Factors behind resistance to voluntary medical male circumcision among the Chewas of Dowa in Central Malawi

By: Kent Y.G. Mphepo, Adamson S. Muula, John Sadalaki, Witness Tapani Alfonso, Joseph Mfutso-Bengo,

Abstract

Globally, the estimated prevalence rate of male circumcision is around 38.7% with half of the circumcisions conducted for religious and cultural reasons. In Malawi, research shows that only 28.0% of the men aged 15–49 are circumcised. This figure includes 18.0% circumcised by traditional practitioners and 9.0% by medical professionals revealing how much resistance this process has met among Malawian males. Comparing the progress of the voluntary male medical circumcision between the Southern and Central region, much resistance and low uptake is recorded and experienced in the Chewa-dominated Central Region. What factors have contributed to this resistance? Methods: A qualitative research approach that interviewed 118 participants (78 males and 44 females). We conducted 11 Focus Group Discussions (FGDs) (involving 67 males and 36 females); a total of 13 In-Depth Interview (IDIs) (involving 8 males and 5 females) and 6 Key Informant Interviews (involving 3 males and 3 females). Findings: Study confirmed that VMMC’s unpopularity in Dowa was due to: a) deep-rooted thinking that circumcision rituals were for Yaos while Chewas’ was “gulewankulu” , proudly called “mpingo wa aloni” b) Religious orientation and beliefs c) Misconceptions about the VMMC procedure (e.g. what was being cut off – the foreskin or head of the penis? d) Poor community sensitization initiatives which overlooked other key benefits of VMMC e) Low involvement of frontline health-workers in primary level facilities f) Accessibility and cost of accessing the service. Conclusion: Chewas view VMMC services from cultural and religious prisms. Implementing agencies must explore integrating services into cultural and religious forms and institutions such as mpingo wa Aloni, due to its cultural, religious and communication value.