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Femal genital mutilation

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Femal genital mutilation

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Femal genital mutilation

  1. 1. Terminology Global prevalence Misperceptions and reasons Risk factors Types & complications Social dynamics of FGM Approaches promoting the abandonment of FGM/C
  2. 2.  female genital mutilation/cutting (FGM/C) (UNICEF)  female genital cutting  female genital mutilation (WHO)  female genital circumcision
  3. 3.  Clitoridectomy: Partial or total removal of the clitoris and/or the prepuce  Infibulation: Excision of part of the external genitalia and stitching of the vulvovaginal opening  Defibulation: Reopening the vulvovaginal opening in a woman who has previously undergone infibulation, for sexual intercourse or childbirth  Reinfibulation: Stitching closed the vulvo-vaginal opening or labia following defibulation
  4. 4.  FGM/C: All procedures involving the partial or total removal of the external genitalia, or any other injury (i.e., pricking, piercing, incising, scraping, cauterization) to the genital organs for non-medical reasons (WHO)
  5. 5. http://www.unicef.org/media/files/FGMC_2016_brochure_final_UNICEF_SPREAD.pdf
  6. 6.  Is supported or mandated by religion  Is an important cultural tradition that should not be questioned or stopped, particularly not by outsiders  Prepares a girl for adulthood and marriage  Reduces a women’s sexual desire, preserves virginity and prevents promiscuity  Improves male sexual pleasure and virility  Facilitates childbirth by increasing a women‟s pain tolerance  Facilitates cleanliness  Prevents the clitoris from growing excessively
  7. 7. There are a variety of reasons why female genital mutilation continues to be practiced. The reasons given by practicing communities are grouped as follows:  Socio-cultural reasons.  Hygienic and aesthetic reasons.  Spiritual and religious reasons.  Psycho-sexual reasons.
  8. 8.  Some communities believe that unless a girl‟s clitoris is removed, she will not become a mature woman, or even a full member of the human race.  A non-circumcised woman blinds anyone attending to her birth or causes the death of the husband;  Female genital mutilation is believed to ensure a girl‟s virginity.
  9. 9.  Women‟s access to land and security is through marriage, and only excised women are considered suitable for marriage.  In communities that practise FGM, girls are generally subjected to powerful social pressure from their peers and family members to undergo the procedure.
  10. 10.  Typically, the traditional excisor is a powerful and well respected member of the community, and FGM is her source of income.
  11. 11.  In FGM practicing communities, it is believed that a woman‟s external genitalia are ugly and dirty, and will continue to grow ever bigger if they are not cut away. Removing these structures makes a girl hygienically clean.  FGM is believed to make a girl beautiful.
  12. 12.  Some communities believe that removing the external genitalia is necessary to make a girl spiritually clean and is therefore required by religion.  In Muslim societies which practice FGM, people believe that it is required by the Koran. However FGM is not mentioned in the Koran.
  13. 13.  FGM prevents premarital sex and preserves virginity – an uncut clitoris grows big and activates intense sexual desire;  It is also believed that the tight vaginal orifice of an infibulated woman, or a woman who has had chemicals placed in the vagina in order to narrow it, will enhance male sexual pleasure, in turn preventing divorce or unfaithfulness.
  14. 14.  In some communities it is believed that excising a woman who fails to conceive will solve the problem of infertility.
  15. 15.  Girls are rewarded with presents after the operation;  Non-circumcised girls have little or no chance of getting married – they will be a financial burden for the family;  Family might loose high position in society (lands, jobs…).
  16. 16.  Women are economically dependent upon males – a lot of privileges are guaranteed through marriage.  Desire of men to gain power over female sexuality.  FGM contributes to the oppression of women.
  17. 17. FGM/C is typically performed at some point between infancy and age 15 years. In half the 29 countries where FGM/C is most commonly practiced, >80% of cutting occurs in girls <5 years of age. Prevalence varies greatly among countries and there is also substantial variation within countries. Countries where the prevalence of FGM/C is highest (>80%) include Somalia, Guinea, Djibouti, Egypt, Eritrea, Mali, Sierra Leone and Sudan.
