Female genital mutilation and sexual behaviour by marital status among a nationally representative sample of Nigerian women

Background Female Genital Mutilation (FGM) is believed to have a negative effect on sexual and reproductive health but the evidence from nationally representative sample in high-burdened countries like Nigeria is scarce. This study explored the association between FGM and sexual behaviour in a nationally representative sample of Nigerian women. Methods A secondary data analysis was conducted using the Nigeria Demographic Health Survey conducted in 2013 and 2018 among women aged 15-49 years. The descriptive summaries of respondent characteristics by marital status were presented using frequencies and percentages. The proportion and 95% Confidence Interval (CI) of circumcision by sexual behaviour characteristics were computed. A multivariable log-binomial logistic regression was used to determine the association between sexual behaviour and female circumcision while adjusting for other covariates. All analyses were performed using Stata 15.1 (StataCorp, College Station, TX, USA) at the 0.05 level of significance. Results The proportion of circumcised women was 38.6% among those who were ever-married and 32.4% among those unmarried. There were no statistically significant relationship between circumcision status and sexual behaviour among women who were unmarried. However, circumcised women who were ever married had 18% higher risk of having contracted sexually transmitted disease in the last 12 months preceeding the survey and 10% higher risk of engaging in pre-marital sex compared to ever married women who were uncircumcised after adjusting for other covariates. However, the risk of having multiple sexual partners in the last 12 month among uncircumcised ever married women was lower (aRR = 0.80; 95% CI: 0.66-0.97) in the adjusted model. Conclusion Circumcision is not associated with positive sexual behavioural outcomes including delay in sexual debut, virginity and marital fidelity, although there exists some perception behind increasing FGM in Nigeria including prevention of premarital sex and ensuring marital fidelity. While we strongly discourage FGM in all its form, we assert the need for alternative health promoting community measures to address these inherent sexual perceptions toward eliminating FGM and improving sexual and reproductive health across population groups. Plain English Summary Female genital mutilation (FGM) recognized internationally as a violation of human right, refers to all procedures that involve partial or complete removal or other injury to the female genital organs for non-medical reasons. About 200 million girls and women in 30 countries mainly in Africa, Middle East and Asia have been subjected to FGM. Almost 22% of the estimated 68 million girls and women that are at the risk of being cut between 2015 and 2030 will be Nigerians. FGM is deeply entrenched within socio-cultural beliefs around preserving a girl's purity, and controlling women's sexuality or chastity. It is also believed that FGM protects girl's virginity, prevents marital infidelity and is necessary to ensure male partners and/or husbands get better sexual satisfaction. However, studies on the association between women sexual behaviour (sexual debut, pre-marital sex, multiple sexual partners, STDs, lifetime sexual partner, number of unions) and FGM is limited in countries where FGM is prevalent. This study utilized pooled datasets from the Nigerian Demographic Health Survey conducted in 2013 and 2018 to explore the association between FGM and sexual behaviour among women of reproductive age. The findings revealed that there is no association between sexual behaviour and FGM among unmarried women. Circumcised ever-married women were more likely to contract sexually transmitted diseases and engage in pre-marital sex than those who were not circumcised. However, circumcised ever married women were less likely to have multiple sexual partner in the last 12 months preceding the survey. This study disproves the assertion that FGM could control women's sexual behaviour.