Determinants of Traditional Birth Attendants Compliance to Existing Legal Frameworks against Female Genital Mutilation/ Cutting in Garissa County, Kenya
DOI:
https://doi.org/10.47604/gjhs.3201Keywords:
Compliance, Determinants, Female Genital Mutilation, Traditional Birth Attendants, Legal FrameworksAbstract
Purpose: The study sought to establish the determinants of traditional birth attendants’ compliances to existing legal frameworks against female genital mutilation/ cutting in Garissa County, Kenya. The study intended to answer complex interplay of cultural, religious, and social factors influencing traditional birth attendants' compliance with legal frameworks against FGM/C.
Methodology: Study adopted cross sectional study design. Mixed methods approach (Survey and KIIs) was used to collect data. Targeted TBAs, law enforcers and opinion leaders residing in Dadaab Sub- County. Semi-structured questionnaires were used to collect quantitative data while key informant interview guide was used to collect qualitative data. Quantitative data collected was entered into Epidata (version 3.1) database then exported to R (version 3.6.4) for analysis while qualitative data were thematically analysed. 261 participants were recruited, with 86.21% being compliant to existing law against FGM/C.
Findings: The independent predictors for compliance to existing legal frameworks against FGM/C in this study were marital status of the active TBAs: married (AOR=7.78, 95% CI=2.4544-24.6443, p<0.001) and widowed (AOR=4.76, 95% CI=1.2063-18.8181, p=0.0259); Education level of the active TBAs: primary education (AOR=5.80, 95% CI=1.3887-24.2616, p=0.016); Required ages for girls/women before circumcision being 5-11 years (AOR=7.91, 95%, CI=2.73-22.95, p<0.001); Mothers accompanying girls/women to circumcision (AOR=7.02, 95% CI=2.0899-23.6125, p=0.0016); Religious background of girls/women to be circumcised (AOR=2.94, 95% CI=1.1688-7.4096, p=0.022); active TBAs who asserted that FGM/C was still deemed necessary in their community (AOR=0.11, 95% CI=0.0146-0.8844, p=0.0378); active TBAs who identified FGM/C Type I as the most predominant in their community (AOR=0.10, 95% CI=0.0261-0.3673, p<0.001); FGM/C being practiced for traditional purposes traditional (AOR=9.86, 95% CI=1.8419-52.7653, p=0.0075); Advocacy through religious approaches on the abandonment of FGM/C (AOR=5.90, 95% CI=2.173-16.0309, p<0.001); active TBAs cognizant of the punishments imposed on perpetrators and accomplices of FGM/C (AOR=3.11, 95% CI=1.279-7.5576, p=0.0123); active TBAs aware of the laws/legislations prohibiting FGM/C in Kenya (AOR=3.06, 95% CI=1.3759-6.7912, p=0.0061); Active TBAs supporting for the education of TBAs on existing anti-FGM/C laws (AOR=4.64, 95% CI=1.7885-12.0514, p=0.0016); active TBAs aware of someone in the community who had reported FGM/C as a crime (AOR=2.71, 95% CI=1.2296-5.9762, p=0.0134).
Unique Contribution to Theory, Practice and Policy: Information from the study will influence policy formulation and complement existing literature.
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References
Too Many (2016). Kenya Country Profile Update, p.31. Available at https://www.28toomany.org/country/kenya.
Abathun, AD., Sundby, J. & Gele AA. (2017). Attitude toward female genital mutilation among Somali and Harari people, Eastern Ethiopia. Int J Womens Health. 6;8:557-569. doi: 10.2147/IJWH.S112226. PMID: 27785105; PMCID: PMC5065096.
Abdi, A.G. & Bente, P. (2013). Attitude towards female genital mutilation among men and women in two districts in Somalia: is it time to rethink our eradication strategy. Norway: Oslo University College.
Abdulcadir, J., Margairaz, C., Boulvain, M., & Irion, O. (2011). Care of women with female genital mutilation/cutting. Swiss Medical Weekly.
Ahanonu EL, Victor O (2014). Mothers' perceptions of female genital mutilation. Health Education Research 29(4): 683-689.
