A: BACKGROUND:

Female genital mutilation (FGM) comprises all procedures that involve the partial or total removal of external genitalia or other injury to the female genital organs for non-medical reasons.  In addition to having no health benefits, FGM interferes with normal body functions and can have a negative effect on several aspects of a girl’s or woman’s life, including her physical, mental and sexual health and her relationship with her husband or partner and other close family members.

FGM is a global concern.  Although it is internationally recognized as a violation of human rights and legislation to prohibit the procedure has been put in place in many countries, to date, the practice is reported in 30 countries in Africa and in a few countries in Asia and the Middle East.  Some forms of FGM are also reported to occur among certain ethnic groups in Central and South America, and Eastern Europe.The rise in international migration has also increased the number of girls and women living in the various diaspora populations, including in Australia,Europe, New Zealand and North America, and who have undergone or may under go the practice.

The age at which girls experience FGM varies across countries and cultural groups. In some communities, FGM is performed before girls turn five years old, but in others, girls are cut when they are between the ages of five and 14 years, or prior to marriage (Care of girls and women living with female genital mutilation: a clinical handbook 2018).  It is estimated that over 200 million girls and women worldwide are living with the effects of FGM, and despite efforts to eradicate the practice, every year some 3 million girls and women are at risk of FGM and are therefore exposed to the potential negative health consequences of this harmful practice.

The World Health Organization (WHO), as part of its core mandate to provide assistance to Member States in achieving the goal of the highest attainable standard of health for all, issued in 2008 an interagency statement on eliminating FGM. The statement describes, among other things, the negative implications of the practice for the health and, very importantly, for the human rights of girls and women, and declared vigorous support for its abandonment.  

B: TERMINOLOGY

The term female genital mutilation (FGM) is used by WHO. The use of the word “mutilation” reinforces the fact that the practice is a serious violation of girls’ and women’s rights. This term also establishes a clear distinction from male circumcision, and emphasizes the gravity and harmfulness of the act.  The terms female genital cutting (FGC) and female genital mutilation/cutting (FGM/C) are often used among practising communities and individuals. These terms reflect the importance of using non-judgemental terminology with practising communities.  Terms such as excision or genital cutting are also acceptable when discussing the topic in practising communities.  The term female circumcision should be avoided since it draws a parallel with male circumcision and, as a result, creates confusion between these two distinct practices.

C: CLASSIFICATION OF FEMALE GENITAL MUTILATION (FGM)?

FGM is defined by the World Health Organization (WHO) as “all procedures that involve the partial or total removal of external genitalia or other injury to the female genital organs for non-medical reasons”. The WHO classifies FGM into four types, with subdivisions.  These are…

Type I. Partial or total removal of the clitoris and/or the prepuce (Clitoridectomy). The subdivisions are:

  • Type Ia. Removal of the clitoral hood or prepuce only.
  • Type Ib. Removal of the clitoris with the prepuce.

Type II. Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision). The subdivisions are:

  • Type IIa. Removal of the labia minora only.
  • Type IIb. Partial or total removal of the clitoris and the labia minora.
  • Type IIc. Partial or total removal of the clitoris, the labia minora, and the labia majora.

Type III. 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).

  • Type IIIa. Removal and apposition of the labia minora.
  • Type IIIb. Removal and apposition of the labia majora.

Type IV. All other harmful procedures to the female genitalia for nonmedical purposes, for example, pricking, piercing, incising, scraping, and cauterization. Type IV also includes introduction of corrosive substances and herbs in the vagina, and other forms. In some communities, in Nigeria, they try to push the clitoris back into the body or apply herbs, petroleum jelly, menthol ointments, or hot water to make the clitoris numb. This is called “MASSAGING or PRESSING”. 

Note: For more information on basic facts about FGM, please visit www.endcuttinggirls.org

D: WHY DO COMMUNITIES PRACTISE FGM?

FGM is practised for a variety of sociocultural reasons, varying from one region and ethnic group to another.  Below are the main reasons why communities practise FGM (WHO, 2018).

