PURPOSE OF REVIEW: Female genital cutting/mutilation (FGM/C) performed by health care professionals (medicalization) and reduced severity of cutting have been advanced as strategies for minimizing health risks, sparking acrimonious ongoing debates. This study summarizes key debates and critically assesses supporting evidence. RECENT FINDINGS: While medicalization is concentrated in Africa, health professionals worldwide have faced requests to perform FGM/C. Whether medicalization is hindering the decline of FGM/C is unclear. Factors motivating medicalization include, but are not limited to, safety concerns. Involvement of health professionals in advocacy to end FGM/C can address both the supply and demand side of medicalization, but raises ethical concerns regarding dual loyalty. Ongoing debates need to address competing rights claims. SUMMARY: Polarizing debates have brought little resolution. We call for a focus on common goals of protecting the health and welfare of girls living in communities where FGM/C is upheld and encourage more informed and open dialog.
BACKGROUND: For the last decades, the international community has emphasised the importance of a multisectoral approach to tackle female genital mutilation (FGM/C). While considerable improvement concerning legislations and community involvement is reported, little is known about the involvement of the health sector. METHOD: A mixed methods approach was employed to map the involvement of the health sector in the management of FGM/C both in countries where FGM/C is a traditional practice (countries of origin), and countries where FGM/C is practiced mainly by migrant populations (countries of migration). Data was collected in 2016 using a pilot-tested questionnaire from 30 countries (11 countries of origin and 19 countries of migration). In 2017, interviews were conducted to check for data accuracy and to request relevant explanations. Qualitative data was used to elucidate the quantitative data. RESULTS: A total of 24 countries had a policy on FGM/C, of which 19 had assigned coordination bodies and 20 had partially or fully implemented the plans. Nevertheless, allocation of funding and incorporation of monitoring and evaluation systems was lacking in 11 and 13 of these countries respectively. The level of the health sectors' involvement varied considerably across and within countries. Systematic training of healthcare providers (HCP) was more prevalent in countries of origin, whereas involvement of HCP in the prevention of FGM/C was more prevalent in countries of migration. Most countries reported to forbid HCP from conducting FGM/C on both minors and adults, but not consistently forbidding re-infibulation. Availability of healthcare services for girls and women with FGM/C related complications also varied between countries dependent on the type of services. Deinfibulation was available in almost all countries, while clitoral reconstruction and psychological and sexual counselling were available predominantly in countries of migration and then in less than half the countries. Finally, systematic recording of FGM/C in medical records was completely lacking in countries of origin and very limited in countries of migration. CONCLUSION: Substantial progress has been made in the involvement of the health sector in both the treatment and prevention of FGM/C. Still, there are several areas in need for improvement, particularly monitoring and evaluation.
R. Elise B. Johansen, Mai Mahgoub Ziyada, Bettina Shell‐Duncan et al.
BACKGROUND: Female genital mutilation (FGM) and its impact on women's health are becoming relevant in Australia due to increases in numbers of refugees and migrants from affected countries. Notwithstanding the psychological trauma from FGM, there is a broad range of sequelae relevant to obstetrics and gynaecology, particularly related to maternal morbidity from labour and delivery. AIMS: To assess the prevalence of FGM in our unit and document its effect on maternal and neonatal outcomes. METHODS: Retrospective cohort study of women affected by FGM who delivered at a metropolitan hospital in Sydney over a five-year period. The primary outcome was mode of delivery and secondary outcomes addressed maternal morbidity and neonatal nursery admission compared with women unaffected by FGM. RESULTS: A full data set was available for 141/142 women affected by FGM. The overall prevalence of FGM was 1.64%. The majority of women affected by FGM were documented to have FGM 3 (41.1%). There was no difference in caesarean section rate. Women with FGM were less likely to be delivered by vacuum or forceps (11.1% vs 2.8%; P = 0.0009). There was no difference in perineal trauma, postpartum haemorrhage and neonatal nursery admission. Women with FGM 3 were more likely to have an episiotomy (4.8% vs 25.9%; P = 0.0007) without an increase in anal sphincter injury (P = 0.7). Documentation complying with local policy and guidelines was poor. CONCLUSIONS: FGM is increasingly common in Australia. This study adds to the Australian literature quantifying the effects on obstetric outcomes in these high-risk women.
