Today, 25th June 2019, the UNICEF Nigeria supported Facebook conference will discuss the topic on “Ending FGM through Strategic partnership with key sectors such as Health, Education, and Law Enforcement”. This Facebook conference is part of a multidisciplinary approach to eliminate the harmful practice of Female Genital Mutilation (FGM) in this generation in line with the global goals.

This Facebook Event will last from 5pm-7pm Nigerian time (GMT +1).  I will attend to your questions and contributions from 6:31 to 7:00pm.  Please feel free to share the event or tag your friends to participate.

For the sake of those joining us for the first time, I shall present a brief overview of Female Genital Mutilation (FGM).  

Female Genital Mutilation (FGM) is defined, by the World Health Organization (WHO), as “all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for nonmedical reasons”. The term FGM is preferred by WHO and United Nations in order to convey the irreparable physical and psychological damage done to girls and women.  

In 1997, World Health Organization (WHO) classified FGM into four types, namely, Type I (Clitoridectomy); Type II (Excision); Type III (Infibulation); and Type IV (Unclassified).  These types, which were further subdivided in 2008 by WHO, are all practiced in Nigeria.  The four Types of FGM and their subtypes are described in 7a-d.  

FGM Type I: partial or total removal of the clitoris and/or the prepuce (Clitoridectomy).  

Subdivisions of FGM Type I are: FGM Type Ia, removal of the clitoral hood or prepuce only and FGM Type Ib, removal of the clitoris with the prepuce.

FGM Type II: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).

Subdivisions of FGM Type II are:  IIa, removal of the labia minora only; IIb, partial or total removal of the clitoris and labia minora; and IIc, partial or total removal of the clitoris, labia minora and labia majora.

FGM 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).

Subdivisions of FGM Type III are: FGM Type IIIa, removal and apposition of the labia minora; and FGM Type IIIb, removal and apposition of the labia majora.

Reinfibulation is covered under this definition. This is a procedure to recreate an infibulation, for example after childbirth when defibulation is necessary.

Type IV: unclassified – All other harmful procedures to the female genitalia for non-medical purposes.  It includes:

  • Piercing or incision of clitoris and/or labia.
  • Cauterisation by burning of clitoris and surrounding tissues;
  • Scraping (angurya cuts) of the vaginal orifice or Cutting (gishiri cuts) of the vagina;
  • Introduction of corrosive substances into the vagina to cause bleeding or Herbs into the vagina with the aim of tightening or narrowing the vagina.

FGM Type IV also includes the practice of “massaging” or applying petroleum jelly, herbal concoctions or hot water to the clitoris to desensitize it or pushing it back into the body, which is common in many parts of Nigeria, especially Imo State.

It is estimated that over 200 million girls and women worldwide are living with or at risk of suffering the associated negative health consequences of FGM. Every year 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 procedure of FGM 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. FGM has no known health benefits. Moreover, the removal of or damage to healthy genital tissue interferes with the natural functioning of the body and may cause immediate and long-term health consequences.  

The “Immediate & Short term complications” of FGM are 1) severe pain and injury to tissues; 2) haemorrhage (bleeding); 3) haemorrhagic shock; 4) infection and septicaemia; 5) genital tissue swelling; 6) acute urine retention; and 7) fracture of bones.

The “long-term complications of FGM” are 1) chronic vulvar pain; 2) clitoral neuroma; 3) reproductive tract infections; 4) menstrual problems; 5) urinary tract infections; 6) painful or difficult urination; 7) epidermal inclusion cysts; and 8) keloids.  

In 2006, WHO study group analysed the obstetric risks associated with FGM and concluded that women living with FGM are significantly more likely than those who have not had FGM to have adverse obstetric outcomes such as 1) Caesarean section; 2) Postpartum haemorrhage (Postpartum blood loss of 500 ml or more); 3) Episiotomy; 4) Prolonged labour); 5) Obstetric tears/lacerations; 6) Instrumental delivery; 7) Difficult labour/dystocia; 8) Extended maternal hospital stay; 9) Stillbirth and early neonatal death; and 10) Infant resuscitation at delivery.

Given that some types of FGM involve the removal of sexually sensitive structures, including the clitoral glans and part of the labia minora, some women may experience the following 1) Dyspareunia (pain during sexual intercourse); 2) Decreased sexual satisfaction; 3) Reduced sexual desire and arousal; 4) Decreased lubrication during sexual intercourse; 5) and Reduced frequency of orgasm or anorgasmia. 

For many girls and women, undergoing FGM can be a traumatic experience that may leave a lasting psychological mark and cause a number of mental health problems, which include 1) Post-traumatic stress disorder (PTSD); 2) Anxiety disorders; and 3) Depression.

