Female Genital Mutilation

The World Health Organisation describes Female Genital Mutilation as the partial or complete removal of external female genitalia or damage to the female genital organ for non-medical reasons. The practice of Female Genital Mutilation has spanned through the years and it is prevalent in many countries in Africa, the Middle East, and Asia, but it is also found in some communities in Europe, North America, and Australia. Migration has also led to the spread of the practice to other countries, as people carry their cultural beliefs with them. It is estimated that around 3 million girls are at risk of FGM each year. Despite being illegal in many countries, FGM continues to be practiced, with an estimated 200 million girls and women worldwide having undergone the procedure.

Female Genital Mutilation is linked with societal ideals of womanly qualities and modesty which includes the belief that a girl only looks virtuous and attractive after some part of the body considered impure and manlike are removed.

In Nigeria it is known as the Female Circumcision, a surgical procedure carried out by traditional practitioners which entails the removal of the external female genitalia for traditional purpose or other non medical aims. It is an extremely establish social norm entrenched in gender inequality. Female Genital Mutilation is mostly hinged on traditional beliefs in some countries where it is being practised.

FGM  is carried  out as a right of passage into womanhood on girls between the ages of 4 and 14, but it can also be performed on infants or adult women. It is often carried out by traditional practitioners who use unsterilized tools such as knives, razor blades or scissors, without any anesthesia. This practice is extremely painful and has no medical benefits, but instead leads to serious health complications. The female genitals are sources of sexual gratification credited with power of arousing sexual interest and drives in girls and women. This has been one of the reasons for circumcising the girl child to guide against promiscuity and also keep her in check, while some believes it will secure a girl child future’s marriage and family’s prestige. In Africa especially chastity is celebrated and the recipient is held in high esteem. An average African mothers make sure their daughter goes through the genital mutilation because it is viewed as achieving a feat. (i.e.The transition to womanhood).

FGM is a violation of human rights and has been recognized as such by the United Nations, which has declared February 6th as the International Day of Zero Tolerance for Female Genital Mutilation. Many organizations and governments are working to eradicate the practice, but it remains a deeply entrenched cultural tradition in some communities.

The National Demographic Health Survey (NDHS 2018) result stated that despite advocacy against Female Genital Mutilation; 20% of Nigerian women still undergo genital cutting.

In some society, girls who have not gone through Female Genital Mutilation are considered unclean and not fit for marriage based on the belief that female circumcision keep the girl child at an advantaged position above others. In view of these, let’s look at the reasons why the Female Genital mutilation is carried out.

1. Repercussions and Taboos are connected to uncircumcision.

2. It is said to increase the female fertility.

3. It is also believe that it discourages promiscuity as it decreases the female urge for sex.

4. It is easier to keep good genital hygiene when circumcised.

These and many more reasons makes the girl child bow to societal pressure out of fear of stigmatisation and rejection by the society since it has been accepted as a norm.

Types Of Female Genital Mutilation (WHO)

Type I

Clictoridectomy – The removal of the clitoral hood and at least part of the clitoris. The process involves pulling off the clitoral glans with the fingers and cutting it off with blood gushing out and a direct pressure is applied on the site to stop the bleeding. Alternatively the water from a squeezed bitter leaf is applied to stop the blood, this method is mostly used by Africans. Note that there are risks and complications associated with these procedures

Type II

Excision: This involves completely or partially removing the clitoris and the inner labia (the lips surrounding the vagina) with or without removing the labia majora (the outer lip)

Type III

Infibulation – Removing the clitoris, labia minora and labia majora. The internal and/or external labia are cut off with or without removing the clitoral glans. This involves stitching the vaginal opening with a miniscule hole for passing urine and menstrual bleeding, this may cause complete vagina obstruction followed by menstrual flow getting accumulated in the vagina and uterus. A woman who has undergone the type 3 FGM  needs to go through a step by step dilation of the vagina opening before any sexual intimacy more especially if it has to do with reproduction this is because Infibulation can create an actual barrier to sexual intercourse and child birth.There are cases where infibulated women had to be cut again in view of the fact that the vagina opening is not wide enough for the smooth passage of a new born baby

