Female genital mutilation/cutting (FGM/C) is a procedure that involves full removal or partial removal of female genitalia, that may include damage to reproductive organs – in most cases, for non-therapeutic reasons. Though this may seem like a breach in basic human rights in the United States, it is seen in other countries around the world as an acceptable, religious-based custom that continues to define the coming of age ceremonies for young girls. Female genital mutilation currently affects approximately two-million women and girls around the world with about twenty-two percent of this population being less than fifteen years of age. Most young girls would have had the procedure performed before the age of 5 years old, which puts into question if these acts are considered a violation of human rights. FGM/C is practiced in Africa, with the highest rate of prevalence in Sudan, Egypt, Sudan and Mali. FGM/C encompasses a variety of types that are more popular in specific areas but are not necessarily standardized as a better method. The international response has continued to address the risks and long-term negative health consequences of these practices with hopes to abolish these traditions.
Even though there is continued social media presence on this topic, the practices are still continuing, and there is a fear that new policies will be put in place to keep the practices running for more years to come. Researchers and strategists have carried out various studies to access the risks and complications associated with FGM/C to bring the negative outcomes to light that these women and girls have endured. It is with these efforts that they hope in the long run will abolish these customs. Most outsiders to these customs consider FGM/C a practice with no therapeutic benefit to the women and children that have the procedure performed. In some areas, FGM/C is seen as exemplifying modesty and cleanliness for a potential mate in the future as they await marriage. FGM/C is broken up into four different types that differ in the degree of removal of female genital/reproductive organs. Type I is a clitoridectomy, which involves full or partial removal of the clitoris or skin surrounding the clitoris (Mccauley, 2018). Type II involves removal of the labia minora in addition to the clitoridectomy, with or without excision of the labia majora. Type III is infibulation, the narrowing of the vaginal opening, with or without removal of the clitoris. Lastly, Type IV encompasses all other practices to remove female genitalia or reproductive organs for non-therapeutic reasons. The meaning/purpose of FGM/C varies beyond various populations, whether religious officials or people high in power advocate for the practices is a contributing factor to how women are seen who do or do not believe in the practices. Proper and respectful healthcare for women that have been affected by FGM/C seems to be a public health issue around the world due to additional complications that these women face when having future gynecologic appointments, childbirth, wound care etc. Some of these women migrate to other areas of the world with hopes to find access to better healthcare practices, but not many protocols have been put in place to address the health needs of this specific population.
A qualitative study was performed in Spain that surveyed fourteen women that migrated from Africa to Spain, to determine the degree of impact FGM/C has had on their health and how their health care moving forward addresses their individual needs by health care professionals. The results were not surprising in that it confirmed that these women suffered various complications and psychological distress. The most important finding was the need to address the barriers that prevent health care providers from providing adequate care and the need for policies to address this issue. Overall these women have additional needs that are being overlooked by another healthcare professional. To push the message that FGM/C practices are unsanitary, dangerous, and can cause reproductive, sexual, and emotional consequences to the women/girls affected the support from healthcare providers, specifically, physicians were strongly urged to take a stance on this controversial topic (Kimani, 2018). Due to the numerous reports and public knowledge about the unsanitary conditions, medicalization has come about in order to make FGM/C seems less controversial with improved sanitary conditions and the acts being performed by licensed health care professionals. Strategists believe it’s due to families that still support FGM/C wanting the procedure performed in a more sanitary and safer environment. Medicalization is defined as a situation where a healthcare provider performs FGM/C in a healthcare facility, at home, or another area where they’re able to use surgical equipment, anesthetics, and antiseptics (Kimani, 2018). This is where ethics come into play as health care professionals are under an oath to do no harm to patients though there are numerous data that proves that FGM/C has caused women immediate and long-term harm.
