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ORIGINAL ARTICLE
Year : 2022 | Volume
: 21
| Issue : 3 | Page : 208-216
Harmful traditional practices among market women in ojuwoye market mushin, South West, Nigeria
Nkechi Chukwudi Ikeaba1, Mobolanle Rasheedat Balogun2, Tope Olubodun1, Ifeoma Okafor2
1 Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria
2 Department of Community Health and Primary Care, College of Medicine of the University of Lagos, Lagos, Nigeria
Correspondence Address:
Nkechi Chukwudi Ikeaba
Department of Community Health, Lagos University Teaching Hospital, Lagos 100254
Nigeria
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/aam.aam_112_20
Abstract
Traditions are the long-established patterns of actions or behaviors, often handed down within a community over many generations. Harmful traditional practices (HTPs) are customs that are known to have deleterious effects on people's health and obstruct the goals of equality, political, and social rights. They include female genital mutilation, intimate partner violence, male preference, child marriage, and food taboos. This study was carried out to assess the knowledge, attitude, and practice of HTPs among market women in Mushin Local Government Area (LGA) of Lagos, Nigeria. This cross-sectional, descriptive study was carried out among 235 market women in Ojuwoye market, Mushin LGA, Lagos. Respondents were selected using the systematic sampling method, and the data were collected using pretested interviewer-administered questionnaires. Data were analyzed using Epi info version 7. Proportions, mean, and standard deviation were generated and Chi-square test was used to explore the associations. Binary logistic regression was used to determine the predictors of HTP. Majority (66.8%) of the respondents had fair knowledge of HTPs. Overall attitude was generally good as 86% had an opposing attitude toward HTPs. About one-third of respondents (35.3%) practiced at least one form of HTP. Supportive attitude toward HTP was a predictor of HTP. Respondents with supportive attitude toward HTPs were 15.5 times more likely to practice HTPs than respondents with opposing attitude (adjusted odds ratio 15.51 confidence interval 4.22–57.07). Behavioral change programs should be geared toward improving the attitude of women against HTP and reducing the practice of HTP.
Abstract in French Résumé
Les traditions sont des modèles d'actions ou de comportements établis de longue date, souvent transmis au sein d'une communauté sur plusieurs générations. Nuisible les pratiques traditionnelles sont des coutumes connues pour avoir des effets délétères sur la santé des personnes et entraver les objectifs d'égalité, politiques, et les droits sociaux. Ils comprennent les mutilations génitales féminines, la violence entre partenaires intimes, la préférence masculine, le mariage des enfants et les tabous alimentaires. Cette étude a été menée pour évaluer la connaissance, l'attitude et la pratique des pratiques traditionnelles parmi les femmes du marché dans la zone de gouvernement local de Mushin de Lagos, Nigéria. Cette étude descriptive transversale a été menée auprès de 235 marchandes du marché d'Ojuwoye, zone de gouvernement local de Mushin, Lagos. Les répondants ont été sélectionnés à l'aide de la méthode d'échantillonnage systématique, et les données ont été recueillies à l'aide d'intervieweurs prétestés administrés questionnaires. Les données ont été analysées à l'aide d'Epi info version 7. Les proportions, la moyenne et l'écart type ont été générés et le chi carré test a été utilisé pour explorer les associations. Une régression logistique binaire a été utilisée pour déterminer les prédicteurs de pratiques traditionnelles. La majorité (66,8 %) des les répondants avaient une bonne connaissance des pratiques traditionnelles. L'attitude globale était généralement bonne puisque 86% avaient une attitude opposée à l'égard pratiques traditionnelles. Environ un tiers des répondants (35,3 %) pratiquaient au moins une forme de pratiques traditionnelles. Attitude de soutien envers les nuisibles les pratiques traditionnelles étaient un prédicteur de pratiques traditionnelles. Les répondants avec attitude de soutien envers les nuisibles les pratiques traditionnelles étaient 15,5 fois plus susceptibles de pratiquer des pratiques nuisibles pratiques traditionnelles que les répondants ayant une attitude opposée (rapport de cotes ajusté intervalle de confiance de 15,51 4,22 à 57,07). Les programmes de changement de comportement devraient viser à améliorer l'attitude des femmes contre les pratiques traditionnelles et réduire la pratique des pratiques traditionnelles.