  18. 18. The prevalence of FGM/C is highest among Muslim girls and women, but this is not always the case. FGM/C is also reported among individuals with other religious backgrounds. FGM/C prevalence tends to be lower in wealthy urban residents, perhaps because they have exposure to a greater number of socio-cultural networks.
  19. 19. The prevalence of FGM/C is generally lower in relatively wealthier households. The prevalence of FGM/C is generally highest among daughters of women with no education. The chances that a girl will undergo FGM/C are significantly increased if her mother has been cut. Risk Factors
  20. 20. 1 Partial or total removal of the clitoris and/or the prepuce (clitoridectomy). 2 Partial or total removal of the clitoris and labia minora, with or without excision of the labia majora (excision).
  21. 21. 3 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). Adhesion of the labia results in near complete covering of the urethra and vaginal orifice, which must be reopened for sexual intercourse and childbirth (defibulation).
  22. 22. 4 All other harmful procedures to the female genitalia for nonmedical purposes (e.g., pricking, piercing, incising, scraping, cauterization). Pricking or nicking involves cutting to draw blood, with no removal of tissue or permanent alteration of the external genitalia, sometimes referred to as symbolic circumcision. Sources: UNICEF, 2013. Female genital mutilation/cutting: A statistical overview and exploration of the dynamics of change; WHO, 2008. Eliminating female genital mutilation: An interagency statement.
  23. 23. FGM/C is recognized as harmful to girls and women, both physically and psychologically, and has no medical benefit. The occurrence of trauma and medical complications may relate to:  The type of FGM/C  The type of practitioner  The absence or misuse of anesthesia  The type of equipment used (scissors, razor blades, and/or broken glass may be used)
  24. 24.  Early complications are usually treated by a local practitioner, and patients may only present to a health care professional for complications that are significant or occur well after the procedure.  Early complications include severe pain, bleeding, infection and urinary retention and are associated more frequently with FGM/C types 2 and 3.
  25. 25. Later complications Type of complication Strongly associated with FGM/C (in case reports and/or cohort studies) Fertility/ sexuality Anorgasmia, apareunia, decreased satisfaction, dyspareunia, lack of sexual desire, vaginal dryness Infection Bacterial vaginosis, herpes simplex virus Pain Clitoral neuroma, dysmenorrhea; lower abdominal, vaginal or vulvar pain
  26. 26. Psychological Anxiety, depression, post-traumatic stress disorder, somatization Scarring Fibrosis, hematocolpos, keloids, labial fusion (partial or complete), sebaceous cysts, vaginal stenosis, vulvar abscesses Urinary Chronic urinary tract infections, meatal obstruction, meatitis, urethral stricture, urinary crystals Source: Hearst AA, Molnar AM. Female genital cutting: An evidence-based approach to clinical management for the primary care physician. Mayo Clin Proc 2013;88(6):618-29. Adapted with permission.
  27. 27. A social convention: Where FGM is a social convention, the social pressure to conform to what others do and have been doing, as well as the need to be accepted socially and the fear of being rejected by the community, are strong motivations to perpetuate the practice. In some communities, FGM is almost universally performed and unquestioned.
  28. 28.  Families will abandon FGM/C only when they believe that most or all others will make the same choice at the same time. Marriage FGM
  29. 29.  In most practicing communities, however, social approval or disapproval, manifested through community and peer pressure, also play important roles in perpetuating the practice.  Failure to conform to FGM/C leads to social exclusion, ostracism, disapproval, rebuke or even violence – in addition to having an effect on a girl‟s marriageability.  Conformity, on the other hand, meets with social approval, brings respect and admiration, and maintains social standing for a girl and her family in the community.
