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Practice and attitudes of Sudanese midwives towards: re-infibulation (re-circumcision).

Abstract

The main focus of this study was to investigate the practice and attitudes of Sudanese Midwives towards re-circumcision (re-infibulation) practice. The opinion of" midwives on why Sudanese women re-circumcise themselves and the magnitude of re-circumcision practice for whatever reasons were investigated.

The qualitative data was collected using semi-structured outlines for personal interviews to obtain information about the practice of recircumcision. The target group was 10 midwives from Khartoum State. The respondents were purposively selected.

The main findings were that re-circumcision is practiced by married and unmarried women.

Married women practice re-circumcision after delivery and sometimes cosmetically twice or three times a year. Married women practice recircumcision to tighten the vaginal orifice for the pleasure of the husband or else, as claimed, to beautify their external genitalia. Unmarried women practice re-circumcision after doing premarital sex as camouflage for virginity before getting married.

Married women of the age group 20-45 years old practice re-circumcision. On the other hand, unmarried women in the age group 16-35 practice recircumcision.

The magnitude of re-circumcision among married women is 40-80% and among unmarried women is 10-15%. Married women pay 20-50 SDG to be re-circumcised, while unmarried women pay 100-250 SDG.

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Introduction:

Of all problems traceable to traditional beliefs, and which adversely affect the health and lives of girls and women in Africa today, those arising from FGM are by far the most serious.

Original, professional and pioneer reporting on health hazards (including fatality) of FGM practice in Sudan has early been documented by Bredie, et al (1945); Shandal (1967); El Dareer (1983); and Rushwan et al (1983) and Rushwan (1994). More recent inputs on the health consequences and gynecological complications have been recorded by El Fadil (2000). The negative psychological impacts were reported by Bashar (1982). Moreover, the negative psychosexual impact of FGM on women has been investigated by Abdel Magied and Musa (2002).

Therefore, within the preceding context, it would seem logical to consider FGM as a synonym of endemic fatal disease and type of slavery specific to girls and women whenever it is prevalent and/or practiced (Abdel Magied, 1998).

Nonetheless, in the Sudan the practice has been perpetuating for many generations. As such, the practice has been institutionalized as habit or a custom that became an integral part of the social system. However, of the 28 identified African Countries (Rahman and Toubia, 2000) known to practice FGM, Sudan is one of the cases that are worthy of special attention.

This is because of the extra prevalence of the unique practice of cosmetic "re-infibulation" or "re-circumcision" by Sudanese women. This is practiced after delivery, but also cosmetically for up to three times a year to have a tighter vagina. The practice is however, claimed mainly for the pleasure of the male spouse (Abdel Magied et al, 2000).

Justification:

Although re-infibulation or re-circumcision is widely practiced in Sudan, yet information about the attitudes and the practice of midwives and traditional birth attendants (TBAs) has not been reported.

General objective:

To investigate the practice and attitudes of Sudanese midwives and (TBAs) towards re-infibulation (re-circumcision) practice.

Specific objectives:

* Assessment of attitudes of midwives and TBAs towards recircumcision (reinfibulation) practice.

Investigate the opinion of midwives and TBAs on why do Sudanese women get re-circumcised (re-infibulated).

Investigate the magnitude of re-circumcision practice for what so ever reasons.

Methodology:

Research design: Cross sectional descriptive study

Study area: The study was carried out in Khartoum State.

The target group: The target group was Sudanese midwives and TBAs.

Sample selection: Purposive snow ball sampling was used for selection of The participants.

Sample size: The sample size was ten midwives and TBAs.

Tools of data collection: Primary data was collected by specially structured guidelines for in depth interviews. Secondary data was collected from books, reports and scientific journals.

Data analysis:

The data was analyised descriptively and thematically.

Results:

Interview (1):

Fatma: a midwife of 50 years old; her education is high school in Al Ersaliya School in Bahri and worked as a legal midwife for a year and half. She practiced re-circumcision for the last 6 years. Her salary is 79 SDG and gets 30-40 SDG for each re-circumcision of a married woman. In her opinion the Sudanese married women who are circumcised, especially pharaonic type, do re-circumcision and most of them are in their forties. She does not know the age of unmarried women who practice recircumcision. The percentage in married women she thinks is about 20%. The Sudanese married women practice re-circumcision usually after delivery according to their husbands' desire. On the other hand, unmarried women who practice premarital sex do it just before marriage fearing the expected social complications when getting married.