Ahmed, HM., Kareem, MS., Shabila, NP. & Mzori, BQ. (2018). Knowledge and perspectives of female genital cutting among the local religious leaders in Erbil governorate, Iraqi Kurdistan region. Reprod Health. 2018 Mar 7;15(1):44. doi: 10.1186/s12978-018-0459-x. PMID: 29514701; PMCID: PMC5842576.
Al Nagar, S., Gindeel, RH. & Salah, A. (2018). Understanding the key elements for designing and implementing social marketing campaigns to inform the development of creative approaches for FGM/C abandonment in Sudan. Evidence to End FGM/C: research to Help Women Thrive. New York: Population Council. doi: 10.31899/rh6.1040.
Allam MF, de-Irala-Estévez J, Fernández-Crehuet Navajas R, Serrano del Castillo A, Hoashi JS, Pankovich MB, Rebollo Liceaga J (2001). Factors associated with the condoning of female genital mutilation among university students. Public Health. 115(5):350–5.
Alo, OA, and B Gbadebo (2011). Intergenerational attitude changes regarding female genital cutting in Nigeria. Journal of Women’s Health 20(11): 1655-1661.
Alo, OA. & Gbadebo, B. (2011). Intergenerational attitude changes regarding female genital cutting in Nigeria. J Womens Health. 20(11):1655–1661. doi:10.1089/jwh.2010.2610
Ameyaw, EK., Tetteh, JK., Armah-Ansah, EK., Aduo-Adjei, K. & Sena-Iddrisu, A. (2020). Female genital mutilation/cutting in Sierra Leone: are educated women intending to circumcise their daughters? BMC Int Health Hum Rights. 20(1):19. doi: 10.1186/s12914-020-00240-0. PMID: 32703226; PMCID: PMC7376916.
Amina, Y. (2013). Influence of female genital mutilation on schooling of girl child in marginalized communities: a case of Masalani location, Garissa County. Nairobi: University of Nairobi Press.
Anuforo, PO., Oyedele, L. & Pacquiao, DF. (2004). Comparative study of meanings, beliefs, and practices of female circumcision among three Nigerian tribes in the United States and Nigeria. J Transcult Nurs. 15(2):103–113. doi:10.1177/1043659603262486
Ashimi, AO and TG Amole (2015a). Perception and attitude of pregnant women in a rural community north-west Nigeria to female genital mutilation. Archives of Gynecology and Obstetrics 291(3): 695-700.
Ashimi, AO, TG Amole, Z Iliyasu (2015b). Prevalence and predictors of female genital mutilation among infants in a semi urban community in northern Nigeria. Sexual and Reproductive Healthcare 6: 243-248.
Asresash, D. Sunby, J. (2016). Attitude towards female genital mutilation among Somali and Hararipeople, Ethiopia.Norway: AkershusUniversity, Dove press.
Bedri, N. (2013) Evidence based advocacy for ending FGM/C in Sudan. Ahfad Journal, 30(1), 9-21.
Bedri, N., Sherfi, H., Rodwan, G., Elhadi, S., Elamin, W. (2018). Medicalisation of Female Genital Mutilation/Cutting in Sudan: Shift in Types and Providers. Evidence to End FGM/C: Research to Help Girls and Women Thrive. New York: Population Council.
Berg, C., Underland, V., Odgaard-Jensen, J., Fretheim, A., & Vist, E. (2014). Effects of female genital cutting on physical health outcomes: a systematic review and meta-analysis. BMJ Open, 4(11).
Berg, R. C., & Denison, E. (2013). A tradition in transition: factors perpetuating and hindering the continuance of female genital mutilation/cutting (FGM/C) summarized in a systematic review. Health Care for Women International, 34(10), 837–859.
Berggren, V. (2005). Female Genital Mutilation, Studies on primary and repeat female genital cutting. Stockholm: Karolinska University Press.
Dalal, K., Lawoko, S. & Jansson B. (2010). Women’s attitudes towards discontinuation of female genital mutilation in Egypt. J Inj Violence Res. 2(1):41. doi:10.5249/jivr. v2i1.33
Dirisu, O., Adetunji, A., Adediran, M. & Obianwo, O. (2020). "A diagnostic assessment of health system response to FGM/C management and prevention in Nigeria." Evidence to End FGM/C: Research to Help Girls and Women Thrive. Nairobi: Population Council.
