The impact of harm full traditional practices

1. HARMFUL TRADITIONAL PRACTICES
(HTPS)
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2. Learning Objectives:
After completion of the session , you will be able to:
 Differentiate the common HTPs in Ethiopia
 Analyze the effect of HTPs on reproductive health
 Be familiar with the reasons why the society practices it
 Internalize ways of mitigation
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3. HTPs
 Harmful traditional practices are those customs, values
and beliefs that are known to affect adversely the health
of people, the goals of equality, the political and social
rights and the process of economic development.
 But there is on-going debate whether the definition is
mainly influenced by the “western” culture or is it really
affecting the overall wellbeing of those practicing it.
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4. Cont…
 There has been hundreds of Harmful traditional practices
reported globally, the common harmful traditional
practices prevailing in the globe include:
 Female Genital Mutilation (FGM)
 Early Marriage
 Marriage by Abduction
 Uvulectomy
 Milk Teeth Extraction
 Food Prohibition …etc.
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5. 1. Female Genital Mutilation (FGM)
 FGM is a traditional operation that involves cutting away
parts of the female external genitalia or other injuries to
the female genitalia for cultural, religious or other non-
therapeutic reasons.
The WHO Four major types of FGM
Type I - Clitoridectomy
 Partial or total removal of the clitoris &/or the prepuce
(clitoral hood)
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6. Types of FGC/FGM
 WHO classifies FGM as
follows:
 Type I (Sunna): Excision
of the prepuce with or
without excision of part or
all of the clitoris.
Fig. 1: Normal female external genitalia and female external genitalia with the
tip of the clitoris excised
Type I may consist of removal of the prepuce without damage to the clitoris
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7. Type II - Clitoridectomy
 Partial or total removal
of the clitoris &/or the
prepuce (clitoral hood)
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8. Cont…
Type III - Excision
 –Partial or total removal of the clitoris and the labia minora,
with or without excision of the labia majora
Type IV - Infibulation
 The prepuce, clitoris, labia minora, labia majora and the
lower part of the vagina are removed.
 The edges are stitched together with thorn or thread leaving
a small opening for the passage of urine and menstrual
blood. After excision the legs are tied together.
 The wound is left to heal taking about two to three weeks.
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9. Cont…
 In societies where infibulation is practiced, the economic
value of a girl depends on her virginity.
 There is support for infibulations from an economic point
of view.
 The concept of preserving family honour further
strengthens this practice.
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10. Cont…
Type V - unclassified FGM
 All other harmful procedures to the female genitalia e.g.:
pricking, piercing, incising, scraping & cauterization
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11. The age at which FGM is
performed
 FGM is performed on girls and women, from birth to
adulthood.
 The age at which FGM is performed varies depending on
ethnic group or geographical location
 In some ethnic groups it is performed on babies
E.g. In Eritrea baby girls are excised around the 7th day
after birth.
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12. FGM…
 Who practices FGM?
 FGM is practiced by followers of different religions
including
Muslims
Christians (Orthodox, Catholics, and Protestants)
Non-believers
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13. Prevalence of FGM
 Magnitude
 100 – 140 million girls and women have undergone some
form of FGM
 About 2 million girls per year are at risk
 Where?
 Most girls and women who have undergone FGM live in
28 African countries
 Some live in the Middle East and Asia.
 Also practiced in India
 Today seen in Europe, Australia, Canada, USA (due to
migration of people who follow this tradition)
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14. Estimated prevalence of FGM
Fig. 6: Estimated prevalence of FGM among female population in African countries
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15. FGM in Ethiopia
 FGM is practiced
 In all regions except in Gambela and among some ethnic groups in
SNNPR
 Rural and urban areas.
