Monday, October 10, 2011

Historical prevalence of female genital mutilation (FGM) and the Shift from infibulation to clitoridectomy and non-circumcision in Sudan.

Historical prevalence of female genital mutilation (FGM) and the Shift from infibulation to clitoridectomy and non-circumcision in Sudan. Abstract Graphical extrapolations from previous national surveys on FGM FGMabbr.female genital mutilation inSudan have shown overall prevalence of about 96% between 1979 and 1983.In 1991, the overall prevalence was 89.2% with a drop of 7.3%. Nationalsurveys of 2000 and 2001 recorded 90% overall prevalence of FGM. Aboutfive years later Sudan House Hold Survey (2006) reported FGM overallprevalence of 69.4% with an unrealistic drop of 21.6% within a period ofabout five years. Graphical extrapolations of historical prevalence of FGM (1979 to2001) have shown a shift in the practice by gradual decline ininfibulations and concomitant rise in clitoridectomies. Historical prevalence (1979 to 2001) by types has also showngradual decline in infibulations, gradual disappearance of intermediatecircumcision circumcision(sûr'kəmsĭzh`ən), operation to remove the foreskin covering the glans of the penis. It dates back to prehistoric times and was widespread throughout the Middle East as a religious rite before it was introduced among the and concomitant gradual rise in clitoridectomies andnoncircumcision. Resent pilot studies on three generations in Sudanese families haveshown gradual decline in infibulations from grandmothers to mothers todaughters; with a reversed situation for clitoridectomies. There is alsoa clear gradual decline in circumcision at large from grandmothers tomothers to daughters; with a reversed situation for non-circumcision. [TEXT NOT REPRODUCIBLE IN ASCII ASCIIor American Standard Code for Information Interchange,a set of codes used to represent letters, numbers, a few symbols, and control characters. Originally designed for teletype operations, it has found wide application in computers. .] Introduction: A process of social and cultural transformation has been in motionthroughout Sudan during the last part of last century. There are somefactors that have positively or negatively influenced FGM practice inSudan. The efforts of the NGOs, SNCTP, BBSAWS and NCEHTP, in coordinationwith many other autonomous organizations and individuals, have led to agradual and slow., yet demonstrable de��mon��stra��ble?adj.1. Capable of being demonstrated or proved: demonstrable truths.2. Obvious or apparent: demonstrable lies. , shift in public attitudes towardsFGM (El-Bashir, 2006). The latter author literally and verbatim stated: "The very fact that the issue of female genital mutilation genital mutilationThe destruction or removal of a portion or the entire external genitalia, which may occur in the context of a crime of passion or as part of a cultural rite. See Bobbittize, Cutter, Female circumcision, Self-mutilation. isnow publicly discussed in the media and among women, men and youngpeople of both sexes is in itself a major indicator of change.Discussion of the issue used to be taboo; at best, it was regarded as'women's private issue and cannot be discussed by men":as a woman interviewed in central Sudan commented". However, the insignificant or rather embryonic change in attitudetowards FGM practice, after about 30 years of struggle, is only seenamong urban communities and only within some select groups of highsocio-economic status (Abdel Magied et al, 2003). Major reasons for thisinclude: Stereotype target groups, untested and not scientifically basedirrelevant messages, messengers not being accepted in major extensionprograms by target groups particularly in rural areas, inappropriateapproaches, and absence of an explicit government policy, commitment orsupport for a proper national strategic plan and lack of laws or decreesagainst FGM. This is in addition to rarity of appropriate, relevant andreliable qualitative research Qualitative researchTraditional analysis of firm-specific prospects for future earnings. It may be based on data collected by the analysts, there is no formal quantitative framework used to generate projections. addressing major issues and providing theneeded information for modulation of a sound national strategy andaction plan with appropriate interventions for the ultimate abolition ofFGM practice in Sudan (Abdel Magied, 2007). Justification: It has been hypothesized that there is a gradual positive shift inattitude towards FGM practice (El-Bashir, 2006). It is, however, oftenbut only said that there is also a shift in the practice from the severeform (infibulation) to the milder form (clitoridectomy clitoridectomy/clit��o��ri��dec��to��my/ (klit?ah-ri-dek��tah-me) excision of the clitoris. clit��o��ri��dec��to��myn.Excision of the clitoris. ) and perhaps tononcircumcision. Objectives: To authenticate (1) To verify (guarantee) the identity of a person or company. To ensure that the individual or organization is really who it says it is. See authentication and digital certificate.