Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Prevalence of Female Genital Mutilation in Northern Upper Egypt

Hanan Elzeblawy Hassan*, Fatima Hosny Abd-ELhakam, Rasha El-Syed Ebrahim, Momen Zakria Mohammed

Maternal and Newborn Health Nursing, Faculty of Nursing, Beni-Suef University, Egypt

Abstract: Background: The utilization of the word “mutilation” reinforces the very fact that the practice may be a serious violation of girls' and women's rights. This term also establishes a transparent distinction from male circumcision and emphasizes the gravity and harmfulness of the act. Although FGM is practiced in some communities within the belief that it's a religious requirement, research shows that FGM predates Islam and Christianity. Aim: the study was conducted to assess Prevalence of Female Genital Mutilation in Northern Upper Egypt. Subject & Methods: A descriptive cross-sectional study was used. The study population consisted of 2837 females in family health centers (FHCs) in different sitting at Beni-Suef. Α Structured Interviewing Questionnaire sheet was used to collect data. Results: Most of the studied participants were rural residents (70.4%). Non-mutilated females constituted 28.6% of the studied females. About 81.3% and 44.5% of circumcised females are from rural and married females. There was a significant association between the illiteracy of father and mother and rural residence and the FGM by barber and dayah. Conclusion: The prevalence of FGM/C is still high despite the health consequences of the procedure. Recommendations: Design and disseminate brochures work on the health effect of female genital mutilation in health centers and hospitals.

Keywords: prevalence, female genital mutilation, Upper Egypt

Received November 28, 2022; Revised January 07, 2023; Accepted January 16, 2023

Citation: Hanan Elzeblawy Hassan, Fatima Hosny Abd-ELhakam, Rasha El-Syed Ebrahim, Momen Zakria Mohammed, Prevalence of Female Genital Mutilation in Northern Upper Egypt. American Journal of Nursing Research, 11 (1). 12-20. January 2023. doi:10.12691/ajnr-11-1-2

1. Introduction

The term female genital mutilation (FGM) is employed by World Health Organization (WHO) [1]. The utilization of the word “mutilation” reinforces the fact that the practice may be a serious violation of girls' and women's rights. This term also establishes a transparent distinction from male circumcision and emphasizes the gravity and harmfulness of the act [1,2,3,4,5,6].

Although FGM is practiced in some communities within the belief that it's a religious requirement, research shows that FGM predates Islam and Christianity. Some anthropologists trace the practice to 5th century BC Egypt, with infibulations being mentioned as Pharaonic circumcision. Other anthropologists believe that it existed among Equatorial African herders as a protection against rape for young female herders, as a custom among stone-age people in Equatorial Africa, or as an outgrowth of human sacrificial practices, or some early attempt at population control. There have been also reporting within the early 1600s of the practice in Somalia as a way of extracting higher prices for female slaves, and within the late 1700s in Egypt to stop pregnancy in women and slaves [7,8,9,10,11].

Female genital mutilation is taken into account as a deep-rooted inequality between boys and girls and is seen as gender discrimination against girls and women [8,9,10,11,12]. Female genital mutilation/cutting may be a global concern. Worldwide; the precise number of women and girls who experienced FGM/C isn't known, but UNICEF reported in 2016 that quite 200 million females had undergone FGM/C [1,13,14]. Approximately 6,000 girls are circumcised every day [15,16,17].

Female genital mutilation (FGM/C) is also prevalent in Europe, North America, New Zealand, and Australia [18]. Young girls in Western countries are at a high risk of undergoing FGM/C as their families tend to keep up their cultural beliefs in their new communes, although it's forbidden by the law [19,20,21].

In Egypt, although the prevalence of FGM/C among females aged 15- 49 declined from 97% in 1985 to 87% in 2015, the prevalence remains high despite governmental efforts. The prevalence of FGM/C among adolescent girls and women has dropped from 94% in 2008 to 88% in 2014 [22].