 Various religious groups
 According to a baseline survey of 1997
 28 ethnic groups (mostly in SNNPR) do not practice FGM
 Infibulation is practiced among 5 ethnic groups
 Somali -90%, Affar – 63%, Berta – 10%, Harari – 5%, Oromo – 1%
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16. FGM in Ethiopia
 Sunna is the commonest FGM [worldwide]
 Over 50% of the circumcision among
Agew
Argoba
Fadashi
Goffa
Harari
Kebena
Oromo
Siltie and
Werji ethinic groups
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17. Reasons for practicing FGM
 To respect Tradition
 Most believe that this custom is a decision/order by their ancestors
and should be inherited
 To keep the moral Behaviour of Women in the Society
 Sexual sensitivity and responses are reduced by performing FGM
 Uncircumcised women are
 thought to be incapable of controlling their sexuality
 they are considered to be prostitutes and will not find husband
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18. Reasons...
 Preservation of virginity
 Virginity is very important in most African cultures
 It is a value and reflection of the status of the family
 After FGM, it is believed that girls will not indulge in
premarital sex and thus stay pure for their husbands
 Enhancement of fertility
 Certain societies believe that circumcised girls become
pregnant very easily.
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19. Reasons...
 Prevention of promiscuity
 Uncircumcised women have too much sexual desire and
might indulge in sex (premarital, extra marital).
 Uncircumcised girl is believed to
run wild
shame to her family
unreserved
breaks utensils, wasteful and absent minded
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20. Reasons...
 Increase matrimonial opportunities
 In some society the bride price goes up with virginity and
tightness of the vagina.
 Hygienic Reasons
 Female external genitalia produce secretions that make the
woman wet and produce bad odour.
 The removal of the genital organ is believed to promote the
cleanliness of the area.
 Aesthetics:- For some ethnic groups the female genitalia are
ugly to look at and thus should be removed.
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21. Reasons...
 Prevention of stillbirths in Primigravidae
 Some communities (in Burkina Faso and Nigeria) believe
that clitoris has the power to kill the first born, if during
delivery, the baby’s head touches it
 Societal privileges and positions
 Failure to accept traditions of a group may lead to loss of
privileges and benefits available to the rest of the
community
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22. Reasons...
 Improvement of male sexual performance
 Clitoris is believed make the man gets excited very fast
which leads to an early ejaculation that may lead to
matrimonial disharmony.
 Maintenance of good health
 Circumcision is said to keep the women healthy and cure her
from diseases such as epilepsy, hysteria, depression,
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23. Complications of FGM
 physical complications:- Acute
 Severe Pain
 Injury to the adjacent tissue of urethra, vagina, perineum and
rectum
 Hemorrhage
 Shock
 Acute urine retention
 Infection
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24. Complications….
 Long-term physical complications
 Recurrent urinary tract infection
 Diffulity in urine
 Pelvic infection
 Infertility
 Keloid scar
 Abscess
 Cysts and abscesses on the vulva
 Difficulties in menstrual flow
 Fistula
 Failure to heal
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25. Complications….
 Psychosocial consequences
 Mutilation is an occasion marked by fear and the suppression of
feelings
 The experience is a vivid “landmark” in their mental development,
the memory never leaves them.
 Some women reported that they suffer pain during sexual
intercourse and menstruation that is almost as bad as the initial
experience of genital mutilation.
E.g. In Sudan an official day off from work every month is given to women to
deal with the menstrual problems.
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26. Complications….
 Sexual complications of FGM
 Women who have undergone genital mutilation may
experience various forms and degrees of sexual
dysfunction.
 Dyspareunia (painful sexual intercourse ) because of
scarring, narrowing of the vaginal opening, obstruction
of the vagina due to elongation of labia minora and
complications such as infection.
with severe forms, vaginal penetration may be difficult
or even impossible without tearing or re-cutting the scar
 Vaginismus may result from injury to the vulval area and
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27. What should be done?
 Education of women
 Creating awareness among youth, community leaders,
religious leaders and men about the health, social and
economic problems of FGM.
 FGM is unethical and should not be performed in health
institutions and home.
