Female Genital Mutilation (FGM)

Female Genital Mutilation (FGM), more commonly referred to as Female circumcision is a harmful practice that is prevalent in many parts of the world. In Africa, Nigeria is one of the 29 countries where FGM is practiced. In Nigeria, there is a wide variation in the prevalence, with the national average being put at 40%. While the practice is widespread, covering practically every state of the federation though in varying magnitude from infancy to childhood, some socio – cultural determinants have been identified as supporting this avoidable practice.


The World Health Organization (WHO) defines FGM as all procedures that involve the partial or total removal of the female external genetalia or injury to the female genital organs for cultural or any other non – therapeutic reasons.


By universal standards, FGM is an abuse of girls’ and women’s right, because it is violence against them and because it leaves a permanent scars on their genitals and on their psyche in such a way as to adversely affect safe motherhood. It also predisposes women to sexually transmitted diseases (STDs) and HIV/AIDS.

GLOBAL MOVE TO ELIMINATE FGM
In 1993, Nigeria joined other members of the 46th World Health Assembly to resolve and eliminate FGM (WHA 46.18). As a result of the risks and impairment to women and girls, the World Health Assembly passed the above Resolution to eliminate FGM. Steps taken so far to achieve this include;

Establishment of Multi – sectoral Technical Working Group on Harmful Traditional Practices (HTPs)


Conduct of various studies and national surveys on HTPs;


Launching of a Regional Plan of Action and ;Formulation of a National Policy and Plan of Action for the elimination of FGM.

In 1994 the WHA passed the Resolution 47.10, urging member states to adopt policies and programs of actions to ensure the elimination of FGM world wide. Again, Nigeria was one of the nations which voted for Resolution 47.10 and was also, prior to the 1993/1994 Resolutions, a signatory, in 1979, to the United Nation (UN) Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and the Declaration on Violence Against Women in 1993.


Further global campaign since 1994 led to the adoption of 6th February of every year as International Day for Zero Tolerance to FGM. In support, the Federal Executive Council also adopted 6th February of every year as National FGM Elimination Day.


Although we in Nigeria, could not (for) this year (2007) joined the rest of the world for the 6th February campaign due to some “unavoidable” setback, we have decided to do so today. After all, it is better late than ever, goes the wise saying.


As a party to the campaign on this particular day (Tuesday 20th February 2007) I have decided to write from all the information I could gather.


HOW? THE PROCESSES OF FGM
FGM is carried out using various types of unseterilized instruments which include special knives, scissors, scalpels, pieces of glass or razor blades etc. there is often additional unintentional damage due to crude tools, poor light and septic conditions. The procedures are usually carried out by an elderly woman of the village who has been specially designated for this task or by traditional birth attendants.


Anesthetics and antiseptics are not generally used. Assistants and/or family members hold down the girl in question to prevent her from struggling. Paste mixtures made of herbs, cow dung, hot ashes, barks and roots of trees or other mixtures are rubbed on to the wounds to stop bleeding.


Although, FGM was traditionally the specialization of traditional healers, traditional birth attendants or members of the community known for the trade, there is however, the new “medicalization” which has introduced modern health practitioners and lay – care into the trade.


The WHO has continually and unequivocally advised that FGM must not be institutionalized, nor should any form of FGM be performed by any health professional in any setting, including hospitals or other health establishments.

WHEN IS IT CARRIED OUT? – AGE

The age varies. Depending on the culture, the practice may be carried out during infancy, childhood, as a “rite of passage” or during an “initiation ceremony”, at the time of marriage or during the first pregnancy. In some communities in Nigeria, they even perform the mutilation on the dead women. Crying is prohibited till the corpse is mutilated and the usual ceremonies performed.

HEALTH CONSEQUENCES OF FGM: EFFECTS?
The effects are physical and psychological. The physical effects include:

ü Uncontrolled/heavy bleeding;
ü Severe pain/infection;
ü Pelvic inflammatory disease;
ü Urine retention;
ü Genital ulcerations;
ü Keloid;
ü Scar formation
ü Vesico Vaginal Fistula/Rector Vaginal Fistula arising from damage to the urethra/rectum;
ü Painful/difficult labor;
ü Shock
ü Risk of catching blood transmitted diseases: HIV/AIDS, Hepatitis B etc;
ü Possible infertility;At times, death.


