Female genital mutilation and reproductive health morbidity in teenage girls and young adult women in Bolgatanga District

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This work was undertaken to assess the prevalence, correlates, and the effect of education and urbanisation on Female Genital Mutilation (FOM) in Secondary School girls in the Bolgatanga District. The associations between FGM and Reproductive Tract Infections (RTI) and Reproductive Health morbidity were also determined. Furthermore it attempted to establish some of the socio-cultural and religious reasons for the practice of FGM. The study used qualitative methods that included Key Informant Interviews, focus group discussion (FGD), and participants’ observation as well as quantitative methods that used structured questionnaire for interviews. Specially trained Doctors, Midwives and Traditional Birth Attendants (TBAs) conducted physical and pelvic examinations to identify the various types of FGM. Finally, laboratory investigations were conducted in the Bolgatanga Central Hospital laboratory, Rural Help Integrated Medical Centre laboratory and the Public Health Reference Laboratory Services, Korlebu Teaching Hospital, Accra. The subjects for the study was made up of 411 in-school subjects and 454 out-of-school subjects aged between 15 years and 23 years all living in the Bolgatanga District for the non-randomised cohort study, 3,520 women who delivered at the Bolgatanga Central Hospital between 1998 and 1999 and 2,119 women who were delivered by TBAs in the rural areas of five sub-districts in the Upper East Region. The study determined that FGM is practiced in the Upper East Region of Ghana for various reasons in the different communities and any effort to eradiate FGM should be addressed on one-on-one basis depending on the major reason why it is practiced in the specific community and the variation in the prevalence rates of FGM is determined by the different reasons why FOM is practised in the different communities and by the geographic location of the community. Overall, subjects living in rural areas have three times the risk of being cut (odds ratio: 3.70 (3.28<OR<4.17) and relative risk: 2.91(2.66<RR3.20) than subjects in the urban areas; this is due to the fact that, girls and young women in the urban areas are spared the sustained pressure that is put on them by the older women who are the custodians of the traditional practices and make sure that all girls are cut before marriage. Girls who are cut are two times more likely to be sexually active (Odds ratio 1.72, 0.92<RR<1.85 at 95% confidence limit) and ten times more likely to be pregnant or have been pregnant before while in school (Odds ratio 10.61, Relative risk: 9.87, 1.72<RR<56.50 at 95% confidence limit). This leads to the girls leaving school to become teenage mothers. Hitherto, FGM had not been mentioned as one of the factors leading to the high school dropout rates for girls in the Upper East Region of Ghana. The complex interwoven matrix of illiteracy, poverty, traditional ancestral worship and rural dwellings and their associations with FOM has been demonstrated. Girls with no education and living in a rural area in the Bolgatanga District has a 77% chance of being cut compared with her counterpart with a secondary level education living in an urban area who had only 0.9% chance of being cut. The quantitative methodology used frequency tables, 2 x 2 single table analysis, determination of cumulative incidence relative risks and cross tabulations tables to demonstrate that, girls and women who are cut run five times the risk of having pain at urination (Odds ratio 5.09, Relative risk: 4.94, 0.53<RR<45.82 at 95% confidence limit), four times the risk of bleeding during sexual intercourse (Odds ratio 3.94, Relative risk: 3.48, 1.26<RR<9.41 at 95% confidence limit), three times the risk of developing pain during sexual intercourse (Odds ratio: 3.46, Relative risk: 3.17, 0.97<RR<10.35 at 95% confidence limit, chi-square: 71.23) and run sixteen times the risk of developing Pelvic Inflammatory Disease. It was determine that for the effective prevention and eradication of FOM, it is necessary to understand the socio-cultural reasons why FGM is practised in these societies in order to institute the appropriate advocacy and behavioural change activities. It is also worth remembering that at the community level, traditional and customary laws supersede civil law and any effective advocacy should be designed with the participation of the community and implemented at the community level.
A thesis submitted to the Department of Biological Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana in partial fulfilment of the requirements for the Degree of Master of Philosophy, 2000