International Day of "Zero Tolerance" for Female Genital Mutilation (FGM).

Today is the International Day of "Zero Tolerance " for female genital mutilation (FGM). 

It is a day set aside for an increase in the awareness of the dangers inherent in this heinous practice. Hence, the UN Secretary General António Guterres calls  "for increased, concerted and global action to end female genital mutilation and fully uphold the human rights of all women and girls."

FGM has no health benefits for girls and women. And over 200 million girls and women alive today have been cut in 30 countries in Africa, the Middle East and Asia where FGM is concentrated. FGM is mostly performed on young girls between infancy and age 15, and it is a violation of the human rights of these girls and women.

FGM is still widely practiced in Nigeria despite the bill passed by the National Assembly in 2015. The traditional practitioners are obstinate to stop what they believe is a cultural heritage. FGM has the highest prevalence in the south-south (77%) (among adult women), followed by the south east (68%) and south west (65%), but practiced on a smaller scale in the north, paradoxically tending to in a more extreme form.

Nigeria has a population of about 200 million people with women forming 52% of the population. The national prevalence rate of FGM is 41% among adult women. 37% of circumcised women do not want FGM to continue. 61% of women who do not want FGM said it was a bad harmful tradition and 22% said it was against their religion. Other reasons cited were medical complications (22%), painful personal experience (10%), and the view that FGM is against the dignity of women (10%).

What is Female Genital Mutilation (FGM)?

Female genital mutilation consists of all procedures that involve the partial or complete removal of the external female genitalia. It also includes any injury done to the female genital organs for non-medical reasons. The practice is mostly done by traditional circumcisers, who perform other roles such as attending to childbirths in rural communities. In many settings, however, health care providers perform FGM due to the erroneous belief that the procedure is safer when medicalise; but the WHO strongly urges health professionals not to perform such procedures.

Types of FGM

There are four major types of FGM:

• Type 1 is often referred to as clitoridectomy, which is the partial or complete removal of the clitoris (a small sensitive and erectile part of the female genital organ).
• Type 2 is often referred to as excision, which is the partial or total removal of the clitoris, labia minora (the inner folds of the skin of the vulva), with or without excision of the labia majora (the outer folds of the skin of the vulva).
• Type 3 is often referred to as  infubulation. It is the narrowing of the vaginal opening through the creation of a covering seal. This seal is formed by cutting and repositioning the labia minora or labia majora, sometimes through stitching , with or without the removal of the clitoris (clitoridectomy).
• Type 4 includes all harmful procedures to the female genitalia for non-medical reason such as incising, scraping, cauterizing and pricking the genital organ. 

Medical Complications caused by FGM

FGM causes immediate complications that have severe impact on the health of a girl or woman who has experienced FGM. The complications include:

• severe pain
• excessive bleeding (haemorrhage)
• genital tissue swelling
• fever
• infections e.g., tetanus
• urinary problems
• wound healing problems
• injury to surrounding genital tissue
• shock
• death.

The long-term consequences of FGM include:

• urinary problems (painful urination, urinary tract infections);
• vaginal problems (discharge, itching, bacterial vaginosis and other infections);
• menstrual problems (painful menstruations, difficulty in passing menstrual blood, etc.);
• scar tissue and keloid;
• sexual problems (pain during intercourse, decreased satisfaction, etc.);
• increased risk of childbirth complications (difficult delivery, excessive bleeding, caesarean section, need to resuscitate the baby, etc.) and newborn deaths etc.

Reasons for FGM

Some of the reasons for FGM include:

• Social convention (social norm), the social pressure to conform to what others do and have been doing.
• FGM is often considered a necessary part of raising a girl, and a way to prepare her for adulthood and marriage.
• FGM is often motivated by beliefs about what is considered acceptable sexual behaviour. It aims to ensure premarital virginity and marital fidelity. FGM is in many communities believed to reduce a woman's libido and therefore believed to help her resist extramarital sexual acts. When a vaginal opening is covered or narrowed (type 3), the fear of the pain of opening it, and the fear that this will be found out, is expected to further discourage extramarital sexual intercourse among women with this type of FGM.
• Where it is believed that being cut increases marriageability, FGM is more likely to be carried out.
• FGM is associated with cultural ideals of femininity and modesty, which include the notion that girls are clean and beautiful after removal of body parts that are considered unclean, unfeminine or male.
• Though no religious scripts prescribe the practice, practitioners often believe the practice has religious support.
• Religious leaders take varying positions with regard to FGM: some promote it, some consider it irrelevant to religion, and others contribute to its elimination.
• Local structures of power and authority, such as community leaders, religious leaders, circumcisers, and even some medical personnel can contribute to upholding the practice.
• In most societies, where FGM is practiced, it is considered a cultural tradition, which is often used as an argument for its continuation.
• In some societies, recent adoption of the practice is linked to copying the traditions of neighbouring groups. Sometimes it has started as part of a wider religious or traditional revival movement.

Surprisingly, none of these reasons are valid!

WHO's Standing

In 2008, the World Health Assembly passed resolution WHA61.16 on the elimination of FGM, emphasizing the need for concerted action in all sectors - health, education, finance, justice and women's affairs.

WHO efforts to eliminate female genital mutilation focus on:

• strengthening the health sector response: guidelines, tools, training and policy to ensure that health professionals can provide medical care and counselling to girls and women living with FGM;
• building evidence: generating knowledge about the causes and consequences of the practice, including why health care professionals carry out procedures, how to eliminate it, and how to care for those who have experienced FGM;
• increasing advocacy: developing publications and advocacy tools for international, regional and local efforts to end FGM within a generation.

In conclusion, having known that FGM has no medical benefits at all, we have to join our voices together to increase the campaign against it in our communities, schools, churches, mosques and at home. And the government at all levels must enforce the law, so that those who persist in the practice will be arrested and prosecuted.

References:

1. https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation
2. http://www.un.org/en/events/femalegenitalmutilationday/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507121/
4. https://www.vanguardngr.com/2018/04/female-genital-mutilation-persists-despite-outlaw/