  30. 30.  FGM is often motivated by beliefs about what is considered acceptable sexual behaviour. It aims to ensure premarital virginity and marital fidelity.  FGM is in many communities believed to reduce a woman's libido and therefore believed to help her resist extramarital sexual acts. When a vaginal opening is covered or narrowed (type 3), the fear of the pain of opening it, and the fear that this will be found out, is expected to further discourage extramarital sexual intercourse among women with this type of FGM.
  31. 31.  Religion is often cited, particularly by Christians and Muslims, as a reason for carrying out FGM/C, although the practice predates Christianity and Islam.  Most Christians and Muslims around the world, however, do not carry out FGM/C on their daughters, sisters and wives  Religious leaders take varying positions with regard to FGM: some promote it, some consider it irrelevant to religion, and others contribute to its elimination.
  32. 32.  In some communities, FGM/C may be an important part of a girl‟s transition to adulthood and marriage-ability and may be accompanied by a coming-of-age ceremony or ritual.  But, In many communities, girls are cut at a very young age and the practice is conducted in private and without fanfare.
  33. 33.  At times, the practice is associated with bodily cleanliness and beauty, where girls who have undergone FGM/C are considered physically „clean‟.  If communities are to make the decision to abandon the practice, credible new information must be introduced from trusted sources.
  34. 34.  Where girls and women are expected to follow prescribed gender roles within the family and community, they may even endorse the discriminatory norms that are meant to control them.  Communities that recognize that girls and women have rights to physical and mental integrity, to freedom from discrimination and torture and to the highest standard of health and to the right to life, are empowered to collectively review, deliberate and change existing discriminatory practices.
  35. 35.  Medicalization of the practice was often perceived to address both health and marriageability concerns: It reduced the immediate health complications yet did not compromise the possibility of the girl getting married.  Medicalization, however, did not provide individuals with the opportunity to revise self-enforcing beliefs, did not change the expectation of rewards and sanctions associated with conforming or not conforming to the socially accepted norm, and tended to legitimize the practice while obscuring the fact that it is a violation of the rights of women and girls.
  36. 36.  FGM, whether carried out in a hospital or any other modern setting, is willful damage to healthy organs for nontherapeutic reasons. It violates the injunction to “do no harm”, and is unethical by any standards.
  37. 37.  Understand the social dynamics of decision- making related to FGM  Work with – not against – cultural and community practices and beliefs (reinforcing positive cultural values can be more effective)
  38. 38.  Target local, national and international levels of influence (implementation of laws)  Use a comprehensive and rights-based approach(focused on reducing gender discrimination, improving social justice and supporting human rights, community development, and empowerment and literacy among women and girls )
  39. 39. The elimination of FGM is a painstaking process that requires long-term commitment and the laying of a foundation that will support successful behaviour change. That foundation includes:  strong and capable anti-FGM programmes at the national, regional and local levels  a committed government that supports FGM elimination with policies, laws and resources
  40. 40.  making FGM a mainstream issue integrating FGM prevention into all relevant government and non-government programmes, e.g. health, family planning, education, social services, human rights, religious programmes etc.  health care providers at all levels who are trained to recognize and manage the complications of FGM and to prevent the practice
  41. 41.  good coordination among governmental and nongovernmental agencies  advocacy that encourages a supportive policy and legal environment for the elimination of FGM, increased support for programmes, and public education  empowerment of women.
  42. 42.  http://www.kidsnewtocanada.ca/screening/fgm  http://www.unicef.org/media/files/FGMC_2016_brochur e_final_UNICEF_SPREAD.pdf  http://www.unicef.org/protection/files/00- FMGC_infographiclow-res.pdf  http://apps.who.int/iris/bitstream/10665/77428/1/WHO_ RHR_12.41_eng.pdf  http://www.who.int/mediacentre/factsheets/fs241/en/  https://www.unicef- irc.org/publications/pdf/fgm_insight_eng.pdf  http://www.who.int/gender/other_health/Studentsmanu al.pdf

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