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28. Cont…
 Social and medical assistance should be made available
to women on whom FGM has been conducted
 Training of educators and health workers on the hazards
of FGM
 Support to programs that aim at abolishing FGM
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29. 2. Early Marriage/Arranged
Marriage
 To be free from early and arranged marriage is a
reproductive right. But many society’s practicing this for
various reasons.
 According to Ethiopian law early marriage occurs before
the age of eighteen(18 years).
 There are three marriage arrangements for early marriage:
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30.  1. Promissory marriage: Oral promises made by two
families to give each other their children in marriage right
after or even before the birth of their children.
 2. Child marriage: Marriage of children less than ten
years of age. Girls then live with their in laws.
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31.  Madego) or live with their parents until the age of twelve
with the frequent visits of their in-laws (Mililis).
 3. Elderly marriage: In some cultures very young girls
are forced to marry an old man for matrimonial or other
benefits.
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32. Reasons for early marriage
Some of the reasons for early marriage are:
 Parents desire to see the marriage of their daughters and
their grandchild before they die.
 Strengthen the family or business ties between the two
parties to be married
 Avoid the possibility of a daughter not getting married or
becoming not eligible for marriage
 Avoid premarital sex or loss of virginity and its
consequences
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33. Effects of early marriage
Harmful effects of include:
 Psychological effect on the girl bride leading to different
somatic problems.
 The small genitalia are traumatized ending up in tears,
bruising, cystitis, and damage to the urethra.
 Preclampsia, prolonged and obstructed labour leading to
fistula formation
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34. Cont…
 Haemorrhage and shock at delivery
 Still born babies
 Loveless marriage often ending in divorce
 Difficulty in managing a household by the young girl
 Deprivation of the girl of her education leading to poor
opportunity for employment and gainful income
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35. 3. Marriage by abduction
 Marriage by abduction is a gross violation of women’s
rights.
 It has been common in some parts of Ethiopia (Afar,
Oromiya and SNNPR).
 In some cases the girl may be willing and ready to proceed
with the marriage. In these cases the consequences are less
grave.
 However, when the girl objects and fights against the
abductors she can be severely hurt and even get killed.
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36. Reasons for Marriage by Abduction:
 Refusal or anticipated refusal of consent by parents or girl
 Avoid excessive wedding ceremony expenses
 Ease the economic burdens of the conventional bride price
 Outsmart rivals when the girl has many suitors and/or the
inclinations of the girl or her parents are not predictable
 Difference of ethnic origins or economic status of partners
may also be reasons for possible abduction.
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37. Harmful effects of marriage by abduction
 Battering (rough treatment), inflicting bodily harm,
suffocation, and severe disabilities and death may
ensue.
 Conflict created between families may lead to feuding
(disputing) lasting for generations.
 There are incidents of ethnic conflicts due to marriage
by abduction
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38. Cont…
 The outcome may be an unhappy, unstable and loveless
marriage
 Psychological stress on the girl. It might end up in suicide.
 There are large expenses related to conflict resettlements as
compensation to the family or for court cases
 Discontinuation of schooling and other opportunities for the
girl.
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39. Other harmful traditional practices
 Other harmful traditional practices that are prevalent in
Ethiopia include uvulectomy, milk teeth extraction, food
prohibitions for mothers, eye brow incision, and soiling
the umbilicus of the new born with cow dung.
 Each of these traditional practices has mistakenly
perceived advantages.
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40. Cont…
 Uvulectomy is supposed to prevent problems of feeding
(swallowing), avoid noisiness and improve speech.
 Milk teeth extraction is assumed to prevent diarrhoea and
cure various diseases.
 Eye brow incision is undertaken to prevent eye diseases
and blindness.
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41. Cont…
 Certain food items which contain important nutrients are
believed to cause diseases in women and children.
 These harmful traditional beliefs and practices might
result in serious health outcomes including serious
bleeding, acquiring dangerous and fatal infection and
malnutrition.
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42. THANK YOU!!!
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