2. Aim of the Study

The aims of the study are to:

1. Assess Prevalence of Female Genital Mutilation in Northern Upper Egypt

2. Assess Relationship between Socio Demographic Data and Female Genital Mutilation in Northern Upper Egypt

2.1. Research Questions

1. What is the prevalence of FGM in Northern Upper Egypt?

2. Is there Relationship between Socio Demographic Data and Female Genital Mutilation in Northern Upper Egypt?

3. Subjects and Methods

3.1. Research Design

A Descriptive Cross-sectional study.

3.2. Subjects & Setting

3.2.1. Setting

The study was conducted different Settings in Beni-Suef govern as the following mention:

Salah Salem, Eastern, Taha Bosh, Beba Medical Center, Tarshoup, Bani Saleh, Al-shantour, El- Mamalik, Elnouira, and Kamen El-Arouse.

3.2.2. Sample

3.2.2.1. Sample Type

A Convenient sample was used.

3.2.2.2. Sample Size

The study population consisted of all females who were accepted to participate in the study at the time of data collection (A period of six months from the start of data collection).

3.2.3. Tools of Data Collection

A pre-designed structured questionnaire was used to collect data. Data were collected through personal interviews. The questionnaire is divided into:

a. А Structured Interviewing Questionnaire sheet which includes the following parts: age, residence, level of education, marital status, occupation and experience with mutilation, etc……

b. Question regarding if exposure to Female Genital Mutilation (FGM/C) among total participant women

c. Data regarding Female Genital Mutilation as: Age at circumcision, Who took the decision? Place at which performed, Medical examination before the procedure, Who perform it?, Types of circumcision, among the participant women.

3.3.4. Ethical & Administrative Considerations

Researchers took approval from setting directors before starting the research. An informed consent to conduct the study was taken from each studied.

3.3.5. Field Work

The researcher identified herself to the subjects and explained to them the nature of the study, and its importance. Data were gathered over six months beginning in November 2021 and ending in April 2022. Data collection took about 45 minutes for each participant to fill a questionnaire on the scheduled days: Saturday, Monday, and Wednesday from 9:00 Am until 12:00 Pm.

3.3.6. Statistical Analysis

All data were collected, tabulated and statistically analyzed using IBM SPSS 25. Data was supplied, and appropriate analysis was performed for each parameter based on the type of data obtained.

3.3.6.1. Descriptive Statistics Data

Descriptive Statistics data were expressed as:

• Count and percentage: Used for describing and summarizing categorical data

• Arithmetic mean (X⁻), Standard deviation (SD): Used for normally distributed quantitative data, these are used as measurements of central tendency and dispersion.

3.3.6.2. Analytical Statistics

• Chi-square (χ²): used to see if there's a link between two category variables or to see if two or more proportions differ.

3.3.6.3. Graphical presentation:

• Data visualization was done with Bar chart graphs.

4. Results

Figure 1 showed that the most of the studied participants was were rural residents (70.4%), 57.5% were single, 96.8% were Muslims, and most of their mothers were educated (72.8%), and most of their fathers were educated (83.2%). About two-thirds of the participants were a student (65.4%).

Figure 1. Socio-demographic Characteristics of the Studied Participants

The distribution of females aged 18-60 years according to their mutilation information is shown in Figure 2. Non-mutilated females constituted 28.6% of the studied females. Among them, 39.9% were medically examined by physicians or other mutilators to know whether they needed to be mutilated or not. The percentage of those who had been mutilated was 15.8% over 15 years. More than half of mutilation cases (51%), the mother was the person responsible for the mutilation decision. Doctors were the most common person performing the mutilation (55.6%). The procedure of FGM is usually performed at home (62.3%).

Figure 2. Information about FGM among the Studied Participants

Figure 3 showed that there were significant association between rural residence, mother and father education, marriage, and the presence of circumcision. About 81.3% and 44.5% of circumcised females are from rural and married females. While 94.4% of those not circumcised were high educated females with educated mothers and fathers (82.2% & 90.7%), respectively.