Interview (2):

Fathia: a midwife of 50 years old, studied primary school and midwifery school at Bahri. She has been practicing reinfibulation (re-circumcision) for last 29 years. She did not take any salary during her work as midwife. She said both married and unmarried women practice re-circumcision. Married women do it to satisfy their husbands' desire in sexual life. Unmarried women do it due to premarital sex practice for retightening the vagina before marriage to avoid future social complications. Recircumcision practice in married women is usually at age of 40-45 years. Those who do it immediately after delivery, the percentage is about 50%. Unmarried women do it at ages between 20-25 years and the percentage is about 20%.

Interview (3):

Dorrya: a midwife of 42 years old; her education level is high school and a legal midwife from 1997-2004, then a health visitor and was not salaried. She thinks in general the reason for practicing re-circumcision is to have better self sexual pleasure. Other married women practice re-circumcision for the husband's desire. Usually married women do it at age of 29-35 years old and conform to about 50 %. They practice it immediately after delivery or once per year. She never did it for unmarried women and hence did not know the practicing age group.

Interview (4):

Fadya Alameen: a midwife of 47 year's old, working in a health center as a health visitor. She has been a midwife for 15 years.

She said re-circumcision is a process practiced by midwives with the claim of repairing the external genitalia for the better (Adal). Recircumcision practice is done on Sudanese married women and usually immediately after delivery. In some cases it is done after 15 days from delivery.

Married women do it for their husbands' desire. They also do it to beautify the dangling sides of labia or skin folds as a result of repeated sexual intercourse. Moreover, they do it for the purpose of narrowing of the vaginal orifice for self pleasure and\or desire of husband.

Some of the women do the re-circumcision operation up to three times a year. Some of them do it after long sex absenteeism (3-6 months) or more to please their husbands. After delivery, women pay 30-50 SDG for recircumcision; after long absenteeism they pay more.

The percentage of practice among married women is about 50%. Recircumcision practicing age for married women is between 30-45 years.

Interview (5):

Halema: a midwife of 50 years old working in Aldayat Hospital. She is a midwife for 20 years.

She defined re-circumcision as the Process practiced by midwives on circumcised married women with any of the three known types (Sunna, Intermediate and Pharaonic). Re-circumcision is practiced by married women and unmarried women. In married women for their husbands' desire and in unmarried before getting married to restore a claimed virginity.

Re-circumcision practice is done on married Sudanese women especially after delivery. In some cases it is done after 15 days from delivery.

Engaged women because of practicing premarital sex they do it just before getting married.

The age of re-circumcision for married women is 25-35 years and for unmarried women is 20-25 years.

Interview (6):

Safiya: a midwife of 31 years, working in Aldayat hospital. She is a midwife for 4 years, graduated from Midwifery School in Omdurman and she is considered a young midwife compared to other midwives.

She said re-circumcision is a process of FGM\C, practiced by midwives on usually circumcised married women. However, re-circumcision is practiced by both married and unmarried women.

In married women for husband's desire and in unmarried women for cover up of premarital sex just before getting married. Re-circumcision practice is done by Sudanese married women immediately after delivery or 15 days from delivery.

The unmarried women pay 150-200 SDG for re-circumcision and they are about 15% and married women about 50%.

Usually married women do it at ages between 20-35 years, while unmarried women between 16-25 years.

Interview (7):

Fatma Ahmed Alameen: a midwife of 42 years of age working in Aldayat Hospital and has been a midwife for 13 years.

She said the re-circumcision practice is done for Sudanese married women by midwives for repairing the external genitalia for the better (Adal). Recircumcision practice is done on Sudanese married women usually immediately after delivery.

Married women do it for their husbands' desire. They do it for the purpose of narrowing the vaginal orifice. Some women do the re-circumcision operation up to three times a year.

The percentage among married women practicing re-circumcision is about 40% and their age group is of 30-45 years. Unmarried women do it at the ages of 18-25 and they are about 15%. They pay 200-250 SDG for recircumcision. They do it just before marriage as cover up for practicing premarital sex.

Interview (8):

Arafa Mohamed: a midwife of 50 years old, working in Aldayat Hospital and midwife for 27 years.

She defined re-circumcision (Adal) as a process of FGM\C practiced by midwives due to husband's selfish desire.

Re-circumcision practice is done on Sudanese married women and usually immediately after delivery or 15 days from delivery.

Most of the married women do it to retighten the vaginal orifice for husband's desire. Married women pay 20-40 SDG. Unmarried women pay from 100-250 SDG. They do it because they practice premarital sex as cover up for a claimed virginity.

The percentage that practice re-circumcision among married women is 50% and they are between 30-45 years. Unmarried women get re-circumcised just before getting married because of practicing premarital sex.

Interview (9):

A midwife of 51 years old; she has been a midwife for 18 years.

