Objectives • To bring to light the issue of ‘Female Genital Mutilation’ - FGM • To understand the implications of this act on the health of BME children. • To explore how professionals can help safeguard these children
OUTLINE • Introduction • Definition of ‘FGM’ • Where it is performed • Types of ‘FGM’ • Reasons for ‘FGM’ • How it is practiced • When it is performed • Health implications of ‘FGM’
INTRODUCTION An estimated 100 to 140 million girls and women in the world today have undergone some form of female genital mutilation, and 2 million girls are at risk from the practice each year. The great majority of affected women live in sub-Saharan Africa, but the practice is also known in parts of the Middle East and Asia. Today, women with FGM are
INTRODUCTION increasingly found in Europe, Australia, New Zealand, Canada and the United States of America, largely as a result of migration from countries where FGM is a cultural tradition.
DEFINITION Female genital mutilation (FGM) constitutes all procedures which involve the partial or total removal of the female external genitalia or other injury to the female genital organs, whether for cultural or any other non therapeutic reasons (WHO 1995). FGM can be defined as ‘Female Central Cutting’ or ‘Female circumcision’
WHERE IT IS PERFORMED Over 28 countries in Africa among all faith groups practice Female genital mutilation (FGM). It is also prevalent in many countries all over the world. (See sheet on prevalence and distribution)
TYPES OF FGM Type 1 Excision: Excision of the prepuce with or without excision of part or the entire clitoris. Type 2 Excision: This refers to the partial or total excision of the labia minora with or without the excision of part or all of the clitoris.
TYPES OF FGM Type 3 Excision (Infibulation): It involves total or partial removal of the clitoris. Type 4 (Unclassified): This includes pricking, piercing and or incising / burning of the clitoris.
REASONS FOR THE PRACTICE • Culture and tradition • Social acceptance • Initiation into womanhood • Religion • Prevention of rape and preservation of virginity • Hygiene and aesthetic reasons • Increasing sexual pleasure of husband • Controlling woman’s sexuality
HOW IT IS PRACTICED OR DONE AND WHO PERFORMS IT • It is performed traditionally by traditional birth attendants or traditional circumciser in very poor conditions. • It is also performed medically by health professionals, doctors, nurses and mid-wives.
WHEN IS FGM PERFORMED? • Age varies and depend on the country to the group and geographical location. • Infancy (from a few days old) • Childhood (from 4 till 10 years) • Onset of puberty • At marriage • During first pregnancy or delivery
HEALTH CONSEQUENCES • There are both short and long term consequences to the practice of ‘FGM’. • For short-term, they are • Haemorrhage • Severe pain and shock • Urine retention • Infection including tetanus and HIV • Injury to adjacent tissue • Fracture or dislocation of limbs as a result of restraint.
HEALTH CONSEQUENCES • For long-term, they are • Difficulty with passing urine. • Difficulty with menstruation • Acute and chronic pelvic infections • Infertility • Neuromas, chronic scar formation and cyst
HEALTH CONSEQUENCES • For long-term, they are • Fracture or dislocation of limbs as a result of restraint • Vesico-vaginal fistula (VVF), recto-vaginal fistula (RVF) • Complications of pregnancy • Neonatal death
ERADICATING ‘FGM’ • To eradicate ‘FGM’, there must be • General education on ‘FGM’ • Awareness raising for practicing communities on the health impacts of ‘FGM’ on girls and women • Religious education for practising communities
ERADICATING ‘FGM’ • To eradicate ‘FGM’, there must be • Engaging young people in the work of ‘FGM’ • More research on the reasons for practising ‘FGM’ • Use of ‘FGM’ Prohibiting law • Implementation of law in the countries where there is a law.
‘FGM’ – CHILD PROTECTION IMPLICATIONS • Summary of the female circumcision act of 1985 which carries 5 years imprisonment penalty. • However, the female circumcision act of 2003 carries 14 years imprisonment penalty • This should be considered under section 47 • Inform parents of the law.
‘FGM’ – IDENTIFYING GIRLS AT RISK • This is difficult because ‘FGM’ does not fall easily into the Eurocentric definition of ‘FGM’. • It is a one-off event • Parents do it because they really believe it is best for their daughters • There are rarely reasons for routine examinations of girls genitalia • The culture does not enable girls to discuss ‘FGM’ openly.
‘FGM’ – IDENTIFYING GIRLS AT RISK But there is a risk only if………………… • The mother had undergone ‘FGM’ herself • There are older girls / siblings who have undergone ‘FGM’ in the family • She is isolated • Her mother-in-law has a great deal of influence in the household
‘FGM’ – IDENTIFYING GIRLS AT RISK But there is a risk only if………………… • No-one has ever raised the issue of ‘FGM’ with her or provided accessible information for her • You fail to respond appropriately and the message that gets back to the communities is that ‘FGM’ is not taken seriously.
SAMPLE QUESTIONS TO ASK CIRCUMCISED WOMEN • I am aware that in some African countries, women are circumcised. • Have you been circumcised or closed? • Do you have any problem passing urine or does it take you a long time to pass urine? • Do you have any pain with menstruation?
REPONSIBILITIES OF PROFESSIONALS Your responsibility as a professional is to • Be alert to the possibility of ‘FGM’ • Be able to recognise and know how to act upon indicators / disclosures that a girl may be at risk of ‘FGM’ or may already have undergone ‘FGM’ • Refer the case to ‘Children’s Social Care’ once you are aware that a girl is at risk or has already undergone ‘FGM’.
ROLE OF HEALTH PROFESSIONALS Your role as a health professional is to • Undertake preventative work via education to promote a better understanding of the health and human rights implications of ‘FGM’ • Provide as much information and support to women from practising communities to enable them to protect their daughters • Ensure that the message that is given out in respect of ‘FGM’ is consistent across all the health services.
References • Female genital mutilation (FGM) by World Health Organisation (http://www.who.int/gender/other_health/teachersguide.pdf) • Extracts from the lecture given by Dr Faduma Hussein at the ‘Safeguarding Black African Children and Families’ training