A: BACKGROUND:
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 (World Health Organisation-WHO). FGM is practiced in 30 countries in Africa and in a few countries in Asia and the Middle East. 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 undergo 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.

B: CLASSIFICATION OF FEMALE GENITAL MUTILATION (FGM)?
The WHO classifies FGM into four types, with subdivisions. These are…
FGM 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.

FGM 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.

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). The subdivisions are Type IIIa. Removal and apposition of the labia minora and Type IIIb.
Removal and apposition of the labia majora.

FGM 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”.

C: WHY DO COMMUNITIES PRACTISE FGM?
FGM is practiced for a variety of sociocultural reasons, varying from one region and ethnic group to another. Some of these reasons are to:
1) Enhance Fertility
2) Respect for Tradition
3) Rite Of Passage
4) Social Convention
5) Marriageability
6) Ensure Virginity, Chastity and Faithfulness
7) Cleanliness and Beauty
8) Femininity
9) Religion.

D: 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.

According to the WHO Publication, “Care of women and girls living with FGM: a clinical handbook”, the health consequences are, broadly, grouped into Immediate & short-term physical complications as well as long-term complications (Gynaecological & urogynaecological, etc.).

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

The “long-term complications of FGM” are chronic vulvar pain; clitoral neuroma; reproductive tract infections; menstrual problems; urinary tract infections; painful or difficult urination; epidermal inclusion cysts and keloids.

The Obstetric Risks: are 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.

The Sexual Functioning Risks are 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.
Finally, the Psychological Risks are: 1) Post-traumatic stress disorder (PTSD); 2) Anxiety disorders; and 3) Depression.

Understanding that FGM/C in some culture is a norm necessitates the need for partnership with relevant stakeholder. Also, identifying the right stakeholders and engaging them successfully is pivotal to identifying the traditional rulers as custodians of culture and “gatekeepers” to the community.

Sets the tone for the partnership that can help reverse this tren. In Nigeria, traditional rulers are next to the gods. They are seen to be infallible and know what’s good for their people. The above presupposes that the Obis, Emirs and Obas can’t and won’t set their people on the wrong path. To this end, traditional rulers and their institutions have crucial roles to play if we must.
In communities around the world where people have openly declared to #EndFGM, it has been led by the traditional rulers/institutions. In 2009, traditional rulers led community members in the Upper Region, The Gambia to publicly declare abandonment of FGM. Because Nigeria is a global player, best practices around the world have been adopted so we can reduce prevalence and ultimately, incidence of FGM

This could be seen in various efforts of wives of Governors in Nigeria to ensure we EndFGM in this generation. These supports have been in collaboration with traditional rulers, village heads, community leaders and traditional institutions. One of such efforts culminated in the most recent (globally) public declaration of abandonment of FGM.

It was a milestone for us and every stakeholder working ceaselessly to This declaration which was the first in Nigeria happened on 19th June 2017 in Izzi clan comprising of 3 LGAs in Ebonyi State, after which several other public declarations had happened in states like Ekiti, Osun etc.
As mentioned earlier, it was also led by the traditional ruler and the declaration was pronounced by the custodian of culture in Izzi cla. Various collaborative efforts by traditional rulers and other stakeholders have resulted in community level dialogue. These dialogues have helped community members to speak openly about FGM/C and end the culture of silence around the practice. It must be said that the culture of silence has been of the biggest challenges in combating FG. Those that have been cut do not have the courage to share their pain. Those that are uncut don’t think it’s necessary to share their stories either.
As we all come together, in solidarity, to lend our voices and support the #endcuttinggirls campaign

The traditional rulers (institutions) remain one which can speed up our reach and aid our goals to partnering and engaging our traditional rulers would be effective when we clearly define how they can help u. Our traditional rulers can function in line with their divine roles as advocates, law makers and law enforcer. As custodians of culture, when our traditional rulers become advocates, it gives our message “divine credibility”.

Being advocates erases the doubt of whether FGM is still acceptable in such communities. As advocates, they will lead discussions in the community (always) and this banishes this culture of silence. As lawmakers, they can set up bodies that would monitor (to eradicate) the activities of cutters in their communities.

Also, introducing alternative rites of passage is within the ambit of our traditional rulers as law makers. When our traditional rulers function as law enforcers, they help ensure that community members respect the country and community’s law changing the incentives for an act helps change the perception about it.

Traditional rulers can also make uncut women community ambassadors to preach the good in leaving women uncut, by and large, to #endcuttinggirls, we must work with traditional rulers and village heads.While they lead from the front as pathfinders for their people in the campaign to #endcuttinggirls.