Applying ban of FGM by Law in the new Democratic Gambia
2017
UN Theme: “Building a solid and interactive bridge between Africa and the world
to accelerate ending FGM
Female
genital mutilation (FGM) comprises all procedures that involve altering or
injuring the female genitalia for non-medical reasons and is recognized
internationally as a violation of the human rights of girls and women.
It
reflects deep-rooted inequality between the sexes, and constitutes an extreme
form of discrimination against women and girls. The practice also violates
their rights to health, security and physical integrity, their right to be free
from torture and cruel, inhuman or degrading treatment, and their right to life
when the procedure results in death.
To
promote the abandonment of FGM, coordinated and systematic efforts are needed,
and they must engage whole communities and focus on human rights and gender
equality. These efforts should emphasize societal dialogue and the empowerment
of communities to act collectively to end the practice. They must also address
the sexual and reproductive health needs of women and girls who suffer from its
consequences.
UNFPA,
jointly with UNICEF, leads the largest global programme to accelerate the
abandonment of FGM. The programme currently focuses on 17 African countries and
also supports regional and global initiatives.
Key
Facts:
· Globally,
it is estimated that at least 200 million girls and women alive today have
undergone some form of FGM.
· Girls 14 and younger represent 44 million of
those who have been cut, with the highest prevalence of FGM among this age in
Gambia at 56 per cent, Mauritania 54 per cent and Indonesia where around half
of girls aged 11 and younger have undergone the practice.
·
Countries with the highest prevalence among girls and women aged 15 to 49 are
Somalia 98 per cent, Guinea 97 per cent and Djibouti 93 per cent.
· FGM is mostly carried out on young girls
sometime between infancy and age 15.
· FGM cause severe bleeding and health issues
including cysts, infections, infertility as well as complications in childbirth
increased risk of new-born deaths.
· FGM is a violation of the human rights of
girls and women.
· The Sustainable Development Goals in 2015
calls for an end to FGM by 2030 under Goal 5 on Gender Equality, Target 5.3
Eliminate all harmful practices, such as child, early and forced marriage and
female genital mutilation.
· The elimination of FGM has been called for by
numerous inter-governmental organizations, including the African Union, the
European Union and the Organization of Islamic Cooperation, as well as in three
resolutions of the United Nations General Assembly.
Female
Genital Mutilation Affects Pregnancy and Childbirth
The
effects of female genital mutilation on women and babies during childbirth.
The study, which provides the first reliable
evidence that female genital mutilation can adversely affect birth outcomes,
was undertaken by African and international researchers, including Associate
Professor Emily Banks from the National Centre for Epidemiology and Population
Health at Australian National University.
It
involved 28,393 women in 28 obstetric centres in six countries: Burkina Faso,
Ghana, Kenya, Nigeria, Senegal and Sudan.
The
study found that women who have had Female Genital Mutilation (FGM) are
significantly more likely to experience difficulties during childbirth and that
their babies are more likely to die as a result of the practice.
Complications
include the need to have a caesarean section, dangerously heavy bleeding after
the birth of the baby and prolonged hospitalization following the birth.
The
degree of complications increased according to the extent and severity of the
FGM.
According
to the WHO, FGM is a common practice in a number of countries around the world,
and over 100 million women and girls are estimated to have had FGM. The study
used a three level scale set out by the WHO on FGM severity.
In
the case of cesarean section, women who have the most severe form of FGM will
have on average 30 per cent more C-sections compared with those who have not
had any FGM. Women affected by severe FGM are 70 per cent more likely to suffer
sever bleeding after birth.
The
researchers also found there was an increased need to resuscitate babies whose
mother had experienced FGM, and the death rate among babies during and
immediately after birth is also higher.
In
all, the study estimated that in the African context an additional one to two
babies die per 100 deliveries as a result of the practice.
“This
collaborative African study provides the first reliable evidence on the impact
of FGM on complications during childbirth, and shows that the practice is
likely to be responsible for large numbers of infant deaths and an increased
burden of maternal illness, affecting millions of deliveries,” Associate
Professor Banks said.
Pregnancy,
childbirth
FGM
may place women at higher risk of problems during pregnancy and childbirth,
which are more common with the more extensive FGM procedures. Infibulated women
may try to make childbirth easier by eating less during pregnancy to reduce the
baby’s size. In women with fistulae, it is difficult to obtain clear urine
samples as part of prenatal care, making the diagnosis of conditions such as
pre-eclampsia harder.[75] Cervical evaluation during labour may be impeded and
labour prolonged or obstructed. Third-degree laceration (tears), anal-sphincter
damage and emergency caesarean section are more common in infibulated women.
Neonatal
mortality is increased. The WHO estimated in 2006 that additional 10–20 babies
die per 1,000 deliveries as a result of FGM. The estimate was based on a study
conducted on 28,393 women attending delivery wards at 28 obstetric centres in
Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan. In those settings all
types of FGM were found to pose an increased risk of death to the baby: 15
percent higher for Type I, 32 percent for Type II and 55 percent for Type III.
