Medically: What are the physical, mental, psychological and why many remain childless?
Mutilation: medical definition and meaning
The adjective mutilated is a gory word that’s good for describing maimed or injured bodies. When something’s mutilated, it’s often harmed in such a way that it’s no longer recognisable without any medical reasons and identification. Female Genital Mutilation (FGM), also known as female genital cutting and female circumcision, is the ritual removal of some or all of the external female genitalia without any kind of medical indication.
The rate of FGM in The Gambia
The rate of FGM in The Gambia is around 76 percent in the 6-year age range, and about 51 percent for girls up to the age of 14. That means that, on average in the Gambia, by WHO 86.6 % undergone (FGM) in the Gambia through mutilation, which involves altering their genitals by cutting the clitoris or labia.
Over 130 million women and girls have experienced FGM in the 29 countries in which it is concentrated. It is not known how many girls and women die as a result of the practice, because complications may not be recognised or reported.
FGM/C is a fundamental violation of the rights of girls and is a deeply entrenched social norm. It is a manifestation of gender discrimination. The practice is perpetrated by families without a primary intention of violence, but is de facto violent in nature.
The many variants of FGM are reflected in dozens of local terms in countries where it is common. These often refer to purification. A common Arabic term for purification has the root t-h-r, used for male and female circumcision (tour and tehari). In Islamic texts the practice is referred to as chaff. In the Bambara language, spoken mostly in Mali, FGM is known as bolo Koli (washing your hands) and in the Igbo language in eastern Nigeria as isa Aru or iwi Aru (having your bath – as in a young woman must have her bath before she has a baby).
The right to health
Because FGM can result in severe physical and mental harm and because it constitutes an invasive procedure on otherwise healthy tissue without any medical necessity, it is seen as a violation of the right to health. The International recognizes the right of all human beings to the “highest attainable standard of physical and mental health.” The World Health Organisation includes physical, mental and social well-being in its definition of health and recognizes that health is “not merely the absence of disease or infirmity.”
Because FGM predominantly affects girls under the age of 18, the issue is fundamentally one of protection of the rights of children. The Convention on the Rights of the Child (CRC), 1989, acknowledges the role of parents and family in making decisions for children, but places the ultimate responsibility for protecting the rights of a child in the hands of the government. (Article 5) The CRC also established the “best interests of the child” standard in addressing the rights of children. (Article 3) FGM is recognised as a violation of that best interest standard and a violation of children’s rights. The CRC mandates governments to abolish “traditional practices prejudicial to the health of children.”
Age conducted, Age range
FGM is not invariably a rite of passage between childhood and adulthood, but is outperformed on much younger children. Girls are most commonly cut shortly after birth to age 15 In half the countries for which national figures were available in 2000-2010, most girls had been cut by age five.
Typically carried out by a traditional circumciser using a blade, without anesthesia, FGM is concentrated in 27 African countries.
The rights of the child
The Concluding Observations of the Committee on the Rights of the Child (CRC): Togo (1997) explicitly directs governments to enact legislation that will abolish the practice of FGM as it is a violation of the rights of children.
In addition to recognizing that FGM violates these fundamental rights, numerous instruments establish that governments have a duty to prohibit the practice and protect women and girls vulnerable to the practice. This duty is fulfilled by enacting legislation and implementing other methods of social and cultural education. Legislation should be enacted that encompasses these fundamental rights and governmental duties related to the practice of FGM:
Medically No health benefits, only harm
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., Immediate complications can include severe pain, shock, haemorrhage (bleeding), tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue. Long-term consequences can include: recurrent bladder and urinary tract infections;
Sunna circumcision usually refers to clitoridectomy, but is also used for the more severe forms; Sunna means “path or way” in Arabic and refers to the tradition of Muhammad, although none of the procedures are required within Islam. The term infibulation derives from fibula, Latin for clasp;
FGM can cause a lifetime of serious health problems and pain.
Girls and women who undergo FGM often experience long-term health consequences including scarring, cysts, abscesses and other tissue damage, infertility, and increased susceptibility to infections. They may experience difficulty and pain when they menstruate, urinate or have sexual intercourse.
FGM can cause life-threatening childbirth complications.
FGM can cause serious and even life-threatening complications during childbirth. Scar tissue may not stretch enough to accommodate a newborn, making delivery even more painful than is usual, and making it more likely that the woman will need a Caesarean section or other emergency interventions.
The risk of prolonged, childbirth is heightened for women who have undergone FGM. Without timely medical intervention, obstructed delivery can also put mother and baby at risk of dying. Women who experienced FGM.
FGM can have lasting consequences for girls’ and women’s mental health.
The psychological impact of FGM can be devastating and long-lasting.
Girls may feel deeply betrayed by the parents who insisted they be subjected to FGM.
