Female genital mutilation: Confronting cultural challenge, health complications across the lifespan

Female genital cutting affects over 140 million women worldwide. Prevalent in certain countries of Africa and the Middle East, the practice continues among immigrants to industrialized countries. In this report, DOOSUUR IWAMBE, examines the health implications, traumatic experience that creates significant gynecological and infectious disease complications.

Female Genital Mutilation or circumcision (FGM) or female genital cutting has been defined as a partial or total removal of some or all external female genitalia, or other injury on the female genital organs for non-therapeutic reasons.

The female circumcision is typically carried out by a traditional circumciser or Traditional Birth Attendant (TBA) using a blade, with or without anaesthesia.

FGM has no health benefits rather than harm the female’s genital organs. FGM is mostly carried out on girls between the ages of 0 and 15 years. However, adult and married women are also subjected to the FGM procedure.

The age at which female genital mutilation is performed varies with local traditions and circumstances, but is decreasing in some countries.

The World Health Organization estimates that about three million girls are at risk of Female Genital Mutilation (FGM) annually. In Nigeria, Female circumcision is widespread.

A study had revealed that medical knowledge on female genital mutilation/circumcision was limited in nurses and their tendency to support its continuation.

It is estimated that more than 50% of Nigerian women have undergone the procedure, which are being made to discourage the practice.

It is performed among adherents of Islam in the North and among Christians in the South. For example, female genital cutting is rite among the urhobos of Delta State and among the Owu Yoruba in Abeokuta, Ogun state.

The WHO had revealed that trained and untrained personnel perform the procedure usually practice in some countries. The world health body said that the untrained personnel used unsterilized equipment such as razor blades and shards of glass.

Places where anesthesia is unavailable, the pain is excruciating, it causes physical, psychosexual and sexual problems.

The severity of health effects depends on the type of female genital mutilation performed and it is dependent on the skill of the circumciser, the cleanliness of the tools, setting used, and the physical condition of the girl or woman.

Furthermore, FGM is practiced not only by Muslims but also by Christians and Jews. FGM is not only a violation of the human right of women and girls, but is also a major health problem, with numerous physical and psychological consequences.

Female circumcision has caused a lot of havoc by rendering most women infertile in their lifetime because of ascending infection following circumcision.

Some get Vesico-Vaginal Fistula (VVF), an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vagina vault. FGM has increased the incidence of death among married women that practice it.

According to the WHO Regional Director for Africa, Dr Matshidiso Moeti, who disclosed this in a statement to mark International Day of Zero Tolerance to FGM however, warned that unless accelerated actions are taken by member countries, the number may raise to 4.6 million yearly by 2030.

‘’Globally, FGM is estimated to have been performed on more than 200 million girls and women alive today. More than three million girls are at risk each year, and this number is expected to increase to 4.6 million girls in 2030 unless we accelerate action to prevent this harmful practice.

‘’The international community recognizes FGM as a human rights violation through several treaties. It has no health benefits and can result in significant health complications for the women and girls affected, as well as social consequences and an economic burden for health systems and society’’.

She, however, revealed that in an effort to support the call for increased investment in FGM, WHO has launched an interactive FGM economic cost calculator.

“The tool visualizes the health and economic costs of FGM and the potential cost savings in implementing interventions to prevent it. “The calculator is relevant to decision-makers, donors and communities, who can use its results to inform actions towards eliminating FGM,” the WHO Regional Director for Africa, explained.

Dr Moeti, therefore, appealed to decision-makers, policy-makers, programme planners, and donors to use the new WHO calculator to inform decisions and invest more to eliminate FGM within a generation.

She, however, lamented that FGM is expected to have been performed on more than 200 million girls and women who are still alive.

According to her, “in the African Region, FGM occurs in 30 countries. We have seen progress – for instance, in Burkina Faso, Kenya, Liberia and Togo, FGM has decreased among girls aged 15 to 19 years over the past 30 years.

“However, collectively we need to do more to protect girls, women and communities from the harms associated with FGM.”

