Is high time we put an end to the practice of Female Genital Mutilation (FGM).
which involves partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons as defined by the World Health Organisation (WHO).
Types of Female Genital Mutilation
Female genital mutilation is classified into four types:
- Type 1
- Type 11
- Type 111
- Type 1v
Also known as clitoridectomy, this type consists of partial or total removal of the clitoris and/or its prepuce.
Also known as excision, the clitoris and labia minora are partially or totally removed, with or without excision of the labia majora.
The most severe form, it is also known as infibulation or pharaonic type.
The procedure consists of narrowing the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or labia majora, with or without removal of the clitoris.
The appositioning of the wound edges consists of stitching or holding the cut areas together for a certain period of time (for example, girls’ legs are bound together), to create the covering seal.
A small opening is left for urine and menstrual blood to escape. An infibulation must be opened either through penetrative sexual intercourse or surgery.
This type consists of all other procedures to the genitalia of women for non-medical purposes, such as pricking, piercing, incising, scraping and cauterization.
The procedure can result in death through severe bleeding leading to haemorrhagic shock, neurogenic shock as a result of pain and trauma, and overwhelming infection and septicaemia, according to Manfred Nowak, UN Special Rapporteur on Torture and other Cruel, Inhuman or Degrading Treatment or Punishment.
Immediate consequences of FGM include severe pain and bleeding, shock, difficulty in passing urine, infections, injury to nearby genital tissue and sometimes death.
Almost all women who have undergone FGM experience pain and bleeding as a consequence of the procedure. The event itself is traumatic as girls are held down during the procedure.
Risk and complications increase with the type of FGM and are more severe and prevalent with infibulations.
“The pain inflicted by FGM does not stop with the initial procedure, but often continues as ongoing torture throughout a woman’s life ”, says Manfred Nowak, UN Special Rapporteur on Torture.
In addition to the severe pain during and in the weeks following the cutting, women who have undergone FGM experience various long-term effects – physical, sexual and psychological.
Women may experience chronic pain, chronic pelvic infections, development of cysts, abscesses and genital ulcers, excessive scar tissue formation, infection of the reproductive system, decreased sexual enjoyment and psychological consequences, such as post-traumatic stress disorder.
Additional risks for complications from infibulations include urinary and menstrual problems, infertility, later surgery (defibulation and reinfibulation) and painful sexual intercourse .
Sexual intercourse can only take place after opening the infibulation, through surgery or penetrative sexual intercourse. Consequently, sexual intercourse is frequently painful during the first weeks after sexual initiation and the male partner can also experience pain and complications.
When giving birth, the scar tissue might tear, or the opening needs to be cut to allow the baby to come out. After childbirth, women from some ethnic communities are often sown up again to make them “tight” for their husband (reinfibulation). Such cutting and restitching of a woman’s genitalia results in painful scar tissue.
A multi-country study by WHO in six African countries, showed that women who had undergone FGM, had significantly increased risks for adverse events during childbirth, and that genital mutilation in mothers has negative effects on their newborn babies . According to the study, an additional one to two babies per 100 deliveries die as a result of FGM.
Female genital mutilation in Nigeria
Nigeria, due to its large population, has the highest absolute number of female genital mutilation (FGM) worldwide, accounting for about one-quarter of the estimated 115–130 million circumcised women in the world.
The objective of this review is to ascertain the current status of FGM in Nigeria.
Pertinent literature on FGM retrieved from internet services FGM in Nigeria the national prevalence rate of FGM is 41% among adult women. Evidence abound that the prevalence of FGM is declining.
The ongoing drive to eradicate FGM is tackled by World Health Organization, United Nations International Children Emergency Fund, Federation of International Obstetrics and Gynecology (FIGO), African Union, The economic commission for Africa, and many women organizations. However, there is no federal law banning FGM in Nigeria. There is need to eradicate FGM in Nigeria.
Education of the general public at all levels with emphasis on the dangers and undesirability of FGM is paramount.
Keywords: Female genital cutting, Female genital mutilation, Harmful traditional practice.
Though FGM is practiced in more than 28 countries in Africa and a few scattered communities worldwide, its burden is seen in Nigeria, Egypt, Mali, Eritrea, Sudan, Central African Republic, and northern part of Ghana where it has been an old traditional and cultural practice of various ethnic groups.
The highest prevalence rates are found in Somalia and Djibouti where FGM is virtually universal.
FGM is widely practiced in Nigeria, and with its large population, Nigeria has the highest absolute number of cases of FGM in the world, accounting for about one-quarter of the estimated 115–130 million circumcised women worldwide.
In Nigeria, FGM has the highest prevalence in the south-south (77%) (among adult women), followed by the south east (68%) and south west (65%), but practiced on a smaller scale in the north, paradoxically tending to in a more extreme form.
Nigeria has a population of 150 million people with the women population forming 52%. The national prevalence rate of FGM is 41% among adult women.
Prevalence rates progressively decline in the young age groups and 37% of circumcised women do not want FGM to continue. 61% of women who do not want FGM said it was a bad harmful tradition and 22% said it was against religion.
Other reasons cited were medical complications (22%), painful personal experience (10%), and the view that FGM is against the dignity of women (10%).
However, there is still considerable support for the practice in areas where it is deeply rooted in local tradition. The aim of this review was to ascertain the current status of FGM in Nigeria.