(2) To verify (guarantee) that data has not been altered. the truth behind the afore said hypothesis andspeculations. Methodology: The historical overall prevalence of FGM practiced in Sudan,decline in infibulations and concomitant rise in clitoridectomies havebeen graphically extrapolated from published literature on the nationalsurveys carried out in the Sudan. Evidence for the inclination to non-circumcision has beenestablished by pilot surveys conducted by the co-workers (Al Amin Al-Amin Ibne Abdullah (born September 6, 1972 in Mymensingh, Dhaka) is a former First-class cricketer who played 6 First-class games and 6 List A matches for Barisal Division in the 2000/01 Bangladesh domestic season. , 2008;Al Bashir and Mohamed, 2008) of the author of this article. Results and Discussion The World Fertility Survey, WFS WFS Wegfahrsperre (German: drive away blocking system)WFS Web Feature ServiceWFS World Future SocietyWFS World Food SummitWFS Wave Front SensorWFS Wolfram SyndromeWFS Wire Feed Speed (welding)(International StatisticalInstitute, Netherlands, 1979) recorded an overall FGM prevalence of 96%.National Surveys in Northern Sudan conducted by Rushwan et al (1983) andEl Dareer (1983) have also recorded an overall prevalence of 96.5%(Figure 1). [FIGURE 1 OMITTED] Sudan Demographic and Health Survey, SDHS SDHS San Diego Historical SocietySDHS Society of Dance History ScholarsSDHS Stephen Decatur High School (Berlin, Maryland)SDHS Satellite Data Handling SystemSDHS South-Doyle High School (Department ofStatistics, Ministry of Economic and National Planning, 1991) reportedan overall FGM prevalence of 89.2%. The Multiple Indicator ClusterSurvey, MICS MICS Multiple Indicator Cluster SurveyMICS Minimum Internal Control StandardsMICS Mobile Information and Communication Systems (National Center of Competence in Research)MICS Minimally Invasive Cardiac Surgery (Central Bureau of Statistics, 2000) reported an overallprevalence of 90%. Safe Motherhood Survey, SMS (1) (Storage Management System) Software used to routinely back up and archive files. See HSM.(2) (Systems Management Server) Systems management software from Microsoft that runs on Windows NT Server. (Central Bureau ofStatistic, Khartoum 2001) also recorded 90% prevalence. Though notpublished, but officially endorsed, Sudan Household Health Survey, SHHS SHHS Sam Houston High SchoolSHHS Sacred Heart High SchoolSHHS Science Hill High SchoolSHHS Strath Haven High SchoolSHHS South Houston High School (South Houston, Texas)SHHS Sunny Hills High School (Central Bureau of Statistic, Khartoum, 2006) reported an abrupt drop ofoverall FGM prevalence of 69.4% (Fig 1). However, extrapolation (mathematics, algorithm) extrapolation - A mathematical procedure which estimates values of a function for certain desired inputs given values for known inputs.If the desired input is outside the range of the known values this is called extrapolation, if it is inside then of theabove results in graphical form (Fig 1) would stimulate interestingcomments and perhaps speculations: While the World Fertility Survey (1979) recorded 96% overall FGMprevalence, four (4) years later the situation, at the best, wasstatistically exactly the same (Rushwan et al, 1983 and El Dareer,1983). However, seven (7) years later Sudan Demographic and HealthSurvey (1991), reported 89.2% with a drop in prevalence of 7.3%.Optimistically op��ti��mist?n.1. One who usually expects a favorable outcome.2. A believer in philosophical optimism.op , the credit should go to the efforts of our local NGOs:Babiker Badri Scientific Association for Women Studies (BBSAWS), andSudan National Committee for Harmful Traditional Practices (SNCTP),Ahfad University rural extension activities, the efforts of UN agenciesand other actors. Nonetheless, consecutively nine (9) and ten (10) yearslater (MICS and SMS) the reported overall FGM prevalence was 90%.Accordingly, since 1991 and up to 2001, at the best, the overall FGMprevalence was static. Hence, the abrupt and unrealistic drop of 21.6%in prevalence (Fig.1) within a period not exceeding five (5) years(SHHS, 2006) should be