumcision. Dr. Stephens in 1931 in the Lancet stated that "I have never seen any ill effects due to circumcision in Nigeria", yet some authors have more recently reported sporadic cases of severe complications, 2 - 9, while others, including a former Nigerian State Governor has clamoured for legislative law banning the archaic practice. The study which is hereby reported was therefore designed to find out the extent to which female circumcision is still being practiced in Nigeria, to study the socio-cultural factors responsible for the perpetuation of this custom and to determine the morbidity, and mortality, if any, arising from the practice, so as to formulate guidelines which will serve as a basis for an action program geared towards eradication of female circumcision.
The survey was carried out in Ibadan, the largest city in black Africa. Ibadan is the capital of Oyo State, situated in the western part of Nigeria and has a population of 5 million, about 2/3 of which are women and children. A questionnaire interview was carried out on samples of women attending the antenatal clinics of the largest general hospital in the city as well as a large child welfare clinic in the city.
The results of the survey have revealed that female circumcision is still widely practised and favoured by quite a large proportion of Nigerians as well as other African countries. Over 70 % of the women interviewed had themselves been circumcised; 67 % of them still favour the idea of female circumcision. Almost half of the respondents had their daughters circumcised and almost a quarter (25 %) of them said that they will spare no pain to see that their daughters are circumcised. It is the mild form (cutting of the clitoris) that is done in Ibadan.
It was shown from the survey that the age of the respondents did not seem to have influenced their attitude to the practice of female circumcision. Both old and young favour the practice though in our survey a high proportion of the respondents were young and below the age of 35 years, and a significant proportion of them favour female circumcision.
Although the majority (72.6 %) of the respondents who favour female circumcision were illiterates, yet it is noteworthy that almost 30 % of those who favour the practice are literate, and as many as 10 % of the literate have had a minimum of secondary education. Thus, the fact that opposition to the practice of female circumcision comes from women who have received some education which has been reported by some workers, 12 has not been clearly demonstrated in this survey. The pattern observed in
this survey is surely a reflection of the strong cultural attitude towards female circumcision among Nigerian respondents. Furthermore, it was observed that even among the educated women who do not favour the practice, family and social pressures are often so great that the women might eventually have to give in and submit their daughters for circumcision. In these instances, the mother-in-law or some paternal grandmother or aunt insisted that it must be done.
In this study although more than 80 % of the respondents were indigenes of Ibadan and its environs, it is generally known that the practice of female circumcision is ethnically linked in Nigeria.
Survey - Ibadan, Nigeria
Ethnic groups such as Ijebus and Egbas (also in the western part of Nigeria) do not favour female circumcision, while the practice is highly prevalent among the Ibadans, Ijeshas, Ebitts in the west, the Benins and Itshekiris in the midwest, Igbos in the east and some tribes in the northern parts. This ethnic differences were also observed by other researchers from other countries, e.g. Sudan and Kenya.
About 70% of the respondents who favour female circumcision are Muslims while 29 are Christians and 1% are traditionalists. Religion, per se, does not seem to play an important role in influencing the people's attitudes toward female circumcision. The sample employed in this study is predominantly Muslim and this is reflected in the results obtained.
Almost 95% or the female circumcision carried out in Ibadan was done by traditional circumcisionists. Nurse/midwives and traditional birth attendants were said to have carried out 4% and 1% respectively of the female circumcisions. The instruments used include sharp knives, scalpels or blades. The operation is usually carried out in the first two weeks of life, or when the child is few months old. In Bendel State (Midwest Region) it is done on the woman at the 7th month of her first pregnancy if she was not circumcised as a child.
With regard to complications, only 8% of the respondents reported complications from female circumcision performed by the native circumcisionists. The possibility of gross under reporting of the outcome of the cases performed by these circumcisionists should nevertheless not be overlooked. On the other hand, some post-operative medications are usually applied to the wound by the circumcisionists which include local herbal preparations as well as penicillin ointment. However, from clinical observation and surveys carried out in hospitals and clinics, some of the complications that have been reported among girls who have been circumcised include shock from severe pain and haemorrhage, infection, especially tetanus.
Urinary retention, damage to the urethra giving rise to urinary in continence, damage to the anus resulting in fistula-in-ane and faecal incontinence, as well as cysts of the clitoris. (10, 11) Others serious gynaecological and obstetrical complications such as chronic pelvic infection an calculi formation and subsequent infertility, obstructed labour as a result of labial adhesions, severe fibrosis and scarring leading to narrowing of the vaginal orifice had also been recorded. (13-17) Such cases of obstructed labour could end up in ruptured uterus and severe haemorrhage, causing the death of both mother and child.
Some of the reasons which the respondents gave in favour of female circumcision were:
1. "Female circumcision which involves the cutting of the clitoris will dampen sexual desire" and thus help to prevent promiscuity and maintain chastity between the age of the puberty and the time of marriage, and it will also ensure fidelity in a married woman.
2. Female circumcision is "an essential ritual" a woman must undergo as a child (or in any case before the birth of her first child) in order to ensure a quick and easy labour during childbirth. It is felt that the clitoris may swell during childbirth and thus obstruct the delivery of the head of the baby.
3. Prevention of the development of a large head (Hydrocephalus) of the baby, as the "contact between the clitoris and the baby's head might give rise to congenital hydrocephalus, and consequent infant death".
4. Excision of the clitoris will reduce excessive vaginal secretion which is thought to cause vaginal irritation and rashes in the pelvic area.
The respondents who do not favour female circumcision gave the following reasons:
1. "It is a cultural/traditional heritage that should be discarded, as it is barbaric."
2. "It is an absolutely unnecessary procedure (which like tribal facial marks) only causes severe pain and suffering for the child".
3. "It is 'disvirgining' at childhood; tampering with a child's genitalia".
4. "It is a denial of a woman's self-fulfilment, as it greatly reduces a woman's sexual pleasure.