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Eradicating Secret Female Genital Mutilation Practice in South-west Nigeria: Challenges and the Way Forward

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Table of Contents

ABSTRACT

Introduction

Aim of the seminar paper

Objectives of the seminar paper.

Reasons for focusing on south-west region of Nigeria

Background

Prevalence

Countries where FGM are practiced

Prevalence in Nigeria

Prevalence in south-west

Consequences of female genital mutilation on women

Immediate problems

CLASSIFICATION OF FEMALE GENITAL MUTILATION BY WORLD HEALTH ORGANIZATION

THE CHALLENGES

Widespread of secrete FGM practices in south-west of Nigeria

Effectiveness of criminalization of FGM in Nigeria.

Effect of formal education on FGM practices in south-west of Nigeria

Effectiveness of public awareness on FGM practices in south-west region of Nigeria

Does living in Urban areas have effect on FGM practice in south-west region of Nigeria?

Effect of family pressure on FGM practice in south west of Nigeria

Religion influence on FGM practice in south-west of Nigeria

Cultural influence on FGM practices in south west region of Nigeria

THE WAY FORWARD

Strong government support and more political commitment toward FGM eradication

Aggressive medial campaign to target re-orientation and behavioural change

Mass mobilization of religious leaders to speak against FGM practices in all villages and towns in south-west region of Nigeria.

Mobilization of women leaders and traditional rulers as advocates and ambassadors against FGM.

Skill acquisitions and empowerment

Compensation for local circumcisers

Collaboration with education sector

Aggressive government enforcement of existing laws against FGM

Summary

Conclusion

REFERENCES

 

Table of figures

Figure 1: A picture showing painful condition a girl go through and unhygienic condition where FGM is performed.

Figure 2: Prevalence of FGM by state in Nigeria

Figure 3: Percentage of women age 15-49 years circumcised by selected ethnic groups

Figure 4: Percentage distribution of FGM according to type for women aged 15 to 49 in Nigeria

Figure 5: A Pokot woman holding a razor blade after performing a circumcision on 4 girls despite a government ban in Kenya.

Figure 6: Picture showing performance of FGM by traditional circumciser

Figure 7: Picture showing normal virginal structure

Figure 8: Picture showing FGM type I (Clitoridectomy)

Figure 9: Picture showing FGM type II (Clitoridectomy and/or labial excision)

Figure 10: Picture showing FGM type III (Infibulation)

Figure 11: Picture showing FGM type IV (Stretching of labia)

 

 

 

 

 

ABSTRACT

Female genital mutilation is a menace ravaging southern Nigerian states. It is an age-long cultural practice that is imposed and enforced by community expectation from generation to generation among Yoruba people in south-west zone of Nigeria. It evolves as a complex chain of events which reinforce itself through a feedback loop, with a sequence of reciprocal cause and effect in a culturally glued society where ancient values and practices still have a grip on its people. Secrete female genital mutilation is a major public health challenge in south-west of Nigeria. Despite their high level of education and awareness rate, their mutilation prevalence was unfortunately the highest in the country. Extensive medial awareness has been employed to stop the practice in the past. Government also banned it nationwide, but people still go secretly to have the procedure done despite health consequences associated with the practice. The aim of this paper is to identify factors that are responsible for continuous secret performance of female genital mutilation in south-west region of Nigeria, evaluate the challenges facing its eradication and proffer the way forward. Cultural influence, societal expectation, family pressure and religion attachment have been identified as the motivators that perpetuate the practice. The most effective way of achieving behavioural change is active engagement of community members in participatory community mobilization to control and shape their own future, destiny and development, using communication as a means of empowering people with the right information. Actions that are necessary to change community way of life, like collective action, public declaration and organized diffusion would definitely go a long way in eradicating the menace.

Introduction

Female genital mutilation (FGM) is an age-long cultural practices that is imposed and enforced by community expectation from generation to generation among Yoruba people in south-west geo-political zone of Nigeria. Female genital mutilation evolves as a complex chain of events which reinforce itself through a feedback loop with a sequence of reciprocal cause and effect in a culturally glued society like south-west of Nigeria, where ancient values and practices still have a grip on its people. Female genital mutilation could be defined as all practices involving total or partial removal of a female genital organ, or any form of injury to the external female genitalia for non-medical purpose (World Health Organization, 2017). If Nigeria is to achieve the relevant United Nation sustainable development goal number three (Good health and well-being) and five (Gender equality) with a view to advance the right of women and girls, we need to be part of actively moving international ambition which tagged 2017 FGM awareness day theme as “Building a solid and interactive bridge between Africa and the world to accelerate ending female genital mutilation by 2030”.

During the last decade, government in Nigeria had recognized female genital mutilation as a major public health challenge and had deployed extensive public medial campaign to combat the menace. Despite the educative media campaign of the government, the practice still largely continues in south-west of Nigeria. Some non-governmental organizations are also making tireless effort to stop the practice. Many international advocacy groups have claimed that FGM is a discrimination against women (Rhoodie, 1989) while human right groups have also claimed that it is a pure form of human right violation (Human Rights Watch, 2010 ), especially as concerned he right violation of women and girls (Yoder et al., 2013). Many of the south-west state of Nigeria also enacted laws that banned the practice in order to dissuade people from carrying out the procedure. The practice actually reduced, but still went on largely been practiced secretly away from the government’s camera lens at the hospitals, but shifted base to the villages in the hands of untrained traditional birth attendants. Many exploited the loophole that not all the states that banned the practice in Nigeria and transported their girls away from the state where it was banned to where it was not banned. In year 2015, in an effort to stop FGM practice across the country, federal government of Nigeria banned it all over the country. Banning the practice nationwide was actually a step forward in the fight against FGM. The law curbed the practice openly but failed to curb it secretly. People still largely performed FGM secretly in various communities, compounded with family pressure.

Aim of the seminar paper

The aim of the seminar paper is to evaluate the challenges facing female genital mutilation eradication in south-west of Nigeria, and to proffer the way forward.

Objectives of the seminar paper.

