|
 |
FGC and the DHS |  |
|
Countries | |
|
DHS FGC Module | |
|
Publications |  |
|
|
|
||||||||||
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Female Genital Cutting and the Demographic and Health Surveys
What are the Demographic and Health Surveys?Since 1984 the Demographic and Health Surveys (DHS) program has assisted host country organizations in conducting nationwide surveys on topics such as fertility, reproductive health, maternal and child health and nutrition, and knowledge and practice related to HIV/AIDS. ORC Macro provides technical and administrative oversight for the DHS program, now known as MEASURE DHS, which is funded by the United States Agency for International Development (USAID). Funding allows for the collection and analysis of survey data as well as the dissemination of reports and data free to interested parties. Data sets, reports of country surveys, and special studies can be found on the DHS web site: www.measuredhs.com The main objectives of the MEASURE DHS project are:
MEASURE DHS also supports a range of other data collection options that can be tailored to fit specific monitoring and evaluation needs of host countries. These activities include Service Provision Assessment (SPA) surveys, AIDS Indicator Surveys (AIS), baseline and follow-up surveys, interim surveys, specialized surveys, and qualitative studies that use a variety of research methods. For example, a study of women’s experience with female genital cutting in Guinea was conducted in 1999 to provide information for questionnaire development for use in the 1999 DHS. The basic sample used in DHS national surveys has usually consisted of 5,000 to 8,000 women of reproductive age (15-49 years old). In addition to the core questionnaire, a number of modules (series of questions) about subjects of special interest may be used: malaria, HIV/AIDS, domestic violence, the status of women, maternal mortality, or female genital cutting (FGC). DHS surveys began using a series of questions on FGC in selected countries in northern Sudan in 1989. By the end of 2004, DHS surveys had asked questions on FGC in 18 countries. What is female genital cutting?Female genital cutting includes a range of practices varying from a simple nick of the clitoris to the partial or complete removal of the female genitalia for non-medical reasons. FGC is a common practice in many societies in the northern half of sub-Saharan Africa. Nearly universal in a few countries, it is practiced by various groups in about 28 African countries, in Yemen, and in immigrant populations in a growing number of countries. In a few societies, the procedure is routinely carried out when a girl is a few weeks or a few months old (e.g. Yemen), while in most others, it occurs later in childhood or adolescence. In the case of the latter, FGC is typically part of a ritual initiation into womanhood that includes a period of seclusion and education about the rights and duties of a wife. Both scholars and activists often assume that FGC “is an ‘ancient’ and deeply entrenched practice, that it is associated with initiation, with Islam, and with patriarchy” (Shell-Duncan and Hernlund, 2000:3). The same authors point out, however, that FGC is a recent practice in some societies; it is not always part of an initiation ritual; and most of the Islamic world does not observe the practice. Indeed, the practice in what is now Egypt and Sudan predates Islam by hundreds of years. Female genital cutting is a term chosen for its neutrality. The practice is more often referred to as female circumcision or female genital mutilation. Many people object to the use of the term female circumcision, which, they argue, suggests that the practice is analogous to male circumcision. In the mid-1990s, the World Health Organization (WHO) and many other groups adopted the term female genital mutilation (FGM), which emphasizes the permanent physical damage done to the female genitalia. This is the term used by the majority of English speakers. Recently, researchers and interested parties have expressed concern that the term female genital mutilation “stigmatizes the practice to the detriment of the programs trying to change it” (USAID, 2000). French speakers generally use the term excision for all types of FGC.DHS data on FGCData on FGC from DHS surveys are now available from 18 countries, all in Africa, with the exception of Yemen (see table 1). In Burkina Faso, Côte d’Ivoire, Egypt, Eritrea, Kenya, Mali, Nigeria, and Tanzania, two surveys that include FGC data have been conducted. DHS collected data on FGC for the first time as part of a survey in 1989-90 in Northern Sudan following discussions with the USAID Mission and the Ministry of Health. Women were asked if they had ever been circumcised, what type of FGC had been done, and who performed the operation. A number of questions followed asking their opinion about the practice. This pattern of questioning has been followed to some extent in subsequent surveys. Through a series of discussions over the years, the DHS team has developed an FGC module with suggested questions to be used in all countries. The questions can be divided into four categories: 1) whether the respondent is circumcised or not; 2) what she remembers of her own experience of circumcision; 3) what she recalls of the experience of one of her daughters; and 4) the respondent’s opinion about various aspects of FGC (benefits and drawbacks, how and why FGC should continue or not, etc.). The FGC module can be found on this CD in English and in French. Prevalence data on FGC at national and regional levels for specific countries have obvious uses, most notably to monitor trends of the practice over time. Data on a respondent’s own experience of FGC (age, type, instrument, place, the person who performed FGC) may provide information on changes in the practice as well as allow some assessment of likely consequences. The way DHS collects information on the type of practice of FGC and other aspects of the FGC experience varies between countries. Responses to questions about daughters