Origin and significance
FGM is a practice whose origin and significance is shrouded in secrecy, uncertainty, and confusion. The origin of FGM is fraught with controversy either as an initiation ceremony of young girls into womanhood or to ensure virginity and curb promiscuity, or to protect female modesty and chastity.
The ritual has been so widespread that it could not have risen from a single origin
Types/variation of Female Genital Mutilation in Nigeria
FGM practiced in Nigeria is classified into four types as follows. Clitoridectomy or Type I (the least severe form of the practice).
Type II or “sunna” is a more severe practice that involves the removal of the clitoris along with partial or total excision of the labia minora.
Type IV or other unclassified types recognized by include introcision and gishiri cuts, pricking, piercing, or incision of the clitoris and/or labia, scraping and/or cutting of the vagina (angrya cuts), stretching the clitoris and/or labia, cauterization, the introduction of corrosive substances and herbs in the vagina, and other forms.
In Nigeria, of the six largest ethnic groups, the Yoruba, Hausa, Fulani, Ibo, Ijaw, and Kanuri, only the Fulani do not practice any form.
In most parts of Nigeria, it is carried out at a very young age (minors) and there is no possibility of the individual’s consent.
Reasons to justify Female Genital Mutilation
The respondents gave reasons for FGM. They regarded FGM as a tribal traditional practice (our custom is a good tradition and has to be protected), as a superstitious belief practiced for preservation of chastity and purification, family honor, hygiene, esthetic reasons, protection of virginity and prevention of promiscuity, modification of sociosexual attitudes (countering failure of a woman to attain orgasm), increasing sexual pleasure of husband, enhancing fertility and increasing matrimonial opportunities.
Other reasons are to prevent mother and child from dying during childbirth and for legal reasons (one cannot inherit property if not circumcised).
In some parts of Nigeria, the cut edges of the external genitalia are smeared with secretions from a snail footpad with the belief that the snail being a slow animal would influence the circumcised girl to “go slow” with sexual activities in future.
However, FGM is often routinely performed as an integral part of social conformity and in line with community identity.
Health consequences of Female Genital Mutilation
An estimated 100–140 million girls and women worldwide are currently living with the consequences of FGM.
In Africa, about 3 million girls are at risk for FGM annually. Despite the increased international and little national attention, the prevalence of FGM overall has declined very little.
The procedure has no health benefits for girls and women.
Adverse consequences of FGM are shock from pain and hemorrhage, infection, acute urinary retention following such trauma, damage to the urethra or anus in the struggle of the victim during the procedure making the extent of the operation dictated in many cases by chance, chronic pelvic infection, acquired gynatresia resulting in hematocolpos, vulval adhesions, dysmenorrhea, retention cysts, and sexual difficulties with anorgasmia. Other complications are implantation dermoid cysts and keloids, and sexual dysfunction.
Obstetric complications include perineal lacerations and inevitable need for episiotomy in infibulated paturients. Others are defibulation with bleeding, injury to urethra and bladder, injury to rectum, and purperial sepsis.
Prolonged labor, delayed 2 stage and obstructed labor leading to fistulae formation, and increased perinatal morbidity and mortality have been associated with FGM
The mental and psychological agony attached with FGM is deemed the most serious complication because the problem does not manifest outwardly for help to be offered.
The young girl is in constant fear of the procedure and after the ritual she dreads sex because of anticipated pain and dreads childbirth because of complications caused by FGM.
Such girls may not complain but end up becoming frigid and withdrawn resulting in marital disharmony.
Current situation of Female Genital Mutilation in Nigeria
FGM is widespread in Nigeria. Some sociocultural determinants have been identified as supporting this avoidable practice. FGM is still deeply entrenched in the Nigerian society where critical decision makers are grandmothers, mothers, women, opinion leaders, men and age groups.
FGM is an extreme example of discrimination based on sex.
Often used as a way to control women’s sexuality, the practice is closely associated with girls’ marriageability. Mothers chose to subject their daughters to the practice to protect them from being ostracized, beaten, shunned, or disgraced.
There is a need for legislation in Nigeria with health education and female emancipation in the society. The process of social change in the community with a collective, coordinated agreement to abandon the practice “community-led action” is therefore essential.
With improvement in education and social status of women and increased awareness of complications of FGM, most women who underwent FGM disapprove of the practice and only very few are prepared to subject their daughters to such harmful procedures.
According to study in 1994, Nigeria joined other members of the 47 World Health Assembly to resolve to eliminate FGM. Steps taken so far to achieve this include establishment of a multisectorial technical working group on harmful traditional practices (HTPs), conduct of various studies and national surveys on HTPs, launching of a regional plan of action, and formulation of a national policy and plan of action, which was approved by the Federal Executive Council for the elimination of FGM in Nigeria.
However, there is no federal law prohibiting the practice of FGM in Nigeria. This is the main reason for the slow progress on declining the prevalence of FGM.
Despite the increased international and little national attention, the prevalence of FGM overall has declined very little. The prevalence depends on the level of education and the geographic location.
At the grassroots, efforts should be taken to join in the crusade to say “NO” to FGM anywhere it is practiced among our people.
It is crude, dangerous, wicked and unhealthy. FGM is not required by any religion and there is no scientific evidence that women who have been mutilated are more faithful or better wives than those who have not undergone the procedure. It is very clear that there is no single benefit derived from FGM.