  • To identify factors responsible for continuous secret FGM performance in south-west of Nigeria.
  • To evaluate challenges facing FGM eradication in south-west Nigeria.
  • To identify consequences of FGM practices.
  • To proffer strategies that could work in eradicating FGM in south-west region of Nigeria.

Reasons for focusing on south-west region of Nigeria

Female genital mutilation practice is widespread in southern Nigerian states, but more alarming in south-west geo-political zone of the country. Demographic and Health Survey (2013) showed that the prevalence of female genital mutilation among Yoruba girls and women between 15 to 49 years of age living in south-west region of the country was 55%. This was the highest in the country. Most of the procedures are secretly done with traditional birth attendants and traditional circumcisers under unhygienic conditions that carries high health risk with serious health complications. Eradicating this practice will significantly reduce the health risk and complications arising from female genital mutilation, thereby improving maternal and child morbidity and mortality arising from the practice.

Practice continues upon ban on FGM

Adopted from The Nigerian Observer news 2015

Figure 1: A picture showing painful condition a girl go through and unhygienic condition where FGM is performed.

Background

Demographically, Nigeria is Africa’s most populous country. It is located in Sub-Sahara African region. According to the Nigerian National Population Commission (2017), It has an estimated population of 182 million with about half of the population women. More than half of its population are under 30 years of age. This put a strain on a country with dwindling economy and declining revenue to improve health and other social services. Nigeria is an African country in the Gulf of Guinea which shares border with Cameroon, Benin republic, Chad and Niger. Nigeria is the most populous country in that region and unfortunately, it has the lowest life expectancy in Africa, lower than many poorer nations in west Africa sub-region. Life expectancy in Nigeria was put at 54.46 years and ranked 176 in the world while life expectancy for Nigerian women went down to number 178 in the world. Issues concerning women like FGM should be of great concern and should not be overlooked. Since the Nigeria population has been growing for the past five decades, the health burden that could arise from the adverse effect and complications from FGM in the next decade could be difficult for the country to cope with in the face of other pressing issues that are competing for her scarce resources. Therefore, it would be economically viable to eradicate FGM practice in order to stop the health burden that could arise from its complications.

Prevalence

It was estimated by World Health Organization (2017) that female genital mutilation affect over 200 million women around the world in countries where FGM is concentrated. The vast majority of these women are from Africa, Middle East and Asian Countries. Due to immigration, many migrants also took this practice to some developed countries they migrated to, thereby making it a global phenomenal today. In 2009, European parliament estimated that over half a million women in Europe have been subjected to FGM, with over 180,000 more at risk (Leye and Sabbe, 2009).

Countries where FGM are practiced

According to United Nations Population Fund (2015), female genital mutilation is practices in different countries around the world. It is known to be practiced in the following countries:

Nigeria, Kenya, Zambia, Tanzania, Uganda, Togo, Sudan, Somalia, Senegal, Sierra Lone, Niger, Liberia, Mauritania, Mali, Guinea, Gambia, Ghana, Guinea-Bissau, Eritrea, Egypt, Djibouti, Ethiopia, Democratic Republic of Congo, Chad, Cote d’Ivoire, Cameroon, Benin, Central African Republic, Burkina Faso.

Middle East

In Middle East, countries where FGM is practice are, Yemen, Iran, United Arab Emirate, Iraq, Israel, Omar, Palestine

Asia

In Asia, some communities in Malaysia, Sri Lanka, India, Pakistan and Indonesia practice female genital mutilation.

South America 

In Southern American countries, certain communities in the following countries practice female genital mutilation. Peru, Ecuador, Colombia and Panama.

 

Eastern Europe

Recently in Eastern Europe, certain communities in Russian Federation and Georgia are known to be practicing female genital mutilation.

Other western countries

Due to immigration in some western countries like United Kingdom, Australia, New Zealand, Canada, United states of America, and several European countries, immigrant population who migrated from regions where FGM practice is endemic still continue the practice in their host countries.

Prevalence in Nigeria

Out of the six largest ethnic groups, the Yoruba, Hausa, Fulani, Ibo, Ijaw and Kanuri, only the Fulani do not practice any form. The Yoruba practice mainly Type II and Type I. The Hausa and Kanuri practice Type III. The Ibo and Ijaw, depending upon the local community, they practice any one of the three forms (International Women’s Issues, 2009). Women from Ijaw ethnic group have the highest rate of type III 18.8% (Demographic and Health Survey, 2013).

Adopted from 28toomany (2017)

Figure 2: Prevalence of FGM by state in Nigeria

Adapted from Demographic and Health Survey (2013)

Figure 3: Percentage of women age 15-49 years circumcised by selected ethnic groups

Prevalence in south-west

Nigeria and Inter-African Committee (1997) showed the following prevalence and type of female genital mutilation in the following Yoruba states in Nigeria. Kwara (60-70 percent, Types I and II); Lagos (20-30 percent, Type I); Ogun (35-45 percent, Types I and II); Ondo (90-98 percent, Type II); Osun (80-90 percent, Type I); Oyo (60-70 percent, Type I)

Types of genital cutting in Nigeria

Adopted from: Demographic and Health Survey (2013, as cited in 28toomany, p 349-350)

Figure 4: Percentage distribution of FGM according to type for women aged 15 to 49 in Nigeria

In a qualitative and quantitative study on Intergenerational attitude change regarding female genital cutting in Yoruba speaking ethnic group of South-west Nigeria. The prevalence rate of female genital cutting among daughters and mothers in each of the 6 states (Alo and Gbadebo, 2011) revealed that Oyo state had the highest prevalence rate of 88% for daughters and 91% for mothers followed by Ondo State of 76% for daughters and 79% for mothers while Lagos had the least prevalence rate of 56% and 64% for daughters and mothers respectively. It is sufficient to note that Lagos state fared better regarding all the indices of modernization than any other state in the country being the former federal capital territory. Lagos state, however, had the highest intergenerational difference of 8%; this is followed closely by Ekiti State with an intergenerational difference of 5%.

