Harm, all harm from female genital mutilation

As International Day of Zero Tolerance to Female Genital Mutilation scheduled for February 6 draws near, Emeka Anuforo (Abuja) calls the attention of the global community to the continuance of the harmful practice.

When it was time for her to deliver, traditional birth attendants battled to take delivery of the baby, but it did not come out. She was in labour for a whole day. Confidence was thereafter taken to the hospital where midwives noticed that her vagina had closed up due to the circumcision. She had suffered from birth obstruction.

On the second day, her baby was finally brought out through a caesarean section surgery.

“Sex with my husband has become painful since the time I did my circumcision. Even after delivering my baby, it has remained painful,” she tells health workers.

Confidence is one of nearly 3 million girls whose health, according to statistics, are undermined by a disturbing practice known as Female Genital Mutilation (FGM).

The United Nations Population Fund (UNFPA) states that girls and women who have undergone FGM were 70 percent more likely to suffer haemorrhage after giving birth and are more likely to die during childbirth.

Official figures show that more than 130 million girls and women in the 29 countries in Africa and the Middle East where the practice is concentrated today have undergone some form of FGM.

According to the World Health Organization (WHO), nearly 140 million girls and women worldwide have been subjected to one form of genital mutilation or the other.

“Estimates based on the most recent prevalence data indicate that 91.5 million girls and women above 9-year old in Africa are currently living with the consequences of female genital mutilation. There are an estimated 3 million girls in Africa at risk of undergoing genital mutilation every year,” WHO says.

Stakeholders call for appropriate programmes to end FGM and respond to the special needs of victims.
An emerging trend, known as ‘Medicalisation’, has also complicated the practice. People are said to be increasingly turning to trained health providers to assist them cut genitals of their girl child. This is in the hope that it will reduce the risk of complications.

But experts alert that medicalised FGM is not necessarily safer and still ignores the long-term sexual, psychological and obstetrical complications of the practice.

In Nigeria, the United Nations Population Fund (UNFPA) wants health workers to abandon the practice of genital mutilation.

The body calls for action plan with concrete actions towards accelerating the abandonment of the practice in Nigeria
UNFPA also wants health workers to use their influence in the communities where they work, and with their colleagues to accelerate the abandonment of female genital mutilation everywhere.

For the World Health Organization, it is a ‘No health benefits, only harm’ verdict.
A WHO fact sheet notes: “FGM has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue and interferes with the natural functions of girls’ and women’s bodies.

“Immediate complications can include severe pain, shock, haemorrhage (bleeding), tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue.”

The world body describes female genital mutilation procedures that involve partial or total removal of the external female genitalia, or another injury to the female genital organs for non-medical reasons.

“The practice is mostly carried out by traditional circumcisers, who often play other roles in communities, such as attending childbirths. However, more than 18 percent of all FGM is performed by health care providers, and the trend towards medicalisation is increasing,” the Organization observes.

It explained: “FGM is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.”

Speaking at the recent 50-anniversary celebration of the Society for Gynaecologists and Obstetricians of Nigeria (SOGON) in Abuja UNFPA officials urged health workers to protect the sexual and reproductive health of those who have already undergone FGM.

UNFPA emphasized the role of health workers in the global effort to end the practice as critical.

“Frontline health workers have knowledge of the social dynamics in the communities they serve and the norms that perpetuate FGM, and they can speed up the rapidly declining support for the practice. Health workers also have a deep understanding of the harmful consequences of this practice. They see the urinary, menstrual, and obstetric complications and they also witness the emotional wounds FGM inflicts which often lasts a lifetime,” says Ratidzai Ndhlovu, UNFPA Resident Representative in Nigeria.

The UN agency notes how health workers are uniquely well-positioned to lead the effort to resist a disturbing trend known as medicalisation that had emerged in many countries including Nigeria.

“Globally, around one in five girls have been cut by a trained health-care provider. Some countries, this can reach as high as 3 in 4 girls. FGM is illegal in many countries, and medical providers who perform it in these places are breaking the law. But in every country, whether legal or not, medical providers who perform FGM are violating the fundamental rights of girls and women. These are lending tacit approval to this wrongful practice and defying the most basic precept of medicine. Do no harm,” UNFPA said.

Ndhlovu wants Nigeria and other countries where FGM is practised to stand together against it, as the health, rights and well-being of millions of girls depend on it.

Her Organization has created a network of ‘FGM Health Care Workers against FGM’ and wants health workers to sign on. She also wants stakeholders to sign petitions in order to make commitments more visible.

Preliminary findings of a joint research conducted by UNFPA and the United Nations Children Fund (UNICEF) have identified six Nigerian states with the highest burden of female genital mutilation and called for urgent policies and programmes to check the menace.

The report of female genital mutilation situation assessment in six states of Nigeria, according to UNFPA Programme Analyst, Dashe Dasogot, shows that Osun has 76.3 per cent prevalence, Ekiti 71.2 per cent prevalence, Oyo 69.7, Ebonyi 55.6 per cent, Imo 48.8 and Lagos 44.8 per cent prevalence.

Nigeria’s national prevalence is put at 24.8 per cent.
A Gender Specialist, Nkeiru Igbokwe, further highlights the dangers of the practice in a country like Nigeria.

She told The Guardian: “FGM is a direct contributor to fistula and the incidence of maternal mortality in Nigeria. We believe that FGM is a form of gender-based violence directed at women and girls, because of their gender and also done with an agenda to dominate, subordinate and be made to feel inferior and incomplete. Society feels a woman who has not undergone FGM will become promiscuous and will not make a good wife.”

She noted that though Nigeria is not ranked among countries with a high incident, it is ranked among the last five.
“The concern for Nigeria is the number. Although the percentage is low, we have very big population. For Nigeria, we have about 19 million women who have under gone FGM.”

Uwem Esiet is a Cofounder and Director of Action Health Incorporated. His organization mobilises young people using conventional and emerging media to reach them.

He speaks on FGM in an interview with The Guardian.

His words: “Our experience so far is mixed. A large populace is not fully aware of the magnitude of the problem. We have recommended intense public education, awareness and sensitisation. We found out that they have not been seriously engaged to be able to appreciate the context. Two communities could have two different reasons for practising FGM. If you want to use a one-all approach in engaging those communities, you will obviously miss the mark.”

He emphasized the need to know the sentiments of each community about the practice to enable adequate work in change their psyche.

“There are communities where it is a social norm. In such communities, people inherit the role of community circumciser.

We need a mixed method approach for engaging in the eradication of FGM,” he says.

In May, Nigeria took a bold step to outlaw female genital mutilation when it signed the Violence Against Persons (Prohibition) Bill 2015 into law.

The Violence Against Persons (Prohibition) Act 2015 expressively prohibits female circumcision or genital mutilation.

No soon had the former President Goodluck Jonathan signed the Act than the civil society groups went into slumber. Few voices, if any, now clamour for the implementation of the VAPP law.

Indeed, and as observed by Executive Director of UNFPA, Dr. Babatunde Osotimehin, millions of girls around the world are still threatened by genital mutilation despite a century of efforts to put an end to it.