Dr. Joseph Keating however, is an editorial board member of PLOS ONE; this does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials.
Conceived and designed the experiments: NO JK JB JR. Analyzed the data: NO JK JR. Wrote the paper: NO JK JB JR.
To establish the prevalence of female genital mutilation (FGM) and force feeding (
Data from the Mauritania 2000–2001 DHS were used in this analysis. Data were collected from men and women about their attitude toward the continuation of FGM and
The overall prevalence of FGM was 77% but varied depending on ethnicity. The majority of both female and male respondents favored the continuation of the practice (64% and 70%, respectively). Almost a quarter (23%) of women reported being force fed as a child and 32% of women and 29% of men approved the continuation of the practice.
The practice of both FGM and
According to Article 5 of the Universal Declaration of Human Rights, “no one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.”
Whereas FGM has been documented in numerous sub-Saharan Africa (SSA) countries
FGM, also known as female genital cutting describes all procedures that involve complete or partial removal of the external female genitalia, or injury to the female genital organs for non-therapeutic reason. It has no known health benefits and may harm girls and women permanently
FGM is generally believed to curb a woman’s sexual desire and many assume it is required for religious reasons; it is also done to confer social acceptance on the family, as well as a rite of passage from childhood to adulthood
As the social norms for marriage favor young girls that have a large amount of body fat, families often force young girls (sometimes as early as 6 years old) to consume large quantities of food and milk to increase their weight, and thus their chances for marriage at an early age. The use of pills (e.g. steroids) to gain weight has also been reported in Mauritania. Thin women are believed to be unhealthy, whereas overweight women are perceived as far more desirable
There is a little reference as to when force-feeding of girls began in Mauritania. Some historians believe that the practice dates back centuries when most of the white Mauritanians, Arabs, and Berbers were nomads; in nomadic society the obesity of women was seen as a sign of beauty and prosperity and the wives of rich men would often not work, preferring instead to sit in tents while black slaves tended to household chores.
Ostensibly, FGM and
There is a dearth of published literature or statistics on public health problems in Mauritania in general, and even less on these two practices specifically. This paper constitutes the first published report to examine these two practices in terms of prevalence, prevailing attitudes and acceptance, and factors associated with their use in Mauritania. While the data used are almost a decade old, the 2001 demographic and health (DHS) survey constitutes the only known population-based survey to collect data on both FGM and
Mauritania is a country located in Northwest Africa between Morocco, Western Sahara and Senegal. It is one of the poorest and least developed countries in the world. In 2011, the country’s Human Development Index (HDI) was very low (0.453), ranking 159th out of 182 countries
Data were obtained from the Mauritania 2001 Demographic and Health survey (DHS)
The DHS targets women of reproductive age and therefore a statement about children is not needed. Due to high illiteracy rates in the area, verbal consent and assent, in lieu of written consent and assent, were obtained during the collection of data. No data were collected from respondents who did not give permission to participate. All interviews were conducted in private to reduce social desirability bias. All data were collected using a standardized structured questionnaire
The survey used a two-stage cluster design to produce a probability sample, representative of the entire country; data were collected on women of reproductive age (15 to 49 years old), and men (15 to 59 years old). A total of 6,149 households were successfully surveyed; only 1.3% of households approached refused to participate. Women between the ages of 15 and 49 years old in selected households were interviewed individually; a total of 7,728 were interviewed, with 3.5% of eligible women refusing to participate. Forty-percent (40%) of households were selected for male interviews; a total of 2,191 men between the ages of 15 and 59 years old were interviewed, with 11.9% of eligible men refusing to participate.
STATA 9.0 (STATA Corporation, College Station, TX) was used for all data analyses. Descriptive statistics were used to summarize 2001 DHS household survey data by demographic characteristics. Chi-square test statistics were used to explore differences between demographic characteristics and the following 6 outcomes: attitude about continuing the practice of FGM (among men and women separately), attitude towards continuing the practice of
Individual level demographic characteristics included age and education. Household level demographic characteristics included wealth, as measured by a household asset index created using a principal components analysis of household assets (e.g. electricity, radio, television, refrigerator, vehicle and animals)
Logistic regression models were used to test whether socio-demographic factors were associated with the 6 outcomes related to attitudes and practices of FGM and
To control for intra-class correlation at the community level, empirically estimated standard errors were used within logistic regression models, using the village as the cluster unit. Probability weights were used to account for the two-stage cluster sample design used. The probability of committing a type-1 error (alpha) was set at 0.05. Wald statistics and log-likelihood ratios were used to identify variable significance and model fit.
