FEMALE GENITAL MUTILATION

Introduction?

Female Genital Mutilation/Cutting (FGM/C) is an intentional practice that violate of the rights of women and girls all over the world. It is an age-old practice that is carried out in most developing countries simply because it is regarded as customary. It reflects deep rooted inequality between the sexes and constitutes an extreme form of discrimination against girls and women. The procedure is usually carried out in infants, children age 5-9 and adolescents but varies between communities (UNICEF, 2020). FGM/C is usually carried out by community elders, religious leaders, and female relatives.?

What is Female Genital Mutilation/Cutting??

According to UNICEF Female genital mutilation/ cutting comprises of all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for nonmedical reasons. Instruments used include knives, razors, scissors, and pieces of glass.?

Classification of FGM/C?

UNFPA categorizes FGM/C into four. They are:??

1. Type I also called clitorodectomy involves total removal of the clitoris or prepuce.?
2. Type II also known as excision is the partial removal of the labia minora unrelated to any mutilation on the labia majora.?
3. Type III also known as infibulation is the narrowing of the vaginal orifice with the sealing of the perineum by cutting and repositioning of the labia minora and labia majora with or without excision of the clitoris.?
4. Type IV refers to all other harmful procedures to the female genitalia for non-medical purpose. Examples are pricking, piercing, incising, scraping and cauterization.?

Reasons for the practice??

FGM/C has deep cultural roots that create societal norms in order for families to be accepted by their communities (Klien et al,). In many of these developing regions where FGM is practiced, girls can only be married if they have undergone FGM/C. It is also used as initiation rite to womanhood.?

The sociocultural significance is that it maintains girls’ chastity thereby preserving the family’s honour, because virginity is a prerequisite for marriage and it is also believed to reduce the woman’s desire for extramarital affairs. Some of the other reasons given by communities and ethnicities for practicing FGM/C include:?

Psychosocial reasons: in some communities, it is believed that girls who are unexcised have an overactive and uncontrollable sex drive which makes them likely to lose her virginity before marriage bringing shame on the family.?

Spiritual and religious reasons: some communities believe that by cutting the female genitalia, the girl is made spiritually clean.?

Religious and aesthetic reasons: in some cultures, woman’s external genitalia are considered as ugly and dirty and removing these parts of the external genitalia is believed to make girls hygienically clean?

Reasons for medicalization of FGM?

The belief that there is reduce risk of complication associated with medicalized FGM as compared to non-medicalized FGM.?

The is also a belief that the medicalization FGM could be a first step towards full abandonment of the practice.?

The health care providers who perform FGM are also members of FGM-Practicing communities and are subject to the same social norms.?

There may be financial incentives to perform the practice (UNICEF, 2013).?

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Prevalence?

According to WHO, FGM/C is practiced in 30 countries throughout Africa and the middle East with an estimated 200 million women and girls currently infibulated. Globally, 6,000 girls are circumcised every day. About 3 million girls are subject to one of the four types of mutilations each year with more than 85% eventually having a medical complication, at some point in their lives.??

Globally, it is estimated that one in five hundred circumcision result in death.?

In Nigeria, the prevalence of FGM in women aged 15–49 is 19%. An estimated 20 million women and girls in Nigeria have undergone FGM. This represents 10% of the global total. The highest prevalence is in South East and South West geopolitical zones.?

WHO has conducted a study of the economic costs of treating health complication of FGM and has found that the current cost for 27 countries where data were available total 1.4 billion USD during a one year period (2018) This amount is expected to rise to 2.3 billion in 30 years (2047) if FGM prevalence remains the same - corresponding to a 68% increase in the cost of inaction. However, if country abandon FGM, this cost will decrease by 60% over the next 30 years (WHO,2018).???

Consequences and complication?

Complications arising from FGM can be both physiological and psychological including short- and long-term complications depending on the method. The use of unsanitary equipment increases the risk of complication from the practice.??

Some of the short-term complications are:?

• Haemorrhage,?
• Severe pain?
• Urinary tract infection??
• Injuries to surrounding genital tissue?
• Shock?
• Genital tissue swelling?
• HIV, chlamydia, herpes is more common with type III FGM/C?
• Death??

When short term complications manifest, mortality risk may increase due to limited access to health care especially in low-income countries such as Nigeria.?

Long term complications?

The long-term complications could be physiological and psychological??

The physiological complications include:?

• Vaginal discharge, itching and bacterial vaginosis?
• Difficulty and pain in passing menstrual blood?
• Keloid??
• Pain during sexual intercourse??
• Increase risk of child birth complication (prolong labour, obstructed labour, increased number of caesarean sections, neonatal death)?

The psychological complications include:?

• Post- traumatic stress disorder (PTSD)?
• Anxiety?
• Depression?
• Low self esteem?

Treatment/conclusion?

Deinfibulation which is the surgery done to reconstruct the labia addresses some of the physiological complications of FGM/C but mostly produces mediocre result.?

Psychological and emotional support from qualified therapists and support groups that specialize in post-traumatic stress disorder (PTSD) can go a long way in addressing the long-term psychological consequences of FGM/C.?

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In conclusion building evidence by generating knowledge about the causes, consequences and costs of the practice can play a vital role in eliminating FGM/C. It is imperative that governments strengthen their health sector response through advocacy and also by developing and implementing guidelines that ensure medical care and counselling is made available to girls and women living with FGM/C.?

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References

https://data.unicef.org/resources/fgm/c-a-global-concern-2013??

https://data.unicef.org/resources/fgm-country-profiles/2020?

https://www.who.int??

Klein, E., Helzner, E., Shayowitz, M., Kohlhoff, S., & Smith-Norowitz, T. A. (2018). Female Genital Mutilation: Health Consequences and Complications-A Short Literature Review. Obstetrics and gynecology international,?

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