Towards zero tolerance for female genital mutilation (FGM)

Optimising health care for women and girls living with consequences of the cultural practice

By Dr Olayide Ogunsiji, School of Nursing and Midwifery, Western Sydney University, Australia.

Female genital mutilation (FGM) also known as female genital circumcision or cutting is a global health issue affecting women and girls. It refers to a range of procedures intended at partial or total removal of the female genital organs for non-therapeutic reasons (Garba, Muhammed, Abubakar & Yakasai, 2012; Ogunsiji, 2016). FGM is a cultural practice which involves the narrowing of the vaginal opening and presents a peculiar health care challenge to women living with the consequences of the practice. It is reported in many countries of the world but prevalent in many African, Middle-Eastern and some Asian countries. According to the World Health Organisation (2018), more than 200 million girls and women are currently living with the consequence of the practice and about 3 million girls are at risk of circumcision every year (Zenner, Liao, Richens & Creighton, 2013). There are four types of FGM depending on the intensity of the injury. The first type is called clitoridectomy, which is the partial or total removal of the clitoris, the second type is called excision, which has to do with the partial or total removal of the clitoris and the labia minora with or without excision of the labia majora (Ogunsiji, Wilkes &Jackson, 2007). The third type is referred to as infibulation, which is the narrowing of the vagina opening through the creation of a covering seal, and the fourth type includes all other harmful procedures to the female genitalia for nonmedical reasons such as pricking, piercing, incising, scraping and cauterizing the genital area (Ogunsiji, et al; 2007; Ogunsiji, 2016).

Due to increasing migration of women and girls from countries where it is prevalent to western countries such as Australia, health care providers who are unfamiliar with the practice are facing peculiar challenges. An Australian qualitative study of midwives revealed a significant gap in general knowledge about FGM and its legality in Australia (Ogunsiji, 2015). These midwives perceived circumcision as an important and complex obstetric issue that must be addressed (Ogunsiji, 2016).

As the world mark the International day of zero tolerance for female genital mutilation on the 6^th of February, ongoing emphasis on women-centred, culturally competent maternity care is crucial to optimising health care of circumcised women.

References

Garba, I. D., Muhammed, Z., Abubakar, I. S., & Yakasai, I.A. (2012). Prevalence of female genital mutilation among female infants in Kano, Northern Nigeria. Archives of Gynaecology and Obstetrics, 286, 423-428.

Ogunsiji, O. (2016). Australian midwives’ perspectives on managing obstetric care of women living with female genital circumcision/mutilation. Health Care for Women International, 37 (10), 1156-1169.

Ogunsiji, O (2015). Female genital mutilation (FGM): Australian midwives’ knowledge and attitudes. Health Care for Women International, 36(11), 1179-1193.

Ogunsiji, O.O., Wilkes, L., & Jackson, D. (2007). Female genital mutilation: Origin, beliefs, prevalence and implications for health care workers caring for immigrant women in Australia. Contemporary Nurse, 25 (1-2), 22-30.

World Health Organisation (WHO) (2018). Female genital Mutilation: Fact sheet. Geneva, Switzerland.

Zenner, N., Liao, L.M., Richens, Y., & Creighton, S. M. (2013). Quality of obstetric and midwifery care for pregnant women who have undergone female genital mutilation. Journal of Obstetrics and Gynaecology, 33, 459-462.