Women (%) | Men (%) | |
n = 7,728 | n = 2,191 | |
|
||
Arab | 76.0 | 74.5 |
Poular | 16.6 | 17.7 |
Soninke | 4.0 | 4.0 |
Wolof | 2.2 | 2.8 |
Others | 1.0 | 0.8 |
|
||
Single never married | 28.6 | 48.8 |
Married | 58.8 | 48.9 |
Divorced and widowed | 12.6 | 2.3 |
|
||
Urban | 46.0 | 56.2 |
Rural | 54.0 | 43.9 |
|
||
Lowest | 35.1 | 28.1 |
Second | 31.2 | 28.8 |
Middle | 4.0 | 7.9 |
Fourth | 16.4 | 20.9 |
Highest | 13.3 | 14.3 |
|
||
No | 30.5 | 21.1 |
Koranic | 27 | 19.2 |
Prim. Education | 27.8 | 26.1 |
Second. Education | 13.6 | 28.3 |
High (University) | 1.1 | 5.3 |
|
||
15–19 | 22.0 | 22.5 |
20–24 | 19.0 | 14.6 |
25–29 | 16.9 | 13.6 |
30–34 | 15.4 | 11.8 |
35–39 | 10.8 | 10.4 |
40–44 | 10.1 | 11.4 |
45–49 | 5.9 | 6.4 |
50–54 | – | 6.1 |
55–59 | – | 3.2 |
|
||
Not working | 70.6 | 33.5 |
Working | 29.4 | 66.2 |
In Mauritania, over 70% of women report experiencing FGM
Women (%) | Men (%) | |
n = 7,728 | n = 2,191 | |
|
||
Yes | 91.7 | 82.2 |
|
|
|
|
||
Social recognition | 34.8 | 29.6 |
Curbs sexual desire | 31.2 | 25.1 |
Religious requirement | 29.2 | 41.2 |
Better for hygiene | 18.8 | 13.0 |
Better chance to get married | 3.8 | 9.8 |
Sexual desire of the other sex | 1.8 | 1.8 |
Other | 8.5 | 10.6 |
None | 21 | 19.9 |
|
||
More sexual desire for women | 19.7 | 12.9 |
Less health problems | 10.6 | 9.7 |
Avoid suffering | 6.9 | 6.1 |
More sexual desire for men | 5.7 | 4.9 |
Less delivery problems | 4.4 | 1.6 |
Accordance with religion | 2.4 | 3.4 |
Other | 11.9 | 12.9 |
None | 52.9 | 58.7 |
|
||
Yes | 38 | 20.5 |
No | 21.6 | 14.2 |
Don’t know | 39.1 | 63.4 |
|
||
Yes | 41.6 | 35.8 |
No | 29.2 | 27.5 |
Don’t know | 28.0 | 34.0 |
|
||
Yes | 64.4 | 70.9 |
No | 22.3 | 17.7 |
It depends | 7.2 | 4.5 |
Don’t know | 5.8 | 6.3 |
|
||
Yes | 37.0 | 56.1 |
No | 14.6 | 13.3 |
It depends | 23.2 | 12.7 |
For some questions the columns do not equal 100% due to missing data.
Bivariate results indicated significant differences in attitude (i.e., approval of the continuation of FGM) for both male and female respondents. The most significant differences were observed among women and among men who live in different regions [female (
In Mauritania, over 20% of women report experiencing
Women (%) | Men (%) | |
n = 7,615 | n = 2,158 | |
|
||
Yes | 93.7 | 91.5 |
|
|
|
|
||
More beautiful | 40.2 | 30.8 |
Show the social level | 27.1 | 20.8 |
More chances for marriage | 13.8 | 3.7 |
Other | 4.4 | 6.4 |
None | 39.8 | 54.5 |
Don’t know | 5.8 | 4.7 |
|
||
Better for health | 44.8 | 55.0 |
Make it easier to work and move | 34.7 | 50.1 |
More attractive | 10.4 | 9.3 |
Avoid pain | 9.8 | 11.4 |
Avoid ugly look when you lose weight | 7.0 | 7.4 |
Facilitate pregnancy and delivery | 3.7 | 5.0 |
Avoid stretch marks | 3.6 | 4.7 |
More chance to get married | 2.6 | 1.3 |
Sexual pleasure of women | 1.5 | 0.6 |
Accordance (in line) with religion | 0.4 | 1.4 |
Other | 3.1 | 2.6 |
None | 24.6 | 23.7 |
Don’t know | 9.0 | 7.1 |
|
|
|
|
||
Bad for health | 52.8 | 58.2 |
Hamper ability to work and move | 28.4 | 33.3 |
Very painful | 11.6 | 15.9 |
Very expensive | 10.1 | 13.0 |
Difficulty for pregnancy and delivery | 8.7 | 8.4 |
Against Gavage | 6.5 | 22.5 |
Ugly if you lose weight | 5.8 | 4.0 |
Stretch marks | 5.7 | 4.2 |
Less chances for marriage | 1.1 | 1.8 |
None | 19.6 | 19.4 |
Others | 5.1 | 6.6 |
Don’t know | 10.9 | 4.6 |
For some questions the columns do not equal 100% due to missing data.