The psychological effects include;
ü Anxiety;
ü Depression;
ü Irritability;
ü Frigidity;
ü Insecurity;
ü Reduced/Elimination/Loss of Sexual Pleasure etc.

TYPES OF FGM

Four types of FGM were identified by the WHO Technical Committee in 1995:

TYPE I: Excision of the prepuce (the fold of skin above the clitoris) with or without excision of part or the entire clitoris – referred to as “Sunna”;


TYPE II: Excision of the prepuce and clitoris (clitoridectomy) along with partial or total excision of the labia minora (inner lip);


TYPE III: excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulations). It is sometime referred to as Pharaonic circumcision or Sudanese circumcision;


TYPE IV: Unclassified:


Ø Pricking, piecing, or incision of clitoris and/or labia;
Ø Stretching of the clitoris and/or labia;
Ø Cauterization by burning of the clitoris and surrounding tissues;
Ø Scrapping (angurya cuts) of the vaginal orifice or cutting of the interior and sometimes, posterior (gishiri cuts) of the vaginal wall;
Ø Introduction of corrosive substance or herbs into the vagina to either cause bleeding, tighten or narrow vagina;
Ø Any other procedures that falls under the definition of FGM given above.


The procedures described above are irreversible and their effects last a lifetime!!

Type I and II (Excision of the clitoris and labia minora) are the commonest types of FGM. In Nigeria, the commonest type is type I. Type III (Infibulations) is the most extreme form of FGM. It involves the complete removal of the clitoris and the labia minora, as well as the inner surface of the labia majora. The two sides of the vulva are then stitched together with thorns or by silk or catgut sutures so that when the remaining skin of the labia majora heals, it forms a bridge of scar tissue over the vagina. A small opening is preserved by the insertion of a foreign body to allow for the passage of urine and menstrual blood. As the wound heals, the developed scar tissue most often creates a barrier to intercourse and child birth, resulting in repeated de – infibulations and trauma.

WHY? – THE PRACTICE


It has not been possible to determine when or where the tradition of FGM originated. However it is still deeply entrenched in the Nigerian society, where critical decision makers are the grandmothers, mothers, women opinion leaders, men aged groups.


The reasons given to justify FGM are numerous, including:
· Custom and tradition;
· (Traditional) Religious demand;
· Purification;
· Family honor;
· Hygiene;
· Aesthetic reasons;
· Protection of virginity and prevention of promiscuity;
· Increasing sexual pleasure for the husband;
· Enhancing fertility;
· Giving a sense of belonging to a group and;
· Increasing matrimonial opportunities.

The geographical/zonal distribution of FGM prevalence in Nigeria

ZONE, PERCENTAGE AND RANGE

South – West
0.1 – 93.8

South – East
1.6 – 95.5

South - South
0.2 – 79.2

Middle – Belt
6.9 – 85.5

North – East
3.4 – 38.8

North – West
6.2 – 76.2

P:S: FGM is carried out in Nigeria irrespective of religion or culture;
Ten states (Bayelsa, Ebonyi, Edo, Ekiti, Cross River, Delta, Ogun, Ondo, Oyo, and Rivers States) have passed out a legislation outlawing FGM;
The House of Representatives has also passed the bill on FGM. Every one awaits the Senates’ passage of the Bill to make it a national law.

BOTTOM LINE

In order to eliminate FGM in Nigeria, it is necessary to promote awareness of the predicament by educating the policy/decision makers, the general public, health workers, and those who carry out the practice on all its health and psychological consequences. This calls for the active involvement of political leaders, professionals, development workers, local communities and their leaders, and women groups and organization.


v It is important to note that FGM is not required by any religion, or at least any modern religion;
v There is no scientific evidence that women who have been mutilated are more faithful or better wives than those who have no;
v The world has risen against FGM, join the campaign against mans’ violation against man and resolve as an individual not to practice it in your home;
v Persuade those who still practice it that there is no benefit in it;
v Lobby your legislator/legislature in the state to vote for the law against FGM – Female Circumcision; and
v Report any known cases of violation to the police.


LET US ALL JOIN HANDS TO ELIMINATE FGM IN NIGERA


Reference:

Female Genital Mutilation (FGM) in Nigeria: know the facts. Federal Ministry of Health (FMoH), Federal Secretariat, Abuja in collaboration with World Health Organization (WHO).
Facts About FGM. What is FGM/Female Circumcision? Funded/Produced by the United Nations Population Fund (UNFPA)