considered with absolute caution. In particular,when we consider the results of a resent survey conducted by AhfadUniversity in collaboration with Population Council International (2008)in Hai Ombadda in Omdurman city which is one of the three corners of thetriangle of the great capital of Sudan. The results of the survey haveshown 90.3% over all prevalence of FGM. Accordingly, the claimed abrupt revolutionary decline in prevalence(21.6%) recorded by Sudan House Hold Survey (2006) seems unrealistic andtherefore doubtful. This is because achieving such a drop within aperiod of less or not more than 5 years efforts, would assuminglyinvolve changing culture and attitudes towards the practice: a situationwhich cannot possibly be effected within such short period of time.Hence, we must always bear in mind that changing the culture andattitudes of any society can only be effected through evolutionarypatterns of relevant and appropriate intervention efforts. [FIGURE 2 OMITTED] Graphical extrapolation of records of previous national surveys(1979-2001) have shown a clear concomitant gradual decline ininfibulations and rise in clitoridectomies (Figure 2). [FIGURE 3 OMITTED] Graphical extrapolation of historical prevalence rates, by typesemphasizes gradual decline in infibulations (Pharaonic Circumcision),gradual disappearance of "Intermediate Circumcision" andconcomitant gradual rise in clitridectomies and non-circumcision (Figure3). Nonetheless, further consolidation to the gradual trend of shift inthe practice from infibulation to clitridectomy and perhapsnon-circumcision has also been indicated by pilot results obtained bythe co-workers (Al Amin, 2008; Al Bashir and Mohamed, 2008) of theauthor of this article. The studies targeted two groups of families oflow and high levels of socio-economic status where in each family thestate of circumcision and the type of circumcision was recorded for thegrandmother, mother, and daughter (Figures 4, 5, 6, 7). Figure 4 shows that of the families of low socio-economic status,95.5% of the grandmothers and 82.2% of the mothers were infibulatedcompared to 60.8% of the daughters. On the other hand, only 4.1% of thegrandmothers and 16.8% of the mothers were clitoridectomised, comparedto 39.1% of the daughters. Figure 5 shows that, of the families of low socio-economic status,98% of the grandmothers and 83% of the mothers were circumcised,compared to 42.6% of the daughters. On the other hand, only 2% of the grandmothers and 17% of themothers were uncircumcised uncircumcisedUrology Referring to a ♂ or penis which has not been circumcised. See Circumcision. , compared to 57.1% of the daughters. Figure 6 shows that of the families of relatively highsocioeconomic status, 87% of the grandmothers and 73% of the motherswere infibulated compared to 67% of the daughters. On the other hand,13% of the grandmothers and 27% of the mothers were clitoridectomisedcompared to 33% of the daughters. Figure 7 shows that 97% of the grandmothers, 82% of the mothers and67% of the daughters were circumcised. On the other hand, 13% of thegrandmothers, 27% of the mothers were uncircumcised compared to 33% ofthe daughters. Conclusions: * Since the World Fertility Survey in 1979 and up to 1983 theoverall prevalence of FGM in Sudan was about 96%. * Due to the efforts of different actors towards abolition of FGMpractice, Sudan Demographic Health Survey in 1991 recorded prevalence of89.2% with 7.3% drop in the practice. * However, the Multi Indicator Cluster Survey of 2000 and SafeMotherhood Survey of 2001 recorded an overall prevalence of 90%. * About five years later (2006) Sudan House Hold Survey reported anoverall prevalence of 69.4% with a doubtful unrealistic drop of 21.6%. * Nevertheless, graphical extrapolation of results of prevalence ofFGM between 1979 and 2001 has shown a shift in the practice with cleargradual decline in infibulations and concomitant gradual rise inclitoridectomies. * Moreover, historical graphical extrapolation of prevalence of FGMin Sudan by types between 1979 and 2001 has shown gradual decline ininfibulations (Pharaonic circumcision), gradual disappearance ofIntermediate circumcision and concomitant gradual rise inclitoridectomies and non-circumcision. * No measurable differences could be observed in the practice ofthe three generations of families of low and comparatively highersocioeconomic status: There is clear gradual decline in infibulations from grandmothersto mothers to daughters; with a reversed situations forclitoridectomies. There is also a clear gradually decline incircumcision from grandmothers to mothers to daughters; with a reversedsituation for non-circumcision. References: * Abdel Magied, Ahmed (2007): Social Determinants and Developmentsin Policies and Practices Connected with Abolition of FGM in Sudan. InCollaboration with Social Research Center, American University, Cairo,Egypt (December 2007). * Abdel Magied, Ahmed and Huda Faried.