Bivariate results indicated significant differences in attitude (approval of the continuation of
Results from the 3 logistic regressions with FGM attitude and practice outcomes are presented in
Favorable attitude for continuing FGM | Experienced FGM | ||
Women (n = 6,074) |
Men (n = 1,583) | Women (n = 7,048) |
|
|
|
|
|
|
|||
Wolof | Reference | Reference | Reference |
Other ethnic groups | 7.71 (3.76–15.83) |
5.22 (2.51–10.86) |
7.61 (4.56–12.68) |
|
|||
Urban | Reference | Reference | Reference |
Rural | 1.20 (0.82–1.75) | 2.82 (1.09–7.31) |
1.45(.95–2.20) |
|
|||
Lowest | Reference | Reference | Reference |
Second | 0.98 (0.79–1.21) | 0.81 (0.48–1.39) | 1.08 (0.85–1.37) |
Middle | 1.14 (0.79–1.65) | 0.84 (0.38–1.87) | 0.67 (0.46–0.97) |
Fourth | 0.74 (0.58–0.94) |
0.50 (0.29–0.86) |
0.63 (0.48–0.81) |
Highest | 0.37 (0.28–0.50) |
0.52 (0.28–0.93) |
0.45 (0.32–0.63) |
|
|||
No | Reference | Reference | Reference |
Koranic | 0.68 (0.52–0.88) |
1.18 (0.65–2.16) | 1.36 (1.06–1.73) |
Prim. Education | 0.60 (0.47–0.76) |
0.67 (0.39–1.17) | 0.93 (0.75–1.14) |
Second. Education | 0.35 (0.27–0.46) |
0.49 (0.29–0.82) |
0.65 (0.52–0.82) |
High (University) | 0.19 (0.11–0.33) |
0.29 (0.16–0.52) |
0.69 (0.39–1.23) |
|
|||
15–19 | Reference | Reference | Reference |
20–24 | 0.78 (0.64–0.94) |
0.77 (0.47–1.27) | 1.00 (0.84–1.20) |
25–29 | 0.67 (0.54–0.83) |
0.69 (0.41–1.15) | 0.88 (0.70–1.10) |
30–34 | 0.65 (0.52–0.82) |
0.64 (0.36–1.14) | 1.14 (0.89–1.47) |
35–39 | 0.47 (0.37–0.61) |
1.05 (0.53–2.11) | 0.89 (0.66–1.20) |
40–44 | 0.72 (0.53–0.97) |
0.57 (0.31–1.08) | 1.02 (0.74–1.38) |
45–49 | 0.54 (0.38–0.75) |
1.00 (0.46–2.18) | 0.72 (0.52–1.00) |
50–54 | NA | 0.68 (0.30–1.50) | NA |
55–59 | NA | 0.76 (0.33–1.76) | NA |
|
|||
Not working | Reference | Reference | Reference |
Working | 1.10 (0.92–1.31) | 0.92 (0.63–1.36) | 1.80 (1.51–2.15) |
|
|||
Rural |
1.78 (1.15–2.75) |
0.94(0.41–2.18) | 1.27(0.83–1.93) |
p<.001;
p<.05.
This analysis was done among those women who know (heard of) the practice of FGM; we excluded women who did not know of FGM, did not belong to one of the 4 major ethnic groups, and the missing variables.
This analysis was done among those women who either approve or disapprove the continuation of FGM; we excluded women who did not know of FGM, did not belong to one of the 4 major ethnic groups, and the missing variables.
The predictors of FGM approval (noted above) were also important in the model assessing relationships between socio-demographic variables and the outcome of FGM experience. In addition, working status and marital status were significant in this model. Married women were almost one and half [O.R. 1.31 (95% CI 1.08–1.58)] times more likely than women not married to have experienced FGM. Working women on the other hand were 1.80 (95% CI: 1.51–2.15) times more likely than non-working women to have experienced FGM. Interestingly, older women (ages 45–49 years old) were less likely to report experiencing FGM compared to women 15–19 years old.