  1. Enhance Fertility: In some practising communities, women and men believe that if a woman is not cut she will not be able to become pregnant or she may face difficulties during labour.
  2. Respect for Tradition: FGM is often seen as part of the history and cultural tradition of the community. Community members, including the women, often support and continue the practice because they see it as a sign of respect towards the elder members of the community.
  3. Rite Of Passage: In many cultures, FGM constitutes an important rite of passage into adulthood for girls. Often the event is marked with a ceremony and/or celebration. It may be considered a necessary step towards being viewed as a respectable adult woman.
  4. Social Convention: Where FGM is widely practised, it is considered a social convention. Those who adhere to the practice may be better accepted in their communities, while those who do not may face condemnation,harassment and exclusion.
  5. Marriageability:There is often an expectation that men will marry only women who have undergone FGM. The desire and pressure to be married,and the economic and social security that may come with marriage, can perpetuate the practice in some settings.
  6. Ensure Virginity, Chastity and Faithfulness: FGM is believed to safeguard a girl’s or woman’s virginity prior to marriage and ensure fidelity after marriage. Therefore, families may believe that FGM protects a girl’s and her family’s honour.
  7. Cleanliness and Beauty: In some communities, FGM is performed in order to make girls “clean” and beautiful. Cleanliness may refer to the body;female genitals that are cut or closed are sometimes seen as more hygienic and beautiful, but it may also refer to spiritual purity.
  8. Femininity: The removal of genital parts that are considered masculine (i.e. the clitoris) is considered to make girls more feminine, respectable and beautiful.
  9. Religion: Some communities believe that FGM is a religious requirement, and some religious leaders may promote the practice, even though it is not mentioned in any major religious texts.Even though the practice can be found among Christians, Jews and Muslims, none of the holy texts of any of these religions prescribes FGM and the practice pre-dates both Christianity and Islam, It should be noted that no religion supports FGM.

E: FGM & HUMAN RIGHTS

FGM violates a series of well-established human rights principles, which include

  • Principles of equality and non-discrimination on the basis of sex
  • Right to life (when the procedure results in death)
  • Right to freedom from torture or cruel, inhuman or degrading treatment or punishment
  • Rights of the child.

As it interferes with healthy genital tissue in the absence of medical necessity and can lead to severe consequences for a girl’s and woman’s physical, mental and sexual health, the Member States of the United Nations have agreed to declare FGM a violation of the human rights of girls and women, including every person’s right to the highest attainable standard of health.

FGM has been recognized as discrimination based on sex because it is rooted in gender inequalities and power imbalances between men and women and inhibits women’s full and equal enjoyment of their human rights. It is a form of violence against girls and women, with physical and psychological consequences. Female genital mutilation deprives girls and women from making an independent decision about an intervention that has a lasting effect on their bodies and infringes on their autonomy and control over their lives.

F: HEALTH RISKS FROM FGM

FGM has no known health benefits, and those girls and women who have undergone the procedure are at great risk of suffering from its complications throughout their lives. The procedure is painful and traumatic, and is often performed under unsterile conditions by a traditional practitioner who has little knowledge of female anatomy or how to manage possible adverse events. Moreover, the removal of or damage to healthy genital tissue interferes with the natural functioning of the body and may cause several immediate and long-term genitourinary health consequences. These health lists are listed below:

  1. Immediate Risks
  2. Haemorrhage
  3. Pain
  4. Shock (Haemorrhagic, neurogenic or septic)
  5. Genital tissue swelling
  6. Due to inflammatory response or local infection
  7. Infections (Acute local infections; abscess formation; septicaemia; genital and reproductive tract infections; urinary tract infections).
  8. Urination problems (Acute urine retention; pain passing urine; injury to the urethra)
  9. Wound healing problems
  10. Death (Due to severe bleeding or septicaemia)
  • OBSTETRIC RISKS:
  • Caesarean section
  • Postpartum haemorrhage (Postpartum blood loss of 500 ml or more)
  • Episiotomy
  • Prolonged labour
  • Obstetric tears/lacerations
  • Instrumental delivery
  • Difficult labour/dystocia
  • Extended maternal hospital stay
  • Stillbirth and early neonatal death
  • Infant resuscitation at delivery
  • SEXUAL FUNCTIONING RISKS
  • Dyspareunia (pain during sexual intercourse)
  • Decreased sexual satisfaction
  • Reduced sexual desire and arousal
  • Decreased lubrication during sexual intercourse
  • Reduced frequency of orgasm or anorgasmia
  • PSYCHOLOGICAL RISKS
  • Post-traumatic stress disorder (PTSD)
  • Anxiety disorders
  • Depression
  • LONG-TERM-RISKS
  • Genital tissue damage (With consequent chronic vulvar and clitoral pain)
  • Vaginal discharge (Due to chronic genital tract infections)
  • Vaginal itching
  • Menstrual problems (Dysmenorrhea, irregular menses and difficulty in passing menstrual blood)
  • Reproductive tract infections (Can cause chronic pelvic pain)
  • Chronic genital infections (Including increased risk of bacterial vaginosis)
  • Urinary tract infections (Often recurrent)
  • Painful urination (Due to obstruction and recurrent urinary tract infections)