Figure 3. Association between Socio Demographic Data and FGM among the Studied Participants

Figure 4 showed that there were significant association between the illiteracy of father and mother and rural residence and the FGM by barber and dayah. About 98.8% of FGM is done by dayah from rural area, while 94.7% and 34.1% of FGM are done by dayah with illiterate mothers and fathers.

Figure 4. Association between Demographic & Personal Characteristics and the Person Performing the FGM/C

5. Discussion

According to the United Nations Educational, Scientific, and Cultural Organization (UNESCO), gender-based discrimination is founded on gender disparities and power imbalances between males and females, and it prevents women from fully exercising their human rights. International law guarantees the right to participate in social life as well as religious freedom. However, the ability to express one's faith or convictions may be constrained by the need to protect others' basic rights and freedoms. As a result, societal and cultural arguments cannot be used to justify FGM/C [22,23].

The results of the current study revealed that the most of the studied participants were rural residents, highly educated, Muslims, about two-thirds of the participants were a student, and most of their parents were educated. The prevalence of Female Genital Mutilation (FGM/C) among total participants was 71.4%. This result is in accordance with other researches. The prevalence of FGM/C is ranging from 61% in Lower Egypt to 97% in Upper Egypt. It is practically common in Upper Egypt, with highs of 73.9%, 75.5%, and 85.5% in Beni-Suef, Assiut, and Luxor, respectively [24]. A study conducted among Suhag University students (2015) institute that the prevalence of FGM/C among female students was 86.87% [25].

A survey of young women living in Beni-Suef City revealed that the prevalence was more than half of the studied participants were circumcised. Another research among university students in Beni-Suef found that near to half of the participants had been circumcised [23]. This may be accounted for by the variations in research settings and times. Despite the lesser incidence, a mutilation performer examined roughly more than one third of non- mutilated girls to determine whether they need mutilation. The prevalence of FGM/C would have been higher if these females had been mutilated.

On the other hand, according to a survey conducted among students at Beni-Suef University (2018), FGM/C is prevalent among female students. FGM was performed on slightly less than half of our students (47.3%). FGM/C was more common in students who lived in rural regions or had illiterate parents [23]. According to a study conducted on 860 preparatory school female students attending two public According to a study conducted on 860 preparatory school female students attending two public schools in the rural area of Beni-Suef city the prevalence of FGM was 78.8% [23]. According to research conducted among schoolgirls in El-Dakahlia Governorate in 2014, the prevalence of FGM was 53.7%. Rural areas had a frequency of 65.6%, while urban areas had a prevalence of 42.3% [26]. According to the United Nations Children's Fund (2020) about Eighty- seven percent of women and girls aged 15 to 49 years have undergone FGM; levels are high throughout most of the country [27].

The results of the current study reveals that non acceptable percentage of mutilated females did not medically examined by physicians or other mutilators to know whether they needed to be mutilated or not. This may attributed to that most of studied participants were from rural areas where traditions and customs cannot allow gynecological examination for their daughters. This may explain the high prevalence of FGM among them.

The mean age at the time of mutilation was greater in the current study compared to studies in conducted El-Mansoura Center, El-Dakahlia among school girls [26]. About three fourths of those had been mutilated between the ages of 10 and 15 years. According to the Survey of young people in Egypt (SYPE), mutilation was performed at a younger age in Upper Egypt compared to the urban governorates and Lower Egypt for females [28]. However, data demonstrates that most Egyptian females are mutilated before puberty [29].

