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Female genital mutilation/cutting: Abolishing the harmful practice

Emeh Joy
By Emeh Joy

Basic Medical Scientist, Freelance Health Writer, Lifestyle Blogger and Business Enthusiast

Female genital mutilation: A woman holding down a girl child in readiness for FGM

It is sad that even in the present age and dispensation, we still hold on to certain practices that are not in any way beneficial but rather detrimental and harmful to health.

Female genital mutilation/cutting (FGM/C) is one of such practices. You'd be surprised how widely prevalent these practices are.

What is female genital mutilation?

The World Health Organization defined or rather described female genital mutilation as all procedures involving the partial or total removal of the female external genitalia or other injuries to the female genital organs for non-medical reasons.

According to UNICEF, while the exact number of girls and women who have undergone the practice globally is unknown, at least 200 million girls and women who live across 31 countries have undergone female genital mutilation.

FGM is typically carried out on girls between infancy and age 15. Adults, too, in some cases, undergo the procedure. The practice is believed to have started before the advent of Islam or Christianity.

People see FGM as an equivalent of male circumcision, but its implications are much different from male circumcision. While male circumcision has medical benefits, FGM has no medical benefit cited for it.

However, it is surprising that in some countries such as Egypt, many FGM procedures are carried out by healthcare professionals.

On the other hand, looking at global data, traditional practitioners are carried out 4 out of 5 procedures, often in very unhealthy, unsanitary conditions.

Even though FGM is commonly practised in the north-eastern, eastern and western regions of Africa and some parts of the Middle East and Asia; It doesn't erase the fact that it is considered a violation of human rights.

In an integrated statement by WHO, UNICEF and UNAIDS, it is a violation of girls and women's rights.

Types of female genital mutilation

As stated earlier, this practice of cutting the female external genitalia can be total or partial. It can also be other injurious practices, asides from cutting the genitals. The World Health Organization broadly classified FGM/C into four categories:

Image illustrating the different types of female genital mutilation/cutting

FGM/C Type 1 (Clitoridectomy)

This involves the total or partial removal of the clitoris. The clitoris is the most sensitive, stimulating zone of the woman's sexual part and the main structure that causes her to attain sexual pleasure.

It is the erectile part which when stimulated, produces clitoral erection, sexual excitement and eventually orgasm.

FGM/C Type 2 (Excision)

Here, the clitoris and labia minora are totally or partially removed. It may also include the removal of the labia majora. The labia are the fleshy lips that surround the vagina.

FGM/C Type 3 (Infibulation)

This involves the narrowing of the vaginal orifice (opening) with the creation of a covering seal. The labia minora and/or majora can also be cut, repositioned and sewn together (with or without excision of the clitoris).

FGM/C Type 4

WHO describes this type as "all other harmful procedures to the female genitalia for non-medical purposes". This means it includes harmful procedures like piercing, pricking, scraping, incising and cauterizing the external genital area.

Reasons for FGM/C

People who practise FGM justify the act for different reasons. The motivation behind it is mostly linked to specific benefits such as those that claim it confers status and value on the female and her family.

Here are some common reasons given for the practice of FGM:

  • Marriageability
  • Morality, purity, fidelity
  • Value to a woman's status
  • Beauty and hygiene
  • Health and fertility
  • To preserve virginity
  • To bring social acceptance and honour to the family
  • For religious purposes
  • For male sexual pleasure

According to data from the Demographic and Health Survey (DHS), a larger percentage of women cited social acceptance as a reason and benefit of FGM.

Health complications of FGM/C

Anatomy of the female external genitalia

Female genital mutilation has both short and long term effects on the female. Its immediate health consequences would be dependent on factors such as:

  • The physical condition of the female
  • The state of the setting and tools used for the procedure (cleanliness and sterility)
  • The extent and type of the mutilation/cutting

In most cases, this procedure is carried out by traditional practitioners under poor sanitary conditions, thus predisposing the female to severe infections and septicaemia. Other short term complications include:

  • Pain and shock can lead to death
  • Sepsis or tetanus
  • Damage and ulceration of the genital area
  • Urine retention
  • Haemorrhage (severe bleeding) can result in death

Asides from the immediate complications, other serious complications might still arise in the future. Some common long-term complication of FGM include:

  • Infertility
  • Recurrent bladder infections
  • Increased risk of newborn deaths
  • Formation of cysts
  • Increased risk of childbirth complications
  • Other gynaecological and obstetrics complications such as postpartum haemorrhage and increased risk of CS and episiotomy

A good number of women have also reported psychosexual problems. For example, some find it hard to enjoy sex with their partners and hardly attain orgasm during sexual intercourse, while others feel pain during sex.

Its impacts get further complicated if the females do not get appropriate healthcare and emotional and psychological care.

In some cases, further surgery may be needed. For instance, if it is infibulation where the opening has been narrowed, it will need to be reopened to enable sexual intercourse and childbirth.

From reports, the risk and severity of complication are worse with Types 2 and 3.

What is the step forward?

From all indications, female genital mutilation/cutting promises nothing beneficial to the female folks medically; instead, it predisposes one to serious health complications.

Measures ought to be taken to abolish it entirely. But, sadly, it is widely practised in different regions of the world.

Reports show that approximately 92 million girls aged ten and above have undergone the procedure in Africa alone. The annual number for the continent is about 3 million.

Its prevalence is 80 per cent in 8 countries alone. Somalia, Guinea and Djibouti have the highest prevalence rate (up to 90 per cent), while countries like Uganda and Cameroon affects about 1 per cent of the adult girls.

Map of Africa showing the prevalence of female genital mutilation/cutting in different regions/countries

The government of nations have more significant roles to play in abolishing the practice. Some governments have already taken steps towards that.

For instance, the former President of Nigeria, Goodluck Ebele Jonathan, signed groundbreaking legislation outlawing the practise in Nigeria in May 2015.

Also, Kenya in 2011 passed a law that states that anyone who subjects a girl to FGM/C will get a jail term of seven years or fined a sum of 500,000 shillings. Furthermore, such a person will also be liable to life imprisonment if it leads to the girl's death.

Other Intervention methods that can help eliminate FGM/C include:

  • Targeting practitioners and ensuring they stop providing the service and dissuade those demanding for it
  • Partnering with traditional and religious leaders to talk to their communities and congregations out of it
  • Using communication and mass media to disseminate the information