FGM is a celebrated event in some communities. They viewed it as a transition from childhood to adulthood (Leonard, 1996). It is also erroneously viewed as a practice which brings dignity and make the woman clean, thereby make her marriageable and prevent promiscuity in marriage. Some also believed that if a baby’s head touches uncut clitoris during childbirth that the baby would die prematurely. Under this unjust social control of sexuality and fertility, traumatic and psychological burden of this gruesome act lies on women and girls. This brings varying decree of complications raging from excessive bleeding (which may lead to loss of life in children with bleeding disorder), infectious disease (including HIV), dermatological and obstetrical problems and complications (Ledger et al., 2015).

http://cdn.thedailybeast.com/content/dailybeast/galleries/2014/11/29/inside-a-female-circumcision-ceremony-in-kenya-photos/jcr:content/gallery/2c1acb3e-ebea-4572-b6b1-727fe04e7334/image.img.1280.1024.jpg/47242050.cached.jpg

Adopted from thedailybeast.com

Figure 5: A Pokot woman holding a razor blade after performing a circumcision on 4 girls despite a government ban in Kenya.

The devastating effect of female genital mutilation on women is globally recognized. This practice is common with people with common historic background and similar socio economic strata, but there are variations within countries, regions and communities. South-West Nigeria is the most educated region in Nigeria, ironically, it is also one of the regions that have highest prevalence of Female genital mutilation in Nigeria. From this clue, education seems to play minimal role in curbing FGM practice in this region, but mother’s education have impact on their decision not to circumcise their daughters (Kandala et al., 2009). It also shows that community have significant impact on the practice with individual factor explaining little on FGM distribution.

In Nigeria, intensive mass media campaign and advocacy has been going on (Ikediego, 2017, International Women’s Peace Group, 2017) for so many year, although significant gain has been made in reducing FGM, but eradicating this menace still remains a mirage. In an effort to tame FGM’s silent wildfire, Nigeria which is the most populous African country took a bold step and banned FGM (Shoaff, 2015), but advocates argued that there is still more work to be done (Goldberg, 2015).

Consequences of female genital mutilation on women

 

Sexual health – Different women experience varying degree of sexual difficulty but a study suggested that woman who had female genital mutilation are likely to experience reduced satisfaction, pain during sexual intercourse and reduced sexual desire (Berg et al., 2010).

Immediate problems

Immediate problems that could arise from FGM include excessive bleeding, severe pain, shock, infections, difficulty in passing urine, injury to surrounding genital tissue, fever, septicemia and death due to excess bleeding and infection. Complication and risk increase with FGM type, but are more severe with infibulation (Nowak, 2010). Long-term effects are severe pain for several weeks after the performance of FGM, psychological consequences, physical and sexual effect, chronic pelvic infection, infection of the reproductive system, chronic pain, genital ulcer, abscesses, development of cyst, excess scar tissue formation, decreased sexual enjoyment and post-traumatic stress disorder.

Female-genital-mutilation

Adopted from Vanguard news website 2015

Figure 6: Picture showing performance of FGM by traditional circumciser

Other complications

Other complication and risk associated with infibulation are, menstrual and urinary problems, infertility, painful sexual intercourse, defibulation and reinfibilation surgery. Sexual intercourse could only be possible after opening the infibulation through surgery or traumatic penetrative sexual intercourse. Sex is usually painful for the woman in the first few weeks following the first sexual intercourse.

Problems during childbirth

During childbirth, the scar tissue may tear and cause significant blood loss. It could also cause post-partum haemorrhage, extended hospital stay and it could necessitate the performance of episiotomy. FGM have significant negative effect on the woman during childbirth. A meta-analysis study result (Berg and Underland, 2013) also showed that obstetric laceration, prolonged labour, difficult delivery, obstetric hemorrhage, instrumental delivery and increased risk of delivery complication were associated with FGM. A study from World Health Organization also showed that 1 to 2 babies per 100 birth die as a result of female genital mutilation (Banks et al., 2006).

Psychological effect

The psychological effect of traumatic FGM may linger long on the girls and women who undergone the procedure, since anaesthetic agent are not usually used. Behavioural disturbance may be triggered by the psychological stress the woman encountered during the procedure. Children could develop loss of trust and confidence in their caregivers. Women may develop depression and feelings of anxiety in the long term. The woman may encounter marital problem and divorce with her husband due to sexual dysfunction in marriage (United Nations Population Fund, 2015).

CLASSIFICATION OF FEMALE GENITAL MUTILATION BY WORLD HEALTH ORGANIZATION

Normal Virginal

FGM 3 ILUSTRATION editted 1 

C:UsersOJO OPEYEMIDesktopType 1A.png

 

 

 

Adapted from Shockey (2017)                     Adapted from Swiss women’s clinic (2014)

Figure 7: Picture showing normal virginal structure

C:UsersOJO OPEYEMIDesktopFGM 3 ILUSTRATION 2.jpg

 

Adapted from Shockey (2017)

Figure 8: Picture showing FGM type I (Clitoridectomy)

Type II AType II B

TYPE II

Clitoridectomy and/or labial excision

Partial or total removal of the clitoris and/or the labia minora, with or without the removal of the labia majora

Adapted from Shockey (2017)

Figure 9: Picture showing FGM type II (Clitoridectomy and/or labial excision)

Type 3AType 3B

TYPE III

Infibulation

Removal of the external female genitalia and sealing or narrowing of the vaginal opening by joining opposing cut parts of the labia, using stitches. The clitoris may or may not be removed. A small opening is left for urination and menstruation

Adapted from Shockey (2017)

Figure 10: Picture showing FGM type III (Infibulation)

Type IV

TYPE IV

All other harmful procedures to the female genitalia for nonmedical purposes

These include, pricking, piercing, incising and stretching the clitoris or labia, burning the clitoris, scraping the vestibule and cauterizing the vaginal vault with corrosive substances or herbs

Adapted from Swiss women’s clinic (2014)

Figure 11: Picture showing FGM type IV (Stretching of labia)

CLASSIFICATION ANATOMICAL INVOLVEMENT SUBCATEGORIES
TYPE I Clitoridectomy: partial or total removal of the clitoris and/or the clitoral hood (prepuce) Type Ia: removal of the clitoral hood or prepuce only 