The practice of FGM is prevalent in 30 countries in Africa and in a few countries in Asia and the Middle East, but also present across the globe due to international migration  

FGM is practiced for a variety of sociocultural reasons, varying from one region and ethnic group to another. The primary reason is that it is part of the history and cultural tradition of the community.

In many cultures, FGM constitutes a rite of passage to adulthood and is also performed in order to confer a sense of ethnic and gender identity within the community. In many contexts, social acceptance is a primary reason for continuing the practice.

Other reasons for practicing FGM include safeguarding virginity before marriage, promoting marriageability (i.e. increasing a girl’s chances of finding a husband), ensuring fidelity after marriage, preventing rape, providing a source of income for circumcisers, as well as aesthetic reasons (cleanliness and beauty).

Some communities believe that FGM is a religious requirement, although it is not mentioned in major religious texts such as the Koran or the Bible.

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.  These include 1) Principles of equality and non-discrimination on the basis of sex; 2) Right to life (when the procedure results in death); 3) Right to freedom from torture or cruel, inhuman or degrading treatment or punishment; and 4) Rights of the child.  Therefore, FGM has to be eliminated.  

When FGM is conducted by healthcare providers this is also known as the “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”.

Healthcare providers who agree to perform FGM are violating the fundamental medical ethical principle or duty of non-maleficence (“do no harm”) and the fundamental principle of providing the highest quality health care possible. 

FGM remains widespread in Nigeria with regional and ethnic variations in prevalence. 

According to the Multiple Indicator Cluster Survey (MICS 2016 -2017), 18.4% of women aged 15-49 years had undergone FGM, a decrease from 27% in 2011.  The decrease was also observed in the five states where the UNFPA-UNICEF Joint Programme on FGM Elimination (UNJP) is working, namely, Ebonyi: 62.3 % to 43.2%; Ekiti: 66.2% to 62.6%; Imo: 58.4% to 51.6%; Osun: 73.4% to 67.8 %; and Oyo: 71% to 55%).

According to the MICS (2016-2017), the FGM prevalence among daughters aged 0-14 years increased from 19.2% (in 2011) to 25.3% (in 2016-2017).  In the five UNJP intervention states, FGM prevalence decreased in three States, namely, Ebonyi (6.4% to 5.2%), Imo (33.4% to 22.2%), and Oyo states (32.9% to 29.6%). While, a slight increase was seen in Ekiti (40.3% to 41.7%) and Osun (33.4 to 34.6%). 

According to the MICS (2016-2017), 21.6% of women surveyed were in support of the continuation of FGM, a very slight decrease from 21.8% in 2011.  In the five UNJP intervention states a decrease was observed in Ebonyi (11.8% to 3.8%) and Ekiti (50.2% to 31.4%); while an increase was seen in Imo (27.8% to 29.6%); Oyo: (21.2% to 30.3%); Osun: (34.8% to 38.5%).

For more information about FGM you can visit http://www.who.int and www.endcuttinggirls.org  or watch https://www.youtube.com/watch?v=f0-dYD9cYKo&t=80s

Now let us talk about “Ending FGM through Strategic partnership with key sectors such as Health, Education, and Law Enforcement”   

FIRST LET US DISCUSS PARTNERSHIP WITH THE HEALTH SECTOR:

Research suggests that there are several ways to win health care professionals’ support as allies in FGM abandonment efforts having in mind their programmes and organizational structures. 