A glans clitoris is the externally visible portion of the clitoris. Its average length is about 1–1.5 cm (0.5 inch) and it's about 0.5 cm in diameter. However, there is a lot of diversity in clitoral size between people. A shaft and glans make up this cylindrical structure (enlarged end). It shares some similarities with the penis (erectile function). The clitoral shaft comprises a pair of corpora cavernosa, spongy cylinders of tissue that fill with blood and cause the clitoris to erect somewhat during sexual stimulation [30]. The clitoral glans is partially covered by the clitoral prepuce, which is homologous to an identical structure covering the glans of the penis. The clitoris is rich in sensory receptors [31]. It is worth mentioning that some participants were mutilated after her marriage; their ages ranged between 23-28 years. This may attributed to that they found that they are not accepted from their husbands; as clitoris corresponds penis in erection that is why they decide by themselves or forced by their husbands to perform FGM after their marriage.

More than half of mutilation cases, their mother was the person responsible for the mutilation decision. This support that the decision maker in Upper Egypt almost in mother's hand especially in this issues related to daughters' circumcision. This was lower than the results of Yasin, (2014) who reported that mothers were responsible for FGM/C decisions. The procedure of FGM is usually performed by physician or nurse but it should be at home as it is not allowed to expose daughters to gynecological clinic especially before marriage [26]. This was in line with UNICEF, 2018 [18]. These are the nations with the highest frequency of medicalized FGM/C. Egypt (78%), Sudan (77%), Guinea (31%), Djibouti (21%), Kenya (20%), Iraq (14%), Yemen (13%), and Nigeria (12%) [32]. Moreover, UNICEF reported that FGM is most commonly performed by health care providers in Egypt and Sudan, with doctors doing the procedure in Egypt and midwives performing the procedure in Sudan. In Egypt alone, 1.5 million girls and women have had their hair cut by health care providers, 1.2 million of whom have had their hair trimmed by doctors [18].

Significant association between FGM and their socio-demographic characteristics (residences, education, and marital status) was found. The prevalence of FGM/C in the present study was higher in rural areas. It is similar to the results of EHIS which reported that the highest prevalence of FGM/C was in rural areas. Moreover, the prevalence of FGM/C was found to be lowest among highly educated females, most of their parents were educated. This finding was at odds with the Survey of young people in Egypt, SYPE findings, and the EHIS, which indicated that the prevalence of FGM/C reduced as educational attainment rose. The findings of the current study agreed with those of a study carried out in Alexandria, which revealed that mutilated females were more likely to be illiterate or have limited reading and writing skills than non-mutilated females [33,34,35,36,37,38,39].

6. Conclusion and Recommendations

The prevalence of FGM/C is still high despite the health consequences of the procedure. There were significant association between socio-demographic characteristics and circumcision. So, research questions were answered. Based on research's results, Increase awareness about FGM/C law against all parties; whether parents seeking to perform FGM/C or health care workers or other persons participating in performing FGM/C should be recommended.