It is still controversial if FGM/C is considered ‘doing harm’ especially if women and children are seeking services by these healthcare professionals. Challenges continue to prevent the abolishment of FGM including the thought of female cleanliness, cultural identity, virginity, and an expectation of men that plan to marry that woman. Additionally, FGM/C is considered a ritual that marks the beginning of womanhood and modesty. Regardless of the specific meaning, the embedded traditions of FGM/C have been passed on for centuries and poses as the main reason why there are challenges to abolish the practice. Societal norms influence these decisions as well. Women who do not agree with the traditions are typically shamed and alienated, and in some cases looked down upon by family members and other community members. Family pressures also continue to be a huge contributor to young women who may not even agree with the practices to still continue them for family support and recognition. Religion is thought to be strongly affiliated with FGM/C, which is false due to the lack of religious references that suggest the support of the procedure. Nonetheless, religious figures in various communities choose to advocate for the eradication of FGM/C, while others have a strong opinion to keep the practices going. Local community leaders have a strong voice in these communities and their influence greatly impacts the way the rest of the community views FGM/C.
Women may face multiple complications associated with the aftermath of FGM/C, whether it is physical, emotional, or sexual. More commonly this population experiences urinary incontinence, painful intercourse, recurring urinary tract infections, and complications during childbirth. Clinical data has also shown that increased inflammation over a prolonged period of time can increase the risk for various cancers (Osterman, 2018). Women in this population endure recurrent infections, inflammation, and scarring that can last for months and years if not addressed by another healthcare provider. Unfortunately, there isn’t a scientifically proven association between cervical cancer and FGM/C due to low sample size and resulting insignificant findings in previous studies. A secondary analysis that reviewed six research studies in Senegal between 1994 and 2012 that assessed FGM/C and the relationship with cervical cancer or the need for cervical treatment to try and close the gap on the association question. They found that women with Invasive cervical cancer (ICC) were 2.5 times more likely to have had FGM/C, but further examination needs to be performed to solidify associations. According to a study that surveyed 830 women of reproductive age (15-49 years), more than sixty percent of the participants undergone FGM/C with also more than sixty percent stating that it was the influence of a female figure in their life, mainly their mother. About 75 percent of the surveyed group believe that FGM/C could be stopped through widespread education due to circumcision practices being commonly done in areas with low socioeconomic status and lower educational levels (Sakeah, 2018). These findings suggest that socioeconomic status and education level in addition to traditional support from relatives and prominent figures that increase the prevalence of female genital mutilation acts occurring.
An effort to increase public awareness and show international support in the eradication of FGM/C, the United National General Assembly supported a resolution to ban FGM/C worldwide, regardless if they were performed in a healthcare facility or not. Forty additional countries agreed and joined to ban FGM/C and its medicalization. In a small percentage of these countries, healthcare providers could face a penalty or imprisonment. In addition, government officials from various countries in Sub-Saharan African have made attempts to decrease the severity of the cutting by eliminating certain types of FGM/C but resulted in increased resistance. Egypt, being a country that has a high prevalence of FGM/C, required that only health care professionals perform the procedures and put aside one day a week solely for these procedures. Senegal passed an anti-FGM legislation in 1999 that would result in 5 years of imprisonment if FGM was exercised. There have been strides overall by various countries around the world, but the urgency of abolishing these practices does not have most countries completely one board due to resistance from citizens and public figures in their communities. The most common way that multiple sources suggest could abolish FGM/C is education. Multiple journals continued to show a positive relationship between low socioeconomic status and the increased incidence of FGM/C. Though education in various populations has been executed, strategists are aware that this alone is not going to completely eradicate FGM/C. A journal that assessed the male perspective of FGM/N and what they thought are key ways to eradicate FGM/C.
“This qualitative study showed these to be the most important: sensitization and awareness building, team action, and abolition-promoting media,”. Yes, there continue to be protests around the world against FGM/C, but the strong presence declines every once in a while and isn’t a matter that remains in the face of influential politicians. Overall, female genital mutilation has brought about numerous discussions and debates regarding the morality of the practice, and the long-term health effects that women face after having these practices done from a young age. Though initiatives and policies have improved over the past couple of decades, there has not been a strong enough collective presence for a prolonged period that urges more politicians and community leaders to abolish these cultural practices. Endless amounts of research confirm that FGM/C can leave women with numerous health complications including, but not limited to prolonged inflammation/scarring, urinary tract complications, pregnancy complications, and ultimately putting them at a higher risk for infections and possibly cervical cancer. These women and children are a vulnerable group, especially in areas with the lack of educational resources, and community leaders that can lead them in a better direction. Though these efforts started in the 1940s, they must continue with a stronger presence in order to see a chance of abolishment.
