Abandonment of Female Genital Mutilation within a generation: what worked and what next?
Oto Buraimo1* and Olatunji Sonoiki2
1Brymore Public Health, Nigeria
2World Food Programme, Nigeria
Submission: February 06, 2018;Published: April 30, 2018
*Corresponding author: Oto Buraimo, Brymore Public Health, Nigeria, Email:[email protected]
How to cite this article: Oto Buraimo,Olatunji S.Abandonment of Female Genital Mutilation within a generation: what worked and what next?. Glob J
Reprod Med. 2018; 4(4): 555641. DOI:10.19080/GJORM.2018.04.555641.
Female Genital Mutilation/Cutting (FGM/C) involves the non-therapeutic partial or complete removal of external female genitalia for non-medical reasons but largely due to cultural, religious and social reasons. Besides the obvious physical agony experienced by women subjected to FGM/C, the practice of FGM/C is still endemic in about 29 countries in Africa, Asia and Middle East, and worldwide due to international migration. Over 200 million are affected, 3 million girls and women stand the risk of undergoing FGM/C annually and more recent statistics show that 15 million girls are at risk of undergoing FGM/C by 2020 in the absence of apt intervention.
An understanding of the drivers of FGM/C is an invaluable first step at ending the crisis, so we highlighted the drivers of this age-long practice and expounded creditable interventions amongst home-based and foreign-based indigenes of communities where FGM/C is highly prevalent. Subsequently, we propose that interventions must be comprehensive and holistic and context-relevant.
Keywords: Female genital mutilation/cutting; Female circumcision; Sexual and reproductive health; Harmful practices; Religious; Social reasons; Clitoridectomy; Infibulations; Psychological; Emotional scars; Chronic infection; Recurrent pains; Urination and menstruation; Obstetric complications; Sexual desire; Globalisation; Perpetuators; Marriage ability; Peulh ethnicity; Sexual morals; Health hazards; Positive reinforcement; Sensitive
Abbreviations: FGM/C: Female Genital Mutilation/Cutting; WHO: World Health Organisation.
Female Genital Mutilation/Cutting (FGM/C) also known as ‘female circumcision’ or ‘female cutting’ involves the non-therapeutic partial or complete removal of external female genitalia for non-medical reasons but largely due to cultural, religious and social reasons . The World Health Organisation (WHO) has broadly classified FGM/C into four types: clitoridectomy, excision, infibulations and other . The act remains a gross human rights violation specifically against girls and women in their early adolescence. Besides the obvious physical agony experienced by women subjected to FGM/C and death in certain cases, the act leaves detrimental lifelong psychological and emotional scars including chronic infection, recurrent pains during sexual intercourse, urination and menstruation and obstetric complications during childbirth . A systematic review of comparative studies between women with FGM/C and without FGM/C concluded that those with FGM/C are more likely experience pain during sexual intercourse and reduced sexual desire and satisfaction, which completely deprives the victims of FGM/C optimum control over their sexuality .
Although the practice of FGM/C is endemic in about 29 countries in Africa, Asia and Middle East, victims are scattered across the globe largely due to globalisation and international migration. The findings from a UNICEF led national survey in over 35 countries show that over 200 million women have undergone FGM/C, a practice which is disproportionately rife in countries like Somalia, Guinea, Djibouti and Egypt where over 90 percent of girls and women aged 15 to 49 years have undergone FGM/C at some point in their lifetime  (Figure 1). In absolute numbers, Egypt, Ethiopia, Nigeria, Sudan, Kenya and Burkina Faso account for almost 100 million (approximately 50 percent) of the entire global cases of FGD (Figure 2). Moreover, 3 million girls and women stand the risk of undergoing FGM/C annually and more recent statistics show that 15 million girls would have undergone FGM/C by 2020 in the absence of apt intervention, which will invariably aggravate the already troubling statistics of girls and women that are managing the lifelong consequences of FGM/C [6,7].
Oftentimes, perpetuators perceive this dangerously life
altering act as a way to curb promiscuity and invariably promote
fidelity among FGM/C victims . Other underlying reasons for
the practice of FGM/C relates to the promotion of the marriage
ability of girls and preservation of their virginity in order to
prevent shame following marriage and as well enhance social
acceptance within communities where the practice of FGM/C
is rife [8,9]. The practice of FGM/C has ethnicity and religious
dimension likewise as observed in the countries like Benin,
Togo and Niger. In Benin, girls and women with Peulh ethnicity
are seven times more likely to undergo FGM/C compared to
counterparts from Adja and Fon ethnicity. Moreover, Muslim
girls and women are more likely to undergo FGM/C compared
to Christian counterparts in Togo whereas Christian girls and
women are more likely the experience the same in Niger.