INTRODUCTION: The impact of female genital mutilation/cutting on obstetric outcomes in high-income countries is not clear. In general, women with female genital mutilation/cutting type 3 (infibulation) seem to be most at risk of adverse outcomes such as cesarean section. Deinfibulation is recommended to prevent obstetric complications. Whether the timing of this procedure affects the complication risk is not known. The aims of this study were, first, to examine the association between female genital mutilation/cutting and the risk of cesarean section in Norway, and, second, whether the timing of deinfibulation affected the cesarean section risk. MATERIAL AND METHODS: This was a historical cohort study of nulliparous Somali-born women who gave birth in Norway between 1990 and 2014. The Medical Birth Registry of Norway identified the women. Data were collected from medical records at 11 participating birth units. The exposures were female genital mutilation/cutting status and deinfibulation before pregnancy, during pregnancy, or no deinfibulation before labor onset. The main outcome was odds ratio (OR) of cesarean section. Type of cesarean section, primary indications, and neonatal outcomes were secondary outcomes. RESULTS: Women with female genital mutilation/cutting type 3 had lower risk of cesarean section compared with women with no female genital mutilation/cutting (OR 0.54, 95% CI 0.33-0.89 P = .02). Among the 1504 included women, the cesarean section rate was 28.0% and the proportion of emergency operations was 92.9%. Fetal distress was the primary indication in approximately 50% of cases, across the groups with different female genital mutilation/cutting status. Women who had no deinfibulation before labor onset had lower risk of cesarean section compared with those who underwent deinfibulation before or during pregnancy (OR 0.64, 95% CI 0.46-0.88 P = .01). CONCLUSIONS: High risk of cesarean section in Somali nulliparous women was not related to the type of female genital mutilation/cutting in the present study. Deinfibulation before labor did not protect against cesarean section. Our findings indicate that nulliparous Somali women are at high risk of intrapartum complications. Future research should focus on measures to reduce maternal morbidity and on how timing of deinfibulation affects the outcomes of vaginal births.
Introduction: Any non-medical intentional alteration or causes injury to female genital is termed female genital mutilation (FGM). FGM typically performed on young girls between infancy and 15-year-olds. World Health Organization classified FGM into 4 types based on the extend of cutting. Herein, we would like to share a case of a young patient presented with acute urinary retention(AUR) secondary to scarred tissue from an un-intentional Type 3 FGM since young. Case: A healthy 20-year-old nulliparous lady presented with AUR. She has reached menarche at 15-years-old with normal menses flow and currently on day 1 of menses. Her abdomen was soft with palpable bladder. External genitalia examination revealed a fused labia majora with a small holes sizing 0.5cm, unable to visualize urinary meatus. Bedside ultrasound showed haematocolpos measuring 7x9cm. Proceeded with examination under anesthesia revealed scarred tissue extending from clitoris to 4cm above anus with fused labia majora. Separation of the fused labia majora was done however there were absence of clitoris and labia minor. History from patient’s mother, patient was circumcised at 2-months-old by local midwife. It was believed that during the procedure unintentional FGM type 3 was performed. Discussion: At least 200 million women living today worldwide had undergone FGM, however knowledge of FGM is limited among healthcare workers because there are no clinical guidelines that are specifically focused on occurrence of FGM; its recognition, complications and management options. FGM is performed by traditional circumciser, and often leads to early and late complications physically and psychologically. Complication rates vary according to the type of FGM performed and more frequently seen with Type3 FGM. Our patient most probably underwent Type3 FGM which complicated with scarring; this leads to formation of hematocolpus, which subsequently caused AUR owing to the pressure effect to the bladder and urethra. Treatment of FGM Type3 is by de-infibulation. It involves incising the fused labia minora to restore the introitus. Conclusion: FGM might not be an everyday occurrence, awareness should be created in order to built a more respectful and cultural sensitive approach when dealing with the physical and psychological consequences of these patient
Abstract: Female genital mutilation or female circumcision is a global public health problem. It is recognized as a gender based violence which affects millions of girls and women’s health. It is estimated to be the longest female violence practice in the World. Tanzania is among thirty African countries which practicing female circumcision. This study aimed to investigate factors that hindering the initiatives of ending female genital mutilation practice in Tanzania. The study used literature sources, document analysis and observation method to collect relevant information which used to generate the results and conclusion of this study. Results revealed that, social-cultural factors, economic factors, patriarchal factors, religious factors and lack of education and knowledge on the negative effects of the female circumcision, have a strong link with the long persistence of the practice, hence hindering the initiatives of ending female genital mutilation in the society. The study disclosed the current challenges facing female circumcision fighters, thus, the study suggested the sustainable intervention which will assist to close the female genital mutilation chapter globally.