How Female Genital Mutilation Affects The Health Of A Woman Or The Girl Child

The effect of the Female Genital Mutilation takes a long toll on the woman/girl because of the grave implications the procedure has on the sexual and reproductive health. Problems may arise in all types of Female Genital Mutilation, but they occur often in the Infibulation type of Mutilation. So, the implications depend on a lot of factors which includes the type of Mutilation carried out, the competency of the practitioner, how hygienic the environment and instruments used are, (some local practitioners don’t care about sterilizing their instruments), and the overall health of the woman or girl who is meant to go through the procedure. The immediate complications that springs up from the procedure includes hemorrhage (excessive bleeding which results to death in severe cases), acute pain, infection, shocks, fever and ulceration of the genital area which cause a formation of ulcer on the mutilated part leading to bleeding and producing irritating discharge. The long term effect of the Female Genital Mutilation can either be gynecological or psychological.

The psychological stress that comes as a result of the procedures may set off behavioural disturbances in a girl child who has been subjected to genital mutilation. Abnomalies caused by Female Genital Mutilation leads to loss of trust and confidence. In the long run she may experience depression, post traumatic stress, anxiety and mood disorder, sexual problems like pains during intercourse, decreased satisfaction, low self esteem, somatization ( demonstrating psychological discomfort which is evident in the physical symptoms) et al. Sexual abnormality caused by Female Genital Mutilation may put stress on a girl/woman marriage as their cravings (libido) for sex has decreased thus depriving them of sexual satisfaction and freedom.

The Gynaecology implications of the female genital mutilation ranges from:

1. Urinary Tract Infection – an infection in the urinary tract system mostly caused by bacteria. These bacteria stems from unsterilsed instruments used for circumcision,

2. Scar Tissue – As  the body responds to repairing a damaged tissue, it leaves a scar (mark) that covers the site of injury.

3. Abscess – An infected area of the body which is painful, swollen and filled with pus.

4. Vaginal adhesion and obstruction – This happens when the inner lip of the vulva are fused, blocking the opening of the vaginal and urethra. Urethra damage may results in urinary incontinence.

5. Cyst – an abnormal growth filled with liquid or a semi-solid substance that may cause pain

6. Infertility: Inability to conceive

7. Risk of contacting Hepatitis B/ Hiv Aids – Unsterilised instruments shared with others during the procedure may eventually pose a risk to the one circumcised.

8. Allergic reactions to the genital region.

Steps Taken To Stop Female Genital Mutilation

Female Genital Mutilation has been a distinct offense after the prohibition of Female Circumcision  Act 1985  became operational in September 1985. United Nation Population Fund in association with Unicef lead the largest global program to put an end to the practice of Female Genital Mutilation. This programme aimed at supporting zero tolerance laws and schemes while working with medical personnel to eradicate female genital mutilation and  provide the necessary care for the women and girls who have gone through genital mutilation.

In Nigeria, Unicef, The World Health Organisation and Federation of Gynaecology obstetrics among others seeks to end Female Genital Mutilation in Nigeria. They are working to implement changes across Nigeria and put a stop to this practice.

Former president of Nigeria, Goodluck Jonathan signed a bill officially prohibiting the practice of Female Genital Mutilation and also the Violence against person, (Prohibition) Act 2015. These acts seek to eliminate Female Genital Mutilation and other forms of gender based violence.

Beside, Education and awareness are key in the fight against FGM. It is important to educate girls, women, and communities on the negative health consequences of FGM and to raise awareness about the fact that it is a violation of human rights. Laws and policies that prohibit FGM must also be enforced, and support services must be provided to girls and women who have undergone the procedure.

In addition to education and awareness-raising, community engagement is essential in the fight against FGM. Community leaders, religious leaders, and traditional practitioners must be involved in efforts to end the practice, as they hold significant influence and power within their communities. Alternative rites of passage that do not involve FGM can be developed, and young girls must be empowered to stand up against the practice.

The elimination of FGM requires a multi-sectoral approach that involves not only health and social services but also education, law enforcement, and human rights. Laws and policies that prohibit FGM must be strengthened and enforced, and health workers must be trained to recognize and report cases of FGM. Support services must also be provided to girls and women who have undergone the procedure, including medical care, counseling, and legal assistance.

Reference:

World Health Organisation

Institute of Current World Affairs