Despite the lifelong adverse effect of FGM/C on the physical
and mental health, girls and women that have undergone FGM in
countries like Gambia perceive the practice as being beneficial and
hence want FGM/C to continue. Also, FGM/C survivors with lower
levels of literacy in Sudan and Ethiopia support the continuation
of FGM/C, which demonstrates how ingrained the practice
remains within some communities . An understanding of the
drivers of FGM/C is an invaluable first step at ending the crisis. In
two systematic reviews of 51 studies involving home-based and
foreign-based indigenes of communities where FGM/C is highly
prevalent, cultural tradition, religious beliefs, and sexual morals
were the reasons for the continuance of the practice [10,11]. The
cultural, social, ethnic and sometimes religious underpinnings of
FGM/C bring the complexities of eradicating the practice to the
foreground. This potentially explains the persistent practice of
FGM/C despite concerted eradication efforts by global advocates,
policy makers and national governments. Nonetheless, these
efforts have yielded marginal returns as the prevalence of
FGM/C has declined steadily over the last three decades despite
the burgeoning global population growth within the same period
Interventions toward abandonment of FGM/C have adopted
many approaches. Some of the widely evaluated methods are
community-led approaches, public declarations, conversion of
excisers, alternative rituals, training of health workers as change
agents, health hazards approaches, and legal sanctions [12,13].
Community-led approaches: They focus on empowering
girls, women and community members to self-examine their
cultural practice of FGM/C and abandon it for their own benefit
. Success of this approach is usually context-dependent. For
example, a similar programme run in paired communities Senegal,
Burkina Faso and Somalia resulted in markedly different rates of
FGM/C abandonment across the three countries [10,15,16].
Public declarations: These are open statements by a large
group in a community to abandon FGM/C. These declarations
can signify a readiness to change or an actual abandonment of
FGM/C. However, public declarations are rewards of effective
intervention, programmes that solicit statements from
authoritative subgroups such as eminent religious leaders or
excisers rarely results in behavioural change if the community
buy-in is low .
Conversion of excisers: Some interventions target excisers,
majority of whom are traditional practitioners, with the aim
of training them on female anatomy and the hazards of FGM/C
and convincing these practitioners to stop performing FGM/C.
Subsequently, ex-excisers are rewarded with training and
funding for alternative source of livelihood. Although this
approach offers an easy measure of the success of intervention,
an ex-practitioner may return to the trade covertly or by proxy
and other aspiring exciser may fill the vacant positions .
Alternative rituals: Many communities perform FGM/C
as a part of rite of passage from childhood to womanhood for
their adolescent girls. Alternative rites interventions proffer a
replacement of FGM/C-included rite of passage with alternative
rite while still upholding the tradition of the community. For
example, in Kenya and Sierra Leone, excising rituals were
replaced non-cutting versions during the ritual seasons .
However, the use of alternative rites are limited to context where
FGM/C is part of rite of passage and not elsewhere.
Health hazards approaches: The health risks of FGM/C
are communicated via health information materials and media.
It is the oldest and most popular method whereby individuals
and community groups are informed on the health hazards of
FGM/C by lay workers, health personnel, community facilitator
or civil society staff . The increased knowledge are expected
to stimulate critical thinking that will eventually foster an
abandonment of FGM/C . Poorly formulated, judgmental
and ‘westernised’ health information have been linked with
disbelief, resistance, defence reaction, outright disregard and
medicalization of FGM/C .
Training of health workers as change agents: Health
professionals are influential members of the community that
can foster healthy changes. Thus, intervention have focused
on health workers with the aim of educating them on FGM/C,
preventing them from practicising it, training them on identifying
and treating associated complications, and ultimately deploying
them as change agents . However, some health workers might
be resistant to abandoning FGM/C owing to their socio-cultural
beliefs. In fact, the literature is rife with medical proponents of
Legal sanctions: Legislative measures against FGM/C
have been adopted in many communities to prevent FGM/C.
Numerous African and Western countries have formally enacted
laws that ban FGM/C and impose prosecutions, punishment and/
or fines [25,26]. Laws may make FGM/C go underground and
may also deter sufferers of immediate complications of FGM/C
from seeking prompt medical treatments .
Throughout the four decades that interventions against
FGM/C have been ongoing, many successes have been achieved,
yet a lot more ground awaits covering. Findings from research
have shown that ‘a one size fit all’ approach will not accelerate
the progress towards elimination of FGM/C. Contrariwise,
interventions that have worked have been those that mobilised
multi-sectors, assembled many actors, ran from and with the
community, and ensured sustained actions . Therefore,
programmes should be comprehensive and holistic; methods
should anchor on a background of community participation
and involvement; sensitive, tailored, locally relevant health
information should be used as a tool to foster change; positive
reinforcement should be supplied from a network of religious
and community leaders, health professionals and peer group
incorporate; and an FGM/C supportive legal framework should
be enacted and enforced at all level of governance.
Many individuals, agencies and organisations have conducted
research and are planning more studies. For example, since
1996, the Population Council with its partner partners like DFID,
USAID, UN Agencies, Wallace Global Fund, Comic Relief and
Norad have focused on research in 13 countries where FGM/C is
highly prevalent . However, scores of research gaps are still
evident, studies designs need to improve, and research should
comply with internationally agreed indicators . Finally
funding fuels progress and many funding agencies have helped
with the progress on eliminating FGM/C so far, but funding gaps
still need to be filled and very quickly too .