While international and regional human rights instruments have recognized female genital mutilation/cutting (FGM/C) as one of the most prevalent forms of violence against women and girls, in many African states FGM/C is a deeply entrenched cultural practice. There is a consensus against FGM, as evidenced by its criminalization in several African countries. The mere fact that the practice continues despite legislative measures to protect women and girls against FGM raises the question of whether change can be legislated. The present article summarizes the trends and effectiveness of FGM criminalization in Africa, including prohibition of medicalization of FGM. Against the backdrop of emerging debate on medicalization of FGM as a harm reduction strategy, we also examine its complex legal and ethical implications. The article argues that while criminalization may not be the best means of stopping FGM, it creates an enabling environment to facilitate the overall strategy of African governments in eradication of the practice.
OBJECTIVES: Describe cases of female genital mutilation (FGM) presenting to consultant paediatricians and sexual assault referral centres (SARCs), including demographics, medical symptoms, examination findings and outcome. DESIGN: The well-established epidemiological surveillance study performed through the British Paediatric Surveillance Unit included FGM on the monthly returns. SETTING: All consultant paediatricians and relevant SARC leads across the UK and Ireland. PATIENTS: Under 16 years old with FGM. INTERVENTIONS: Data on cases from November 2015 to November 2017 and 12 months later meeting the case definition of FGM. MAIN OUTCOME MEASURES: Returns included 146 cases, 103 (71%) had confirmed FGM and 43 (29%) did not meet the case definition. There were none from Northern Ireland. RESULTS: The mean reported age was 3 years. Using the WHO classification of FGM, 58% (n=60) had either type 1 or type 2, 8% (n=8) had type 3 and 21% (n=22) had type 4. 13% (n=13) of the cases were not classified and none had piercings or labiaplasty. The majority, 70% had FGM performed in Africa with others from Europe, Middle East and South-East Asia. There were few physical and mental health symptoms. Only one case resulted in a successful prosecution. CONCLUSIONS: There were low numbers of children presenting with FGM and in the 2 years there was only one prosecution. The findings may be consistent with attitude changes in FGM practising communities and those at risk should be protected and supported by culturally competent national policies.
Deborah Hodes, Najette Ayadi O’Donnell, Karina Pall et al.
Background: Female Genital Mutilation/Cutting is an ancient cultural practice, predating the Bible and therefore the Koran, and has no basis in any religion. It is related to deep social and cultural ideas impeded in several societies regarding femininity and modesty because it is viewed as girls clean and delightful only after being genitally cut. FGM/C is additionally viewed as a protection of virginity, and it prevents premarital sex. Aim: The present study was carried find out to assess Females' Intention in Northern Upper Egypt regarding Female Genital Mutilation. Subject & Methods: A Descriptive Cross-sectional study was used. The study was conducted in family health centers (FHCs) in different sitting at Beni-Suef Governorate. A Convenient sample was used. А Structured Interviewing Questionnaire sheet which includes three sections: Socio-demographic data, Intention to practice FGM/C, and Causes for intention or not to practicing FGM/C. Results: The mean age of the studied participants was 22.6±5. Prevalence of Female Genital Mutilation is 71.4percentage, 29.7percentage of participants are suffering from complications after FGM. About 28.6percentage of females who had mutilated their daughters were planning to mutilate their other daughters in the future. More than one-third of females (35.5percentage) had an unfavorable attitude and 40.5percentage had poor levels of knowledge regarding FGM/C. 71.3percentage of females mentioned that the source of their information about FGM/C was their personal experience. Conclusion: Northern Upper Egyptian Females' Intention regarding intention of mutilating their daughters was significantly affected by demographic characteristics, level of knowledge, and level of attitude, source information, exposure to complications or pressure from family and neighbors. Recommendations: Alleviate females' intention toward Female Genital Mutilation should be improving their awareness regarding complications and Egyptian law against FGM, established by improve females' resistance toward family or neighbor regarding bad and harmful traditions.
Female Genital Mutilation is a human rights violation that is practised in India. The Bohra community uses it extensively. FGM/C is thought to be practised for non-medical or cultural reasonsas well as to protect a women virginity before marriage by limiting her enjoyment of intercourse and to deter her from becoming disloyal to her husband after marriage. Hence, FGM/C not only violates the right to life and dignitybut it also clearly violates the right to equality based on gender. The intent, purpose and impact of male and female circumcision are all distinct resulting in gender discrimination.Thus, it is pertinent to note that such cruelty is prevalent in India with female children aged 1 to 15 years being victims of Female Genital Mutilation.