Type Ib: removal of the clitoris with the prepuce

TYPE II Clitoridectomy and/or labial excision: partial or total removal of the clitoris and/or the labia minora, with or without the removal of the labia majora Type IIa: removal of the labia minora only 

Type IIb: partial or total removal of the clitoris and the labia minora

Type IIc: partial or total removal of the clitoris, the labia minora and the labia majora

TYPE III Infibulation: removal of the external female genitalia and sealing or narrowing of the vaginal opening by joining opposing cut parts of the labia, using stitches. The clitoris may or may not be removed. A small opening is left for urination and menstruation Type IIIa: removal and apposition of the labia minora 

Type IIIb: removal and apposition of the labia majora

TYPE IV All other harmful procedures to the female genitalia for nonmedical purposes These include, pricking, piercing, incising and stretching the clitoris or labia, burning the clitoris, scraping the vestibule and cauterizing the vaginal vault with corrosive substances or herbs

Type I and type II may be called Sunna, while Type III may be called pharaonic in some countries or religion.

Adapted from  World Health Organization (2016)

 

THE CHALLENGES

Widespread of secrete FGM practices in south-west of Nigeria

It is obvious that the female genital mutilation is being secretly done in South-west Nigeria and some other part of the world. In Nigeria, secret cutting has been going on virtually unnoticed in all the states in the south-west region despite the practice being banned by state governments (Edukugho, 2015). It was also stressed in a conference organized by Good Health and Community Development group that female circumcision was most prevalent among south-westerners in Nigeria (Johnson, 2015). A special report from Osun state by channels television, a popular television station in Nigeria (Sodiq, 2017) shows that people still secretly perform FGM on their daughters and still opposed to eradication of the practice for different reasons. In Osun-state capital, Osogbo, the only occupation of some families is circumcision, and people go there for secret FGM in order to avoid being detected by government. Iaccino and Palumbo (2016) stated that thousands of girls and women are still been mutilated secretly every day in Nigeria despite the law banning this practice. 24.8% of girls and women between 15 to 49 years of age have undergone female genital mutilation (Demographic and Health Survey, 2013) in a country where a total of 20 million of girls and women have been estimated to have been mutilated (United Nations International Children’s Emergency Fund, 2016). This was not peculiar to Nigeria alone, only that the extent of this secret practice is obviously widespread in south-west region of Nigeria. A study done in Tanzania by Galukande et al. (2015) on the eradication of female genital mutilation and cutting revealed that the practice is still being done secretly to some uncertain extent. In the year 2000, it was approximated by African Women’s Health Center under Brigham and Women’s Hospital (2015) in United State of America that 227,887 women and girls were at risk of being cut and by the year 2010, the number had gone up to 300,000 which indicated about 35% increase within 10years despite been prohibited in the west. The former president Obama also championed legislation that prohibits transportation of girls outside United State to perform FGM punishable by 5years jail (Equality Now, 2013). Along the same vein, secret cutting was also going on in UK. In 2011, it was estimated that 66,000 women and girls were cut compared to 103,000 women in 2011 and about 500,000 women and girls were threatened in Europe (Spooner, 2014).

During an interview on 23rd of July 2016 with a nurse in one of the tertiary health institution in Ondo-state, Nigeria, who also had a private clinic where she regularly performs male circumcision, revealed on the condition of anonymity that health professionals in her government institution where she works still pressurize her and other colleagues who have private clinics to perform female circumcision (FGM) based on their religion and cultural conviction.

Sometimes when the pressure was too much, I will take the baby inside and scratch small part of the labial minoral so that little blood would come out and I will use cotton wool to clean it and show them that I have performed the circumcision. They will be happy, if not, they could still take the child to another place where she could be fully mutilated.

Effectiveness of criminalization of FGM in Nigeria.

Criminalization of a deeply-rooted age-long cultural practices and traditional norms would definitely meet some form of resistance from the people. Ending FGM will require comprehensive approach including investment and community engagement, with a view to reverse societal norms. There should be proper education of girls and women in order to facilitate case reporting to the authority. All these would be key to eradicating FGM, not just law or a decree written in black and white. Legal restriction is a giant leap toward ending FGM, but not enough to eradicate it. Above all, lackadaisical enforcement of law would not yield the desired result, but strict implementation of the law.

In year 2015, Federal government of Nigeria criminalized female genital mutilation in Nigeria. Despite the criminalization of this practice, no single prosecution had been made (Immigration and Refugee Board of Canada, 2016). This seems not to always be a priority of government as similar situations also occur in Egypt. Only one case of a doctor who was prosecuted for the death of a 13-year-old girl from FGM complication in 2013 existed, since it was banned in Egypt in 2008. On the same vein, first prosecution of FGM offender (a doctor) was made in United Kingdom in 2012 since it had been outlawed in 1985 (Olivia, 2014). In many of the south-west states of Nigeria, where it was estimated that over 6 million people were victims of FGM had not prosecuted anybody (Ezeamalu, 2016). It has been rhetoric and promises upon promises to prosecute offenders from political actors, but nothing has been done (Sonubi, 2014). A training supported by British High Commission on reduction of violent and discrimination against women in south-west Nigeria reiterated that the legal and judicial system does not give much protection to women, and the act was further complicated by the culture of silence among the victims (Ezeamalu, 2016). Ending FGM practice is more complex than just passing a law to criminalize the act. It has to do with proper implementation of the law and prosecution of the offenders, coupled with mental re-orientation of the public with aggressive community mobilization and advocacy. Besides, since this act is carried out by parents and other family members, it may be difficult to get the victims to testify against their family members. The legal issue has been settled, it is necessary to ensure its enforcement and awareness. Comprehensive campaign against FGM should target the villagers and allow them to take the ownership of the project by involving community traditional rulers, community elders, religious leaders and prominent women in the communities. It should also include educating the victim on their rights under the law, coupled with empowerment of the traditional birth attendance base on every intending FGM parent referred to a particular agency in charge of FGM eradicating unit. There should be holistic access of the victims to medical, social, psychological and legal assistance. In addition, identity of the victims should be protected during court trials.

