Post 20. FGM

It kills me to have to write this blog.

It kills me to have to write this blog.

On a personal level, the whole reason why I am here is to chip away at my own ignorance and try to understand all the perceptions and misconceptions, realities and reasonings that make up this place that so kindly hosts me.   Both in my own mind and in the minds of whoever has the patience and interest to follow my bumbling journey, I want to break stereotypes and foster understanding.

In this particular case, however, I remain eons away from any sort of understanding.

Female genital mutilation.  Those three words should never be found in the same paragraph, let alone neatly abbreviated to the common acronym of FGM.  Sorry – I can’t abbreviate it.  FGM rolls off the tongue too easily; but the words “female genital mutilation” slap me in the face every time I read/write them.

According to the Female Genital Mutilation Network, the practice is most common in counties such as Somalia, Guinea, Egypt, Sudan and Mali, all of which have a prevalence of over 90%.  The WHO reports that worldwide, between 100 and 140 million girls and women are living with the consequences of female genital mutilation, with 3 million new cases per year.  Most often girls from 4 to 14 years of age.

WHO describes 4 different categories of female genital mutilation:

  • Type I: Clitoridectomy - partial or total removal of the clitoris
  • Type II: Excision - partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora
  • Type III: Infibulation - narrowing of the vaginal opening through the creation of a covering seal, formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris.
  • Type IV: Other - all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

You can only imagine the list of health risks that accompany this mutilation.  Immediately following the procedure there is risk of infection, severe bleeding, tetanus, and urine retention.  Not to mention pain.  In the longer term, there is the risk of recurrent urinary tract infections, cysts, infertility, childbirth complications and newborn deaths.

Female genital mutilation obviously has no health benefit for the girl whatsoever; rather its justification is purely cultural.  UNICEF lists the following factors perpetuating the practice:

  • Sexual - to control or reduce female sexuality by reducing libido and sexual enjoyment; to ensure virginity and fidelity.
  • Sociological - as an initiation for girls into womanhood, social integration and the maintenance of social tradition and cohesion.
  • Hygiene - where it is believed that the female genitalia are dirty and unsightly.
  • Health - in the belief that it enhances fertility and child survival.
  • Religious - in the mistaken belief that FGM is a religious requirement.

Increased sexual pleasure for men, family honour and an income source for those performing the procedure are also frequently listed as contributing factors.

A survey in Chad in 2004 found a prevalence of 45%.  Type II was found to be commonly practiced across the country, while Type III was limited to the border area with Sudan. However, in the MSF supported maternity ward in Am Timan, seeing a woman without mutilation is the exception, suggesting that the prevalence might be higher in Am Timan than reported by the 2004 survey. Most often just the clitoris is removed, but the remaining scar tissue is so thick it requires significant incisions to deliver the baby.

As MSF, we treat the medical consequences, but we are aware that actions going beyond the medical sphere, involving all the local leaders, are required. This limited role is hard for the team here in Am Timan to swallow, particularly those of us with our own clitorises, perfectly intact. As an innovative initiative to rectify this impasse, MSF is planning to partner with a well established Chadian NGO who will train, sensitize, and inform in an attempt to reduce the phenomenon.

Many of my male Chadian colleagues openly balk and laugh at me when I suggest the possibility of equality between men and women and are appalled when I tell them Grant makes pancakes for me on Sunday mornings.  While I am amused by this light-hearted banter, the profoundness of their sentiments strike me silent whenever I think of that simple little abbreviation,  F.G.M.

References UNICEF World Health Organization Measure DHS Female Genital Mutilation Network