Results from the 3 logistic regressions with the outcomes of attitude and practice of
Favorable attitude for continuing |
Experienced |
||
Women (n = 6,190) | Men (n = 1,803) | Women (n = 7,208) | |
|
|
|
|
|
|||
Other ethnic groups | Reference | Reference | Reference |
Arab | 4.96 (3.07–8.00) |
2.52 (1.53–4.18) |
17.46 (10.75–28.35) |
|
|||
Urban | Reference | Reference | Reference |
Rural | 1.47 (1.13–1.92) |
1.33 (0.69–2.56) | 1.45 (1.12–1.89) |
|
|||
Lowest | Reference | Reference | Reference |
Second | 0.76 (0.63–0.90) |
0.75 (0.54–1.04) | 0.91 (0.77–1.08) |
Middle | 1.00 (0.70–1.43) | 1.01 (0.60–1.71) | 0.94 (0.68–1.28) |
Fourth | 0.63 (0.50–0.79) |
0.52 (0.32–0.84) |
1.19 (0.95–1.50) |
Highest | 0.58 (0.45–0.74) |
0.57 (0.34–0.95) |
1.23 (0.96–1.57) |
|
|||
No | Reference | Reference | Reference |
Koranic | 0.77 (0.64–0.93) |
0.81 (0.56–1.18) | 2.13 (1.76–2.59) |
Prim. Education | 0.64 (0.52–77) |
0.45 (0.31–0.66) |
1.27 (1.00–1.60) |
Second. Education | 0.35 (0.28–0.44) |
0.32 (0.22–0.47) |
1.05 (0.79–1.39) |
High (University) | 0.27 (0.15–0.50) |
0.13 (0.06–0.26) |
0.75 (0.41–1.35) |
|
|||
15–19 | Reference | Reference | Reference |
20–24 | 0.86 (0.70–1.06) | 0.60 (0.40–0.92) |
1.43 (1.14–1.79) |
25–29 | 0.82 (0.66–1.02) | 0.69 (0.46–1.05) | 1.63 (1.28–2.07) |
30–34 | 0.75 (0.60–0.93) |
1.90 (0.52–1.56) | 2.18 (1.66–2.87) |
35–39 | 0.51 (0.40–0.67) |
0.54 (0.30–0.95) |
2.73 (2.10–3.55) |
40–44 | 0.49 (0.37–0.64) |
0.46 (0.25–0.86) |
4.10 (3.03–5.55) |
45–49 | 0.51 (0.38–0.68) |
0.50 (0.26–0.98) |
4.14 (3.02–5.67) |
50–54 | NA | 0.60 (0.29–1.24) | NA |
55–59 | NA | 0.55 (0.25–1.21) | NA |
|
|||
Not working | Reference | Reference | Reference |
Working | 0.84 (0.69–1.03) | 1.56 (1.06–2.29) |
1.01 (0.85–1.20) |
|
|||
Rural |
1.67 (1.22–2.28) |
0.75 (0.40–1.39) | 0.69 (0.51–0.93) |
p<.001;
p<.05.
This analysis was done among those women who know (heard of) the practice of
This analysis was done among those women who either approve or disapprove the continuation of
Results from the regression with the outcome of having experienced
An investigation into the potential overlap between practices among women suggests that in general little overlap exists. One in five (19%) reported experiencing both
Results from this study suggest that both FGM and
The results of this study are important, as they constitute the first study around the practice and attitude of women and men toward FGM and
Both practices appear to be largely tied to ethnicity, although the ethnicities are different for FGM and
While other studies have produced mixed results on associations between education and FGM,
One perplexing finding from this analysis was the seemingly contradictory role of age in relation to attitudes and practice of
A second perplexing finding relates to the discordance between those that reported no disadvantages to the practice of FGM and those that favored its continuation. In this analysis, it was clear that some respondents (both male and female) reported disadvantages related to the practice of FGM yet favored its continuation. While the explanation is not clear from our data, it could be that Mauritania is a society with engrained and culturally sanctioned norms and values that directly influencs decision-making.
As these data were collected over a decade ago, information from other sources also provides useful insights into the problem of
Despite the legislation banning harm to children, both FGM and
This study has a few limitations worth mentioning. First, the analyses performed were done using cross-sectional data, thus precluding any causal inference. Second, the data were collected in 2000; although unlikely, given information from other sources, it is possible that the current situation related to FGM and
In conclusion, this study lends insight into two culturally sanctioned practices that have implications for the protection of children. These results should serve as a basis for the development of targeted interventions and strategies to change cultural perceptions. Until
The authors wish to thank the Mauritanian government for granting permission to use the 2001 DHS data.