can be used to examine trends over time through comparisons of mothers’ and daughters’ data. And finally, women’s opinions about the benefits of FGC may add to our understanding of what this practice accomplishes for those who participate in it. In the process of organizing a national DHS survey and finalizing a questionnaire, countries are free to add questions to the FGC module that address issues of specific concern to them. A number of countries have added questions about the health consequences of the operation for the respondent (mother) or her daughter. Several countries have added questions about the respondent’s knowledge of campaigns to eradicate FGC. Therefore, the text and tables included in the chapters on FGC data may vary somewhat from one country to another. In the interpretation of the differences in prevalence rates in the two surveys for Burkina and for Kenya, two aspects of the surveys should be considered. In Burkina, the first survey (1998-99) was conducted soon after the passage of a law forbidding the practice of FGC. Specialists in FGC in Burkina say that the prevalence rate in the 1998-99 survey was likely higher than the survey found, for some women were afraid to say they had been cut. Therefore, it is likely that the prevalence of FGC in Burkina remained stable between the two surveys. In Kenya, the first survey did not include the northern region where FGC is common, while the second survey included that region. Therefore, national FGC prevalence for the first survey should actually have been a little higher, which means that the decrease in FGC prevalence between the two surveys was actually larger than shown in the table. Key issuesDHS data on FGC can be used to answer a number of key questions, such as: What is FGC prevalence among (all) women 15-49 years old; How is FGC distributed within the country? What evidence can be found for changes in prevalence over time, in the way FGC was practiced, or in public opinion about the practice? To facilitate the exploration of these questions, FGC data have been assembled onto a CD Rom to make the data accessible to researchers and program specialists, and to assist programs in monitoring and evaluating the impact of program activities on knowledge and on practices. On this compact disc (CD) are found all the data and materials related to FGC that have been produced by DHS from 1990 to 2004. Of course prevalence data are critical, but prevalence reported at a national level has a limited value in countries where a major portion of the population does not practice FGC. In those countries, more information is gained by examining prevalence aggregated by region, by ethnic group, or by religion. Some idea of trends in prevalence over time can be obtained by examining prevalence rates in age cohorts of women. The proportion of women who say that they would like the practice to be abandoned or continued is currently used to track trends in the level of acceptance of the practice. It is unclear, however, how such statements relate to actual practice. In some countries the identity of the persons who do the cutting may change over time. For instance, in many countries the proportion of girls cut by traditional circumcisers has decreased while the proportion cut by medical personnel has increased. During the 1990s the World Health Organization (WHO) classified FGC into three types that varied by severity: clitoridectomy, excision, and infibulation (WHO 1998). Types that do not fit into these categories were classified as “Other.” In 2004, WHO began discussions to revise their own typology, but that discussion has not yet been completed. The FGC module has used various ways to obtain information about the type of FGC practiced on respondents and on their daughters. In some countries women were asked to say what was done to them, and their answers were then classified according to the WHO types. In other countries, women were asked which of the three types corresponded to their experience. The current model of the FGC module asks about the amount of cutting that was done. Comparisons of data from two surveys or in age cohorts in the same country may sometimes reveal changes in the type of circumcision practiced. Questions about the type of FGC are asked to get some sense of the relative severity of the operation, for infibulation causes major health consequences for women. What is actually done to women, however, does not easily fall into specific types. Thus the data on types should be used with great caution. Disaggregation of variables in tablesFGC data are presented as a separate chapter in each of the country reports in the form of text, tables, and graphs. Although the specific questions asked vary somewhat from one country to another, the reporting format of the tables follows the same formula throughout. Key outcome variables such as prevalence, age at the time of circumcision, identity of the person who performed the operation, and the responses relating to the respondent’s opinion of FGC are aggregated by a series of socio-demographic variables. The data are usually disaggregated by age of respondent, urban or rural residence, education, and region. In general, the tables in the FGC chapters follow the same model of disaggregation by these variables. Some countries also present data aggregated by ethnic group or religion, or both. In a few countries, women were asked if they had been circumcised, but no other questions were asked. In many countries a sub-sample of the husbands of respondents were asked questions about their knowledge of FGC and their opinions about the practice. Their responses are reported in a similar manner.
ReferencesShell-Duncan, Bettina and Ylva Hernlund. 2000. Female "Circumcision" in Africa. Boulder, CO: Lynne Reinner Publishers, Inc. U.S. Agency for International Development (USAID). 2000. USAID policy on female genital cutting (FGC). Washington, D.C.: USAID. World Health Organization. 1998. Female genital mutilation: An overview. Geneva: WHO. |
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