Dorkenoo, Efua and Scilla Elworthy (1992). Female genital mutilation: proposals for change, London, Series: MRG report; no. 92/3.
Dunbar P, Keyes LM, Browne JP (2023). Determinants of regulatory compliance in health and social care services: A systematic review using the Consolidated Framework for Implementation Research. PLoS ONE 18(4): e0278007. https://doi.org/10.1371/journal.pone.0278007
EGLDAM. (2008). Old Beyond Imaginings: Ethiopia Harmful Traditional Practices. National Committee for Traditional Practices in Ethiopia (NCTPE). Available from: https://www.cartercenter.org/resources/pdfs/health/ephti/library/modules/degree/mod_htp_final.pdf. Accessed November 20, 2022.
Elise, B. Johannes, S. et al. (2012). When female circumcision comes to the west attitude towards the practice among Somali immigrants in Oslo. Norway Oslo university press
Fried, S. & Warsame, A. (2013). Outpatients’ Perspective on problems and needs related to female genital mutilation: A qualitative study from Somalil. Karolinka Institute, 17177Stockholm, Sweden
Gajaa, et al., (2016). Prevalence and factors associated of circumcision among daughters of reproductive age women in Hababo, west Ethiopia. Ethiopia cross mark printers
Gali, M. (1997). Female circumcision: A transcultural study of attitudes, identity and reproductive health of east African immigrants. (Ph.D. dissertation.) Wright Institute Graduate School of Psychology, University of Michigan, Ann Arbor, MI.
Government of Kenya, (2010). Constitution of Kenya. Government printers, Nairobi Kenya
Government of Kenya, (2012). Kenya Health Policy 2012-2030: Ministry of Medical Services and Ministry of Public Health and Sanitation. Kenya School of Government Working paper 4; 94500
Hosken, F. (1993). The Hosken Report: Genital and Sexual Mutilation of Females. Fourth edition. Lexington, MA: Women's International Network.
Hussein, MA., Adem, A., Mohammed, MA. (2013). Knowledge, attitude and practice of female genital mutilation among women in Jigjiga Town, Eastern Ethiopia. Gaziantep Med J. 2013;19(3):164–168. doi:10.5455/GMJ-30-2013-157
Iliyasu Z, Abubakar IS, Galadanci HS, Haruna F, Aliyu MH (2012). Predictors of female genital cutting among university students in northern Nigeria. J Obstet Gynaecol. 32(4):387–92.
Ismael, et al., (2017). Effects of female genital mutilation type 1 and 2 on sexual functions-a case control study: Egypt Assiut University press
Johansen R.E.B., Diop N.J., Laverack G, Leye E. (2013). What works and what does not: a discussion of popular approaches for the abandonment of female genital mutilation. Obstetrics and Gynecology International.
Johansen, R.E.B. (2007). Experiencing sex in exile: Can genitals change their gender? On conception and experiences related to female genital cutting (FGC) among Somalis in Norway. In Yl. Hernlund & B. Shell-Duncan (Eds.), Transcultural bodies: Female genital cutting in global context. London, England: Rutgers University Press. 248–277.
Johnsdotter S. (2003). Somali women in Western exile: Reassessing female circumcision in the light of Islamic teachings. Journal of Muslim Minority Affairs, 23, 361–373.
Jordan, M.J. & Jones, L. (2015). A qualitative study exploring how Somali women exposed to female genital mutilation experience and perceive antenatal care and Intrapartum care in England: International Journal of Advanced Research. Volume 2, Issue 4, 263-268.
Kandala et al., (2019). “A Spatial Analysis of the Prevalence of Female Genital Mutilation/Cutting among 0–14-Year-Old Girls in Kenya.” International Journal of Environmental Research and Public Health 16(21): 4155.
Kaplan-Marcusan, A., Torán-Monserrat, P., Moreno-Navarro, J., Castany-Fàbregas, MJ. & Muñoz-Ortiz, L. (2009). Perception of primary health professionals about female genital mutilation: from healthcare to intercultural competence. BMC Health Serv Res. 9:11. doi: 10.1186/1472-6963-9-11. PMID: 19146694; PMCID: PMC2631456.