 

Effect of formal education on FGM practices in south-west of Nigeria

In a United Nation report, as stated in Premium Times Nigeria (2016) opined that female genital mutilation was high in south-west geo-political zone of Nigeria despite their high awareness and literacy rate. A study by Adeyemo et al. (2012) also showed a direct link between education and practice of FGM in south-west zone of Nigeria. Ajite et al. (2016) study showed that FGM was still commonly practiced among their study population in south-west Nigeria, regardless of parental level of Education. It was surprising to know that the most educated south-west of Nigeria incidentally top the Female genital mutilation table in the country (Demographic and Health Survey, 2013). In south-west of Nigeria, Osun state had the highest prevalent rate of female genital mutilation with 77%, followed by Ondo state with 74% (Oyegbade, 2015, United Nations Population Fund, 2016). Ekiti state which was considered the most educated state in Nigeria and also reputed to have the highest number of professors in Nigeria (Adetola, 2008) was among the highest with 72% prevalence rate. Demographic and Health Survey (2013) also put Lagos which is most urban and westernized city in Nigeria with better access to education to 34.8%. The report showed that FGM is more common among Yoruba women with 55% who were located within the south-west sub region of Nigeria, followed by Igbo women with 45% who occupied the south-east region. The northern part of Nigeria with less education had the lowest rate, with Hausa women having 19%, Fulani women was 13%, Kanuri/Beriberi was 3% while 0.3 % was among Igala women and 0.3 % among Tiv women. Despite high prevalence rate in south-west region, education and awareness seems to still play some appreciable role within the region, especially among women. According to findings of Immigration and Refugee Board of Canada (2016) which stated that more informed, educated, and economically independent women stands a better chance of refusing female genital mutilation for their daughters, while non-educated women who resides in the villages or rural areas are more vulnerable to bow to cultural pressure.

Effectiveness of public awareness on FGM practices in south-west region of Nigeria

Galukande et al. (2015) study showed that multi-dimensional educational campaign strategy achieved moderate result as it increases the knowledge of FGM risk and change of attitude but its effectiveness in eradicating FGM prevalence was uncertain. A study by Oyekale (2014) on tribal perspective on FGM and HIV risk on Nigerian women showed that awareness was directly related to the practice in the southern Nigeria and awareness level among Yoruba was the highest in the country with 92.51% while their practice level was 69.94%, followed by Igbo 90.37% of awareness and practice level of 56.95%. Trained nurses’ involvement among Yoruba was 24.30%, but the involvement of traditional birth attendants and traditional circumcisers put the women to greater health risk. Their reasons for FGM in this study were cleanliness (8.85%), social acceptance (3.53%), better marriage prospect (7.51%), sexual pleasure (23.45%) and religious (6.68%). Another study of Adeyemo et al. (2012) showed that awareness of the respondents to the practice of FGM have direct link to its practice. From the result of these studies, one could easily deduce that literacy and awareness among people of south-west Nigeria does not play a significant role in reducing the practice of FGM in this region.

Does living in Urban areas have effect on FGM practice in south-west region of Nigeria?

Leaving in urban area does not have much effect on changing orientation of people who so much belief and adhere to their tradition. In a study conducted in three urban cities in Osun-state (Popoola, 2007) which was the state that had the highest FGM prevalence level (Oyegbade, 2015) showed that the majority of the mothers that were sampled in the cities have done FGM for their daughters in the last 5 years in an effort to adherent to their age long tradition and to prevent their girls from being promiscuous. A study conducted in Lagos in the year 2016 showed that Lagos which was also the most metropolitan city in the south-west region of Nigeria had prevalence rate of 34.8 % for women between 15-49 years of age. This was notably high around Ikorodu area of the city (Immigration and Refugee Board of Canada, 2016). People from different towns with different cultural practices meet and marry in the cities of south-west Nigeria. Many inter-ethnic marriages also occur in the cities too. This could be a source of strength at effort toward abolishing FGM practice, but it could also be a source of weakness too. Just like the case of lady that got media attention (Adelaja, 2016) whose family members were physically assaulted for refusing FGM. She hailed from the Eastern part of Nigeria but got married to a Yoruba man in south-west of the country. It is very important to stress that the south-west sub-region of Nigeria is culturally diverse area and they are highly entrenched in their cultural practices. They are culturally attached to their old age practices with the zeal to continue the old tradition. Some erroneously believe that something evil or bad luck could happen if they abandon the practices. Conversely, the analysis from Demographic and Health Survey (2013) showed 13% in variation between the prevalence of FGM among women between the ages of 15 to 49 years living in urban areas (32.3%) and rural areas (19.3%) which shows that the prevalence is more among urban women, but migration from rural to urban between their childhood to adulthood should have been taken into account during the survey.  The good thing about the survey result was that the wealthy and better educated women living in the cities were not likely to perform FGM on their daughters before the age of 15. This pointed out a decline from generation to generation in their lineage, while the women who live in the village were most likely to have their daughters cut before the age of 15 and were more favourably disposed to the continuation of the practice (28toomany, 2017).

