Doris Obinna
Nigeria is one of the countries that still practicing Female Genital Mutilation (FGM) also known as Female Genital Cutting (FGC). Nigeria is one of the seven countries, which accounts for over 200 million girls and women who are mutilated.
Though the incidence is dropping but the practice still persists because of gender inequality, the belief that it can curb promiscuity, it must be part of the rite of passage, weak enforcements of laws and recently medicalisation.
The practice is customarily a family tradition that the young female of the age 0-15 would experience. The practice is considered harmful to girls and women and a violation of human rights. Nationally, 27 per cent of Nigerian women between the ages of 15 and 49 were victims of FGM, as of 2012. In the last 30 years, prevalence of the practice has decreased by half in some parts of Nigeria.
The practice, according to World Health Organisation (WHO), is mostly carried out by traditional circumcisers, who often play other central roles in communities, such as attending childbirths. In many settings, health care providers perform FGM due to the belief that the procedure is safer when medicalised. WHO strongly urges healthcare providers not to perform FGM.
However, the International Day of Zero Tolerance for Female Genital Mutilation is a United Nations-sponsored annual awareness day that takes place globally every February 6, as part of the UN’s efforts to eradicate FGM. The 2020 theme: “Unleashing Youth Power,” aim to amplify and direct the efforts on the elimination of this practice.
According to Gender and Reproductive Health Analyst, Dr. Esther Oluwatosin female genital mutilation is a female circumcision comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.
However, 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.
More than 200 million girls and women alive today have been cut in 30 countries in Africa, the Middle East and Asia where FGM is concentrated. According to WHO, the practice has no health benefits for girls and women and is mostly carried out on young girls between infancy and age 15. FGM is a violation of the human rights of girls and women. WHO is opposed to all forms of FGM, and is opposed to health care providers performing FGM (medicalisation of FGM). Treatment of health complications of FGM in 27 high prevalence countries costs 1.4 billion USD per year.
Explaining further, the gender and reproductive health analyst said, due to the complications that arise from FGM, women find it difficult to enjoy sex because the external female organ, the clitoris, which ensures lubrication during sex, has been cut off. In some cases, the external organ has been sown up. The infertility, pelvic inflammatory infections, menstrual pains, keloids, obstructed labour.
Statistically, according to her, “currently, five states accounts for the high burden of case: Ekiti, Osun, Imo, Ebonyi and Oyo. In Oyo – 55.0 per cent, Osun 67.8 per cent, Ebonyi – 43.2 per cent, Imo – 51.6 per cent and Ekiti -62.6 per cent. Osun still account for the highest.
“Subsequently, Osun accounts for a high number of cases due to deep seated cultural norms including prevention of promiscuity, family ritual which must be done for all women to clean and free of evil spirits, weak enforcement of laws and mediclisation of FGM.
Last year, United Nations Population Fund (UNFPA) supported the federal government to revise their National Policy and plan of action on FGM. All five states have now adopted the violence against person prohibition act, which put in place sanctions on perpetrators. All supported by UNFPA.
“Knowing that it is a cultural issue, UNFPA has since 2014 engaged community, traditional and religious leaders to have a consensus to abandon FGM. Currently, we have over 600 anti FGM champions conducting door to door counselling on the need to abandon FGM in those states.
“Also over 100 communities in Osun state have declared abandonment for FGM,” she stated.
Explaining further, the expert said, if by chance, there is any effect during child delivery, lubricants can be used but it will not total resolve the pain. “Depending on the type of FGM, corrective surgery can be done to open the external genitalia to allow for easy passage of the male external genitalia. FGM can cause obstructed labour due to the narrowing of the external genitalia.
Despite being internationally recognised as a human rights violation, FGM according to United Nations Children’s Fund (UNICEF) has been performed on more than 200 million girls and women alive today. The practice occurs in 30 countries across three continents, with half of those cut living in Egypt, Ethiopia and Indonesia.
Each year, more than 3 million girls worldwide are at risk of undergoing FGM, with most girls cut before the age of 15. Numerous factors contribute to the prevalence of the practice. Yet in every society in which it occurs, FGM is a manifestation of entrenched gender inequality.
“Some communities endorse it as a means of controlling girls’ sexuality or safeguarding their chastity. Others force girls to undergo FGM as a prerequisite for marriage or inheritance. Where the practice is most prevalent, societies often see it as a rite of passage for girls. FGM is not endorsed by Islam or Christianity, but religious narratives are commonly deployed to justify the practice.
“Global efforts have accelerated progress being made to eliminate FGM. Today, a girl is about one third less likely to be cut than she was 30 years ago. Still, sustaining these achievements in the face of population growth presents a considerable challenge. By 2030, more than one in three girls worldwide will be born in the 30 countries where FGM is most prevalent, putting 68 million girls, some as young as infants, at risk of being cut.
