الفهرس 
INTRODUCTION and Aim of present studyOnly 14 pages are availabe for public view
 |  | from | 159 |  |  |
| | | from | 159 | | |
Abstract
Female genital mutilation/cutting refers to all the procedures that involve partial or complete removal of female external genitalia or other injuries to the female genital organs for non-medical causes. It has no health benefits, otherwise, it interferes with the normal body functions and has a negative effect on physical, mental, social and sexual health of females.
Female genital mutilation/cutting is practiced in 31 countries in Africa, Middle East and some countries in Asia. More than 200 million females were mutilated worldwide. In Egypt, although the prevalence of FGM/C is declining, it is still high.
Knowledge, beliefs and attitude of females regrading FGM/C can affect their decision for performing it which will be reflected on the prevalence of the practice in the future.
The study was carried out with to investigate women’s knowledge, attitude and intention to practice regarding FGM/C in Egypt with the following specific objectives:
1. To assess knowledge of women regarding female genital mutilation/cutting.
2. To assess attitude of women regarding female genital mutilation/cutting.
3. To investigate the intention of women to practice female genital mutilation/cutting.
4. To determine the personal, social and cultural correlates of female genital mutilation/cutting.
The study was carried out among females attending family health centers in different Egyptian governorates using a cross sectional study design. A total sample of 770 females aged 15-49 years were included in the study.
A multistage stratified random sampling technique was used dividing Egypt into seven different provinces: Greater Cairo, Alexandria, Canal, Delta, North Upper Egypt, Middle Upper Egypt and South Upper Egypt. Four different governorates were randomly selected to represent the first four Egyptian provinces and one governorate was randomly selected to represent the Upper Egypt provinces. The five selected governorates were Cairo, Alexandria, Port Said, Kafr El Sheikh and Fayoum.
Data were collected from females using a predesigned structured questionnaire which included sociodemographic data (age, residence, level of education, marital status, occupation and experience with mutilation), questions about females’ knowledge (spread, types and procedure of FGM/C, health consequences and side effects of FGM/C and FGM/C in the Egyptian law), questions about females’ attitude (the social prospective of FGM/C, FGM/C and sexual life, effect of FGM/C on female genitalia, violation and disability of FGM/C, FGM/C from the religious point of view, encouragement of the FGM/C practice in society, FGM/C and marriage and FGM/C law), questions about females’ intention to continue practicing FGM/C (planning mutilating daughter(s), supporting the continuation of FGM/C, mutilating daughters information, facing social pressure from family members or neighbors to undergo FGM/C for daughter(s) and knowing the desire of husband to mutilate daughter(s)) and reasons of performing and refusing FGM/C.
The study revealed the following main results:
The prevalence of FGM/C among females aged 15-49 was 74.2%.
More than half of non-mutilated females were medically examined by physicians or other mutilators to decide if they needed to be mutilated.
The mean age of mutilation was 10.79 ± 2.17 years.
Forty three percent of females were mutilated by medical care providers.
Type I was the most common type of FGM/C among females, followed by type II.
FGM/C prevalence was higher among females aged 25-49 years with statistically significant difference between mutilated and non-mutilated females (χ2= 119.158, p<0.001).
The prevalence of FGM/C was higher among females from slum areas than other residential areas. The difference between mutilated and non-mutilated was statistically significant (χ2= 6.564, p= 0.038).
Females living in Cairo had the highest prevalence of FGM/C than other governorates, followed by Alexandria. The difference was significant (χ2= 29.229, p<0.001)
The prevalence of FGM/C was higher among illiterate or could just read and write females with statistically significant difference ((χ2 = 47.976, p <0.001)
The mean knowledge score was 12.97 ± 5.55 among females aged 15-49 years.
Only 5.7% of females had a good level of knowledge.
Poor level of knowledge was higher among:
1. Females aged from 15 to less than 25 with a significant difference (MCp<0.001). The correlation between age and knowledge was weak, positive and statistically significant (r = 0.197, p <0.001).
2. Females from rural residence, followed by slum areas. The difference was significant (MCp<0.001).
3. Females living in Kafr El Sheikh (62.5%) followed by Cairo and Fayoum (47.7% and 46.1%, respectively). This difference was statistically significant (MCp<0.001).