Effect of family pressure on FGM practice in south west of Nigeria

Unfortunately, in south-west Nigeria, the decision of parents either to cut or not to cut their daughters sometimes depends on overwhelming pressure from other extended family members’ choice, or pressure from community social demand. Family and social pressure play a significant role in the continuation of FGM in south-west region of Nigeria. Just like the cases of a woman that was assaulted by her husband’s family members for refusing female genital mutilation for their girls (Adelaja, 2016) and also supported by another case from a royal family in Osun state that got media attention. Royal family demanded that FGM should be performed on their daughter according to their tradition, but the girl’s mother narrowly escaped with the children during royal family attack for being declined (Ezeobi, 2015). Although some scholars interviewed by Immigration and Refugee Board of Canada (2016) said he did not believe that pressure could mounted on parents living in Lagos to perform FGM on their girls because they are far from their villages, but the same source coated some people they interviewed that they believe that pressure could be mounted on parents living in Lagos or other cities from their family members in order to preserve their cultural values. In community where FGM is rampant or where it is used as a yardstick for initiation to adulthood, if an individual abandon the practice, the family will suffer greatly and no one would marry their daughters. A lot of people are needed to accept abandonment of FGM before it could be meaningfully reduced or eradicated in those areas, thereby reducing the social stigma attached to non-performance of female circumcision. Since FGM is widely acceptable or practiced in those communities, the occurrence of FGM may also go unnoticed and unreported to the authorities because of the fear of what may happen to their children if they refuse to perform the cultural rite. This corroborated the two incidences of family pressure mentioned above (Adelaja, 2016, Ezeobi, 2015) that pressure from family members play a significant role in the performance of FGM. A doctoral candidate interviewed said that if some persons have not undergone FGM in  some areas in Lagos, they will never be viewed as full adults, regardless of their age (Immigration and Refugee Board of Canada, 2016). Collective choice and declaration of abandonment among communities that intermarry could lead to natural enforcement of anti-FGM law within those communities.

 

Religion influence on FGM practice in south-west of Nigeria

A report from Iaccino and Palumbo (2016) stated that female genital mutilation is mostly practiced in Christian and traditional communities in Nigeria. Religion is a powerful institution in south-west of Nigeria and the study of Adeyemo et al. (2012) showed that religion has direct link with the practice of FGM in south-west region of the country. Three major religions were dominant in this region, namely Christianity, Islam and African traditional religion. FGM predates Islam and Christianity and no traditional African religion has openly prescribed it. FGM acquired religious dimension among Christian and Muslims before campaign against it started in the past decades. Those Muslims who practiced FGM always cite religion obligation for their action. When one considers that the practice does not succeed and was widely condemned in country like Saudi Arabia which was considered as a center of Islamic world shows that the practice truly had no Islamic connection (Uwer and Thomas, 2007). Many Islamic scholars in the west have also argued that the practice is not obligatory in Islam (Stone, 2015), but those practicing it relies on “Sunni fatwa” which was believed to justify “makrumah” granted by prophet Mohammed and to avoid taboo behavior. Some Islamic scholar have explained that “makrumah” means female circumcision adds to man’s pleasure. Most of the fatwa that allows female circumcision was only meant that it was a commendable or meritorious act on the part of the woman (Abu-Sahlieh, 1994). The Shiite Muslim “makrumah” context also maintained that it was a meritorious act or noble deed but not obligatory by Islam (Denniston et al., 2007). This was also maintained by Iran’s Islamic supreme leader’s ruling in year 2011.  FGM is widely practiced among Christians in south-west of Nigeria but was not on the basis of religious injunction. This was clear at the international stage where Christian authority unanimously  agreed in 2006 East-Africa Coptic Christian event that FGM has no foundation in Christianity (El-Damanhoury, 2013). In Nigeria also, the seventh day Adventist Christians have been outspoken about it (Harvard Divinity School, 2017). Some Pentecostal churches are also speaking against it in south-west states of Nigeria. In Osun state that had the highest prevalence rate in Nigeria, a Bishop from a Pentecostal church called Sufficient Grace and Ministry openly said that the act is inhumane against children and there was no instruction from Bible to support it and therefore declaring it as anti-God and unacceptable (Sodiq, 2017). FGM act is also widely viewed as a religious obligation among Muslims who practiced it in Nigeria, while some Muslims who against it said there was no link between Islam and the practice. Unfortunately, Islamic leaders have not come out unanimous on FGM in south-west region of Nigeria and there were different views and interpretations of the matter by different Islamic scholars.  This was obvious when a leader of the Islamic movement in Osun state said that female circumcision is not a crime and refusal to perform it was neither a crime too, according to the tradition of prophet Mohammed. Islam mandated the circumcision of male children but does not prohibit the circumcision of female children and refusal to perform FGM would not attract God’s punishment. He reiterated that any parent that decide to perform female circumcision has not done anything wrong, but emphasized that it must be done by an expert because one of the Hadiths of Prophet Mohammed warned that anyone who wishes to circumcise her daughter must consult an expert for it to be properly done. Surprisingly he maintained that the circumcision should not be criminalized but should be made optional (Sodiq, 2017).

Cultural influence on FGM practices in south west region of Nigeria

Culture and tradition has been the major drive for female genital mutilation in south-west of Nigeria and other countries in Africa. Snow et al. (2002) explained that the slow eradication of FGM was caused by its deep root in tradition. A report from Johnson (2015) also indicated that Female circumcision was most prevalent among Yoruba people in Nigeria. Nigerians continue the practice of FGM out of their strong cultural attachment and traditional believe that women who are not circumcised would be unclean, promiscuous, unmarriageable with serious risk to their male child during childbirth, because if his head touches the clitoris, the baby will die (International Women’s Issues, 2009). The work of Snow et al. (2002) done with 1709 women on Female genital cutting in southern urban and peri-urban Nigeria showed that ethnicity was major significant social predictor of FGM. In some communities, female genital mutilation is regarded as part of their initiation into adulthood, and a lady will never be regarded as a full adult, marriageable, or part of the community without FGM (Onomerhievurhoyen and Mercy, 2015). In certain communities, it is a well celebrated event. Abolition of this age long tradition pose a serious challenge and changing their orientation will involve a lot of energy and total mental re-orientation.

THE WAY FORWARD

Strong government support and more political commitment toward FGM eradication

State governors and political leaders must demonstrate their commitment to total FGM eradication in Nigeria by collaborating with Federal government to declare FGM eradication programme a special national project, with a goal of eradicating the practice within a specified time frame. This would be a real sign of government’s dedication to eradicating FGM practices. This would also give room for progress monitoring and evaluation during the specified time frame.  South west state governors must be pressured to fully involved and take active step on FGM eradication programmes.

Proper funding of anti-FGM programmes by Nigerian government, coupled with a well-coordinated financial and materials assistance from other international organizations like united nations (UN), World Health Organization (WHO), United Nations International Children’s Emergency Fund (UNICEF) and World Bank. Snow et al. (2002) identified in their study that reduced funding to anti-FGM campaign programmes was part of what was responsible for the slow eradication of FGM in Africa.