Explaining how WHO is working with member states to eliminate FGM, Dr, Moeti said: “We are working with Member States and partners to eliminate FGM by developing guidelines, tools, training, and policies for health workers to provide the highest quality health care, including counselling girls and women living with FGM, while also taking actions to prevent the practice; generating knowledge about the causes and consequences of the practice and about how to prevent it; and developing publications and advocacy tools efforts to end FGM.”

The theme the 2020 celebration is: “Unleashing Youth Power: One Decade of Accelerating Actions for Zero Female Genital Mutilation by 2030.”

Health complications for girls and women

All forms of FGM carry the risk of adverse health consequences. Almost all girls and women who have undergone the procedure experience pain and bleeding. Immediate health complications include shock, hemorrhage, and infection.

FGM can also cause death, disability, miscarriage, stillbirth, problems during urination, infertility, ovarian cysts, open sores in the genital region, bacterial infections (tetanus or sepsis) during and after pregnancy, and increased risk of newborn deaths.

The intervention itself is traumatic, as girls are usually physically held down during the procedure. Those who are infibulated often have their legs bound together for several days or weeks. The immediate consequences, such as infections, are usually documented only when girls and women seek hospital treatment.

The long-term health risks of FGM include chronic pain, infection, keloids, fibrosis, primary infertility, and psychological suffering, such as post-traumatic stress disorder.

FGM is often performed under unsterile conditions by a traditional female practitioner who has little knowledge of female anatomy or how to manage possible adverse events.

Of all types of FGM, type III appears to pose the greatest risk of immediate harm, and these events tend to be considerably underreported.

A 2006 WHO study in which more than 28,000 women participated concluded that women living with FGM are significantly more likely than those not living with FGM to experience adverse obstetric outcomes and that this risk seems to be greater with more extreme forms of the procedure.

Given that, some types of FGM involve the removal of or injury to sexually sensitive structures, including the clitoral glens and part of the labia minora, some women report a reduction in sexual response and diminished sexual satisfaction.

READ ALSO: Female Genital Mutilation hurts women, cost economies $1.4bn, says WHO

In addition, scarring of the vulvar area may result in pain, including during sexual intercourse. Other findings from the WHO study confirm that women who have undergone FGM/C are at significantly increased risk of adverse events during childbirth.

Such women also experience higher rates of Caesarean section and post-partum hemorrhage compared to those who have not undergone the procedure, and this risk increases with the severity of the procedure.

Cultural reasons for FGM

The practice of FGM dates back thousands of years, with mummies in Egypt showing that it was a routine practice. There is evidence that FGM goes back at least to Pharaonic times and that the practice is prevalent among animists, Catholics, Jews, Muslims, Protestants, and those without religious beliefs.

Some communities believe that FGM is a religious requirement, although it is not mentioned in major religious texts such as the Quran or the Bible.30 In the United Kingdom, clitoridectomy was used in the management of epilepsy, sterility, and masturbation as recently as the 19th century.

One of the first-known formal oppositions to the practice came from medical doctors in Egypt and from missionaries in Kenya, both in the early 20th century.

In many societies, FGM is a rite of passage to womanhood with strong ancestral and socio-cultural roots. Rationalizations for the procedure’s perpetuation include the preservation of ethnic and gender identity, femininity, female “purity,” and family honor; the maintenance of cleanliness and health; and assurance of women’s marriageability.

In many contexts, social acceptance is the primary reason for continuing the practice. Other reasons include ensuring fidelity after marriage, preventing rape, providing a source of income for circumcisers, and enhancing aesthetic appeal.34

Meanwhile, non-cultural and non-historical reasons for perpetuating FGM also exist. For example, people in countries such as Mali and Burkina Faso, as well as in most of West Africa, perceive the clitoris as a dangerous organ and require its removal. According to this view, the clitoris is poisonous and causes a man to become ill or die if it comes in contact with his penis.

Other beliefs suggest that an uncut clitoris creates male impotency and kills babies upon delivery. Performing FGM is also perceived as a way to minimize a woman’s libido and assist her in resisting sexual activity by preventing her from acting promiscuously, thereby making her more appealing to her future husband.