G: MEDICALIZATION OF FGM:

The medicalization of FGM refers to “situations in which the procedure (including re-infibulation) is practised by any category of health-care provider, whether in a public or a private clinic, at home or elsewhere, at any point in time in a woman’s life”. This definition was first adopted by WHO in 1997, and reaffirmed in 2008 by 10 UN agencies in the interagency statement, Eliminating female genital mutilation. The interagency statement strongly emphasizes that regardless of whether FGM is carried out by traditional or medical personnel, it represents a harmful and unethical practice, with no benefits whatsoever, which should not be performed under any circumstances.

H: TAKING ACTION FOR THE COMPLETE ELIMINATION OF FEMALE GENITAL MUTILATION

Action taken at international, regional and national levels over the past decade or more has begun to bear fruit. Increasing numbers of women and men from practising groups have declared support for discontinuing the practice, in some areas, the prevalence of FGM has decreased and some communities have publicly declared that they are no longer mutilating their daughters. The reduction in prevalence is not, however, as substantial as hoped for. Therefore, it is vital that the work against FGM be intensified to more effectively counteract the underlying reasons behind continuation of the practice. Bringing an end to FGM requires a broad-based, long-term commitment.

In 2007, the United Nations Population Fund (UNFPA) and United Nations Children’s Fund (UNICEF) launched the Joint Programme, in 15 African Countries. The Goal was “to support governments, communities, and girls and women concerned towards the abandonment of Female Genital Mutilation/Cutting”. The programme aimed to reduce the practice of FGM/C among girls aged 0 -15 by 40%, and eliminate FGM/C in at least one country by 2012. This Joint Programme was established as the main United Nations instrument to promote the acceleration of FGM/C abandonment. While the duration of the Programme was meant to be 5 years (2008 – 2012), it was extended to 2013 to provide additional time to meet its goals.  

A second phase of the “UNFPA/UNICEF Joint Programme on FGM/C Abandonment: Accelerating Change”, which commenced in 2014, took place in 17 Countries, including Nigeria and Yemen.  The second phase of the Joint Programme ended in December 2017.  In Nigeria the Joint programme is taking place in the five States with the highest FGM/C prevalence in the country, namely; Osun (77%), Ebonyi (74%), Ekiti (72%), Imo (68%), and Oyo (66%). This is based on the 2013 Nigeria Demographic Health Survey (NDHS).  A third phase of the “UNFPA/UNICEF Joint Programme on Eliminating FGM: Accelerating Change”, which commenced in January 2018, is taking place in 16 Countries, including Nigeria, and will end in December 2021.

Experience over the past two or three decades has shown that there are no quick or easy solutions. Getting a community to publicly declare their support for the #endcuttinggirls campaign is not easy also, especially in communities where the practice of FGM is a Social Norm.

The concept of social norms:

A social norm is a behavioural rule ‘R’ that applies to a certain social context ‘C’ for a given population ‘P’ (bicchieri 2008a, 2010). People in the population prefer to follow the rule in the appropriate context if they believe that a sufficiently large part of the population follows the rule, and further, if they believe that other people think that they ought to follow the rule, and may sanction them if they don’t.  For example, in Western countries, brides traditionally wear white at weddings because nearly all other brides do and they believe that others think that they should wear white because white represents purity. This is unlike why everyone wears shoes. I wear shoes because I want to protect my feet, not because I’m concerned about what others do or what they think of me.

A social norm might be enforced by informal social sanctions that range from gossip to open censure, ostracism and/ or dishonour. Social sanction motivates individuals to follow a norm out of fear of punishment or out of a desire to please and thus be rewarded.

A Social Norm can be very fragile, particularly in cases of pluralistic ignorance. This occurs when a majority of individuals have private attitudes/preferences in conflict with the prevailing Social norm. Often people are not able to freely talk about their private attitudes, for fear of social sanction, and so the norm remains in place, even if most people do not want to continue to follow it. Until expectations are changed, individuals in a group will continue to obey the norm because of their belief that he/she is expected to do so. A public pledge to abandon a harmful norm suddenly and collectively changes expectations and can therefore induce a norm shift. Public pledges allow people to create common knowledge of new expectations. For example, everyone knows that everyone else knows that we expect others not to cut their daughters.

