Adolescent and Youth Reproductive Health Module: 5. Harmful Traditional Practices (HTPs)

Study Session 5  Harmful Traditional Practices (HTPs)

Introduction

In this study session, you will learn about traditional practices that can be harmful to young people’s sexual and reproductive health. These practices include; female genital mutilation, early marriage, marriage by abduction, and polygamy. You will also learn some of the reasons that are given to explain why communities practise these harmful acts and what you can do to minimise or eliminate harmful traditional practices in your community.

Learning Outcomes for Study Session 5

When you have studied this session, you should be able to:

5.1  Define and use correctly all of the key words printed in bold. (SAQs 5.1 and 5.2)

5.2  Describe common harmful traditional practices (HTPs) and the consequences they have for sexual and reproductive health. (SAQs 5.1 and 5.2)

5.1  Harmful traditional practices (HTPs)

Traditions are long-established patterns of actions or behaviours, often handed down within a community over many generations. These customs are based on the beliefs and values held by members of the community. Traditions are often protected by taboos, which are strong social prohibitions (or bans) relating to human activity or social custom based on moral judgement and religious beliefs. This means that traditions are not easy to change, because people adhere to these patterns of behaviour, believing that they are the right things to do. Ethiopia has both beneficial traditional practices (such as breastfeeding, relieving women from work after delivery, providing special care and a nutritious diet for a newly delivered mother) and harmful traditional practices.

Harmful traditional practices are those customs that are known to have bad effects on people’s health and to obstruct the goals of equality, political and social rights and the process of economic development.

Harmful traditional practices affecting young people in Ethiopia are very common. Among these, female genital mutilation (FGM), early marriage, and marriage by abduction, forced marriage and polygamy are particularly important for you to understand because of their effect on reproductive health. Examples of other which we will not discuss here because they are not very much related to reproductive health include uvulectomy (excision of the uvula), bloodletting through vein puncture (called wagemt in Amharic), and milk tooth extraction.

5.1.1  Female genital mutilation (FGM)

The World Health Organization (WHO) defines female genital mutilation (also called ‘female genital cutting’ or ‘female circumcision’) as any procedure which involves the partial or total removal of the external female genitalia (see Figure 5.1) or which causes any other injury to the female genital organs whether for cultural or any other non-therapeutic reasons. Instruments used include knives, scissors, razors, and pieces of glass. Occasionally sharp stones and cauterisation (burning) are used.

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Figure 5.1  (a) Female external genitalia. (b) Female genitalia after cutting showing total removal of the clitoris and/or the prepuce (clitoridectomy).

FGM has no known benefits; instead, it can have both short- and long-term bad consequences for health.

In the long term, FGM can cause repeated recurrent urinary tract infections, increased risk of childbirth complications and newborn deaths and the need for later surgery. For example, the FGM procedure that seals or narrows a vaginal opening needs to be cut open later in life to allow for sexual intercourse and childbirth. Sometimes it is stitched again several times, e.g. after childbirth, hence the woman goes through repeated opening and closing procedures.

There are often psychosocial consequences of FGM (see Box 5.1).

Now read Case Study 5.1.

Case Study 5.1  Almaz

Almaz is a seven-year-old living in Southern Ethiopia. Her parents have decided that she will be ‘circumcised’ because they believe that without it, she won’t be married (Figure 5.2). They believe it is a kind of ‘cleaning’. No one has explained to Almaz exactly what will happen to her on the day of her circumcision. Abebech, a 65-year-old known traditional practitioner, used a new razorblade to cut her genitalia. The practitioner needed six women to hold Almaz down.

Figure 5.2  FGM is nearly always carried out on minors under 18 years of age in violation of their rights. Parents believe they are doing the right thing (Case Study 5.1) (Photo: UNICEF information sheet)

Almaz almost lost consciousness because of the pain, and shortly after the procedure she was taken to her parents as she was not able to walk on her own.

Although FGM is recognised as a violation of human rights under Ethiopian law, it continues to be practised in many regions of Ethiopia. A study in 2005 indicated that three in four Ethiopian women aged 15–49 had undergone some form of FGM.

The age at which girls are made to undergo FGM varies from region to region. In Amhara and Tigray, for example, FGM is performed at infancy, usually on the eighth day after birth. In Somalia, Afar and Oromia, girls are subjected to FGM between the ages of seven and nine, or just before marriage between the ages of 15 and 17. According to the same study (in 2005), FGM is highest in Afar, where 85% of women have a daughter with genital mutilation, and lowest in Gambela, where 11% of women have a daughter with mutilation. It is a shocking measure of deep-rooted gender inequality that one in three rural women believes that the practice should continue.

There are a variety of reasons why FGM continues to be practised. You have already reflected on the reasons that are given for FGM in your community. Box 5.2 gives reasons that are commonly reported.

It is important to note that all the above reasons for practicing FGM are based on false beliefs that FGM has advantages for the girls and their community. You will learn and teach others that none of these reasons are true. In fact, FGM harms women’s sexual and reproductive health. In particular it can cause difficulties during childbirth.

As a health worker, you need to acknowledge the fact that it is not easy to change such a tradition when it has been believed by many generations of people in your community. That is why it needs constant teaching and society’s support to stop the practice. It is especially helpful if men can accept that it is damaging to their daughters and if the women who perform the procedure can be convinced that it needs to stop. (Remember that this will be very hard for them as they would lose a source of income).

5.2  Early marriage

Early marriage is a common practice in many regions, particularly in rural Ethiopian communities where it is thought to ensure virginity. Parents often wish to see their daughters married and to see grandchildren before they die. People also practise early marriage for traditional reasons. If a girl is not married at an early age, other members of the community may think she must be too unattractive or ill-behaved to get a husband. This attitude usually causes shame to both the girl and her family.

