Female Genital Mutilation


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Female Genital Mutilation

  1. 1. Female Genital Mutilation Elizabeth Kus FO618-C April 23, 2008
  2. 2. Definition <ul><li>“ All procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for cultural or other non-medical reasons” (WHO, 2008) </li></ul>
  3. 3. 4 Types <ul><li>Type I </li></ul><ul><ul><li>“ excision of the prepuce (foreskin), with or without the excision of part or all of the clitoris” </li></ul></ul><ul><li>Type II </li></ul><ul><ul><li>Expands Type I </li></ul></ul><ul><ul><li>Adds “the excision of the clitoris with partial or total excision of the labia minora” </li></ul></ul><ul><ul><ul><ul><ul><li>(UNFPA, 2008) </li></ul></ul></ul></ul></ul>
  4. 4. <ul><li>Type III </li></ul><ul><ul><li>Expands on Type II </li></ul></ul><ul><ul><li>Adds “the excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation)” </li></ul></ul><ul><ul><li>Legs are tied together afterwards </li></ul></ul><ul><li>Type IV </li></ul><ul><ul><li>Most extreme </li></ul></ul><ul><ul><li>“ pricking, piercing or incising, stretching, burning of the clitoris, scraping of tissue surrounding the vaginal orifice, cutting of the vagina, introductions of corrosive substances or herbs into the vagina to cause bleeding or to tighten the opening” </li></ul></ul><ul><ul><ul><ul><ul><li> (UNFPA, 2008) </li></ul></ul></ul></ul></ul>
  5. 6. Practice <ul><li>Where? </li></ul><ul><ul><li>Predominantly in African, Asian, and Arab countries </li></ul></ul><ul><ul><li>Has been found practiced among immigrants </li></ul></ul><ul><li>Who? </li></ul><ul><ul><li>Predominantly amongst certain ethnic and religious groups </li></ul></ul><ul><ul><ul><li>Diverse practitioners </li></ul></ul></ul><ul><ul><li>Practiced on girls, from birth into adulthood- majority are done between 7 and 10 years </li></ul></ul><ul><li>How? </li></ul><ul><ul><li>Instruments used </li></ul></ul><ul><ul><li>Performed by mostly non-medically trained people </li></ul></ul><ul><li>Why? </li></ul><ul><ul><li>Reasons given encompass psychosexual, sociological and cultural, hygiene and aesthetic, religion, and socio-economic factors </li></ul></ul>
  6. 8. <ul><li>“ My two sisters, myself and our mother went to visit our family back home. I assumed we were going for a holiday. A bit later they told us that we going to be infibulated. The day before our operation was due to take place, another girl was infibulated and she died because of the operation. We were so scared and didn’t want to suffer the same fate. But our parents told us it was an obligation, so we went. We fought back; we really thought we were going to die because of the pain. You have one woman holding your mouth so you won’t scream, two holding your chest and the other two holding your legs. After we were infibulated, we had rope tied across our legs so it was like we had to learn to walk again. We had to try to go to the toilet, if you couldn’t pass water in the next 10 days something was wrong. We were lucky, I suppose, we gradually recovered and didn’t die like the other girl. But the memory and the pain never really goes.” </li></ul><ul><ul><ul><ul><ul><li>Zainab (22) had the procedure at 8 yrs old, (WHO, 2008) </li></ul></ul></ul></ul></ul>
  7. 9. Effect <ul><li>Physical </li></ul><ul><ul><li>Increased risk of HIV/AIDS </li></ul></ul><ul><ul><li>Acute complications include </li></ul></ul><ul><ul><ul><li>Heavy bleeding Severe pain </li></ul></ul></ul><ul><ul><ul><li>Swelling Fever </li></ul></ul></ul><ul><ul><ul><li>Urine retention </li></ul></ul></ul><ul><ul><li>Chronic complications include </li></ul></ul><ul><ul><ul><li>Cysts & abscesses Scar formation </li></ul></ul></ul><ul><ul><ul><li>Urinary tract damage Sexual dysfunction </li></ul></ul></ul><ul><ul><ul><li>Infertility &/or protracted labor </li></ul></ul></ul><ul><ul><ul><li>Difficult childbirth </li></ul></ul></ul>
  8. 10. <ul><li>Psychological </li></ul><ul><ul><li>Linked to PTSD </li></ul></ul><ul><ul><li>Anxiety and affective disorders </li></ul></ul><ul><ul><li>Behavioral disturbances, loss of trust/confidence </li></ul></ul><ul><ul><li>Depression </li></ul></ul>
  9. 11. Treatment <ul><li>Cognitive Behavioral Therapy </li></ul><ul><ul><li>Recommended because of the risk of PTSD </li></ul></ul><ul><li>Education </li></ul><ul><ul><li>About risks and effects of procedure </li></ul></ul><ul><ul><li>About impact of procedure </li></ul></ul><ul><ul><li>To all areas where FGM is practiced </li></ul></ul><ul><ul><ul><li>Particularly rural and lower SES areas </li></ul></ul></ul>
