Female genital mutilation: an ‘old’ problem with no place in a modern world

Abstract

Women and girls who have experienced female genital mutilation (FGM) identify that it can "make you really angry, or one becomes so passive that one continues in the role mapped out". Others attest that "it changes our position in our families", while some women suggest, "we can't win. If we circumcise our daughters there is pain. If we don't circumcise our daughters there is a different pain. The community will not accept us" (1). These experiences illustrate the complexity of FGM.The practice of FGM is old, steeped in tradition and ritualistic custom (2). FGM is the deliberate cutting, burning and/or removal of the female genitalia, often (incorrectly) identified as female circumcision, and is a cause of morbidity and mortality. Of all aspects of FGM, the psychological and emotional consequences are the least reported. Toubia (3) cites three psychological cases: "anxiety state" originating from lack of sleep and hallucinations; "reaction depression" from delayed healing, and "psychotic excitement" from childlessness and divorce. FGM is abuse of the most serious kind and has been criminalized in many countries, including the UK (4).FGM is not a new cultural practice or health concern. In 1982, in an attempt to end medicalized forms of FGM, the World Health Organization (WHO) (5) identified that "hygienic", "pain free" and "less drastic" forms of FGM should not, under any circumstances, be performed by medical practitioners. FGM Prevention Programs have been increasing, and in 2012 the UN General Assembly (6) called for an intensification of programs consisting of comprehensive, integrated strategies that include community education, government strategies, legislation and prosecution.Although there are estimates (7), the true numbers of women and girls who have undergone FGM are not known. In the UK it is only recently, due to Intercollegiate guidelines (8) and government pressure (9), that hospitals and healthcare professionals have been asked to record and report the numbers of women and girls effected by FGM using the WHO classification (7). This was also a result of campaigning by the FGM National Clinical Group, which was founded in 1989 by Yana Richens (midwife) and Sarah Creighton (obstetrician) in response to the lack of knowledge and training for midwives and doctors in the UK. Since its inception, the group have developed numerous resources on FGM, including a DVD on how to perform a deinfibulation (10) and clinical standards guidelines for midwives and doctors (11), and will shortly publish clinical competences and assessment criteria for FGM midwife specialists. The Intercollegiate Group (8) has emphasized prioritizing empowerment and support of those affected and at risk in order to achieve the elimination of FGM. The current strategy is to mobilize a movement to end FGM within a generation.The Girl Summit in 2014 (12) enabled women, girls, community leaders, governments, international organizations and NGOs to share success stories while sharing good practice in tackling and ending the harmful prac...

Reproductive Health and Ethical Problems in Women’s Health

“…It is important to mention about three important psychological outcomes: the "anxiety" caused by insomnia and hallucinations; "Response Depression" caused by delayed recovery and "psychotic excitement" caused by childlessness and divorce. FGM is the most serious type of sexual abuse and is considered a crime in many countries [58] (Table 2).…”