Female Genital Mutilation - An Abominable Human Rights Violation

What Is Female Genital Mutilation?

Female genital mutilation (FGM) is the practice of wholly or partially removing the external female genital organs or causing injury to these organs.

Other terms for female genital mutilation are:

• Female circumcision.

• Cutting.

The external female genital organs are collectively referred to as the vulva. It includes the following organs:

• Mons Pubis: Fatty tissue towards the front of the pubic bone and covered in pubic hair.

• Labia Majora: Prominent skin folds that border and protects most of the remaining genitalia.

• Labia Minora: Smaller skin folds that encircle the clitoris and engorge during sexual arousal.

• Clitoris: Nerve-laden sensory organ that becomes engorged or erect during sexual arousal.

• Vestibular Bulbs: Bulbs of erectile tissue that are present close to the clitoris and become engorged with blood during sexual arousal.

• Vulva Vestibule: The area between the labia minora that contains the urethral and vaginal openings.

• Bartholin's Glands: Two pea-sized glands that secrete a mucus-like lubricating fluid into the vagina during sexual intercourse, thereby reducing friction and pain.

• Skene's Glands: Two glands on either side of the urethra that secrete a lubricating substance for the urethral opening, which is also antimicrobial and protects against infections.

• Urethra: The tube-like organ responsible for the excretion of urine from the body.

• Vaginal Opening: Muscular tube that functions as a reservoir for semen collection, thereby assisting with sexual intercourse and childbirth.

What Are the Types of Female Genital Mutilation?

Female genital mutilation could involve total or partial removal of one or more external genitalia or other harmful procedures like pricking and incising the genital area. Based on the specific areas and the procedure performed, FGM can fall under one of four categories:

• Type 1: Partial or complete removal of the visible portion of the clitoris known as the clitoral glans and/or the skin folds surrounding the clitoris glans known as the clitoral hood.

• Type 2: Partial or complete removal of the clitoral glans and labia minora. The labia majora may or may not be removed as well.

• Type 3: The vaginal opening is narrowed by creating a seal that covers it. The seal is made by cutting the labia minora or labia majora and repositioning them - the procedure is called infibulation.

• Type 4: Pricking, incising, scraping, cauterizing, and piercing the female external genitalia for non-medical reasons.

At What Age Is Female Genital Mutilation Usually Carried Out?

Female genital mutilation may usually be carried out anywhere between infancy to 15 years of age. However, it may also be done in girls and women older than 15 years. Women over 40 years of age have been subjected to the practice in some parts of the world.

Where Is Female Genital Mutilation Practiced?

Certain countries and societies within Africa, Asia, Latin America, and the Middle East have reported the highest occurrences of female genital mutilation. Immigrants living in countries within North America, Australia, New Zealand, and Western Europe have also been known to perform female genital mutilation, despite strict regulations against the practice. Reports have suggested that worldwide, over 200 million females (girls and women) alive today have been subjected to the practice of female genital mutilation. It has also been estimated that by the year 2030, around 68 million girls will have been genitally mutilated.

Who Performs Female Genital Mutilation?

In most countries, the procedure is performed by traditional cutters or circumcisers - they do not possess adequate medical knowledge and can cause great harm. In some countries, medical professionals may perform the procedure. However, female genital mutilation, whether performed by an untrained cutter or a trained medical professional, is a dangerous and unnecessary practice.

Why Is Female Genital Mutilation Practiced in Some Countries?

Female genital mutilation is usually performed in countries where societal constructs and cultural beliefs perpetuate false ideas that are generally unscientific in their origin. The reasons could be:

• Cultural Norm: The most common reason that applies to almost any society practicing FGM is that it is a part of their cultural beliefs and traditions.

• Female Purity: In some societies, it is believed that feminine modesty and beauty can only be achieved by removing the organs that are considered dirty or unclean or indicative of immodesty.

• Preparing for the Future: In some cultures, female genital mutilation may be propounded as the only way to prepare women for marriage while also ensuring she remains a virgin until she is married.

• Societal Pressure: It is often performed to stay in line with social practices to be a part of the same society and be accepted by the community.

• False Religious Beliefs: Some cultures and people mistakenly claim that the practice has religious origins, but in fact, no religion references female genital mutilation as an acceptable practice.

Are There Any Benefits to Female Genital Mutilation?

There are no benefits at all to female genital mutilation. FGM constitutes a violation of female rights and is also responsible for negatively affecting the quality of health, whether physical or mental.

How Does Female Genital Mutilation Affect Its Victims?

Female genital mutilation is essentially the removal of normal genital tissue required for the body's proper functioning. There are both physical and mental repercussions to the practice:

Immediate or Short-Term Complications:

• Extreme pain and bleeding.