References

[1]   | UNICEF, 2016. Female genital mutilation/cutting: a global concern. Geneva. 2016. http://data.unicef.org/resources/female-genital-mutilation-cutting-a-global-concern.html.
[2]   | Hassan H., Abd-ELhakam F., Ebrahim R., Mohammed M. Call for Change Enhancement Upper Egyptian Females' Knowledge Regarding Effect of Female Genital Mutilation. American Journal of Public Health Research, 2023; 11(1).
[3]   | Abd-ELhakam F., Ebrahim R., Mohammed M., Hassan H. Female Genital Mutilation: Females' Related Knowledge. Biomedical Research and Clinical Reviews, 2022, 7(2).
[4]   | Ebrahim R., Abd-ELhakam F., Hassan H., Mohammed M. Relationship between Females' Knowledge and Attitude and Intention of Female Genital Mutilation. Research in Psychology and Behavioral Sciences, 2023; 11(1).
[5]   | Abd-ELhakam F., Ebrahim R., Mohammed M., Hassan H. Relationship between Women's Intention for Female Genital Mutilation and their Exposure to Complication and Pressure. Journal of Medical Case Reports and Case series, 2022; 3(10).
[6]   | Hassan H., Abd-ELhakam F., Ebrahim R., Mohammed M. Female Genital Mutilation: Females' Intention in Northern Upper Egypt. Journal of Obstetrics Gynecology and Reproductive Sciences, 2022; 6(4).
[7]   | Amin, T., Moety, A. M. A., & Sabry, H. A. Female genital mutilation: Egypt in Focus. Eur J Forensic Sci.Jan-Mar, 2017; 4(1): 24.
[8]   | Hassan H., Ebrahim R., Mohammed M., Abd-ELhakam F. Female Genital Mutilation: Impact on Knowledge, Attitude, Sexual Score Domains and Intention of Females in Northern Upper Egypt. Archives of Medical Case Reports and Case Study, 2022; 6(4).
[9]   | Abd-ELhakam F., Ebrahim R., Mohammed M., Hassan H. Female Genital Mutilation: Relationship Association between Upper Egyptian Females' Knowledge and Attitude. American Journal of Medical Case Reports, 2022; 10(12).
[10]   | Abd-Elhakam F., Ibrahim R., Mohamed M., Hassan H. Prevalence of Female Genital Mutilation at Beni-Suef Governorate, Egypt. Egyptian Journal of Health Care, (EJHC), 2023; 14 (1).
[11]   | Mohammed M., Abd-ELhakam F., Hassan H., Ebrahim R. Study Females' Intention to practice Female Genital Mutilation for their Daughters at Beni-Suef. Public Health Open Access, 2022; 6(2): 1-8.
[12]   | Abd-ELhakam F., Hassan H., Ebrahim R., Mohammed M. Relationship between Females' Intention of Mutilating Their Daughters and Demographic Characteristics, Journal of Psychology and Neuroscience, 2023; 5(1): 1-6
[13]   | Abdou, M. S., Wahdan, I. M., & El-Nimr, N. A. Prevalence of Female Genital Mutilation, and Women’s Knowledge, Attitude, and Intention to Practice in Egypt: A Nationwide Survey. Journal of High Institute of Public Health, 2020; 50(3): 139-145.
[14]   | Hassan H., Ebrahim R., Mohammed M., Abd-ELhakam F. Prevalence and Determinants of Female Genital Mutilation at Beni-Suef. Journal of Gynecology and Women’s Health, 2022, 24(3): 1-10.
[15]   | Abd-ELhakam F., Ebrahim R., Mohammed M., Hassan H. Relationship between Socio Demographic Data and Female Genital Mutilation. Archives of Medical Case Reports and Case Study, 2022; 6(4).
[16]   | Ebrahim R., Mohammed M., Hassan H., Abd-ELhakam F. Relationship between Personal Characteristics and the Person Performing Female Genital Mutilation. Journal of Community Medicine and Public Health Reports, 2022.
[17]   | Hassan H. Evidence-Based Practice in Midwifery and Maternity Nursing for Excellent Quality of Care Outcomes. American Journal of Nursing Research, 2020; 8(6): 606-607.
[18]   | Hrvatin, I., & Šćepanović, D. Female Genital Mutilation–Recent Literature Review. Challenges of the Future, 2018; 3: 90-102.
[19]   | UNICEF, 2018. At least 200 million girls and women alive today living in 30 countries have undergone FGM. https://data.unicef.org/topic/child-protection/female-genital-mutilation.
[20]   | Hassan H., Abd-ELhakam F., Zakria M., El-sayed R. Female Genital Mutilation in Northern Upper Egypt: Prospects of Reasons for Performing and Refusing. International Journal of Nursing Science, 2022; 12(1).