Mots-clés: les mutilations génitales féminines, la violence entre partenaires intimes, la préférence masculine, le mariage des enfants, les tabous alimentaires, Les pratiques traditionnelles néfastes, Nigeria
Keywords: Child marriage, female genital mutilation, food taboos, harmful traditional practice, intimate partner violence, male preference, Nigeria
Introduction 
Harmful traditional practices (HTPs) as defined by the United Nations are cultural practices, which are passed across generations and are harmful to an individual both physically and psychologically and are highly implicated in women and girls.[1] These HTPs include female genital mutilation/cutting (FGM/C), forced feeding of women, early marriage, the various taboos or practices, which prevent women from controlling their own fertility, nutritional taboos and traditional birth practices, son preference and its implications for the status of the girl child, female infanticide, early pregnancy, and dowry price.[2]
Despite effort from the international scene, close to 3.1 million girls undergo female genital cutting (FGC) every year. FGC has a prevalence rate of 41% among Nigerian women aged 15–45 years.[3] As regard early marriage, while more women are marrying in their thirties in developed countries, 20%–50% of women are married by the age of 18 in developing world and in Nigeria, 24.4% of girls between the ages of 15 and 19 years are married.[4]
Globally, 30.0% of women aged 15 years and over have experienced physical and/or sexual intimate partner violence (IPV) during their lifetime.[5] In Nigeria, the rates of IPV are high. A cross-sectional, descriptive study conducted in Ikosi Isheri Local Council Development Area of Lagos state showed that the lifetime prevalence for physical violence, sexual violence, and psychological violence were 50.5%, 33.8%, and 85.0%, respectively.[6] In Nigeria, the preference for sons is very prevalent and exists in several cultures where there is a strong penchant for patriarchy.[7]
Researchers from the western parts of Nigeria have reported that 75% of pregnant women had inadequate dietary energy intake, leading to severe malnutrition and another study from South-west Nigeria, reported that up to 19.4% adhere to traditional beliefs or taboos about feeding practices in pregnancy.[8]
The immediate and long-term health consequences of HTPs cannot be overemphasized. FGC increases the risk of transmission of infections such as human immunodeficiency virus-acquired immunodeficiency syndrome (HIV/AIDS), hemorrhage, causes adverse effects in childbirth thus increasing maternal mortality. Childhood marriage has many implications. It robs girls of power over their bodies and their freedom to make decisions about their own reproductive health. Early childbirth has negative demographic, socioeconomic, and sociocultural consequences. It compounds the general inability of girls and women to claim their constitutional and universal right to education, thus increasing the level of unemployment and decreasing productivity. More severe is the harmful effects of child pregnancy on the health of the mother.[9]
Physical and mental health sequelae of IPV include injury or death, chronic pain, gastrointestinal and gynecological problems, depression, and posttraumatic stress disorder. Many women also suffer rape and violence during pregnancy, causing harm to both mothers and children.[10]
The neglect of girl children because of son preference leads to biased feeding practices, inadequate clothing, and less and lower-quality health care and education for the girl child.[11] In its extreme form, son preference leads to female infanticide, which is the intentional killing of baby girls.[7] Severe under nutrition from food taboos could lead to permanent changes in structure and metabolism in the fetus. The imbalance or relative deficiency of nutrients could affect fetal growth.
