• Camelia Brande

Female Genital Mutilation (FGM)

This week we want to talk with you about Female Genital Mutilation (FGM). As difficult it is to talk about it, as necessary it is to spread awareness. From cultural practices to major health consequences, read all about female genital mutilation.


The World Health Organization (WHO) defines female genital mutilation/cutting (FMG/C) as the removal (partial or total) of external female genitalia or other injury to the female genital organs for non-medical reasons. FMG is internationally recognized as a form of discrimination and violation of human rights of girls and women.


FGM can be classified into 4 categories:

  • Type 1. Partial or total removal of the clitoral glans (the external and visible part of the clitoris) and/or the clitoral hood (the fold of skin that covers the clitoral glans)

  • Type 2. Partial or total removal of the clitoral glans and the labia minora with/without the removal of labia majora

  • Type 3. Infibulation: narrowing the vaginal opening by covering a part of it. The covering is made by cutting, repositioning and stitching the labia minora or labia majora. This process can be accompanied or not by the removal of the clitoral glans and hood

  • Type 4. Other harmful procedures that involve female genitalia: piercing, scraping, incising and cauterizing


Deinfibulation refers to cutting open the covered part of the vaginal opening of a woman that has undergone infibulation. This reverted practice is necessary in order to improve health and facilitate intercourse and childbirth.


FGM Facts

  • Between 100-400 million women and girls have undergone FGM and every year 3 million girls are at risk of undergoing FMG

  • Most girls undergo this procedure before the age of 14

  • It has no health benefits and causes damage to physical and psychological health

  • It is common in religious and non-religious groups

  • It is predominantly performed in Africa, Asia and the Middle East but due to migration the practice of FGM has spread around the globe

  • According to United Nations Children’s Funds (UNICEF ) approximately 130 million of women and girls are estimated to live with FGM worldwide, which are located in 29 countries. These numbers are only estimates, as the nature of this subject is sensible and perceived as a taboo, partly due to the legal aspect of this practice. Upon questioning, researchers realized that women who underwent FGM didn’t even know exactly what happened during this practice. So they were aware that they were subject to FGM but din’t know what it implied.

  • A study conducted in 2011, found that in England and Wales alone approximately 130’000 women and girls underwent FGM. They originated from countries where this practise is a tradition.

  • In case of infibulation, irritative substances or herbs may be introduced into the vagina to cause bleeding for the purpose of narrowing the vagina.


FGM health consequences

Female Genital Mutilation is a dangerous practice that frequently results in complications. It is estimated that 1 of 3 girls and women develop complications, either short or long term.

Several studies found it difficult to find a specific consequence of FGM. The reasons is that when women, that underwent this procedure were asked present complications or symptoms, they didn’t associated them with FGM. One explanation could be that they perceive certain symptoms as something normal.


Short-term complications

  • Death has been reported as a consequence of FGM but there is no approximate number

  • As this procedure result in open wounds, during and immediately after the procedure is done, the girl or woman has a high risk of developing traumatic bleeding and various infections such as wound infections, septicaemia (blood bacterial infection), gangrene (death of body tissue due to a lack of blood supply) and tetanus (bacterial infection).

  • Damage of of neighbouring organs and incomplete healing


Long term consequences


1. Gynaecological

  • Infections: long term genital abscesses, vaginal infections, blood infections: HIV, Hepatitis B

  • Genital scarring: painful scars, keloids (type of scar that outgrows the initial wound), cysts; they can grow very big and require surgical removal

  • Menstrual problems: FGM is linked to painful and extended menstruation. Although not proven, one explanation could be that because of the narrowing of the vaginal opening the menstrual flow might get slowed down. Even cases of hematocolpos (menstrual blood accumulated in the vagina due to an obstruction) were reported.

  • Urinary issues: 22% of women undergoing FGM reported urinary tract infections. Infections are thought to develop because of the narrowing of the vaginal opening, causing obstruction.

  • Infertility: although there is no conclusive scientific data to prove this, there is thought that FMG can cause infertility through an indirect way, because of painful intercourse and frequent pelvic infections.

2. Obstetric complications

  • Complications during pregnancy and labour can appear due to inelasticity of scar tissue developed in the genital area

  • In developing countries there is a higher number of complications than in developed countries because of the lack of resources

  • FMG increases the risks of having prolonged labour, developing severe postpartum bleeding, perineal (the area between the anus and vulva) trauma and giving birth through a C-section.

  • Complications with giving birth: newborn death, resuscitation of newborns, stillbirth (giving birth to an infant that has died in the womb)

  • High rates of episiotomy (surgical cut at the opening of the vagina to help pregnancy delivery) especially with Type III FGM (infibulation)

3. Psychological effects

  • Because there are not sufficient studies to support this, FGM is assumed to have negative psychological effects

  • Small studies showed that women with FGM presented anxiety, depression, bad memory, stress and post-traumattic stress disorder (PTSD)

4. Sexual function

  • Only small studies with unstandardized questionnaire have been conducted, making it difficult to have reliable results, but researchers believe that FGM has a negative impact on female sexual function. This makes sense, since part of the clitoris (sexually sensitive organ) is removed or damaged.

  • All types of FGM can be associated with female sexual dysfunctions: affecting the abilility to achieve orgasms, lack of arousal and lubrication and satisfaction and dyspareunia (pain during intercourse).

  • Women with FGM were approx. 50% more likely to report dyspareunia (pain during intercourse)

Cultural meaning

  • FGM represents a traditional practice with origins in specific ethnic groups from Africa, Asia and Middle East and is practiced by Muslims, Christians and Jews.

