Country Department Africa - Western Africa II, Angola and Pan-African Organisations and Programmes
TOPICS
E N D I N G F E M A L E G E N I T A L M U T I L AT I O N
Female Genital Mutilation and Health
I n t r o d u ctio n
It is estimated that some 140 million
women, girls and babies throughout the world have been genitally
mutilated. Another three million girls are at risk of such mutilation each year. Female genital mutilation (FGM) is primarily practised in 28 African countries, to a lesser extent in certain countries
in Asia and the Middle East and also, as a result of migration, in
western host countries.
Although the elimination of FGM was originally regarded as a
mere question of health education and information, today FGM
is recognised as a socio-cultural problem that is deeply rooted
within the societies in which it is practised. Thus social change is
indispensable if the practice is to be ended permanently. Commitment to ending FGM is symbolic of the effort to strengthen the
position of women and women’s rights generally, because FGM
is a serious violation of human rights, and its elimination would
serve to advance virtually every one of the UN Millennium Development Goals.
W O RLD HEALT H O R G AN I Z AT I O N C LA S S I F I C AT I O N :
Type I: Partial or total removal of the clitoris and/or the
prepuce (clitoridectomy).
Type II: Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora
(excision).
Type III: Narrowing of the vaginal orifice with creation of a
covering seal by cutting and appositioning the labia minora
and/or the labia majora, with or without excision of the
clitoris (infibulation).
Type IV: All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing,
incising, scraping and cauterization.
C l a ssi f ic a tio n
The World Health Organization
(WHO) has divided the various forms of female genital mutilation into four categories (see box). Although this lends the terminology greater uniformity and consistency, definitive classification
is not always possible.
Ris k s a n d co m p l ic a tio n s o f F G M
FGM can be
linked to a whole series of physical and psychological injuries,
some of which arise immediately following the procedure, some
later on. A 2008 WHO publication concluded that the risks and
complications associated with the practice increase in proportion
to the severity of the intervention. However, since health complications are only documented when those affected seek hospital
treatment, which they rarely do (particularly when health problems occur immediately following the procedure), the actual extent of complications caused by FGM is not known.
I m m e d i a t e h e a l t h r is k s
During the procedure itself,
incisions into the nerve endings and sensitive tissues of the genital
region cause extreme pain, which may continue throughout the
period of recovery. Anaesthesia is seldom used. Pain and/or heavy
bleeding and haemorrhaging may induce shock. Swelling, oedema
and pain may lead to difficulty with urination and bowel movement. Studies show that Type II FGM can result in such extreme
scarring that the vaginal opening is narrowed to a degree comparable with infibulation. Non-sterilised instruments may cause
infection, which in turn can result in septicaemia and death. The
use of the same non-sterilised instrument could increase the risk
for transmission of HIV between girls who undergo female genital
mutilation together.
Lo n g - t e r m h e a l t h r is k s
When nerve endings are
pinched or laid bare, FGM can result in chronic pain. Further
side effects are repeated urinary and bacterial vaginal infections.
Several studies note increased susceptibility to genital herpes due
to FGM. Bleeding during sexual intercourse, particularly in the
case of women who have been infibulated, increases the risk of
HIV transmission as does genital herpes, too.
FGM can reduce sexual sensitivity, diminish sexual desire and
result in pain during sexual intercourse. Complications during
childbirth are documented as being more common among women who have been genitally mutilated than among women who
have not been cut. Such complications include Caesarean section,
haemorrhaging following birth, and episiotomy (cutting of the
vulva to facilitate childbirth). A 2006 WHO study also confirms
that FGM contributes to higher rates of infant and child mortality. Of 100 newborn babies, one or two die during or shortly after
childbirth due to maternal complications resulting from FGM.
FGM is a traumatic experience for many women. Among the
long-term psychological consequences are fear of sexual intercourse, post-traumatic stress disorder, and depression. Women
subjected to FGM may suffer psychologically despite the cultural
significance and traditional roots of the practice.
In addition to the complications already named, further negative
impacts on health caused by infibulation may include: surgical defibulation (reopening of the vulval orifice) to make possible sexual
intercourse and/or childbirth; re-infibulation following childbirth
to close the vaginal opening once more; urinary and menstrual
problems caused by closing of the vaginal opening, so that surgical
reopening may be required; painful sexual intercourse; and infertility due to the increased risk of infection.
At the same time, medical personnel can come into conflict with
their communities if their role contradicts the values and norms
of the society as a whole. Further, they are often not well informed
themselves about FGM and seldom have the necessary knowledge
and skills to advise parents or to care for or treat women with serious complications.
This is also true in European countries, where repeated demands
have been made that the issue of FGM be incorporated in medical
training. In its policy guidelines for nurses and midwives, WHO
specifically demands of medical personnel that they support the
drive to eliminate FGM.
C o n c l u sio n
Genital mutilation has grave consequences
for the health of those affected. Years of experience have shown,
however, that measures to end FGM ought not to take place in
the health sector alone, since social change is needed to end the
practice sustainably.
For this reason, effective information campaigns today go beyond
health considerations and include the social, economic, cultural
and historical aspects of the tradition. These can be taken up with
the local population in a culturally sensitive manner, for example,
through dialogue approaches.
F G M a s a h e a l t h iss u e
For many years, negative impacts on health were at the forefront of information campaigns
against FGM. The argument was that FGM was harmful to health
and that it must be abandoned for this reason. This approach was
based on the assumption that this sensitive issue would best be addressed without reference to religious and cultural factors.
However, the result of this approach was a ‘medicalisation’ of the
practice, that is, the performance of the procedure by trained
medical personnel under comparatively hygienic conditions often a welcome source of additional income for medical staff.
The authority and social status that medical personnel enjoy
within the society can thus lend FGM greater respectability and
permanence. In some regions, an increase in medicalisation has
been observed.
Along with WHO, GIZ rejects the medicalisation of FGM, since
such ‘medical’ methods in no way alter the fact that FGM is damaging to female health and a violation of human rights.
Medical personnel
play a key role in efforts to end FGM, since they are well placed
and qualified to inform patients and their families about the risks
the practice involves. On the community level, medical staff enjoy
considerable respect and act as opinion-shapers and role models.
Thus they are well placed to train multipliers, participate in information and education activities and act as change agents to help
bring about social change.
T h e r o l e o f h e a l t h p e r so n n e l
Imprint
Published by:
Deutsche Gesellschaft für
Internationale Zusammenarbeit (GIZ) GmbH
Sectoral and supraregional project
“Ending Female Genital Mutilation”
Dag-Hammarskjöld-Weg 1-5
65760 Eschborn/Germany
E [email protected]
I www.giz.de/fgm
Photo: Eric Isselée - Fotolia.com
January 2011
Sources:
WHO: Female Genital Mutilation - The Prevention and the Management of the Health Complications: Policy Guidelines for nurses and
midwives, 2001.
WHO: Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries, 2006.
WHO: Eliminating female genital mutilation: an interagency statement, OHCHR, UNAIDS, UNDP, et. al., 2008.