The reasons for this were unclear, but may be connected to genital and
urinary-tract infections and the presence of scar tissue. The researchers wrote
that FGM was associated with an increased risk to the mother of damage to the
perineum and excessive, as well as a need to resuscitate the baby, and
stillbirth, perhaps because of a long second stage of labour
Complications
Short-term
and late
FGM
harms women’s physical and emotional health throughout their lives. It has no
known health benefits.The short-term and late complications depend on the type
of FGM, whether the practitioner had medical training, and whether she used
antibiotics and unsterilized or surgical single-use instruments. In the case of
Type III, other factors include how small a hole was left for the passage of
urine and menstrual blood, whether surgical thread was used instead of agave or
acacia thorns, and whether the procedure was performed more than once (for
example, to close an opening regarded as too wide or re-open one too small).
Common
short-term complications include swelling, excessive bleeding, pain, urine
retention and healing problems/wound infection. A 2015 systematic review of 56
studies that recorded immediate complications suggested that each of these
occurred in more than one in ten girls and women undergoing any form of FGM,
including symbolic nicking of the clitoris (Type IV), although the risks
increased with Type III. The review also suggested that there was
under-reporting.[71] Other short-term complications include fatal bleeding,
anaemia, urinary infection, septicaemia, tetanus, gangrene, necrotizing
fasciitis (flesh-eating disease)It is not known how many girls and women die as
a result of the practice, because complications may not be recognized or
reported.The practitioners’ use of shared instruments is thought to aid the
transmission of hepatitis B, hepatitis C and HIV, although no epidemiological
studies have shown this.
Late
complications vary depending on the type of FGM. They include the formation of
scars that lead to obstruction that may become infected, and formation (growth
of nerve tissue) involving nerves that supplied the clitoris. An infibulated
girl may be left with an opening as small as 2–3 mm, which can cause prolonged,
drop-by-drop urination, pain while urinating, and a feeling of needing to
urinate all the time. Urine may collect underneath the scar, leaving the area
under the skin constantly wet, which can lead to infection and the formation of
small stones. The opening is larger in women who are sexually active or have
given birth by vaginal delivery, but the urethra opening may still be
obstructed by scar tissue can develop (holes that allow urine or faeces to seep
into the vagina).This and other damage to the urethra and bladder can lead to
infections and incontinence, pain during sexual intercourse and infertility.
Painful
periods are common because of the obstruction to the menstrual flow, and blood
can stagnate in the vagina and uterus. Complete obstruction of the vagina can
result (where the vagina and uterus fill with menstrual blood). The swelling of
the abdomen that results from the collection of fluid, together with the lack
of menstruation, can lead to suspicion of pregnancy.
United
Nations
The
United Nations General Assembly included FGM in resolution 48/104 in December
1993, the Declaration on the Elimination of Violence against Women. In 2003 the
UN began sponsoring an International every 6 February.UNICEF began that year to
promote an evidence-based social norms approach to the evaluation of
intervention, using ideas from game theory about how communities reach
decisions, and building on the work of Gerry Mackie about how foot binding had
ended in China.In 2005 the UNICEF Innocent Research Centre in Florence
published its first report on FGM.
In
2008 several United Nations bodies, including the Office of the High
Commissioner for Human Rights, published a joint statement recognizing FGM as a
human-rights violation. In December 2012 the General Assembly passed resolution
67/146, calling for intensified efforts to eliminate it.In July 2014 UNICEF and
the UK government co-hosted the first Girl Summit, aimed at ending FGM and
child marriage.
UNFPA
and UNICEF launched a joint programme in 2007 to reduce FGM by 40 percent
within the 0–15 age group, and eliminate it entirely from at least one country.
Fifteen countries joined the programme: Djibouti, Egypt, Ethiopia, Guinea,
Guinea-Bissau, Kenya, Senegal and Sudan in 2008; Burkina Faso, Gambia, Uganda
and Somalia in 2009; and Eritrea, Mali and Mauritania in 2011.[214] Phase 1
lasted from 2008 to 2013, with a budget of $37 million, over $20 million of it
donated by Norway. Phase 2 extends the programme from 2014 to 2017.
By
2013 the programme had organized public declarations of abandonment in 12,753
communities, integrated FGM prevention into pre- and postnatal care in 5,571
health facilities, and trained over 100,000 doctors, nurses and midwives in FGM
care and prevention. The programme helped to create alternative rites of
passage in Uganda and Kenya, and in Sudan supported the (pre-existing) Saleema
initiative. Saleema means “whole” in Arabic; the initiative promotes the term
as a desirable description of an uncut woman. The programme noted that anti-FGM
law enforcement is weak, and that, even where arrests are made, prosecution may
fail because of inadequate collection of evidence. It therefore supported the
training of 3,011 personnel in eight countries (Djibouti, Eritrea, Ethiopia,
Guinea, Guinea-Bissau, Kenya, Senegal and Uganda) in how to enforce the laws,
and sponsored campaigns to raise awareness of them.
For
further information UN, WHO, UNICEF web sites in the Gambia and
internationally, In the Gambia NGO’s WASSU, www.mgf.uab.es, Gamcotrap, email:
Azadehhassanmd10@gmail.com,
text only 002207774469, 3774469 between 3-6 pm.
Author
DR AZADEH Senior Lecturer at the University of the Gambia, Senior Consultant in
Obstetrics & Gynaecology, Clinical Director Medicare Health Services