Spotlight Series - Time to Cut Mutilation Out of FGM

Female Genital Mutilation (FGM) is not a glamorous topic. The meaning of mutilation involves inflicting a violent and disfiguring injury on an item. In this case, it is the female genitals, an area which is synonymous with femininity and human life. Therefore the concept of gravely damaging this area, sends a shiver down the down spine of most people from developed countries. However in some societies in developing countries, the perception of FGM is very different and is embedded in cultural and religious ties.

 Amnesty International FGM poster - Flickr layalk 

FGM can be broken into 4 categories depending on the type of mutilation. Type I is the partial or complete removal of the clitoris. Type II is the partial or complete removal of the clitoris and labia minoria with or without excision of the labia majora. Type III is the creation of a seal in the vagina by cutting and connecting the labia minora and labia majora (with or without altering the clitoris). Finally type IV involves harmful non-medical alterations to the female genitalia such as scraping, piercing and pricking. I think it’s fair to say that even the description of FGM is hard to read. However this is very much the reality demonstrating the severity of this health issue. 

Diagrams of Normal Female Genitalia and FGM - Royal College of Nursing, 2007

It is believed that 140 million females currently have to live each day with the consequences of FGM. These symptoms include pelvic infections, abscesses, obstruction to urinary flow and subsequent urinary tract infections, along with long term effects of psychosocial disorders, increased risk of HIV, disruption of sex life and complications to the baby and mother during childbirth. This is assuming that the individual doesn’t die as a result of FGM due to the loss of blood, infection of the wound and shock of the initial procedure. Unfortunately these girls often are forcibly subjected to FGM and have little choice but to accept this as a form of normality. 

There are 3 million new girls each year, who are aged 9 years or above, who are at risk of FGM across 28 countries in Africa, Asia and the Middle East. It should be mentioned that due to immigration, this is not an issue which is absent from the western world. It is estimated that tens of thousands of women and girls in the UK have experienced FGM. 

Anti FGM Public Painting - Flickr fluckduffy

The reason why this 2000 year old tradition continues, is that by inflicting FGM, you ensure the girl is ‘preserved’ and ‘prepared’ for adulthood and marriage. For a husband this ensures that the female that he is going to marry, will be a ‘proper’ wife as she will be a virgin. The thought of sexual activity before marriage is seen as a deviant practice which can have devastating social consequences for a woman. FGM also bares a positive social status, allowing girls to join adolescent female social groups, feel socially accepted, receive praise from her elders and possibly receive a number of celebratory gifts. This also results in girls seeing FGM as a norm and therefore feel a social pressure to being cut. There is also the belief that if a male is to be circumcised, then females should do the the same to seek social acceptance. However the medical advantages of males being circumcised far outweigh the negative implications. This can’t be said FGM where the risks astronomically outweigh any medical advantage. It should also be noted that if a woman decided not to be cut, then she risks rejection from her family, groom, tribe and all aspects of her community, as she would be labelled as ‘dirty’ by her peers and elders.

By having this strong cultural connection with preserving a female’s purity, it is not surprising that other women who have gone through FGM, support and defend the process. However regardless of the cultural and religious beliefs which interlink communities practicing FGM, it’s a fundamental abuse of women’s human rights. The right to the basis of sex, the right to life (when the procedure leads to death), the right to freedom from torture and cruel, inhumane or degrading treatment or punishment, are all violated when a woman undergoes FGM. The practice also further enhances gender inequality and symbolically ruins one of the anatomical components which makes her female. Not to forget the previously mentioned physiological and psychological implications this cultural practice results in.

Somali Women Say Yes to Abandonment of All Forms of FGM - Flickr Tostan 

So how can we eliminate FGM and learn from decades of work which has failed ? Well like many global health initiatives there needs to be a multisectoral approach involving a number of different actors ranging from community groups to Non-Government Organisations. These initiatives must be community led programmes which promote ceasing the practice of FGM by building on knowledge regarding gender equality, human rights and the negative medical consequences related to this action. This can be through community workshops using traditional communication methods such as theatrical or musical performances; or alternative through the modern method of mobile based health interventions (m-health) such as computer based applications. It is also important to ensure there is widespread community involvement to ensure different clans are accepting un-cut woman as wives. There also needs to be a rewording of the terminology used in describing FGM. As previously mentioned the wording of FGM evokes a strong negative connotation which can further negative discrimination towards the individual. It has been suggested that ‘Female Genital Cutting’ may be a more sensitive term to use when describing the condition. I would also argue that during my research into this topic, there seems to be a distinct lack of male professionals who are involved in this area. Therefore to maximise the effectiveness of community interventions, there needs to be more male professional involvement. After all the male community input to this female global health issue is equally important if we wish to successfully to change a practice which has lasted thousands of years. 

The ‘Spotlight Series‘ aims to focus on non glamorous diseases or challenges which don’t necessarily receive much of the limelight in Global Health. These are often health issues which are hard hitting, symptomatically bleak in nature or outcome but should receive much more focus due to the serious threat they pose globally.