• Damage to the surrounding genital tissue.

• Swelling of the genital tissue.

• Development of wound-associated infections like tetanus.

• Improper wound healing.

• Urinary infections and other issues.

• Fever.

• Shock.

• Death.

Long-Term Complications:

• Vaginal infections and discharge.

• Urinary Problems: Urinary tract infections and painful urination.

• Scar tissue formation in the area (collection of cells forming tissue on the skin in response to an injury, with reduced elasticity and sometimes causing pain and restricted movement).

• Menstrual Problems: Issues with blood flow, excessively painful menstruation.

• Sexual Problems: Painful sexual intercourse.

• Complications of Childbirth: The need for cesarean sections, labor troubles, complicated process of childbirth, and death of the child.

• Deinfibulation: The surgical process of infibulation creates a vaginal seal that may need to be cut open so that regular sexual intercourse and easier childbirth are facilitated. This reversal procedure is called deinfibulation.

• Psychological Issues: Low self-esteem, anxiety, post-traumatic stress disorder (PTSD), and depression.

What Are the Economic Consequences of Female Genital Mutilation?

The negative health consequences of FGM have resulted in rising costs of FGM-directed healthcare alone. The WHO estimates these costs at 2.3 billion USD per year by 2047 - this is roughly equivalent to a 68 % increase from the yearly average of 1.4 billion USD in 2018.

Conversely, if FGM were eliminated, there would be a 60 % decline in FGM-directed costs by 2047.

How Has COVID-19 Impacted Female Genital Mutilation?

The impact of the COVID-19 pandemic has been particularly detrimental for women at risk of undergoing FGM. The discriminatory practices against women have been perpetuated further without any preventive factors. Programs created and implemented in the past for awareness against FGM have been put on hold in deference to social distancing rules. The United Nations Population Fund (UNFPA) estimates that two million instances of FGM that could have been avoided may occur in consequence and cause a 33 % decline in the previously established progress towards eliminating FGM.

How Can Female Genital Mutilation Be Treated?

As such, there is no specific treatment that can reverse the consequences of all types of FGM, but in the case of Type 3 (infibulation), it is possible to undergo a surgery called deinfibulation that opens up the vaginal seal. Treatment would be indicated for the effects rather than the cause - treatment for the short and long-term complications and therapy for resultant psychological issues.

What Is Being Done for Victims of Female Genital Mutilation?

• The United Nations Population Fund (UNFPA) and United Nations Children's Fund (UNICEF) set up the Joint Programme on the Elimination of FGM in 2008. It is the most extensive worldwide program that works against eliminating FGM and creates awareness of its negative consequences and complications. It has assisted over 5.5 million girls and women in preventing FGM. Additionally, it has contributed to the care and treatment of those who have already undergone the procedure.

Currently, the Joint Programme is in Phase 4 of its implementation (2022-2030) and is working to eradicate the practice by 2030.

• UNFPA has also provided awareness programs and dialogue sessions in collaboration with civil service organizations. Religious leaders and the media have been approached to stand against FGM and create support among communities.

• Countries like Nigeria, Egypt, and Sudan have established laws and policies against FGM due to the Joint Programme's efforts.

• In 2021, UNICEF, WHO, UNFPA, and Population Council worked together to create a research agenda for FGM that included ethical guidance.

• In 2022, the WHO plans to release a training manual dealing with person-centered communication (PCC) - this is a type of counseling that promotes communication skills and critical thinking in healthcare leaders towards the goal of changing FGM-related attitudes and practices.

What More Can Be Done for Victims of Female Genital Mutilation?

Eliminating female genital mutilation is a collective responsibility that rests on the shoulders of those in positions of authority and power and those with expertise on the subject. Communities must stand together in the fight against FGM, and this may only be achieved with proper awareness, education, dialogue, and discussion. It should be highlighted to communities that FGM is a violation of human rights and is detrimental to health. The term ‘collective abandonment’ has been used to imply whole communities making conscious efforts to abandon FGM completely.

How to Support Victims of Female Genital Mutilation?

Supporting victims of female genital mutilation would require treatment at the effect level - this may include the provision of after-FGM care services, psychotherapy, antibiotics, emergency surgeries, and extra obstetric and gynecological care and attention. Support and help would be necessary at every level as the consequences are life-long.

Conclusion:

Female genital mutilation is an atrocity against women's health and human rights and should be eliminated. Factors such as the pandemic, community opposition, general gender bias, and difficulty in deploying resources may contribute to a fall in the effectiveness of campaigns against FGM. However, the joint efforts of the UNFPA, UNICEF, WHO, and Population Council are laudable and will most certainly continue to evoke changes for the better gradually.