  • Having this procedure done was considered to be part of the process of entering womanhood. Girls and women believe that by this they will have a personal and collective identity, and power in their household.

  • Women and girls undergoing this, acquire respect and social position while refusing to undergo FGM leads to shame, stigmatization and difficulty in finding a husband.

  • FGM is associated with cleanness, femminity, beauty, purity, virginity, by keeping the “family’s honour” and ensuring marriageability.

  • Over the decades, this perception has changed and now this procedure is done more due to peer pressure to integrate in the society and have access to social support and other resources.

  • In countries where FMG was performed, male circumcision is a common procedure as well and some locals consider these practices equal. The reason why these two practices can never be considered equal is because the male circumcision has health benefits while FMG does not.

  • In these cultures, the majority of men support FGM practices but around 70% of them do not know about the negative impact on physical and psychological health.

  • Studies show that younger generations of men understand more the consequences of FMG and do not support it.

The dilemma of religion

  • Various studies argue if FGM is a religious practice or not

  • Study participants that supported the practice considered it as a religious one, while the ones that did not support it said it was contrary to their religious beliefs.

  • This contrast can be explained by the fact that not everyone has access to religious text or in some geographical regions the level of illiteracy is high, therefore many of the sayings transmitted suffer interpretations.

  • WHO busted the myth about FGM being a religious practice and states that FGM is not supported in major religious texts and many religious leaders think that this practice should end.


Over the years cases of FGM have started to lower thanks to several factors

  • Migration of women to Western countries: different culture and social environment of host countries helps leaving behind some traditions

  • Empowerment of women and girls

  • Legislation

  • The media: televisions, radio, newspapers, family and friends meetings can spread awareness about these practices, clarify and debunk the misconceptions around it.


Legislation against FGM

  • Around 59 countries have passed laws against FGM, and from 29 African Countries where FGM is practiced 26 of them implemented laws that prohibit it

  • FGM is prohibited by law in several African and Western countries, including Australia, Canada, New Zealand, USA and Western Europe

  • Unfortunately, laws are incomplete and few of them offer protection measures for girls that are at risk of FGM


So why does FGM keeps happening even though numerous studies show the negative consequences of this practice? We gathered some reasons:

  • Sociocultural reasons: social pressure, cultural identity, family honor

  • Religious or myth related reasons: the clitoris was believed to be an evil spirit

  • Traditions are being passed on through generations

  • Even though numerous families migrated to the USA or Europe, there were cases reported of FGM in host countries. Because of this, it is very important for western healthcare physicians to be aware of this practices and to know how to treat women and girls that were subject to FGM and develop complications. By improving the healthcare system in regards to this practice, the embarrassment of patients toward the western medicine can be alleviated. Global migration of FGM practice requires further specialization of healthcare personnel in order to give individualized and personalized care and attention.


Modern approaches of this practice try to minimize the negative health effects

  • The traditional knife was replaced by individual razor blades (as a result of HIV/AIDS campaign).

  • The age of girls undergoing this procedure lowered to 4 years old, as it is believed that the wounds would heal faster.

  • Traditional herbs are replaced with modern medicine.

  • When complications occur, girls and babies are sent to the hospital.

  • Sometimes, FGM is performed even by healthcare professionals in order to manage the possible complications and to ensure a safe procedure.


WHO and UNICEF remind healthcare professionals that FMG is an attack on human rights and should not perform them. Performing this procedure in clinics is against medical ethics and may lead to normalizing and legitimizing FGM.


During our research we found several organizations that fight to eradicate FGM and we truly support their mission to spread awareness about FGM:

  • European Institute for Gender Equality: provides information and research on the prevalence of FGM and supports Member States to prevent and combat FGM

  • Network Against Female Genital Mutilation: campaigns to end harmful traditional practices against women and girls in Tanzania.

  • UNICEF in partnership with UNFPA: work to tackle female genital mutilation through interventions in 17 countries: Burkina Faso, Djibouti, Egypt, Eritrea, Ethiopia, Gambia, Guinea, Guinea-Bissau, Kenya, Mali, Mauritania, Nigeria, Senegal, Sudan, Somalia, Uganda and Yemen.

  • WHO: provides information and infographics regarded to FGM practices and misconceptions

https://www.desertflowerfoundation.org/en/home.html


http://www.dofeve.org/


Future prospects

The overall consequences of FGM are still an under-researched issue and spreading awareness about this subject is imperious. As FGM is a global health issue, all 193 countries of the United Nations aim to eradicate FGM by 2030.

We hope for a world free of FGM.


Kohe Lele’s view on FGM is based on our research and personal opinions.

All of the information presented wishes to explain the practice of FGM. We do not stand by FGM and believe that it is a violation of human rights of women and girls. Being very aware of this disturbing topic, we believe that by raising awareness we can contribute to putting an end to this practice.



Sources:

https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation

https://www.unicef.org/protection/female-genital-mutilation

https://www.equalitynow.org/the_law_and_fgm

https://www.fertstert.org/article/S0015-0282(08)04269-6/pdf

https://pubmed.ncbi.nlm.nih.gov/25466303/

https://www.researchgate.net/publication/255736818_Female_Genital_MutilationCutting_The_Secret_World_of_Women_as_Seen_by_Men

https://pubmed.ncbi.nlm.nih.gov/24237176/

https://www.fhi.no/en/publ/2010/psychological-social-and-sexual-consequences-of-female-genital-mutilationcu/



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