In Northern Ethiopia, girls as young as seven are married to teenage boys or older men. Studies show that the average age at marriage in Ethiopia is around 16 years. Hence marriage happens when the young adolescent or preadolescent girl is not ready, physically and psychologically, for intercourse, pregnancy, or childbearing and rearing.

This quote from an Ethiopian girl, aged 11, married at age five shows the long-term psychological damage caused by early marriage. Now read Case Study 5.2, which describes the problems another young girl had because of early marriage.

Figure 5.3  A young woman suffering from obstetric fistula.

Early marriage is associated with many health and social consequences. These include:

Health impacts of early marriage:

• Early pregnancy, which may lead to nutritional deficiencies for the mother and child
• Increased risk of death due to pregnancy-related causes
• Risks to baby include premature birth, low birth weight (reflecting poor nutritional status), fetal loss, and neonatal mortality (death of the newborn within the first 28 days of life)
• Vaginal tear and fistula
• Sexual abuse (see quote from Ethiopian girl in Section 5.2)
• Young married girls are less likely to participate in decision making.

Figure 5.4   Pregnant girl watching other children setting off to school.

Social impacts of early marriage:

• Disrupts life of the victim
• Limited opportunity for education and employment (see Figure 5.4)
• Higher likelihood of broken marriage
• Rural-urban migration (which may predispose them to prostitution, STIs, HIV and AIDS)
• Stigma, and low self-esteem.

5.2.1  Legal aspects of early marriage

As you have seen, early marriage is associated with many health and social consequences which could be prevented if the community has sufficient knowledge and the law is enforced.

5.3  Marriage by abduction

Marriage by abduction is the unlawful carrying away of a woman for marriage. It is a form of sexual violence against the woman. The would-be abductor forms a group of intimate friends and relatives to kidnap the girl without the slightest clue or information being given to the girl’s family, relatives or friends. In some cases abduction is followed by rape.

Marriage by abduction is prevalent in Ethiopia. According to a study conducted in 2005 8% of women of reproductive age reported that they had been married by abduction. Figure 5.5 shows that it is more common in Oromia (11%) and SNNPR (13%) but less common in some other region, e.g. Tigray (1.4%), and Amhara (2.4%).

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Figure 5.5  Map of Ethiopia showing the prevalence of marriage by abduction in some regions in the year 2005.

The reasons for marriage by abduction include:

• Refusal or anticipated refusal of consent by the parents or the girl
• To avoid excessive wedding ceremony expenses and ease the economic burden of the conventional bride price
• To outsmart rivals when the girl has many suitors or potential spouses and/or the inclination of the girl or her parents is not predictable
• Difference of economic status of partners.

Some of the harmful effects include:

• Maltreatment of the girl including beating, inflicting bodily harm, severe disabilities and death
• Conflicts between families may lead to quarrels lasting for generations
• Unhappy, unstable and loveless marriage
• Psychological stress on the girl resulting in suicide
• Expenses related to conflict resettlements as compensation to the family or for court cases
• Discontinuation of schooling and other opportunities for the girl.

5.4  Polygamy

Figure 5.6  A young woman with older co-wives and her husband.

Polygamy is a common practice in Ethiopia. It is a form of marriage in which a person marries more than one spouse. Polygyny (from Greek words: poly = many; gyny = woman) refers to a polygamy in which a man has two or more wives. About 12% of married women in Ethiopia are in polygynous unions (see Figure 5.6). It is usual for a young girl to be married to an older married man.

In most rural parts of Ethiopia, girls have no power to choose their husbands. It is usually their parents, particularly their father, who decides who they will marry and the marriage is usually arranged by the parents. It is the legal right of Ethiopian women to choose whom to marry and when to do it. However, their right is not respected and is almost always violated (usually by their parents).

5.5  Intervention strategies to minimise and eliminate HTPs

This is obviously a difficult and sensitive subject for you to discuss with people in your community. It may help if you make it widely known that the Ethiopian government and religious leaders, including Islamic and Christian, have taken a lead internationally in condemning HTPs.

Summary of Study Session 5

In Study Session 5, you have learned that:

1. There are both useful (such as breastfeeding; relieving women from work after delivery) and harmful traditional practices in Ethiopia that affect the health of adolescents and youth.
2. Among the harmful traditional practices affecting young people in Ethiopia, female genital mutilation (FGM), early marriage, marriage by abduction and polygamy affect reproductive health.
3. Communities have reasons for practising some of the harmful traditional practices. Some of the reasons for practising female genital mutilation include sociocultural reasons (such as ensuring girls’ virginity and hence the family’s honour), hygienic and aesthetic reasons (to make girls hygienically clean), spiritual and religious reasons (wrongly believing that it is required by their religion), and psychosexual reasons (to control the sex drive of uncircumcised girls).
4. Parents desire early marriage for their daughters so that they can see many grandchildren before they die. Early marriage is also preferred by parents to ensure their daughters are virgins when they marry and hence live up to traditional expectations.
5. Harmful traditional practices have multiple negative health consequences for adolescents (and, if they became pregnant, for their children). These consequences range from long- and short-term physical problems such as unwanted pregnancy, severe pain, bleeding and infections, to psychological problems such as mental disorders like depression and social consequences such as limited educational opportunities.
6. HTPs and their complications are completely preventable. However, it is not easy to change traditions which have been practised for a long time. Hence, you need to raise awareness not only about the bad consequences of HTPs but also about the legal implications of such practices.

Self-Assessment Questions (SAQs) for Study Session 5

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.