Today we are focusing on the benefit of community public declaration against FGM.  Under the UNFPA/UNICEF Joint Programme on Eliminating FGM, a public declaration /affirmation is defined as “formal public ceremonies involving one or more communities—typically villages, but increasingly also districts and ethnic groups—that take part in an event where they manifest, through their representatives, the specific commitment to abandon FGM/C”.  This is a moment of broad social recognition, which shows that most support abandonment of FGM, and most likely will abandon the practice.  A public declaration does not mean that the declaring village is free from FGM; rather it represents a milestone in the process of abandonment because it signals the change in social expectations.

Since 1997, when the people of Malicounda Bambara in Senegal, the first village to abandon, publicly declared their abandonment of FGM, other communities in Guinea, Burkina Faso, Mali, the Gambia and Nigeria have all publicly declared their commitment to abandon the practice. Experience from these interventions shown that, after months or years of engagement and consensus building, these public affirmations constitute a bottom-up, rather than top-down, manifestation of change.  According to an evaluation conducted by UNICEF in 2007, in Senegal, one of the first countries to make a series of public declarations, these events are perhaps the most critical step on the path to abandonment.  Findings showed that 77% (almost 8 out of 10 communities) of those who committed to abandon FGM publically had indeed abandoned the practice and maintained their decision 10 years later. When a community publicly denounces the practice they are not only declaring to themselves, but to other communities, that they have abandoned FGM, which then helps in paving the way for other communities – especially those with which they regularly inter-marry – to do the same. 

I believe you would agree with me that programs that are led by communities are, by nature, participatory and generally guide communities to define the problems and solutions themselves. Programs that have demonstrated success in promoting abandonment of FGM on a large scale build on human rights and gender equality and are nonjudgmental and non-coercive. They focus on encouraging a collective choice to abandon FGM. To reach the collective, coordinated choice necessary for sustained abandonment of FGM, communities must have the opportunity to discuss and reflect on new knowledge in public.

Public dialogue provides opportunities to increase awareness and understanding by the community as a whole on women’s human rights and on national and international legal instruments on FGM. This dialogue among community member often focuses on women’s rights, health, and FGM, and brings about recognition of the value of women in the community, thus fostering their active contribution to decision-making and enhancing their ability to end the practice.  Most importantly, such public discussions can stimulate discussions in the private, family setting where decisions about FGM are made by parents and other family members.  The collective, coordinated choice by a practicing group to abandon FGM should be made visible or explicit through a public pledge (public declaration/affirmation) so that it can be trusted by all concerned.  Indeed, many of the approaches adopted by community based initiatives lead towards a public declaration of social change. This creates the confidence needed by individuals who intend to stop the practice to actually do so and is therefore a key step in the process of real and sustained change in communities.  So far in 2018, UNICEF, under the UNFPA/UNICEF Joint Programme on Eliminating FGM: Accelerating Change, has supported 241 communities to publicly declare abandonment of FGM in three States, (Ekiti-78, Imo-26 and Osun-137).  More communities are expected to publicly declare FGM abandonment in Oyo State before the end of 2018.

The Benefit of Public Declaration

Some of the benefits of public declaration as follow.

  1. It assures each individual that other community members are willing to end the practice.
  2. It activates individual and collective resolve to live up to the abandonment decision.
  3. It helps shift the social norm, so that families who do not cut are socially respected and those who cut are socially-sanctioned
  4. It reassures those who intend to stop FGM but are scared of been sanctioned by the society.
  5. It helps to get more people committed to the campaign against FGM, for example in one of the communities in Ekiti, one of their chiefs stood up during the public declaration and said that he would not stop speaking to everyone about the reason why the act must be frowned at.
  6. It ensures ownership because the people automatically take it upon themselves to ensure no onecarries it out. During the Public Declaration in a particular community inEkiti, some members of the community were asking, who do we report to, if wefind anyone who mutilates a girl? This is an indication of their willingness tojoin the community surveillance system that will be established to monitor thecompliance to the public declaration of abandonment of FGM.
  7. It can indirectly lead to the change in the decision orbelieve of neighbouring communities.
  8. It is used to educate and influence communitymembers. It also increases their knowledge on the harmful effects of FGM bothduring the public declarations
  9. W

While we wait for the questions, Are you aware of the social media accounts of the UNICEF-trained Social Media Advocates (SMAs) that are managing the #endcuttinggirls Social Media Campaign (@endcuttinggirls)?You can follow us on Instagram; check our videos on YouTube; like and follow our page on Facebook. Search for #endcuttinggirls. Also be informed that every Thursday of the week by 5pm we have a tweet conference on twitter using the hashtag #endcuttinggirls.