In young children, that loss of trust and confidence can lead to behavioural problems alongside the psychological pain. As girls grow up and marry, the sexual dysfunction caused by FGM may put stress on their marriages.
And over the long term, FGM can leave serious psychological scars. Girls and women who experienced it may suffer anxiety, depression, memory loss, sleep disorders and stress disorder.
FGM performed even by medical practitioners is never safe or beneficial.
In some places, FGM may be performed by health care providers – community health workers, midwives, nurses or doctors. It may even be offered to new parents as part of a standard package of care for newborn girls.
UNFPA estimates that one in five girls subjected to FGM were cut by trained health care providers, and in some countries, it’s more than three in four. Medicalized FGM is most common in the Sudan, where midwives are the main practitioners, and Egypt, where it is usually performed by doctors. And in seven of eight countries where over 10 per cent of girls subjected to FGM are cut by health care providers, medicalisation of FGM is increasing.
Medicalised FGM may or may not ensure a sterile environment or use of Anaesthetic. That does not make it safe or beneficial for girls, however. It remains a grievous injury with a host of serious short- and long-term health risks – and no medical justification.
Circumcisers, methods
The procedures are generally performed by a traditional circumciser in the girls’ homes, with or without anaesthesia. The circumciser is usually an older woman, but in communities where the male barber has assumed the role of health worker, he will perform FGM too. Health professionals are often involved in Egypt, Sudan and Kenya; according to a 2008 survey in Egypt, 77 percent of FGM procedures there were performed by medical professionals, often physicians.
When traditional circumcisers are involved, non-sterile cutting devices are likely to be used, including knives, razors, scissors, glass, sharpened rocks and fingernails. A nurse in Uganda, quoted in 2007 in The Lancet, said that a circumciser would use one knife to cut up to 30 girls at a time. Depending on the involvement of healthcare professionals, the procedures may include a local or general, or neither.
Complications Short-term and late
FGM harms women’s physical and emotional health throughout their lives. It has no known health benefits. The short-term and late complications depend on the type of FGM, whether the practitioner had medical training, and whether she used antibiotics and unsterilised or surgical single-use instruments.
Common short-term complications include swelling, excessive bleeding, pain, urine retention and healing problems/wound infection.
Late complications vary depending on the type of FGM. They include the formation of scars and keloids that lead to strictures and obstruction, epidermoid cysts that may become infected, and neuroma formation (growth of nerve tissue) involving nerves that supply the clitoris.
Painful periods are common because of the obstruction to the menstrual flow, and blood can stagnate in the womb.
Late complications depend on the type of FGM, whether the practitioner had medical training, and whether she used antibiotics and unsterilised or surgical single-use instruments. In the case of Type III, other factors include how small a hole was left for the passage of urine and menstrual blood, whether surgical thread was used instead of agave or acacia thorns, and whether the procedure was performed more than once.
Common short-term complications include swelling, excessive bleeding, pain, urine retention and healing problems/wound infection.
Other short-term complications include fatal bleeding, anaemia, urinary infection, septicaemia, tetanus, gangrene, necrotising fasciitis (flesh-eating disease) and endometritis.
It is not known how many girls and women die as a result of the practice, because complications may not be recognised or reported. The practitioners’ use of shared instruments is thought to aid the transmission of hepatitis B, hepatitis C and HIV, although no epidemiological studies have shown this.
Late complications vary depending on the type of FGM. They include the formation of scars and keloids that lead to strictures and obstruction, epidermoid cysts that may become infected, and neuroma formation (growth of nerve tissue) involving nerves that supply the clitoris.
Painful periods are common because of the obstruction to the menstrual flow, and blood can stagnate in the vagina and uterus. Complete obstruction of the vagina can result in hepatocytes and hematometra (where the vagina and uterus fill with menstrual blood).
The swelling of the stomach that results from the collection of fluid, together with the lack of menstruation, can lead to suspicion of pregnancy.
Meanwhile, the UNFPA-Unicef Joint Programmed on the Elimination of FGM is working in 17 high-prevalence countries to accelerate action to eliminate the practice, through a holistic approach combining protection and care services, advocacy and community engagement to change the social norms that perpetuate FGM.
And 68 million girls depend on that accelerated action to maintain their physical integrity, safeguard their health and uphold their human rights.
Ending FGM and other harmful practices as now the young Gambian students are extremely concern that undermine the health and rights of women and girls is at the heart of this communications
The FGM issue will continue next week on the outcome of pregnancy and childbirth women undergone FGM.
For more visit the WHO and UNICEF Website, or email to [email protected], or text to Dr Azadeh on 220 7774 469/3063333.
By Dr Azadeh, a senior lecturer at the University of the Gambia, consultant in obstetrics & gynaecology, clinical director at Medicare Health Services.