  1. 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.
  2. 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.
  3. Second, these 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.
  4. Health professionals’ associations and health regulatory agencies should have clear guidelines and standards for providers that outline the sanctions on those who perform FGM. 
  5. These organizations should also offer opportunities for health care professionals to contribute to community efforts to promote the abandonment of the practice.
  6. Community health outreaches should include sensitization of the people on the dangers of Female Genital mutilation on the health of girls and women. 
  7. Health-care providers should be equipped with the reasons why FGM should not be performed by health-care providers and how to resist requests to do so from parents;
  8. Health-care providers should be equipped with how to recognize and manage complications of FGM, including suitable obstetric care; and how to counsel women and families on FGM-related issues.
  9. Guidelines should be in place, including medical, ethical and legal information, such as how to counsel and care for girls and women who have undergone FGM, including counselling against reinfibulation. 
  10. Deeply rooted discriminatory norms and practices that underlie FGM, including sexual concerns and eventual religious underpinnings, should be addressed, where relevant, when designing training programmes and developing protocols. 
  11. Necessary actions in this area are: appropriate national authorities should develop national guidelines for various health-care providers on how to deal with issues related to FGM, including how to care for complications and on how to resist pressure to perform any form of FGM, including reinfibulation.
  12. Training modules on FGM for inclusion in pre-and in-service curricula and training, including refresher courses and updates for all health-care providers, should be developed including nurses, midwives, medical doctors and other health outreach workers.
  13. Training of health-care providers should be integrated at the community level with other community-based activities promoting the abandonment of FGM.
  14. Health-care providers should be informed without delay about human rights and ethical perspectives as well as the harmful consequences of FGM, and that performing FGM, including reinfibulation, would give rise to civil and criminal liability.
  15. Appropriate ethical guidelines on FGM should be incorporated into the training curricula of health-care providers.
  16. The Ministry of Health and professional regulatory bodies should issue a joint policy statement against FGM.
  17. The application of existing laws and policies should address the role health-care providers play in the elimination of FGM and forbid the performance of any type of FGM, including reinfibulation.
  18. Licensed health-care practitioners must be subject to the maximum available criminal penalties that apply to anyone performing FGM. Offending practitioners may be suspended or their licences withdrawn if they perform FGM.
  19. Strengthen monitoring, evaluation and accountability Monitoring and evaluation are essential for improving health-care providers’ approaches to FGM and for refining plans to promote abandonment of the practice.

SECOND, LET US REVIEW HOW TO PARTNER WITH THE EDUCATION SECTOR

  1. Addressing a complex issue such as FGM in a way that will bring about sustainable change requires a comprehensive and context-sensitive response involving many and varied education organizational structures .
  2. Coordination across all levels is needed to understand the perspectives of these different structures, what constrains and enables them to act, and what support, training and resources they need.
  3. It is clear from previous research undertaken by @28TooMany that the inclusion of FGM education in schools is an essential element in addressing the issue.
  4. This view is also reflected in other studies; for instance, a survey of secondary-school teachers in North Central Nigeria (2015) put forward the opinion of the participating teachers that awareness of FGM and its implications should be taught in schools (Adeniran et al, 2015).
  5. In the education sector, there are also different union and associations that sees to the overall development of teachers.  Some of these unions and association includes: Teachers Union, International School Educators of Nigeria, and Association of Christian Schools International.
  6. Teachers’ union is one important structure to partner with in the education sector to end FGM in Nigeria.
  7. Teachers’ union represent the collective of teachers as employees. As such, they have strong legitimacy among teachers and play a key role in setting the standards, codes of conduct and practice, and employment terms of teachers.
  8. As teachers play a key role in preventing and responding to FGM, teaching unions can support their members to access appropriate training and support on FGM, raise awareness about FGM and advocate at a national policy level.
  9. Teachers’ unions are therefore key partners in both changing teachers’ behaviours and experiences and in looking at the wider system of education to strengthen support, capacity and readiness to address FGM.
  10. With growing pressure on teachers worldwide to measure progress in more limited ways, such as enrolment, attendance or learning outcomes, teacher report that the well-being and wider development of learners can be sacrificed (UNAIDS IATT, 2015).
  11. Working with teachers’ unions can help education systems to give teachers the mandate to better promote students’ social and emotional well-being and create safer learning environments to this end.
  12. Teachers’ unions should be involved in raising awareness of FGM among their members, producing tools and materials and training teachers. 
  13. The Federal and State Ministries of Education could do more to support teachers to address FGM by reviewing the school curriculum to accommodate FGM and other harmful practices affecting the wellbeing of children. 
  14. The Federal and State Ministries of Education (F/SMOE) could, for example, provide better and more training, professional guidance, stronger teacher resources, as well as clear written codes of conduct and ethics on FGM and harmful practices. 
  15. Work is also being done by various NGOs in Nigeria to ensure that FGM education is included in school curricula. The Girls’ Power Initiative provides information for adolescent girls both in their centres and by conducting lessons in selected schools. This outreach programme aims to educate girls on gender and reproductive-health issues, including issues around Gender Based Violence and FGM, and aims to train teachers to further this work by continuing lessons and running GPI clubs in their schools (GPI, 2016).
  16. The Centre for Healthcare and Economic Empowerment for Women and Youth (CHCEEWY) also attempts to advance FGM education in the school curriculum in Plateau, Benue and Enugu States, where it operates. In partnership with others, it trains teachers to deliver the Family Life and HIV Education and Family Life and Emerging Health Issues programmes, which are approved by the Federal Government. @28Toomany  
  17. The formation of clubs in schools to continue this education is proving successful and being supported by a number of international donors such as Oxfam (CHCEEWY, 2016). @28Toomany
  18. The Child Health Advocacy Initiative (CHAI) advocates for more FGM education in schools and through clubs in Lagos, Osun, Ekiti, and Ogun States, where it works. @28Toomany 
  19. The Center for Social Value and Early Childhood Development (CESVED) also raises awareness in schools and holds workshops for school head-teachers in Cross River State (Augustine, 2016).  @28Toomany
  20. Currently, The UNCEF-UNFPA Joint Programme is building the capacity of in and out of school girls with life skills that will enable them resist any form of FGM and educate their peers and family members on the consequences of the practice.
  21. In Nigeria, FGM has, finally being included being included in the Junior Secondary School (JSS 3) Curriculum. It is under Social Studies (Sub-Theme Culture and Social Values), and the topic on FGM is treated under the harmful traditional practices.
  22. In Nigeria, FGM has also being included being included in the Curriculum for Out of School Boys and Girls. FGM is treated under the harmful traditional practices.

