Fe­male gen­i­tal mu­ti­la­tion: Why healthcare providers should not do the ‘cut’

Sunday Trust - - NEWS HEALTH - By Ojoma Akor

The lit­tle in­fant cried end­lessly as the nurse ap­plied pow­der to her gen­i­tal, and kept press­ing it hard. Fi­nally, she used a blade to re­move part of it.

The baby’s mother had gone to a nurse to per­form the pro­ce­dure be­cause she be­lieved it was more hy­gienic and safer.

Twenty-five-year old Amina hails from the North-East of the coun­try where fe­male gen­i­tal mu­ti­la­tion is prac­ticed. She re­called a med­i­cal doc­tor telling some women and girls dur­ing a so­cial gath­er­ing that since the type of fe­male gen­i­tal mu­ti­la­tion in their cul­ture in­volves ‘just cut­ting a bit of the cli­toris,’ that it was okay for them to do it but that they should meet a qual­i­fied health pro­fes­sional to do it for them.

She said this ad­vice gave some women at the gath­er­ing con­fi­dence that it is okay to con­tinue the prac­tice to ful­fill cul­ture so long as it is done ‘prop­erly’ by a health per­son­nel.

As more voices and ef­forts rise against fe­male gen­i­tal mu­ti­la­tion, more peo­ple are now aban­don­ing the ser­vices of tra­di­tional cir­cum­cis­ers for med­i­cal and other al­lied health pro­fes­sion­als.

Some par­ents go to the hos­pi­tal or meet healthcare providers in their homes to do it for their chil­dren.

Experts have said that that since fe­male gen­i­tal mu­ti­la­tion has no ben­e­fits for women and girls, there is no need to do it, whether in bits or full, and that healthcare providers should not be in­volved in the prac­tice.

They said that fe­male gen­i­tal mu­ti­la­tion has short and long term neg­a­tive ef­fects even when done by health pro­fes­sion­als, and that med­i­cal­iza­tion of fe­male gen­i­tal mu­ti­la­tion frus­trates ef­forts to end the prac­tice for good.

They experts added that healthcare providers who en­cour­age or par­tic­i­pate in fe­male gen­i­tal mu­ti­la­tion even in in hos­pi­tal set­tings are con­tribut­ing to the neg­a­tive ef­fects of the prac­tice on women in Nige­ria.

The experts also called for sanc­tions against erring med­i­cal per­son­nel in the coun­try.

Ac­cord­ing to the World Health Or­gan­i­sa­tion (WHO), fe­male gen­i­tal mu­ti­la­tion (FGM) com­prises all pro­ce­dures that in­volve par­tial or to­tal re­moval of the ex­ter­nal fe­male gen­i­talia, or other in­jury to the fe­male gen­i­tal or­gans for non-med­i­cal rea­sons.

WHO strongly urges health pro­fes­sion­als not to per­form such pro­ce­dures. “While the prac­tice is mostly car­ried out by tra­di­tional cir­cum­cis­ers, in many set­tings, healthcare providers per­form fe­male gen­i­tal mu­ti­la­tion due to the er­ro­neous be­lief that the pro­ce­dure is safer when med­i­cal­ized.,” it said.

Fe­male gen­i­tal mu­ti­la­tion is clas­si­fied into four ma­jor types, the first type called cli­toridec­tomy in­volves the par­tial or to­tal re­moval of the cli­toris. The sec­ond type; re­ferred to as ex­ci­sion, in­volves the par­tial or to­tal re­moval of the cli­toris and the labia mi­nora (the in­ner folds of the vulva). The third type called in­fibu­la­tion in­volves the nar­row­ing of the vagi­nal open­ing through the cre­ation of a cov­er­ing seal. The seal is formed by cut­ting and repo­si­tion­ing the labia mi­nora, or labia ma­jora (the outer folds of skin of the vulva), some­times through stitch­ing, with or with­out re­moval of the cli­toris, ac­cord­ing to WHO. This al­lows only a small hole for uri­nat­ing and men­strual bleed­ing. The wo­man or girl may later be de­in­fibu­lated, that is cut­ting open the sealed vagi­nal open­ing to al­low in­ter­course and child­birth.