  10. 12. Controversy <ul><li>Outsider/ non-practitioner views </li></ul><ul><li>Within the ethnic groups </li></ul><ul><li>Male v. female / educated v. uneducated </li></ul>
  11. 13. Legislation <ul><li>Procedure banned by law in several countries </li></ul><ul><li>International conventions and declarations </li></ul><ul><ul><li>Universal Declaration of Human Rights (1948) </li></ul></ul><ul><ul><li>Convention on the Rights of the Child (1989) </li></ul></ul><ul><ul><li>Vienna Declaration and the Programme of Action of the World Conference on Human Rights (1993) </li></ul></ul><ul><ul><li>Addis Ababa Declaration (1997) </li></ul></ul>
  12. 14. Agencies working to end FGM <ul><li>Equality Now </li></ul><ul><li>Unicef </li></ul><ul><li>United Nations Funds for Population Activities </li></ul><ul><li>World Health Organization </li></ul><ul><li>Grassroots organizations </li></ul><ul><ul><li>Lack of funding and volunteers </li></ul></ul>
  13. 15. Discussion <ul><li>What thoughts or feelings has this information provided you? </li></ul><ul><li>Consider the issues relating to pregnancy & pregnancy- does the practice of FGM make any sense? </li></ul><ul><li>How do you think you would react if a client came to you with problems stemming from FGM? Would you be able to treat them? </li></ul><ul><li>Do you have any ideas regarding ending the practice of FGM? Or do you think this is not our issue? </li></ul>
  14. 16. References <ul><li>Affara, F. (2002). Guest editorial. International Council of Nurses , 49 , 195-197. </li></ul><ul><li>Behrendt, A., & Moritz, S. (2005). Posttraumatic stress disorder and memory problems after female genital mutilation. American Journal of Psychiatry , 162 (5), 1000-1002. </li></ul><ul><li>Berggren, V., Musa Ahmed, S., Hernlund, Y., Johansson, E., Habbani, B., & Edberg, A.-K. (2006). Being victims or beneficiaries? Perspectives of female genital cutting and reinfibulation in Sudan. African Journal of Reproductive Health , 10 (2), 24-36. </li></ul><ul><li>Dandash, K., Refaat, A., & Eyada, M. [. (2001). Female genital mutilation: A prospective view. Journal of Sex & Marital Therapy , 27 , 459-464. </li></ul><ul><li>Dandash, K., Refaat, A., & Eyada, M. (2001). Female genital mutilation: A descriptive study. Journal of Sex & Marital Therapy , 27 , 453-458. </li></ul><ul><li>Dare, F., Oboro, V., Fadiora, S., Orji, E., Sule-Odu, A., & Olabode, T. (2004). Female genital mutilation: an analysis of 522 cases in South-Western Nigeria. Journal of Obstetrics and Gynaecology , 24 (3), 281-283. </li></ul><ul><li>El-Defrawi, M., Lotfy, G., Dandash, K., Refaat, A., & Eyada, M. (2001). Female genital mutilation and its psychosexual impact. Journal of Sex & Marital Therapy , 27 , 465-473. </li></ul><ul><li>Elgaali, M., Strevens, H., & Mardh, P. (2005). Female genital mutilation- an exported medical hazard. The European Journal of Contraception and Reproductive Health , 10 (2), 93-97. </li></ul><ul><li>Equality Now. (2008). Campaign Against FGM . Retrieved March 15, 2008, from Equality Now: http://www.equalitynow.org/english/campaigns/fgm/fgm-campaign_en.html </li></ul><ul><li>Fox, E., de Ruiter, A., & Bingham, J. (1997). Female genital mutilation. International Journal of STD & AIDS , 8 , 599-601. </li></ul><ul><li>Harvey, A., Bryant, R., & Tarrier, N. (2003). Cognitive behaviour therapy for posttraumatic stress disorder. Clinical Psychology Review , 23 , 501-522. </li></ul><ul><li>Refaat, A., Dandash, K., El-Defrawi, M., & Eyada, M. (2001). Female genital mutilation and domestic violence among egyptian women. Journal of Sex & Marital Therapy , 27 , 593-596. </li></ul><ul><li>Satti, A., Elmusharaf, S., Bedri, H., Idris, T., Hashim, M., Suliman, G., et al. (2006). Prevalence and determinants of the practice of genital mutilation of girls in Khartoum, Sudan. Annals of Tropical Paediatrics , 26 , 303- 310. </li></ul><ul><li>United Nations Population Fund. (2008). Frequently asked questions on female genital mutilation/cutting. Retrieved March 15, 2008, from UNFPA: http://www.unfpa.org/gender/practices2.htm </li></ul><ul><li>World Health Organization. (2008). WHO| Female genital mutilation . Retrieved March 15, 2008, from World Health Organization: http://www.who.int/topics/female_genital_mutilation/en </li></ul>