[21]   | Kawous, R., Van Den Muijsenbergh, M. E., Geraci, D., Van Der Kwaak, A., Leye, E., Middelburg, A. & Burdorf, A. The prevalence and risk of female genital mutilation/cutting among migrant women and girls in the Netherlands: an extrapolation method. PLoS One, 2020; 15(4): e0230919.
[22]   | Klein, E., Helzner, E., Shayowitz, M., Kohlhoff, S., & Smith-Norowitz, T. A. Female genital mutilation: health consequences and complications-a short literature review. Obstetrics and gynecology international, 2018; 2018: 1-7.
[23]   | Abd-ELhakam F. Prevalence of Female Genital Mutilation at Beni-Suef Governorate, Egypt. [Master's Disseration, Beni-Suef University]. Beni-Suef, Egypt. 2022.
[24]   | Hassan H., Abd-ELhakam F., Ebrahim R., Mohammed M. Study Females' Attitude toward Female Genital Mutilation. Journal of Gynecology and Women’s Health, 2022, 24(3): 1-9.
[25]   | Hassan H. The Impact of Evidence-Based Nursing as The Foundation for Professional Maternity Nursing Practices. Open Access Journal of Reproductive System and Sexual Disorder, 2019; 2(2): 195-197.
[26]   | Hassan H., Saber N., Sheha E. Comprehension of Dyspareunia and Related Anxiety among Northern Upper Egyptian women: Impact of Nursing Consultation Context Using PLISSIT Model. Nursing & Care Open Access Journal. 2019; 6(1): 1-19.
[27]   | Yasin, Y. A. Prevalence of female genital mutilation among school girls in El Mansoura Center, El-Dakahlia Governorate, Egypt. IOSR Journal of Dental and Medical Sciences, 2014; 13: 11-76.
[28]   | Abd El Salam S., Hassan H., Kamal K., Ali R. Sexual Dysfunction of Women’s Associated with Cervical Cancer. Journal of Applied Health Sciences and Medicine, 2021; 1(2): 12-27.
[29]   | Dirisu, O., Adetunji, A., Adediran, M., & Obianwu, O. A diagnostic assessment of the health system's response to FGM/C management and prevention in Nigeria, 2020: 1-26.
[30]   | EL-Gharib, M. N. Female genital cutting: A persistent African health challenge. Gyne and Obste Open A Open J, 2019; 1(1): 1-6.
[31]   | Yousef, F., Hamed, A., & Mostafa, N. Female genital cutting: prevalence, knowledge, and attitudes of Sohag University level students, Upper Egypt. Egyptian Journal of Community Medicine, 2017; 35(1):1-9.
[32]   | UNICEF Data. Female Genital Mutilation: A New Generation Calls for Ending an Old Practice. 2020. Available online: https://data.unicef.org/resources/female-genital-mutilation-a-new-generation-calls-for-ending-an-old-practice/ (accessed on 2 January 2021).
[33]   | Roushdy, R., & Sieverding, M. Panel Survey of Young People in Egypt (SYPE) 2014: Generating evidence for policy, programs, and research, 2015: 7-234.
[34]   | Konar, H. DC Dutta's Textbook of obstetrics. JP Medical Ltd. 2018; 9th edition: 1-14.
[35]   | Crouch, N. Female Genital Anatomy. In S. Creighton & L. Liao (Eds.), Female Genital Cosmetic Surgery: Solution to What Problem? 2019: 11-22. Cambridge: Cambridge University Press: 141-152.
[36]   | United Nations Population Fund [UNFPA]. (2018). UNFPA-UNICEF joint program to eliminate female genital mutilation. UNFPA https://www.unfpa.org/unfpa-unicef-joint-programme-eliminate-female-genitalmutilation.
[37]   | Ministry of Health and Population [Egypt] (MOHP) El-Zanaty and Associates [Egypt], and ICF International. Egypt Health Issues Survey. Cairo and Rockville: Ministry of Health and Population and ICF International; 2015.
[38]   | Mady, A. A. M. Assessment of knowledge, attitude and practices among females in the reproductive age (15-49 years) regarding females genital mutilation in rural and urban areas in Alexandria. [Master's Disseration, Alexandria University]. Alexandria, Egypt. 2017; 134: 79-85.
[39]   | Hassan H., Mohammed M., Abd-ELhakam F., Ebrahim R. Female Genital Mutilation: Study Sexual Issues. American Journal of Nursing Research, 2023; 11(1).