The Convention on the Elimination of All Forms of Discrimination against Women explicitly acknowledges that “extensive discrimination against women, including IPV continues to exist.” The Convention requires States parties to take “all appropriate measures, including legislation, to ensure the full development and advancement of women, for the purpose of guaranteeing them the exercise and enjoyment of human rights and fundamental freedoms on a basis of equality with men.”[1]
The United Nations Sustainable Development Goal (SDG) 5 aims to eliminate all harmful practices such as child, early and forced marriage, and FGM.[12] Substantial progress has been made to meet this goal, and this includes improvement in gender inequality, massive decline in the prevalence of FGC and early marriage, although overall prevalence continues to be high.[13]
HTPs have been found to be associated with the lack of formal education and low household income, signifying low socioeconomic status, which is a common situation to market women in Nigeria.[14] This study was carried out to assess the knowledge, attitude, and practice of HTPs among market women in Mushin Local Government Area (LGA) of Lagos, Nigeria. The findings from this study will guide program and policy implementation to reduce HTP, hence ensuring healthy living and promoting well-being for all at all ages-SDG 3.[15]
Materials and Methods Mushin LGA is one of the 20 LGAs in Lagos. It is an urban LGA. Mushin had a projected population of 870,100 in 2016.[16] There are several markets in Mushin LGA. The predominant language is Yoruba. The Yoruba tribe has a rich cultural background. Ojuwoye market which was used for this study is one of the largest markets in Mushin LGA. The population of market traders in Ojuwoye market is uncertain but that of market women has been estimated to be about 500 from a gross head count, and the market trades mainly in provision, fruits, vegetables, and foodstuffs. Orthodox and Unorthodox health-care services are also available in the LGA.
This study was carried out among market women in Ojuwoye market in Mushin LGA using a cross-sectional, descriptive design to determine their knowledge, attitude and HTP. Street hawkers and those who did not have their shops within the confines of the market were excluded from this study. This includes market women who sold on the main road and without any proper siting arrangement or those who were not in shops.
In determining the minimum sample size, Cochran's equation was used: n = z2pq/d2 where, n = sample size for population >10,000; z = the standard normal deviation/Confidence interval (CI) set at 1.96, which corresponds to 95% confidence limit, P = percentage of respondents who knew about HTPs in a previous study carried out in the south west 56.9%.[3]d = precision value/degree of error acceptable usually set at 0.05. Sample size came to 376. After correcting for a finite population factor (market population <10,000), minimum sample size came to 214. Ten percent of the sample size was added to compensate for nonresponse, and final sample size came to 235. Two hundred and thirty-five women were thus interviewed.
The sampling method adopted was the systematic sampling method. The sampling interval was approximately 2 (approximate market women population ÷ sample size). The first market woman that owned a shop) was selected at the market entrance and subsequently every second market woman (that owned a shop) was included in the survey.
Information was obtained from the respondents by four trained interviewers using a structured questionnaire, which was developed from the literature review.[4],[17],[18] The questionnaire elicited the sociodemographic characteristics of the respondents, their knowledge on HTPs, their attitude toward the HTPs, and their involvement in HTPs.[4] The questionnaire was pretested among 20 market women in Oshodi market of Oshodi LGA of Lagos State, which is similar to the study setting.
Data were analyzed using Epi Info version 7. Proportions, mean, and standard deviation were generated. The Chi-square test was used to test for the associations between the categorical variables and practice of HTP. Variables that were statistically significant were inputted into a binary logistic regression model to rule out confounders and determine the predictors of HTPs. Confidence level was set at 95%, with levels ≤0.05 considered statistically significant.
Knowledge questions scored were types of HTP known, complications of FGC, early marriage is harmful to teenage girls, early marriage enhances growth and maturity, complications of early marriage, effects of male child preference, food taboos, and IPV. A correct response was scored 1, otherwise 0. Highest possible score was 23, whereas lowest possible score was 0. Overall knowledge was graded as follows: 0–7 was poor knowledge, 8–15 was fair knowledge, and 16–23 was good knowledge.
Respondents' attitude to HTPs was assessed with Likert statements on a five-point scale. The lowest possible score was 13 and the highest possible score was 65, the midpoint – 39, was used as the cutoff point. Scores <39 (13–38) were graded as supportive attitude indicating they support HTP while ≥39 (39–65) was graded as having an opposing attitude indicating they do not support HTP. If respondents answered yes to at least one of the HTP questions, it was taken that such respondent practiced HTP.
