BY Dorcas Onyinyechi Mbam (@Mbamonyii), Dare Olagoke-Adaramoye (@dareadaramoye), Olabintan Odunola (@thesocial_nerd)

INTRODUCTION

On behalf of my colleagues @dareadaramoye and @thesocial_nerd; I welcome you to today’s Tweet conference. #endcuttinggirls

Today’s Topic is; The Health Sector As A Strategic Partner In Providing Quality FGM/C-Related Services For Protection, Prevention & Care. #endcuttinggirls

We will start taking your questions from 6:45pm (Nigerian Time). Let’s start our discussion for the day… #endcuttinggirls

1: FGM/C comprises all procedures involving partial or total removal of the external female genitalia fit non-medical reasons. #endcuttinggirls

2a: in Yoruba it is called  ‘Di dabe fun omo’ binrin’. #endcuttinggirls

2b: In igbo it is called ibi nwanyi Ugwu #endcuttinggirls

2c: In Hausa it is called kaciyan mata #endcuttinggirls

3: There are four types of FGM/c #endcuttinggirls

3(a): Type 1 – Partial Clitoridectomy #endcuttinggirls

3(b): Type 2 – Total Excision #endcuttinggirls

3(c): Type 3 – Clitoridectomy + infibulation #endcuttinggirls

3(d): Type 4 – Other forms which may include massaging, pricking, insertion of substances #endcuttinggirls

4: FGM/C is carried out traditionally by traditional circumcisers and traditional birth attendants. #endcuttinggirls

5: Recently, reports of medical professionals carrying out FGM/C have been recorded. #endcuttinggirls

6: These health workers include midwives, doctors and community health extension workers #endcuttinggirls

7: Globally, a woman or girl is at risk of being cut every ten seconds, about 8,500 women and girls are violated every ten seconds #endcuttinggirls

8: In Nigeria, 25%of Nigeria women between the ages of 15 and 49 are FGM/C victims’(NDHS 2013) #endcuttinggirls

9: FGMC has both short term and long term implications #endcuttinggirls

10: short term implications are: excessive bleeding, trauma, infections, sepsis, bruises,  fractures and so many others #endcuttinggirls

11: long term effects includes: Keloid scar formation, painful intercourse, cession vaginal fistula, psychological trauma, obstructive labour, asphyxia at child birth. @endcuttinggirls #endcuttinggirls

12a: FGM/C harms women not only physically, but emotionally throughout their lives @endcuttinggirls #endcuttinggirls

12b: and it is considered an act of human rights violations. @endcuttinggirls #endcuttinggirls

13: In many settings, healthcare providers perform FGM/C due to the erroneous belief that the procedure is safer when medicalized. #endcuttinggirls

14: Medicalization of FGM/C has no medical indication and violates medical ethics @endcuttinggirls #endcuttinggirls

15: Healthcare professionals globally are very important key partners in the elimination of FGMC. @endcuttinggirls #endcuttinggirls

16(1/2): This further explains the importance of health sector as a strategic partner in providing quality FGM/C related services… #endcuttinggirls

16(2/2)…for protection, prevention and care. @endcuttinggirls #endcuttinggirls

17: FGM/C-related services include interventions implored to achieve total abandonment of FGM/C practice. They include; CBT… #endcuttinggirls

18: CBT means Cognitive Behavioural therapy. This is a psychological therapy based on the idea that feelings are affected by thinking #endcuttinggirls

19: Beliefs are that if unchecked these thoughts can lead to harmful behaviors which may be of suicide tendencies #endcuttinggirls

20a: CBT typically helps the person develop the ability to challenge unrealistic negative thoughts @endcuttinggirls #endcuttinggirls

20b: …and a behavioural conducts associated with FGM/C @endcuttinggirls #endcuttinggirls

21a: Use of IEC @endcuttinggirls #endcuttinggirls

21b: IEC is information, education and communication @endcuttinggirls #endcuttinggirls

21c(i): This is a health approach aiming at changing or re-enforcing health related behaviours @endcuttinggirls #endcuttinggirls

21c(ii): in a target audience concerning a specific problem within a predefined period of time through @endcuttinggirls #endcuttinggirls

22: predefined period of time through communication methods and principles. @endcuttinggirls #endcuttinggirls

23: Roles of health sector as key partners to ensuring protection of at risk persons to FGMC @endcuttinggirls #endcuttinggirls

24: Emphasis legislation can be achieved by health and human rights education and community awareness campaigns #endcuttinggirls

25: while legislation may acts as a disincentive its important lies in underpinning an integrated, holistic frame work for the prevention of FGM/C. #endcuttinggirls

26(1/2): As well as protection from FGM/C this embraces culturally informed interventions #endcuttinggirls

26(2/2) that respectively involves community health workers and child protection professionals #endcuttinggirls

27(1/2): obstetrics and gynecology unit of the health sector passed a resolution in 1994 at its general assembly #endcuttinggirls

27(2/2)…opposing the performance of FGM/C under any circumstances of health professionals #endcuttinggirls

28: To ensure prevention and foster protection health workers should ensure women’s first encounter at consultation is a positive experience

29(1/2): Health workers need to be familiar with the types of FGM/C, the areas of high prevalence, #endcuttinggirls

29(2/2): cultural predetermination the indication of a girl being at risk of being cut per day #endcuttinggirls

30: the laws and who to contact in the case of suspecting that a family may be planning to organise a circumcision. #endcuttinggirls

31: Develop skills to engage with women in the sensitive, personal and secretive area of risk of FGM? #endcuttinggirls