Kayombo, E et al., (2013). Impact of traditional birth attendants on maternal mortality and morbidity in Sub-Sahara African countries: Tanzania Journal of Health Research Volume 15, Number 2.
KDHS (2014). Kenya Demographic and Health Survey 2014. Kenya National Bureau of Statistics (KNBS) in partnership with the National AIDS Control Council (NACC), the National AIDS/STD Control Programme (NASCOP), the Ministry of Health and Sanitation, the Kenya Medical Research Institute (KEMRI), the National Coordinating Agency for Population and Development (NCAPD), ICF Macro, USAID, USAID/Kenya, the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), UNAIDS, and the World Bank
Keles, E., Eker, HH., Bektemur, G., Hilowle, IA., Kassim, MM., Hassan-Kadle, MA., Adali, A. & Karaketir, Ş. (2022). Determinants of Disagreement with Female Genital Mutilation Among Mothers. Int J Womens Health. 14:1863-1870. doi: 10.2147/IJWH.S391043. PMID: 36597478; PMCID: PMC9805744.
Kelly, E., & Hillard, P. (2005). Female genital mutilation. Current Opinion in Obstetrics and Gynecology. 17(5), 490-494.
Kimani S, Kabiru CW, Muteshi J, Guyo J (2020) Female genital mutilation/cutting: Emerging factors sustaining medicalization related changes in selected Kenyan communities. PLoS ONE 15(3): e0228410. https://doi.org/10.1371/journal. pone.0228410
Kimani, S. & Obianwu, O. (2020). “Female Genital Mutilation/Cutting: A Review of Laws and Policies in Kenya and Nigeria.” Evidence to End FGM/C: Research to Help Girls and Women Thrive. New York: Population Council.
Kleinman A. (1980). Patients and healers in the context of culture. An exploration of the borderland between anthropology, medicine, and psychiatry. London, England: University of California Press.
KNBS, Garissa County. (2019). 2019 Census. Kenya National Bureau of Statistics
Koso et al., (1987). The circumcision of women strategy for eradication: London: Dotesi Ltd; pp27-27.
Lavazzo, C., Sardi, T., Gkegkes, I. (2013). Female genital mutilation and infections: a systematic review of the clinical evidence. Archives of Gynecology and Obstetrics, 287(6), 1137-1149.
Lightfoot-Klein, H. (1989). The sexual experience and marital adjustment of genitally circumcised and infibulated females in the Sudan. The Journal of Sex Research, 26, 375–392.
Lightfoot-Klein, H. (1991). Prisoners of Ritual: Some contemporary developments in the history of Female Genital Mutilation. Available at: http://www.fgmnetwork.org/articles/prisonersofritual.php
Masho, SW. & Matthews, L. (2009). Factors determining whether Ethiopian women support continuation of female genital mutilation. Int J Gynaecol Obstet. 107(3):232–235. doi: 10.1016/j.ijgo. 2009.07.022.
Muchene, K. & Mageto, I.et al. (2018) Knowledge and attitude on obstetric effect of female genital mutilation among Somali women in maternity ward at Loitokitok Sub-County, Kenya: Nairobi University of Nairobi press
Mwendwa, P., Mutea, N., Kaimuri, M. J., De Brún A. & Kroll T. (2020). “Promote locally led initiatives to fight female genital mutilation/cutting (FGM/C)” lessons from anti-FGM/C advocates in rural Kenya. Reproductive Health, 17(1), Article 30. 10.1186/s12978-020-0884-5
National Council for Law Reporting. (2011). Prohibition of Female Genital Mutilation Act, (32): 5– 14. Available at: http://kenyalaw.org/kl/fileadmin/pdfdownloads/Acts/ProhibitionofFemaleGenitalMutilationAct _No32of2011.pdf
NCPD (2020). The State of Kenya Population 2020: “Zero Harmful Practices – Accelerating the Promise of ICPD25”. National Council for Population and Development.