She said re-circumcision is done by both married and unmarried women but it is more in married women.

Married women practice re-circumcision after repeated sexual intercourse for narrowing the vaginal orifice. Usually married women do it after delivery and at the age of 20-45 years. Unmarried women at the age of 18-35 years and they usually do it just before getting married as a cover up for premarital sex.

Interview (10):

The participant asked for in-nomination:

Sudanese married women get re-circumcised to retighten the vaginal orifice. Unmarried women practice re-circumcision as cover up for premarital sex. Married women practice re-circumcision after delivery and twice a year to have good looking external genitalia for the husband, usually at the age of 40 years.

The percentage in married women practicing re-circumcision is about 70%; while in unmarried women is 10%.

Conclusions:

This study was to investigate the practice and attitudes of midwives towards re-circumcision and to determine the magnitude of the recircumcision practice for whatever reasons.

The investigation revealed that re-circumcision or re-infibulation is practiced by both married and unmarried women for different reasons.

Married Sudanese women do it to retighten the vaginal orifice, and in some of them for self pleasure or else to also beautify the external genitalia for their husbands' desire. Unmarried women do it because of practicing premarital sex and just before getting married.

The midwives mentioned that re-circumcision is practiced in married women with any type of mutilation immediately after delivery. However, the participants reported that married women also practice re-circumcision cosmetically once to three times a year.

According to the respondents, the magnitude of re-circumcision practice among Sudanese married women is 40-80%. In unmarried women the practice varies between 10-15%.

The majority of married women who practice re-circumcision are normally at ages of 20-45 years while in unmarried women the range is between 16-35 years.

The midwives reported that unmarried women pay for each recircumcision 100-250 SDG, while married women pay 20-50 SDG.

References

--Abdel Magied Ahmed, El Balah A. Sulima and Dawood M. Kawthar (2000): Re- circumcision; the hidden devil of Female Genital Mutilation Case study on the perception, attitudes and practices of Sudanese Women The Ahfad Journal, Vol 17, No.1 June. (Reprinted by Women's International Network NEWS: 187grany st. lexington, ma02420-2126 USA 2002, 63,64,65)

--Abdel Magied Ahmed, and Suad Musa (2002): Sexual Experiences and Psychosexual Effects of Female Genital Mutation (FGM) or Female Circumcision (FC) on Sudanese Women. The Ahfad Journal, Vol 19, No. 1 June. (Reprinted by ATLANTIS: A WOMEN STUDIES JOURNAL, FKN SPECIAL ISSUE ONE 2003, 25, 30).

--Abdel Magied Ahmed (1998): Some FGM Terminology Between the Negative and Positive Impacts The Ahfad Journal. Vol. 15, No.2.

--Bashar, Taha (1982); Psycho-social Aspects of Female Circumcision. WHO Seminar on Traditional Practices Affecting the Health of Women and Children. Khartoum-Sudan. WHO/EMRO Technical Publication No. 2 Volume 2, 162-178.

--Bredie, E.D; Lorenzen, A.E; Guickshank, A.; Hovel, J.S; McDoland, D.K; Ali Bedri; Abdel Halim Mohamed; Abdl Allah Abu Shamma; Al Tigani Al Mahi (1945): Female Circumcision in The Anglo-Egyptian Sudan. McCorcodale printing press. S.G 1185.CS.5000. 6/51.

--El Dareer, Asma (1983): Women, Why Do You Weep? Circumcision and its Consequences. Zed Press, London.

--El Fadil, Saad (2000): Gynecological Complications of Female Genital Mutilation (FGM). Proceedings of the World Congress of Obstetrics and Gynecology. Washington D.C, September, 2000.

--Rushwan, Hamid; (1994): The Health Consequences of Female Genital Mutilation from a Health Provider's Perspective. Presented at: The Briefing Session on Female Genital Mutilation at 47th World Health Assembly (Geneva, 9-11 May, 1994).

--Rushwan, Hamid; Corry Scot; El Dreer, Asma; Nadia Bushra (1983): Female Circumcision in the Sudan, Prevalence, Complications, Attitudes and Changes. University of Khartoum.

Shandal Abu Futuh Ahmed (1967): Circumcision and Infibulation of Females. Sudan Medical Journal. Vol. 69.

Professor Ahmed Abdel Magied ; Islam El Tayeb; Mieaad El Hassan (School of Health Sciences and School of Medicine, Ahfad University for Women)
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Author:Magied, Ahmed Abdel; Tayeb, Islam El; Hassan, Mieaad El
Publication:Ahfad Journal
Article Type:Report
Geographic Code:6SUDA
Date:Jun 1, 2009
Words:2374
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