TWEET CONFERENCE SCRIPT: The health sector as a strategic partner in providing quality FGM-related services for protection, prevention and care in Nigeria – 31st January 2019
Female Genital Mutilation (FGM) is a global health issue. More than 200 million girls and women in Africa, Asia and Middle East have undergone the practice, and more than 3 million girls are annually at risk.
The impact of FGM is also spreading further through migration to other parts of the world including Europe, the USA, Australia and Canada.
Hence policies are needed to address this issue in both countries of origin and countries of migration.
FGM practice is deeply rooted in a strong cultural/social framework. It is endorsed by the practicing community & supported by loving parents who believe that undergoing FGM is in the best interest of their daughter.
Despite its cultural importance, we need to acknowledge the fact that FGM is a harmful traditional practice that violates the rights or girls and women. Therefore, FGM has to be eliminated.
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.
FGM is associated with a greater risk for a series of health complications, dependent on the extent and type of tissue removed. Immediate health risks include pain, haemorrhage, infection, urinary retention and injury to the urethra,
Long-term health complications include genitourinary (urinary tract infection, bacterial vaginosis, problems with menstruation), obstetrical (caesarean section, postpartum haemorrhage, episiotomy, prolonged labour, tears or lacerations, instrumental delivery, difficult labour, external maternal hospital stay, still birth and early neonatal death, infant resuscitation at delivery) sexual (dyspareunia, no sexual desire and reduced sexual satisfaction), and psychological (post-traumatic stress disorder, anxiety disorder and depression) consequences.
Considering the health impact of FGM, the World Health Organization (WHO) has played a key role in tackling the issue from its first international conference on FGM in 1979 onwards.
In 1997, the WHO, UNICEF and UNFPA issued a Joint Statement on FGM which described the implications of the practice for public health and human rights and declared support for its abandonment; it was reaffirmed in 2008. The statement emphasized the importance of broad-based, long-term commitment as well as a multi-sectoral approach involving education, finance, justice, women’s affairs and health.
In 2001, the WHO developed its first policy guidelines for the health sector, accompanied by practical and clinical guidelines that were updated in 2016. The UN emphasizes and outlines the role of healthcare providers (HCP) in primary prevention and provision of care.
In 2008 and 2012 the World Health Assembly (WHA) and the UN General Assembly respectively agreed on resolutions against FGM urging all member states to develop, support and implement national policies and action plans as well as to allocate sufficient resources for its implementation.
The resolutions also highlighted the importance of incorporating clear targets and indicators in the national plans and policies for the effective monitoring, impact assessment and coordination of programmes. The World Health Assembly (WHA) also commits its member states to follow up and regularly report on a set of points targeting prevention (in particular community based interventions), legislation, guidelines and provision of care.
Literature on FGM shows that several countries have developed national policies, guidelines and legislations, as well as making progress in the involvement of community based interventions. Less is known however about the involvement of the health sector in national plans, nor the implementation levels, allocated resources, coordination and monitoring and evaluation of such plans in the different countries.
A 2012 review of policies in 28 countries in the European Union (EU) reports insufficient and unequal distribution of support- and health services as well as inconsistent funding to ensure access to services.
No similar data is available from non-EU countries with high numbers of migrants from FGM practicing countries, nor from countries where FGM is traditionally practiced.
Nevertheless, a 2010 progress report on the World Health Assembly (WHA) resolution from African member states highlights the involvement of the health sector as an area in need for improvement. As we try to end the practice of FGM, there has been a lot of concern over the trend of replacing traditional circumcisers with medical professionals, otherwise known as the medicalization of FGM.
The World Health Organization defines “medicalisation of FGM” as a “situation in which FGM is practiced by any category of healthcare provider, whether in a public or private clinic, at home, or elsewhere”.
Debate has raged about whether FGM could be carried out ‘safely’ under certain circumstances or whether all forms of the practice should be condemned. However, WHO has recommended that health workers should not engage in medicalization
Many countries have banned the use of government clinics and hospitals to perform FGM. On December 20, 2012 the United Nations General Assembly adopted a resolution that reflected universal agreement that FGM constitutes a violation of human rights and that all countries should take action to end the practice, committed within or outside a medical institution.
A recent survey looked at whether medicalisation had increased between generations and found that in countries with substantial levels of medicalisation (over ten percent) rates are higher among daughters than mothers; the only exception is Nigeria, where rates of medicalisation among mothers and daughters are roughly equal.
Research suggests that there are several ways to win health care professionals’ support as allies in FGM abandonment efforts. First, training programs for these professionals, particularly those living in areas where FGM is widely practiced, should focus on what FGM is, why it is practiced, its health impacts, and ways to prevent it, such trainings must also sensitize health care practitioners to the fact that FGM is a violation of girls’ and women’s rights to health and conflicts with the “do no harm” principle of medical practice.
Second, these health professionals, as a focus of FGM abandonment programs, should be given the opportunity to reflect on their own beliefs and think critically about how these views may fuel the continuation of the practice
Third, health professionals’ associations and health regulatory agencies should have clear guidelines and standards for providers that outline the sanctions on those who perform FGM.
These organizations should also offer opportunities for health care professionals to contribute to community efforts to promote the abandonment of the practice.
Health Care Practitioners (HCP) can play a key role in the prevention of FGM by providing health education to patients and/or parents during consultations as their educational background and social status give extra credit to their messages also, the regular interactions with families provide them with unique opportunities to share such infor mation. Findings show that providing health education on FGM/C to patients and/or parents during consultations is part of HCP.
It is striking to see that the preventive role of HCP is highly underused in countries of origin. Several studies have identified numerous challenges to the involvement of HCP, particularly in countries of origin, some HCP support FGM or consider it as a sensitive issue and consequently resist working against the practice. This resistance is further aggravated by a high workload and the lack of skills to adequately address FGM.
The WHO, however, condemns the medicalization as it is considered a perpetuation and legitimization of a harmful practice that counteracts efforts towards its abandonment
Another area for improvement is the systematic use of FGM codes in medical records. Records serve many central purposes such as providing an overview of the management of a particular disease monitoring and improving quality of care, and providing robust databases for research. Data on FGM/C in most medical records has so far been negligible for several reasons including lack of codes on FGM
Finally, routines and guidelines should be put in place to ensure the availability of FGM/C codes, particularly in countries of origin, and their systematic use in medical records in all countries.
At this point, I will end the presentation to give room for questions and contributions from participants. Thank you all for reading our tweets
[BCM1]I don’t understand
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[BCM3]World Health Assembly (WHA)