Pashaei, T., Rahimi, A., Ardalan, A., Felah, A. & Majlessi, F. (2012) Related Factors of Female Genital Mutilation (FGM) in Ravansar (Iran). JWomen’s Health Care 1:108. doi:10.4172/2167-0420.1000108
Population Reference Bureau (2001). Abandoning female genital cutting. Prevalence, attitudes, and efforts to end the practice. Webpage: Population Reference Bureau.
Powell, R.A., & Yussuf, M. (2018). Changes in FGM/C in Somaliland: medical narrative driving shift in types of cutting. Evidence to End FGM/C: Research to Help Women Thrive. New York: Population Council.
Rawat R. (2017). The association between economic development, education and FGM in six selected African countries. J Midwifery Womens Health. 2017;11(3):137–146. doi:10.12968/ajmw.2017.11.3.137.
Rushwan, H. (2013). Female genital mutilation: a tragedy for women's reproductive health. African Journal of Urology, 19(3), 130-133.
Sabahelzain, MM., Gamal, EA., Babiker, S., Kabiru, CW. & Eltayeb, M. (2019). Decision-making in the practice of female genital mutilation or cutting in Sudan: a cross-sectional study. Glob Health Res Policy. 4:5. doi: 10.1186/s41256-019-0096-0. PMID: 30859137; PMCID: PMC6394000.
Shell-Duncan B, Moreau A, Wander K, Smith S. (2018). The role of older women in contesting norms associated with female genital mutilation/cutting in Senegambia: a factorial focus group analysis. PLoS One. 2018;13. https://doi.org/10.1371/journal.pone.0199217.
Shell-Duncan, B., Hernlund, Y., Wander, K. & Moreau, A. (2013). Legislating Change? Responses to Criminalizing Female Genital Cutting in Senegal. Law Soc Rev. 1;47(4):803-835. doi: 10.1111/lasr.12044. PMID: 24771947; PMCID: PMC3997264.
Toubia, N. (1994). Female circumcision as a public health issue. New England Journal of Medicine, 331(11), 712–716.
UNFPA (2013). Driving forces in outlawing the practice of female genital mutilation/cutting in Kenya, Uganda and Guinea-Bissau. New York: United Nations Population Fund, p. 22.
UNFPA (2018). Analysis of Legal Frameworks on Female Genital Mutilation in Selected Countries in West Africa. UNFPA Regional Office for West and Central Africa.
UNFPA, (2012). Trends in maternal mortality 1990-2010.Geneva: World Health Organization
UNFPA-UNICEF (2020). Measuring Effectiveness of Female Genital Mutilation Elimination: A Compendium of Indicators. UNFPA-UNICEF Joint Programme on the Elimination of Female Genital Mutilation: Accelerating Change.
UNICEF (2021). Case Study on the End Female Genital Mutilation (FGM) programme in the Republic of Kenya. UNICEF Kenya.
United Nations Children’s Fund (UNICEF). (2013). Female genital mutilation/cutting: a statistical overview and exploration of the dynamics of change. New York: UNICEF.
United Nations Children’s Fund (UNICEF). (2016). Female genital mutilation/cutting (FGM/C) and child marriage in Sudan - are there any changes taking place? An in-depth analysis using Multiple Indicators Cluster Surveys (MICS) and Sudanese Household and Health Surveys (SHHS). UNICEF.
United Nations, (2015) Sustainable development goals 2030 Agenda. Geneva: World Health Organization
Upvall, M. J., Mohammed, K., & Dodge, P. D. (2009). Perspectives of Somali Bantu refugee women living with circumcision in the United States: A focus group approach. International Journal of Nursing Studies, 46, 360–368.
WHO (2023). Female genital mutilation. World Health Organization. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation
World Health Organization (2017). Female genital mutilation factsheet. Geneva, Switzerland.
World Health Organization (WHO) (2020). Female Genital Mutilation https://www.who.int/reproductivehealth/top-ics/fgm/prevalence/en/
World Health Organization (WHO), United Nations Children’s Fund (UNICEF), & United Nations Population Fund (UNFPA). (1997). Female genital mutilation: a joint WHO/UNICEF/UNFPA statement. Geneva: World Health Organization. Retrieved from http://www.who.int/iris/handle/10665/41903
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