(2003): The Impact of SocioEconomic Status on the Practice, Perception and Attitudes of SecondarySchool Girls Towards Female Genital Mutilation (FGM). The Ahfad Journal,Vol. 20, No. 1. * Al Amin, Hiba (2008): The Shift from Infibulation toClitordictomy in Sudan--Case study: Population of Low SocioeconomicStatus. Dissertation Submitted in Partial Fulfillment for the Award ofB.Sc. (Hons.) in Psychology, Ahfad University for Women Ahfad University for Women is a private women's university in Omdurman, Sudan,and was originaly founded as a girls school by babiker badri in 1905 and was awarded the status of university in 1966. , Omdurman, Sudan(in Arabic). * Al Bashir, Areej and Mohammed, Leena (2008): The Shift fromInfibulation to Clitordictomy in Sudan--Case study: Population of HighSocio-economic Status. Dissertation Submitted in Partial Fulfillment forthe Award of B.Sc. (Hons.) in Psychology, Ahfad University for Women,Omdurman, Sudan (in Arabic). * Central Bureau of Statistics (CBS (Cell Broadcast Service) See cell broadcast. ), Khartoum (2000): MultipleIndicator Cluster Survey (MICS). * Central Bureau of Statistics (CBS), Khartoum (2001): SafeMotherhood Survey (SMS). * Central Bureau of Statistics (CBS), Khartoum (2006): Sudan HouseHold Survey (SHHS). * Department of Statistics, Ministry of Economic and NationalPlanning, Khartoum-Sudan (1991): Sudan Demographic and HealthSurvey(SDHS). * El-Bashir, H. (2006): The Sudanese National Committee on theEradication of Harmful Traditional Practices and the Campaigns AgainstFemale Genital Mutilation--"Al Sayga Wasila". In Abu Sharaf R.M. (Editor), Female Circumcision from Multi-cultural Perspective (pp.142-170). Philadelphia, Pennsylvania: University of Pennsylvania Press The University of Pennsylvania Press (or Penn Press) was originally incorporated with the Commonwealth of Pennsylvania on 26 March 1890, and the imprint of the University of Pennsylvania Press first appeared on publications in the closing decade of the nineteenth ,PENN. * El Dareer, Asma (1983): Women, Why Do You Weep? Circumcision andits Consequences. Zed Press, London. * International Statistical Institute, Netherlands (1979): WorldFertility Survey (WFS). The Summary of Findings, p 5. * Population Council International and Ahfad University for Women(2008): Strengthening Ahfad University for Women (AUW AUW Aloha United Way (Hawaii)AUW All Up Weight (Gross)AUW Authorized Unpriced WorkAUW As You WantAUW As You WishAUW Airframe Unit WeightAUW Advanced Undersea Weapon ) Capacity forIntegrating RH Out Reach Services Delivery Activities Project (Personalcommunication). * Rushwan, Hamid; Corry Scot; El Dareer, Asma; Nadia Bushra (1983):Female Circumcision in the Sudan, Prevalence, Complications, Attitudes,and Changes. University of Khartoum The University of Khartoum (U of K) is a public co-educational university located in and near Khartoum, Sudan.Founded as Gordon Memorial College in 1902 and established in 1956 when Sudan gained independence, the University of Khartoum is the most historically . Abdel Magied Ahmed (School of Health Sciences, Ahfad University forWomen)Figure 4: Prevalence of infibulations and clitoridectomies of threegenerations of families of low socio-economic status: Infibulation ClitoridectomyG M 95.9% 4.1%M 82.2% 16.8%D 60.9% 39.1%GM = Grandmothers, M = Mothers, D = DaughtersNote: Table made from bar graph.Figure 5: Prevalence rates of states of circumcision andnon-circumcision of three generations in families of lowsocio-economic status: Circumcised Non-circumcisedG M 98% 2%M 83% 17%D 42.6% 57.4%GM = Grandmothers, M = Mothers, D = DaughtersNote: Table made from bar graph.Figure 6: Prevalence rates of infibulations and clitoridectomiesof three generators in the same families of relatively highsocio-economic status: Infibulation ClitoridectomyG M 87% 13%M 73% 27%D 67% 33%GM = Grandmothers, M = Mothers, D = DaughtersNote: Table made from bar graph.Figure 7: Prevalence of states of circumcision and non-circumcisionin the same families of relatively high socio-economic status: Circumcised Non-circumcisedG M 97% 3%M 82% 18%D 61% 39%GM = Grandmothers, M = Mothers, D = DaughtersNote: Table made from bar graph.

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