Ethical approval was obtained from the Health Research and Ethics Committee of Lagos University Teaching Hospital (approval number: ADM/DCST/HREC/APP/142). Permission was obtained from the market women association. The participants were informed of the purpose of the study and a written informed consent was obtained before carrying out the study. Confidentiality was maintained throughout the study.
Results In this study, respondents between the age group of 18 and 34 years accounted for the most common age group (47.7%). The mean age was 36.7 ± 12.5. Respondents were predominantly Christians 168 (71.5%). More than half 137 (58.3%) of the respondents were Yoruba. Most 108 (45.9%) of the respondents attained tertiary level of education [Table 1].
Majority 228 (97.4%) of the respondents have heard about HTPs and they got this knowledge mainly through family discussions or traditions taught in the family 57 (24.5%). Majority 142 (60.4%) of the respondents did not know of any complication of FGC, though over one-third 81 (34.5%) identified infection as a major complication. About one-third 63 (27.0%) of the respondents believed that early marriage enhances growth and maturity [Table 2].
Table 2: Awareness of harmful traditional practices, knowledge of female genital cutting and early marriageMajority 167 (71.1%) of the respondents agreed that the main reason for male child preference was that males retain the names of the family. Most 91 (38.7%) of the respondents identified malnutrition in pregnant women as a major effect of food taboos. Over half 121 (51.5%) of the respondent identified arguing with partner as a major cause or trigger for wife beating and IPV [Table 3]. Overall, majority 157 (66.8%) of the respondent had fair knowledge of HTPs, 56 (23.8%) had poor knowledge while few 22 (9.7%) had good knowledge of HTPs [Figure 1].
Table 3: Knowledge of male child preference, food taboos and intimate partner violenceAs regards attitude, this study showed that majority 73 (31.1%) of respondents strongly disagree that FGC is a good practice while 37 (15.7%) agree that FGC prevents premarital sex. Majority 84 (35.7%) of respondent strongly disagree that early marriage guarantees financial security. Majority 151 (64.3%) of the respondent strongly disagree that it is proper for husband to beat his wife. Majority 202 (86.0%) of the respondents had an opposing attitude toward HTPs, while only 33 (14.0%) had a supportive attitude [Table 4].
Only 33 (14.4%) of the respondents had performed FGC in the past, and 24 (10.5%) would perform FGC on daughters if compelled to. Thirteen percent would allow their daughters marry early. Only 31 (13.4%) preferred male children to female children. Overall, 83 (35.3%) respondents practiced harmful traditions [Table 5].
There was a statistically significant association between the age of the respondents and practice of HTP, a higher proportion 12 (54.6%) of women aged 55–74 years practiced harmful traditions. There was a statistically significant association between the level of education of the respondents and practice, 20 (74.1%) respondents with primary or no formal education practiced harmful traditions the most. There was also a statistically significant association between marital status and level of practice in that a higher proportion 3 (50.0%) of the widowed and divorced practiced harmful traditions. There was a statistically significant association between the level of knowledge of the respondents and their practice as more respondents with poor knowledge 27 (48.2%) practiced harmful traditions. There was a statistically significant association between the overall attitude of the respondents and their practice. A higher proportion 29 (87.9%) of respondents who had supportive attitude practiced harmful traditions [Table 6].
The only predictor of HTP was supportive attitude toward HTP. Respondents with supportive attitude toward HTPs were 15.1 times more likely to practice HTP than respondents with opposing attitude (adjusted odds ratio [OR] 15.51 CI 4.22–57.07) [Table 7].
Discussion This study revealed that majority of the respondents had fair knowledge of HTPs as only a few of them could correctly identify the complications of the various HTPs. Even though overall attitude was generally good, some of respondents still agreed to early marriage helping to protect virginity and prevent teenage pregnancy, and some of the respondents agreed that security of mother in a marriage depends on having a male child. Over one-third of respondents had practiced at least one form of HTP, and supportive attitude was seen as a predictor of HTPs.