Aggressive medial campaign to target re-orientation and behavioural change

Aggressive medial campaign to target re-orientation and behavioural change of the people in town and villages. It has been shown that the main engine behind behaviour change concerning FGM was dissemination of information (Berg and Denison, 2013). However, it must be accompanied with community mobilization and engagement project, targeting community women, traditional birth attendants, traditional circumcisers, traditional leaders and religious leaders. Moreover, since Galukande et al. (2015) study revealed that multi-dimensional educational campaign strategy achieved moderate result, as it increases the knowledge of FGM risk and change of attitude, but its effectiveness in eradicating FGM prevalence was uncertain. Therefore, it is important to focus on effort that would re-shape traditional and cultural views that perpetuates FGM in south-west states of Nigeria. Women empowerment and education, legal protection and access to social, psychological and medical support. Above all, encouraging people to be reporting cases of FGM to the authority would go a long way on war against FGM. Moreover, information, education and communication (IEC) must not be imposing, as people could view it in such a way that the organizers have come to impose their wish or the wishes of people in authority on them, thereby creating huge gap between knowledge and what the people practice (Leye et al., 2005 p 3).

Mass mobilization of religious leaders to speak against FGM practices in all villages and towns in south-west region of Nigeria.

It is very important to mobilize religious leaders to speak against FGM since religion is like a pillar holding the minds of people together in south west of Nigeria. Besides, religious leaders are highly influential, respected and enjoy overwhelming support from their communities. This gave them power and uncommon influence to sway the minds of their people, which is a much-needed tool to change peoples’ way of life and make them abolish female genital mutilation. Moreover, a realist synthesis of controlled studies (Berg and Denison, 2013) to determine the effectiveness of intervention that was planned to prevent genital mutilation of girls using media communication, training, outreach and advocacy, informal adult education and classroom education showed that most of their interventions would have been largely successful if it was pre-planned thoroughly, using community analysis and securing commitment of religious leaders to eradicate FGM.

 

Mobilization of women leaders and traditional rulers as advocates and ambassadors against FGM.

Since the FGM affect women, it is logical to allow women to lead the campaign and mobilise women who have undergone the painful procedure to go into the town and villages to share their experiences and sway people away from the practice. Traditional rulers are highly respected as the custodian of culture and tradition. They are responsible for sustaining the people’s tradition and ways of life. Their involvement in fight against FGM would yield a positive result.  It is recommended that all south-west governor’s wife must adopt FGM as one of their women empowerment projects for 10 years. This kind of approach has yielded desired results in some of the villages in Osun state where 16 communities across 4 different local Government in the state abandoned FGM through the effort of Shericare foundation, an initiative of the Governor’s wife, Sherifat Aregbesola (Olarinoye, 2016). This calls for more community-led behavioural change educational campaign and more support for dialogue within female genital mutilation practicing communities (Berer, 2015). The willingness of the people who are closely connected and intra-marries to collectively abandoned FGM is the most encouraging and effective way, because the forces from social norms that perpetuate the practice would be the sustaining factor that would ensure compliance and sustainability of their declaration since they are all aware of the dangers associated with the practice (Lewnes, 2005). Some traditional rulers and community leaders in Osun state also  declared their intentions to desist from FGM practice with a promise to take the campaign to their towns and villages during a campaign to stop female genital mutilation (Sodiq, 2017). Initiators of FGM abandonment programme must ensure that a process of organized diffusion is initiated and sustained. Organized diffusion is a process by which decision of a village to abandon FGM spreads rapidly from one community to another. This process ensures that concerned villages actively engage their neighbouring villages on the fight against FGM, thereby increasing FGM abandonment rate in their locality.

Skill acquisitions and empowerment

Skill acquisitions and empowerment for traditional circumcisers in order to provide alternative source of income for them after they might have agreed to abandon their FGM craft. This will address the concerns of some members of traditional circumcisers association called Circumcision Descendants Association of Nigeria in Oyo and Osun state that have joined the anti-FGM campaign. They gave a clues that it would be almost impossible to eradicate FGM without empowerment and robust involvement of their members who have no other alternative source of income, because they will still perform the procedure secretly  (Ezeamalu, 2017, Sodiq, 2017). This was also supported by an article published by Mukasa (2015) which emphasized that criminalizing must be backed by investment. It is pertinent to also take a clue from one of the most successful strategy that have ever worked for FGM abandonment campaign in history (Tostan, 2017). This approach was used in Senegal where the programme was based on promotion of human right in addition to actions that were necessary to change community way of life like collective action, public declaration and organized diffusion. With support of UNICEF and collaboration with government, Tostan introduced community women empowerment programmes, coupled with promotion of human right which broadened the minds of the community members through informer education. This enhanced their willingness and ability to take informed decision and stop FGM after knowing its health consequences and also realized that it has no medical advantage as it was erroneously portrayed. This method became a rallying point for social change and many countries adopted this method which had led to over 8,000 communities from Senegal, Guinea-Bissau, Mauritania, Mali, Djibouti, Guinea, Gambia and Somalia to publicly declare their decision to abandon FGM and child /forced marriage. One of the interesting thing to note is that Sudanese Programme for Accelerated Social Transformation (PFAST) adopted Tostan model when they discovered that providing information about health consequences of FGM and dissociating it from Islam alone did not yield a desired result (Lewnes, 2005). Another initiative that had worked was the one used in Egypt by Centre for Development and Population Activities (CEDPA) where “Positive Deviance Approach” was used. Its female genital mutilation abandonment programme centers on community participatory and mobilization approach, which aim on building on already existed solution in the communities. Community members who opposed FGM were identified and supported to recruit others, thereby expanding anti-FGM numbers in the communities (Leye et al., 2005 p 17). Attempts in different countries (Lewnes, 2005 p 26) to provide alternative source of income with provision of new skills and soft loan to traditional circumciser who agreed to surrender their practices and embrace anti-FGM campaign did not yield desired result, because community members still secretly sought individual who could perform the procedure (Shaaban and Harbison, 2005). It is obvious that the most effective way of achieving behavioural change is active engagement of community members in participatory community mobilization to control and shape their own future, destiny and development, using communication as a means of empowering people with the right information, couple with other related strategies that could help in achieving the set objectives that are peculiar to their situation.

