Femal genital mutilation

2. Terminology
Global prevalence
Misperceptions and reasons
Risk factors
Types & complications
Social dynamics of FGM
Approaches promoting the abandonment of FGM/C

3.  female genital mutilation/cutting (FGM/C)
(UNICEF)
 female genital cutting
 female genital mutilation (WHO)
 female genital circumcision

4.  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

5.  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)

6. http://www.unicef.org/media/files/FGMC_2016_brochure_final_UNICEF_SPREAD.pdf

16.  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

17. 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.

18.  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.

19.  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.

20.  Typically, the traditional excisor is a
powerful and well respected member of
the community, and FGM is her source of
income.

21.  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.

22.  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.

23.  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.

24.  In some communities it is believed that
excising a woman who fails to conceive
will solve the problem of infertility.

25.  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…).

26.  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.

27. 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.

28. 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.

29. 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

30. 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).

31. 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).

32. 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.

33. 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)

34.  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.

35. 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

36. 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.

37. 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.

38.  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

39.  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.

40.  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.

41.  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.

42.  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.

43.  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.

44.  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.

45.  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.

46.  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.

47.  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)

48.  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 )

49. 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

50.  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

51.  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.

52.  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