In this study, majority of the respondents had good awareness of FGC; however, barely one-third of respondents could identify major complications of FGC, which reveals poor in depth knowledge about FGC. The public health implication of this is that there may be an increase in the number of people who believe FGC is harmless. This will further increase the practice of FGC, and hence, the incidence of FGC-related complications among young girls-bleeding, high spread of infection, HIV, and other blood-borne diseases. In comparison with a cross-sectional study involving antenatal patients at Aminu Kano Teaching Hospital, almost all of the respondents had good awareness about FGC; however, a significant proportion (60%) of respondents were aware of the major complications of FGC which includes infection and transmission of HIV/AIDS.[19]
This study showed that a significant number of respondents still had supportive attitude toward HTPs. One in four women (25.1%) believed that FGC decreases promiscuity. This can increase the practice of FGC, leading to violation of women human rights and freedom. Our finding is similar to a cross-sectional study among women attending a primary health-care center in a semi-urban area of Lagos State, which revealed that 30.5% of women believed FGM promotes faithfulness of a woman to her husband.[20] These myths and misconceptions promote the practice of FGC and are fraught with many detrimental health effects, which include bleeding, poor wound healing leading to painful sex, spread of infection, and even death from these complications.
On the subject of early marriage, more than a quarter of respondents (26.4%) agreed that early marriage prevents immorality, thus having attitudes that support early marriage. With females marrying below the age of 18 years, the risk of obstructed labor, maternal morbidity, and mortality increases due to the small pelvic size. In addition, low levels of female education can result in poverty among girls and their families. In a secondary analysis of the Indonesian Adolescent Reproductive Health Survey 2012, unlike this study, only 5.3% of the adolescents had attitudes that supported marriage <18 years.[21] The disparity may be adduced to the difference in the age distribution of respondents when compared to this study. Younger people may want to experience more freedom that being single provides, and the opportunity to further their education and career pursuits. Hence, a lower proportion of respondents in the Indonesian study favoring child marriage.
In our study, 13.4% of the women preferred male children to female children. This is however different from another study carried out in Ekpoma Edo State, South-South Nigeria where 89.5% of the respondents still preferred male to female children.[22] Ekpoma is a rural area which is less developed than Lagos and this may be the reason for such high preference. Son preference leads to the neglect of female children, biased feeding practices, and less education for the girl child. This can have ripple effects including intergenerational poverty and malnutrition.
This study revealed that a significant proportion (35.3%) of women practiced HTPs in one form or the other. Older age, less than secondary level of education, and widowed and divorced marital status were among the factors associated with the increased practice of HTPs; however, the only predictor of HTP was supportive attitude toward HTP. Respondents with supportive attitude toward HTPs were 15 times more likely to practice HTP than respondents with opposing attitude. Not only can poor attitude lead to the continuous practice of these harmful traditions but it may also result in the transfer of such believes to the younger generation, to maintain and continue indulging in such practices. Furthermore, there will be a huge resistance to embrace correct knowledge regarding the harmfulness of these practices. In a study among 325 women in Okada Community Edo State, attitude toward FGM was also a significant predictor influencing FGM, with respondents with opposing attitude being less likely to practice FGM (OR = 0.115; 95% CI = 0.056–0.235; P < 0.001).[23]
Strengths and weaknesses
This study would add to body of knowledge, as there are many studies that highlight individual HTPs such as FGC, early marriage, nutritional taboos, but few that encompasses various forms of HTPs as done in this study. This study was however, not without limitations. Being of cross-sectional study design, causal inferences cannot be made. It is limited to only one market, which could affect generalization of findings. In addition, there is limitation of data collection; as face-to-face interview was used which can affect responses especially under-reporting of practice.
Conclusion This study showed that majority of the respondents had fair knowledge of HTPs though overall attitude was generally good as 86% had an opposing attitude toward HTP. A significant proportion (35.3%) of respondents practiced HTPs. Finally, supportive attitude toward HTP was a predictor of HTP. It is recommended that behavioral change programs be carried out to reduce HTPs and promote positive attitudes. Such programs include health awareness campaigns to enlighten the public on the harm these practices bring. These campaigns can be organized by the local health authority. There should also be enactment of laws and policies at both State and Federal levels, against early marriage and IPV, and this should be backed with enforcement.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References 
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