4. Single females (62.1%), while good level of knowledge was higher among widowed females (13.6%) with statistically significant difference (MCp =0.004).
5. Illiterate females (64.7%) with a statistically significant difference ((χ2 = 22.859, p = 0.001). The correlation between level of knowledge and level of education was weak, positive and statistically significant (rs = 0.151, p <0.001).
Logistic regression revealed that young age, rural residence and absence of education were the predictors of poor level of knowledge among females.
The mean attitude score was 61.3 ± 14.2 among females aged 15-49 years.
Two thirds of females had a favorable attitude (against) towards FGM/C.
Unfavorable attitude was higher among:
1. Females aged more than 45 years with no statistically significant difference (χ2 = 7.100, p = 0.312). The correlation of attitude with age was negative, weak and not significant (r = -0.056, p = 0.123).
2. Females living in rural areas (11.6%) followed by females living in slum areas (11.5%). The difference was not statistically significant (χ2 = 1.215, p = 0.876).
3. Housewivesthan employed females with no significant difference (χ2 = 5.664, p = 0.059).
4. Mutilated females than non-mutilated females with statistically significant difference (χ2 = 65.530, p <0.001).
The difference between governorates regarding level of attitude was not statistically significant (χ2 = 14.856, p = 0.062).
Single females had a higher level of favorable attitude than other females with a statistically significant difference (MCp = 0.001).
Unfavorable attitude decreased with the increase in the level of education with a statistically significant difference (χ2 = 66.173, p <0.001). The correlation between level of education and level of attitude was positive, weak and statistically significant (rs = 0.312, p <0.001).
Level of attitude increased with the increase in the level of knowledge with statistically significant association (MCp<0.001). The correlation between knowledge and attitude of females regarding FGM/C was moderate, positive and statistically significant (r = 0.503, p <0.001).
Mutilation experience, absence of education, marriage and poor level of knowledge were the significant predictors of unfavorable attitude of females towards FGM/C.
Nearly one third of females (31.8%) had the intention to mutilate their daughters in the future and the same percentage were supporting the continuation of FGM/C practice.
One tenth of females mutilated their daughter(s) and 74.7% of these daughters were mutilated by medical care providers.
Females facing pressure from family constituted 41.1%, while females facing pressure from neighbor constituted 23.1%.
Husbands of 31% of females suggested or wished their daughter(s) to be mutilated.
Females aged more than 45 years had the higher percent of intention to mutilate their daughter(s) but the difference was not statistically significant (χ2 = 2.422, p = 0.490).
Females from rural areas had the intention to mutilate their daughters followed by females from slum areas. The difference was significant (χ2 = 8.663, p = 0.013).
There was no statistically significant difference between different governorates regarding the intention of females to mutilate their daughters (χ2 = 7.180, p = 0.127).
Widowed females had the intention to mutilate their daughters more than other females, followed by married females (45.5% and 34.8%, respectively). The difference was statistically significant (χ2 = 21.210, p <0.001).
The intention to practice FGM/C decreased with the increase in the level of education and this association was statistically significant (χ2 = 57.792, p <0.001).
The highest intention to practice proportion was found among unemployed (33.8%) than employed females (21.9%). This difference was statistically significant (χ2 = 6.996, p = 0.008).
Mutilated females, females with poor level of knowledge and females with unfavorable attitude had the higher percent of intention to mutilate their daughters (39.6%, 53% and 98.8%, respectively). These differences were statistically significant (χ2 = 61.351, p <0.001, χ2 = 145.829, p <0.001 and χ2 = 436.630, p <0.001, respectively).
Logistic regression of intention to practice revealed that mutilation experience, poor level of knowledge, unfavorable attitude and pressure from husband were the significant factors affecting females’ intention to mutilate their daughters.
Tradition was the main reason behind performing FGM/C (72.5%), followed by reduction of sexual desire of females (32.5%), protection of virginity (24.8%) and religious requirements (14.2%).
Causation of medical, sexual and psychological health consequences of FGM/C was the main reason of refusing FGM/C among females (67.8%) followed by the belief that FGM/C is not necessary or has no benefits (11%).