“If global efforts are not significantly scaled up, the number of girls and women undergoing FGM will be higher in 2030 than it is today,” says UNICEF.
Types of FGM
Female genital mutilation is classified into 4 major types.
Type 1: this is the partial or total removal of the clitoral glans (the external and visible part of the clitoris, which is a sensitive part of the female genitals), and/or the prepuce/ clitoral hood (the fold of skin surrounding the clitoral glans).
Type 2: this is the partial or total removal of the clitoral glans and the labia minora (the inner folds of the vulva), with or without removal of the labia majora (the outer folds of skin of the vulva).
Type 3: Also known as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoral prepuce/clitoral hood and glans (type I FGM).
Type 4: This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.
“Deinfibulation refers to the practice of cutting open the sealed vaginal opening of a woman who has been infibulated, which is often necessary for improving health and well-being as well as to allow intercourse or to facilitate childbirth.”
“There are huge benefits both for short term and long term. There is no risk of gynaecological problems including, painful menstruation, repeated pelvic infections, infertility, and urinary tract infections. Women with type 2 and 3 are most at risk during delivery.
“In other states collectively, over 1,500 communities have declared abandonment of FGM, all states have VAPP laws in place to prosecute perpetrators, and each state has a state technical committees that ensures compliance. About 300 heath care workers have also been trained to offer services to women with complication,” Oluwatosin stated.
No health benefits, only harm
According to WHO, 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. Generally speaking, risks of FGM increase with increasing severity (which here corresponds to the amount of tissue damaged), although all forms of FGM are associated with increased health risk.
Immediate complications can include: severe pain, excessive bleeding (haemorrhage), genital tissue swelling, fever, infections e.g., tetanus, urinary problems and wound healing problems. Others are: injury to surrounding genital tissue, shock and death.
Long-term complications can 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 and sexual problems (pain during intercourse, decreased satisfaction, etc).
Also, increased risk of childbirth complications (difficult delivery, excessive bleeding, caesarean section, need to resuscitate the baby, etc.) and newborn deaths, need for later surgeries: for example, the sealing or narrowing of the vaginal opening (Type 3) may lead to the practice of cutting open the sealed vagina later to allow for sexual intercourse and childbirth (deinfibulation). Sometimes genital tissue is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing both immediate and long-term risks and psychological problems (depression, anxiety, post-traumatic stress disorder, low self-esteem, etc).
Who is at risk?
FGM is mostly carried out on young girls sometime between infancy and adolescence, and occasionally on adult women. More than 3 million girls are estimated to be at risk for FGM annually.
More than 200 million girls and women alive today have been subjected to the practice, according to data from 30 countries where population data exist.
The practice is mainly concentrated in the Western, Eastern, and North-Eastern regions of Africa, in some countries the Middle East and Asia, as well as among migrants from these areas. FGM is therefore a global concern.
Health implications of FGM
FGM has serious implications for the sexual and reproductive health of girls and women according to UNFPA.
The effects of FGM depend on a number of factors, including the type performed, the expertise of the practitioner, the hygiene conditions under which it is performed, the amount of resistance and the general health condition of the girl/woman undergoing the procedure. Complications may occur in all types of FGM, but are most frequent with infibulations.
Immediate complications include severe pain, shock, haemorrhage, tetanus or infection, urine retention, ulceration of the genital region and injury to adjacent tissue, wound infection, urinary infection, fever, and septicemia. Haemorrhage and infection can be severe enough to cause death.
Infibulation, or type III FGM, may cause complete vaginal obstruction resulting in the accumulation of menstrual flow in the vagina and uterus. Infibulation creates a physical barrier to sexual intercourse and childbirth. An infibulated woman therefore has to undergo gradual dilation of the vaginal opening before sexual intercourse can take place. Often, infibulated women are cut open on the first night of marriage (by the husband or a circumciser) to enable the husband to be intimate with his wife. At childbirth, many women also have to be cut again because the vaginal opening is too small to allow for the passage of a baby. Infibulation is also linked to menstrual and urination disorders, recurrent bladder and urinary tract infections, fistulae and infertility.
Consequences for childbirth
A recent study found that, compared with women who had not been subjected to FGM, those who had undergone FGM faced a significantly greater risk of requiring a caesarean section, an episiotomy and an extended hospital stay, and also of suffering post-partum haemorrhage.
Women who have undergone infibulation are more likely to suffer from prolonged and obstructed labour, sometimes resulting in foetal death and obstertric fistula. The infants of mothers who have undergone more extensive forms of FGM are at an increased risk of dying at birth.
Very recent estimates by WHO, UNICEF, UNFPA, the World Bank and the United Nations Population Division reveal that most of the high-FGM-prevalence countries also have high maternal mortality ratios and high numbers of maternal death. Two high-FGM-prevalence countries are among the four countries with the highest numbers of maternal death globally. Five of the high-prevalence countries have maternal mortality ratios of 550 per 100,000 live births and above.