The last type in­cludes all other harm­ful pro­ce­dures to the fe­male gen­i­talia for non-med­i­cal pur­poses, such as prick­ing, stretch­ing, pierc­ing, in­cis­ing, scrap­ing and cau­ter­iz­ing or in­sert­ing herbs in the gen­i­tal area. Some ef­fects of fe­male gen­i­tal mu­ti­la­tion in­clude, uri­nary prob­lems, sex­ual prob­lems, in­fer­til­ity, in­fec­tions, se­vere pain, ma­ter­nal death, psy­cho­log­i­cal prob­lems, and death.

The five states with the high­est preva­lence of fe­male gen­i­tal mu­ti­la­tion in the coun­try are: Osun, Oyo, Ek­iti, Imo and Ebonyi.

Ex­plain­ing med­i­cal­iza­tion of fe­male gen­i­tal mu­ti­la­tion, Dr Im­ran Bello , a gy­nea­col­o­gist, said it does not only mean healthcare pro­fes­sional per­form­ing the pro­ce­dure, but also pro­vid­ing ac­cess to equip­ment, fa­cil­ity and train­ing for those who en­gage in the act. He said some med­i­cal per­son­nel have em­pow­ered tra­di­tional birth at­ten­dants to en­gage in the prac­tice.

Dr Bello said some med­i­cal per­son­nel pro­vide anes­the­sia, or pain re­lief for the tra­di­tional ser­vice providers of fe­male gen­i­tal mu­ti­la­tion or go to peo­ple’s home to carry out the pro­ce­dure. Ac­cord­ing to him, some hos­pi­tals have also in­te­grated the prac­tice into other ex­ist­ing ac­tiv­i­ties such as im­mu­ni­sa­tion, child­birth, an­te­na­tal care, and post-na­tal care .

“Med­i­cal­i­sa­tion of fe­male gen­i­tal mu­ti­la­tion is harm­ful. It is a form of hu­man right vi­o­la­tion and child abuse, and also a med­i­cal mal­prac­tice be­cause it is against the law and of­ten­times we don’t get con­sent be­fore we do it, ”he said.

Pro­fes­sor Ola­dosu Ojengbede, the Ex­ec­u­tive Direc­tor of the Cen­tre for Pop­u­la­tion and Re­pro­duc­tive Health, Univer­sity of Ibadan said med­i­cal­iza­tion of fe­male gen­i­tal mu­ti­la­tion is a new trend in the coun­try and was fast be­com­ing wor­ri­some.

Ojengbede who is a pro­fes­sor of Gy­nae­col­ogy and Ob­stet­rics said fe­male gen­i­tal mu­ti­la­tion is a form of gen­der-based vi­o­lence which vi­o­lates the rights of women. He said med­i­cal­iza­tion of fe­male gen­i­tal mu­ti­la­tion en­cour­ages tra­di­tional prac­ti­tion­ers to con­tinue in the trade, be­liev­ing they were be­ing cheated out of their trade .

He added that cul­ture of si­lence and lack of laws in some states slows sanc­tion­ing of erring med­i­cal per­son­nel who per­form fe­male gen­i­tal mu­ti­la­tion and those that sup­port them.

He said: “It is a surgery per­formed with­out the con­sent of the per­son and preva­lent in Asia and Africa. The long and short term con­se­quences makes it im­por­tant to end the prac­tice. You can’t be telling the lo­cal or tra­di­tional peo­ple to stop the prac­tice, and you a doc­tor or nurse then be­gins to en­gage in it. By med­i­cal­is­ing it, you are rolling back the gains of stop­ping fe­male gen­i­tal mu­ti­la­tion.

“Why cut at all? There is no rea­son why this part of the wo­man’s body should be cut. There is no jus­ti­fi­ca­tion for it.We need to put a sur­veil­lance sys­tem in place at the com­mu­nity level and healthcare level. Pros­e­cu­tion is also dif­fi­cult as only 11 states have laws ban­ning fe­male gen­i­tal mu­ti­la­tion.