THIRD, LET US REVIEW HOW TO PARTNER WITH THE LAW ENFORCEMENT AGENCIES

  1. To best address the issue of FGM, the law enforcement (@PoliceNGR) should work as part of a broader multi-sectoral approach.
  2. As part of this interagency approach, law enforcement (@PoliceNGR should “be educated about violence against women and girls and be trained on how to appropriately intervene in cases of violence against women and girls.”
  3. @PoliceNGR and other Law enforcement agencies such as Nigeria Security and Civil Defence Corps (NSCDC) should include FGM as part of their in service training programmes for officers.
  4. The @PoliceNGR should ensure that their officers at different organizational structures are well equipped with information on how best to handle FGM cases when brought to their table. Establishing gender desks alone are insufficient; there should be routine technical/training support to designated officers on enforcing the law without compromising the safety of informants, or undermining the cultural sensitivities of the people.
  5. Nigeria’s Violence Against Persons (Prohibition) (VAPP) Bill was signed into Law on 28th May 2015 as the VAPP Act. The legislation contains provisions banning various forms of gender-based violence, including FGM. The VAPP Act 2015 law criminalizes “harmful traditional practices,” a term defined broadly to include FGM. This includes “all traditional behaviour, attitudes and/or practices, which negatively affect the fundamental rights of girls and women (VAPP Act 2015). Any person who performs FGM, engages, incites or abets another person to carry out FGM is on conviction, subject to a punishment of 4 years imprisonment or a fine of NGN200,000 (VAPP Act 2015). An attempt to commit any form of FGM on conviction be liable to a punishment of 2 years imprisonment or a fine NGN100,000 (VAPP Act 2015).
  6. Various states in Nigeria has domesticated the VAPP Act 2015 and in states where the it is yet to be domesticated, the Child Rights Law (CRL) and other anti-FGM laws still prohibits the practice of FGM. The VAPP Act 2015 and other laws against FGM empower the Law enforcement Agencies in Nigeria (Police, NSCDC, etc.) to arrest any individual involved in the practice of FGM.
  7. @PoliceNGR should make it easy for community members and other stakeholders to report suspected cases of FGM, and ensure that the reporter’s identity is not revealed to the public.
  8. Having in mind the organizational structure of the @PoliceNGR, the Community stakeholders should have a good working relationship with the closest police station in other to report cases of FGM.
  9. During community dialogue sessions, @PoliceNGR can be invited too to speak about the laws prohibiting the practice of FGM, its provisions and how cases can be reported to them.
  10. FGM Community surveillance team should also work closely with law enforcement agencies (Police, NSCDC, etc.) at the community or village level to effectively track down new cases of FGM.
  11. Often times, FGM survivors, those at risk and witnesses cannot report to the police directly for fear of social backlash.  Anti-FGM Advocates should be available to provide the cloak of anonymity by receiving the information and sharing with law enforcement. For advocates to be able to do this, they must be committed, trustworthy and reliable. Law enforcement will take advocates serious if their information is credible and devoid of malice. So they must ensure the credibility of the information received. Also, the members of the community must trust us to keep their confidentiality, and trust that we will take prompt steps to when aware of a threat. Advocates and Community stakeholders must also follow up on cases and reports that the law enforcement agencies are handling.
  12. We must appreciate the fact that the work of policing is an onerous one. The officers can get overwhelmed by a heavy workload.  Following up constantly helps to ensure that cases don’t fall through the cracks. When a FGM case is taken to court, advocates and community stakeholders need to be there too to provide both moral and technical support to the prosecutors and the FGM survivors.

In conclusions, partnership with key sectors such as Health, Education and law Enforcement is required to accelerate the elimination of FGM given the structure, system and personal available within these sectors to provide FGM prevention, protection and care services to women and girls in Nigeria.