Prevalence, knowledge, attitude and practices of female genital mutilation and cutting (FGM/C) among United Arab Emirates population

Abstract

Background: Female genital mutilation/cutting (FGM/C) is a common practice in developing countries, including the UAE, and presents a major health problem. Methods: A questionnaire-based cross-sectional study was conducted among 1035 participants: 831 (80.3%) females and 204 (19.7%) males. Results: The number of women with FGM/C was 344; hence the prevalence of FGM/C in our study was 41.4%. Type I was the most prevalent (62.8%), followed by Type II (16.6%) and Type III (5%). FGM/C was less prevalent among educated and employed women (p-value < 0.001) and was mostly performed during infancy and childhood. Among the participants, 13.7% reported that their daughters had undergone FGM/C, with Type I being the most common, and 25% of them planned to have their future daughters undergo Type I FGM/C. While FGM/C was mostly performed by ritual circumcisers (74.4%), in 25 and 36.7% of the cases, it was performed by health professionals and in the clinic setting, respectively. About 69% of the participants considered FGM/C a custom, 72.8% were against the practice, and only 17.4% believed in its legality. Complications occurred in 30% of cases. The type of FGM/C was associated with the occurrence of complications: bleeding, difficulties in sexual life, and delivery-related problems (p-value < 0.05). One-fifth of the male participants expressed plans to circumcise future daughters (p-value < 0.001). Conclusion: FGM/C remains a prevalent practice in the UAE and has a negative association with the general health of Emirati women. The lack of clear legislation to criminalize this practice is a problem to be addressed. In this context, national-level educational and legal strategies should be a priority.

Beyond illegality: Primary healthcare providers' perspectives on elimination of female genital mutilation/cutting.

“…It is possible that the education and public campaigns have not been culturally sensitive enough to bring the practising communities to critically think through and question the practice themselves. We envisage that if practising communities are able to question the practice, they will be willing to stop the practice rather than ongoing findings of future plans to cut their daughters in cultural backgrounds where it is prevalent (Al Awar et al, 2020; Amusan & Asekun‐Olarinmoye, 2006; Sakeah et al, 2019). We suggest further studies on key elements that can engage the communities to question the practice are needed.…”

“…The WHO (2008) classified FGM/C into four types based on their severity, ranging from a nick of the clitoris (type 1) to the excision of labia minora (type II), infibulation, which involves the removal of clitoris and labia with the remaining genitals sewn up, leaving a small opening (type III) and all other types of injury to the female genitalia including pricking, piercing, incising, scraping and cauterising (type IV; Kawous et al, 2020; Todkari, 2018). Infibulation which is type III has been associated with greatest risk of complications including haemorrhage, difficulty in sexual life, difficult labour and childbirth (Al Awar et al, 2020). Given these complications which are not compensated for by medical benefits, the United Nations Sustainable Development Goal (UNSDG) is to eliminate the practice by 2030 (United Nations, 2019).…”

“…Female genital mutilation/cutting is a human rights, public health and women's health issue, given that it is associated with many short‐term, medium‐term and long‐term health problems for women (Al Awar et al, 2020), including infection, pain, incontinence, sexual problems, psychological trauma and obstetric complications (Burrage, 2020). It is also a human rights issue because of the young age at which it is practised on girls (Gaffney‐Rhys, 2020; Varol et al, 2015).…”

Female Genital Mutilation/Cutting in Sudan and Subsequent Pelvic Floor Dysfunction.

“…Although the prevalence of FGM/C worldwide is unknown, it has been practiced to more than 200 million women in 30 countries in Africa, the Middle East and Asia and is still ongoing practice (1). FGM/C have also been reported from the other world countries such as United States, Spain, South America due to widespread migration (2) and widely prevelant in many Muslim countries although Islam or any religion does not command FGM/C (3)(4)(5). The prevalence rates of FGM/C vary considerably in African countries and the highest rate of FGM/C was reported in Somalia (98%) and Guinea (97%) (6).…”

“…The short-term physical complications include; severe pain, swelling of genital tissue, infection or tetanus due to unhygienic conditions and unsterilized instruments, fever, acute haemorrhage and related haemorrhagic shock and death, failure to wound healing, acute urine retention and related urinary tract infection, damage to adjacent tissue of the vagina, urethra and rectum, fracture or dislocation of femur or humerus and serious psychosocial and sexual function impairments (1,2). The long-term consequences include; recurrent/chronic urinary tract, pelvic and vaginal infections, painful urination, incontinence, female sexual dysfunctions (dyspareunia, reduced sexual sensitivity, female orgasmic disorders, vaginismus, vaginal penetration di culties), menstrual problems (dysmenorrhoea, haematocolpos), infertility, keloid scar, epidermoid inclusion cyst and neuroma of the clitoris, abscesses on the vulva, vesico-vaginal or recto-vaginal stulae, childbirth complications (post-partum haemorrhage, deep tearing of the perineum, prolonged and obstructed labour, stula, inertia or rupture of the uterus, increased risk of emergency caesarean section and maternal death), perinatal risks (need to resuscitate, stillbirth), pelvic organe prolapse, need later surgeries (dein bulation, clitoral reconstruction, urogynecological procedures), psychological consequences (depression, anxiety, post-traumatic stress disorder) (1)(2)(3)(4)(12)(13)(14)(15)(16). All these risks increase with the severity of the FGM/C procedure (16).…”