 

Compensation for local circumcisers

Compensation of traditional circumcisers who report or bring any parents who intends to perform FGM on their daughters, in community where participatory community mobilization strategy to stop FGM is ongoing or has been fully implemented. This incentive based referral programme worked in Ondo-State “Agbebiye” programme, on maternal and child health reduction. Traditional Birth Attendants (TBA) and Missionary Home Birth Attendants (MHA) were registered to refer pregnant women to health facilities for safe delivery. They were paid 3,000 naira (10 USD) every time they bring any of their client (pregnant woman) to the Hospital. The amount paid was usually more than what they usually charged their clients after home delivery. They also acquired vocational skills in baking, soap-making, tie and dye. They were barred from continuing delivery of babies at home themselves. This led to reduction of maternal and child mortality to 84.9%. From 745 per 100,000 live birth in 2009 to 112 per 100,000 live birth in 2016 (Offiong, 2014). A feat that attracted World Bank grant to the state.

The same strategy could also be initiated to support fight against FGM in south-west of Nigeria. An international non-governmental organization called Centre for Development and Population Activities (CEDPA) also reiterated importance of providing support to the communities that have chosen to abandon FGM, because it strengthens their choice and empowers them to initiate FGM discussion with other people, thereby spreading FGM abandonment messages to other community members and neighbouring villages. This will significantly increase the number of people who abandons FGM (Leye et al., 2005).

 

Collaboration with education sector

FGM eradication activist and lobbyist must work with policy makers in education sector, so that massive FGM campaign could be taken to the secondary schools and also integrate FGM as part of subject to be taught in Biology and any science related subject in secondary schools. Government could also support and encourage teachers in both primary and secondary (basic schools) to identify those student at risk of FGM in their schools (Giuliani, 2006) for appropriate intervention and follow up. FGM could also be inculcated into the medical school syllabus in Nigeria, in order to dissuade health workers from performing the procedure, since Ajite et al. (2016) discovered in their study which conducted in a teaching Hospital in one of the south-west state of Nigeria that 62.3% of FGM performed on the subjects were carried out by health workers.

Aggressive government enforcement of existing laws against FGM

Different State governments from south-west geo-political zone must set up a special FGM undercover task force to apprehend and prosecute offenders to serve as deterrent to others. It is certain that criminalization of a deeply-rooted age-long cultural practices and traditional norms will meet some form of resistance from the people. Legal restriction is a giant step toward ending FGM. It is very important to note that poor enforcement of law will not yield the desired result, but strict implementation of the law is the way forward.

Summary

Secrete female genital mutilation practice is a major public health challenge in south-west geo political zone of Nigeria. It is a practice involving total or partial removal of the female genital organs or any form of injury to the external female genitalia for non-medical purpose. Extensive medial awareness has been employed to stop the practice. Government went further to ban the practice, but people go secretly to have the procedure done. Different health consequences have been identified to be associated with the procedure, such as excessive bleeding, severe pain, shock, infections, difficulty in passing urine, injury to surrounding genital tissue, fever, septicemia, infertility and death. Complications and risk involve in unhygienic handling of the mutilation in the hand of traditional circumcisers are alarming, yet people still go to them. South-west region of Nigeria is considered to be the most educated part of the country and their awareness rate of FGM was also very high, but their mutilation prevalence rate was unfortunately the highest in the country. Cultural influence contributed to the age long tradition as people see the practice as a way of life. Even FGM performance is a celebrated event in some communities and is a criterion to transmit from childhood to adulthood. Family pressure also play a significant role in perpetuating FGM in certain situations. Refusal to perform FGM would attract fierce resistance from other extended family members. Religion attachment have also been identified as part of what perpetuate the practice as people try to falsely link the practice to religion obligation. Criminalization of the age long tradition does not yield the desired result as it only makes people to secretly continue the practice. Poor enforcement of law compounded the situation as no single prosecution has been made since it was banned in the country.

Some of the way forward that could end this practice could be strong government support and more political commitment to end the practice in Nigeria and aggressive medial campaign to target re-orientation and behavioural change among the populace. Mass mobilization of religious leaders to speak against FGM practices in all villages and towns in south-west Nigeria would definitely go a long way in taming the secrete wildfire. Mobilization of women leaders and traditional rulers as advocates and ambassadors against FGM would serve as a boost to the struggle. Moreover, skill acquisition and empowerment for the traditional circumcisers who have no alternative source of income would serve as an impetus to achieving the eradication of FGM in the region. This could go in conjunction with an incentive based referral programme for the traditional circumcisers. Collaboration with education sector could help in shaping the minds of future generation against the practice of FGM and could also help identify those who at risk of cutting and protect them. Finally, aggressive government enforcement of existing laws against FGM would serve as a deterrent and discourage other people from carrying out the act.

Conclusion

Female genital mutilation is a menace that is ravaging southern Nigerian states and other part of the country where the practice is viewed as part of societal norms. Its health consequences vary from mild to severe, and could be immediate or lead to lifetime psychological trauma on victims. It is internationally accepted that FGM is a form of discrimination against women which must be tamed. Medicalization of the procedure gives false security to the practice when it is performed by a medical professional. Cultural and religion dimension the practice assumed coupled with family and community pressure complicate the fight for the eradication of female genital mutilation. Engagement of political actors and international organizations would go a long way in curbing the practice. Information, education and communication alone only increase the people’s awareness and risk factors, but does not dissuade people from carrying out the practice.

It is obvious that the most effective way of achieving behavioural change is active engagement of community members in participatory community mobilization to control and shape their own future, destiny and development, using communication as a means of empowering people with the right information. Programmes that would be supported by government and international organizations that would focus on promotion of human right in addition to actions that are necessary to change community way of life, like collective action, public declaration and organized diffusion would definitely go a long way in eradicating female genital mutilation in south-west geo political zone of Nigerian states.

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