“We call on the Med­i­cal and Den­tal Coun­cil of Nige­ria (MDCN), mid­wives and other reg­u­la­tory bod­ies to fish out the per­pe­tra­tors. We all have to be part of the grand move­ment to stop the med­i­cal­i­sa­tion of fe­male gen­i­tal mu­ti­la­tion”

Min­is­ter of Health, Prof Isaac Ade­wole, who was rep­re­sented by Dr Kay­ode Afo­labi , Head, Re­pro­duc­tive Health Divi­sion of the min­istry at a work­shop on fe­male gen­i­tal mu­ti­la­tion re­cently said there was a wrong be­lief among the pop­u­lace that fe­male gen­i­tal mu­ti­la­tion is ac­cept­able if it is per­formed by a doc­tor, nurse or other healthcare pro­fes­sion­als.

“Fe­male gen­i­tal mu­ti­la­tion is be­ing hos­pi­tal­ized. This is a big prob­lem. Med­i­cal­iza­tion is of con­cern all over the coun­try be­cause peo­ple tend to be­lieve that once it is done by maybe a doc­tor or nurse it is jus­ti­fied. The is­sue is far beyond hy­giene or im­me­di­ate com­pli­ca­tions. It is time to com­mit re­sources, and fund­ing to end med­i­cal­i­sa­tion of fe­male gen­i­tal mu­ti­la­tion,” he said.

He said the Vi­o­lence Against Per­sons Pro­hi­bi­tion Act (VAPP) of 2015 crim­i­nalises fe­male gen­i­tal mu­ti­la­tion and any doc­tor or health pro­fes­sional caught en­gag­ing in it will be pros­e­cuted .

“The VAPP law com­pletely out­laws fe­male gen­i­tal mu­ti­la­tion of any form. Since fe­male gen­i­tal mu­ti­la­tion is out­lawed, it also cov­ers whether is done by a health provider or by a non-qual­i­fied tra­di­tional provider. It has short and long term ef­fects that is why it needs to stop. It is also an in­fringe­ment of the women who are ex­posed to such mu­ti­la­tion.”

How­ever, he added that it is a na­tional law and needs to be do­mes­ti­cated at the state level. “It is op­er­a­tional in the Fed­eral Cap­i­tal Ter­ri­tory (FCT) and a few states, other states need to do­mes­ti­cate it. There should be im­ple­men­ta­tion at ev­ery level, so that the prac­tice will be phased out in the coun­try.”

He said govern­ment was work­ing to­wards a re­view of cur­ric­u­lar of train­ing in­sti­tu­tions for health work­ers to em­pha­size that fe­male gen­i­tal mu­ti­la­tion is out­lawed, and to also link it to the is­suance of prac­tic­ing li­censes to healthcare providers.

Act­ing rep­re­sen­ta­tive of the United Na­tions Pop­u­la­tion Fund (UNFPA) Nige­ria, Dr Eu­gene Kongnyuy, said Nige­ria con­sti­tutes at least 10% of the bur­den of the fe­male gen­i­tal mu­ti­la­tion glob­ally. He added that about 13% per­cent of the prac­tice in the coun­try is done by health pro­fes­sion­als.

He said, “Out of 200 mil­lion women with fe­male gen­i­tal mu­ti­la­tion, Nige­ria ac­counts for 20 mil­lion women. Also 25% of women in Nige­ria have un­der­gone fe­male gen­i­tal mu­ti­la­tion. About 12.7 to 13% per­cent of fe­male gen­i­tal mu­ti­la­tion is ac­tu­ally done by health pro­fes­sion­als in Nige­ria; that to me is un­ac­cept­able, and the jus­ti­fi­ca­tion could be that well ‘if it is done by a med­i­cal pro­fes­sional then it is less risky. That is not a jus­ti­fi­ca­tion, there is no med­i­cal rea­son or ben­e­fits for fe­male gen­i­tal mu­ti­la­tion”.

Pres­i­dent of the In­ter­na­tional Fed­er­a­tion of Fe­male Lawyers (FIDA), Fed­eral Cap­i­tal Ter­ri­tory chap­ter, Bar­ris­ter Ikenga Ngozi, stressed the need for all states to op­er­a­tional­ize the VAPP.

She called on health pro­fes­sion­als to ad­vise par­ents and peo­ple who bring their girls to them at home for ‘cir­cum­ci­sion’ to re­ject the money, and ed­u­cate them on the im­pli­ca­tions of what they in­tend do­ing to their daugh­ters .

She also en­joined Nige­ri­ans to al­ways re­port peo­ple who en­gage in the prac­tice to ap­pro­pri­ate au­thor­i­ties.

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