32: People from high prevalence areas may have inadequate knowledge of their bodies and biological facts and be shocked or angry when they learn that FGM/C is not a universally accepted practice. #endcuttinggirls

33: Health workers should develop ways of talking about FGM/C with affected women. #endcuttinggirls

34: it’s suggested they should use sensitive simple language and direct questions so that women and girls feel comfortable to discuss their issues and #endcuttinggirls

35: return for further services without fear of discrimination and judgement. #endcuttinggirls

36: Health professionals can equally foster their contributory roles towards endcuttinggirls by playing key care roles such as #endcuttinggirls

37: Educating survivors on the obstetrics problems caused by FGM/C types, how it may complicate pregnancy and child birth and measures. It may warrant to ensure successful delivery. #endcuttinggirls

38: Early assessment and preparation need to be made to enable survivors become familiar with her care team and for the team to be fully aware of potential risks difficulties that may occur #endcuttinggirls

39: Health professionals should document presence type and impact of FGM/C on their patients #endcuttinggirls

40: As well as help them develop a pregnancy and birth plan that addresses survivor’s peculiar needs during pregnancy and at delivery. #endcuttinggirls

41: Health professionals should advice women who may require DE-INFIBULATION on what better time to carry out the procedure to ensure safety, proper wound healing and minimize complications #endcuttinggirls

42: Gynecologist should assist women with complications from FGMC procedures done in aseptic infections inducing environment #endcuttinggirls

43: Training of more health workers to ensure the following positive changes #endcuttinggirls

44: Training of more health workers to ensure the following positive changes

45: That women who have been cut are able to seek support and protection that prevents her from becoming an FGM/C victim instead of a survivor #endcuttinggirls

46: That women that have been cut resolves but to put her daughters through FGM/C procedures despite a long family tradition #endcuttinggirls

47: that women ask for counseling and referrals to enable them handle the psychological impacts of FGM/C. @endcuttinggirls #endcuttinggirls

47: mandatory screening for FGM/C during antenatal care @endcuttinggirls #endcuttinggirls

48: Monitor at risk female children during immunization visits as well as during other visits to the children outpatient clinics @endcuttinggirls #endcuttinggirls

48: When all these roles are put in place our society will surely have no option but to #endcuttinggirls.

I will stop here for my colleague @dareadaramoye to continue. @endcuttinggirls #endcuttinggirls

DARE

49a: Health-care providers should not perform any type of FGM/C in any setting @endcuttinggirls #endcuttinggirls

49b …neither should they perform re-infibulation after delivery or in any other situation. @endcuttinggirls #endcuttinggirls

50a: They should provide care for girls and women suffering from complications associated with FGM/C, @endcuttinggirls #endcuttinggirls

50b …including special care during childbirth for women who have already undergone FGM. @endcuttinggirls #endcuttinggirls

51a: Healthcare  providers should counsel women suffering consequences from FGM/C, and their families, @endcuttinggirls #endcuttinggirls

51b: …and advise them to seek care for their complications and mental health consequences, @endcuttinggirls #endcuttinggirls

51c: advise them against re-infibulation& counsel them to resist having FGM performed on their daughters or other family members. #endcuttinggirls

52: Health-care providers should also act as advocates for the abandonment of the practice in the community at large. #endcuttinggirls

53: When providing care to migrant women and in cases of limited language skills,… @endcuttinggirls #endcuttinggirls

53b: health-care providers should have access to cultural interpreters specifically trained on FGM/C, @endcuttinggirls #endcuttinggirls

53c: to ensure counselling to women and families is adequate and done with respect for their cultural beliefs. @endcuttinggirls #endcuttinggirls

54: Instead of performing procedures that are harmful to girls’ and women’s health, and that violate their human rights,… @endcuttinggirls #endcuttinggirls

54b: health-care providers should use their competencies and authority to promote the health and human rights of girls and women, @endcuttinggirls #endcuttinggirls

54c: including their rights to information, physical integrity, freedom from violence, and health. @endcuttinggirls #endcuttinggirls

55ai: Countries should set priorities and develop specific plans of action according to the country situation, @endcuttinggirls #endcuttinggirls

55aii: within a consultative process involving all stakeholders. @endcuttinggirls #endcuttinggirls

55b: Four overarching activities are recommended: @endcuttinggirls #endcuttinggirls

55b1: mobilize political will and funding; @endcuttinggirls #endcuttinggirls

55b2: strengthen the understanding and knowledge of health-care providers; @endcuttinggirls #endcuttinggirls

55b3: create supporting legislative and regulatory framework; @endcuttinggirls #endcuttinggirls

55b4: strengthen monitoring, evaluation and accountability. @endcuttinggirls #endcuttinggirls

56a: A prerequisite for preventing the medicalization of FGM/C is that all health-care providers should be familiar with… @endcuttinggirls #endcuttinggirls

56b: factors surrounding the practice of FGM/C; @endcuttinggirls #endcuttinggirls

56b1 the reasons why it should not be performed by health-care providers and… @endcuttinggirls #endcuttinggirls

56b2: how to resist requests to do so; @endcuttinggirls #endcuttinggirls

56b3: how to recognize and manage complications of FGM/C, including suitable obstetric care; @endcuttinggirls #endcuttinggirls

56b4: and how to counsel women and families on FGM/C-related issues. @endcuttinggirls #endcuttinggirls

57: Together we will #endFGM in this generation. @endcuttinggirls #endcuttinggirls

58: Thank you for your time. You can now start asking your questions… @endcuttinggirls #endcuttinggirls