STUDENTS' KNOWLEDGE OF AND ATTITUDES ABOUT FEMALE CIRCUMCISION IN EGYPT New England Journal of Medicine
To the Editor: Female circumcision, the surgical modification or removal of the female genitalia, is an ancient custom that continues to be widely practiced, mainly in non-hospital settings. Over 120 million women worldwide have been subjected to female circumcision, and 2 million girls are at risk for the procedure each year.(1) Immediate complications, such as massive hemorrhage and infection, and long-term effects on physical, sexual, and psychological health are frequent and can be life-threatening.(2,3) Cultural reasons for women to subject their young daughters to female circumcision include the false beliefs that it is necessary for chastity, marriage, good hygiene, and increased fertility.(4,5) In Egypt, 95 percent of women have undergone female circumcision. Most are poor and uneducated, which suggests that a lack of education may play a part in the continued use of the procedure. We studied university students in Cairo, Egypt, to assess their knowledge of female circumcision and attitudes toward its abolishment. Studying a population that can help shape the future of society can provide insight into gaps in knowledge concerning female circumcision that may influence attitudes toward the practice. We randomly selected 1070 students from universities in Cairo, using a stratification scheme to obtain equal numbers of medical and nonmedical students as well as of men and women. Students were individually interviewed face to face with use of a 32-item questionnaire. The response rate was 95 percent. Of the 1020 students interviewed, 734 (72 percent) supported the abolishment of female circumcision. The percentages of women and medical students who were against this custom were even higher. (Table 1). |
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Although medical students were significantly more knowledgeable than nonmedical students, less than half of them knew that hemorrhage and infection could follow female circumcision. Male students were more knowledgeable than female students, although the differences were only significant with respect to the knowledge of sexual problems resulting from female circumcision. Most students agreed that female circumcision has no religious basis, is not necessary for chastity, and is unnecessary for the maintenance of hygiene. The attitudes of the majority were against female circumcision, with a higher percentage of medical students having negative attitudes in most cases. Despite the recent ban on female circumcision in Egypt, the practice continues. The high proportion of students in favor of abolishing female circumcision is a hopeful sign that the situation may change in the future. However, the opposing opinions of the other 28 percent of students and the lack of knowledge, especially concerning the complications of female circumcision, suggest that some action is still warranted. Through further education, the beliefs about female circumcision can be changed and thus will help bring an end to this custom in Egypt and in other countries. Mohamed F. Ahmed Allam, M.S., M.P.H.
Jokin de Irala-Estevez, M.D., Ph.D.
Rafael Fernandez-Crehuet Navajas, M.D., Ph.D.
Jane S. Hoashi, M.P.H.
1. Toubia N. Female genital mutilation: a call for global action. 2nd ed. New York: RAINBO, 1995:24-5. 2. Idem. Female circumcision as a public health issue. N Engl J Med 1994;331:712-6. 3. World Health Organization, International Federation of Gynecology and Obstetrics. Female circumcision: female genital mutilation. Eur J Obstet Gynecol Reprod Biol 1992;45:153-4. 4. Council on Scientific Affairs, American Medical Association. Female genital mutilation. JAMA 1995;274:1714-6. 5. Ladjali M, Rattray TW, Walder RJ. Female genital mutilation. BMJ 1993;307:460. Cite as: Allam, MFA et al. Students' Knowledge of and Attitudes about Female Circumcision in Egypt (Correspondence). NEJM 1999;341(20):1552-3. ^Top |