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Research on the Elimination of Female Genital Mutilation

Source: TropIKA.net editorial team

Title of presentation: Research on the Elimination of Female Genital Mutilation

Date: 18 Nov 2008

Location: Salle Plénière

Chair: Nafissatou J. Diop, Programme Associate, Frontiers in Reproductive Health, Population Council, Senegal.

Presenters:

• Moustapha Touré, gynecologist obstetrician, Centre Santé Référence, Commune IV, Ministry of Health, Mali
• Oumou Soumana Maïga Diakité, Technical Adviser, Ministry of Health, Mali
• Mamadou Wane, Child Protection Specialist, UNICEF, Senegal
• Guyo Jaldesa, Medical Practitioner and Research, Obstetrics, Kenyatta National Hospital, Kenya
• Julia Hasler, Programme Specialist, Division of Basic and Engineering Sciences, Natural Sciences Sector, UNESCO, Paris
• Andrew Kosia, Regional Adviser, Reproductive Health Training and Family Planning, WHO Regional Office for Africa, Brazzaville
• Heli Bathija, Scientist, Reproductive Health and Research, Technical Cooperation with Countries for Sexual and Reproductive Health, World Health Organization, Geneva

Official Rapporteur: Heli Bathija

TropIKA Rapporteurs: Jocelyne Ndouyou-Mouliom

Major topics: Female genital mutilation, elimination; research strengthening; data collection; physical and psychological complications

Scope: Policy; scientific, social, anthropological research; global issue, regional, national and local contexts;

Overview

Female Genital Mutilation (FGM) is a practice carried out in violation of the fundamental rights of young girls and women, including their right to enjoy the highest possible level of physical and mental health. http://www.who.int/mediacentre/factsheets/fs241/en/index.html The practice remains common in a number of countries and areas. Based on survey data, it is estimated that, worldwide, between 100 million and 140 million girls and women alive today have undergone some form of FGM and that about 3 million are exposed to it every year. http://www.who.int/reproductive-health/fgm/prevalence.htm

Following commitment at government level to the goal of FGM elimination, adoption of international and legal declarations and provisions to denounce and/or outlaw the practice, and major efforts at global and national level for advocacy, information and education of the general public on the physical and psychological consequences of FGM, the practice has declined although slowly. In recent years, however, it has been observed that in some countries the practice is being medicalized. The trend, a matter of concern, is probably due to the fact that parents have become better informed on the biomedical risks involved, want to prevent or contain them, but culturally are not prepared yet to abandon the practice.

FGM is generally carried out on girls under the age of 15 years, but obtaining data in that age group poses several methodological challenges. The need to carry out more research and build up research capacity in this area was a focus of the session’s recommendations.

A music video clip by the West African singer Tiken Jah Fakoly, called "Non à l'excision" (Stop the cutting") was shown.

Context and issue

In this session senior staff members from UNICEF, WHO, UNESCO as well as researchers from Kenya, Mali and Senegal presented findings from studies documenting the prevalence and trends of female genital mutilation, health complications related to the practice, estimates of costs of treating some of these complications, social determinants of the practice and decision-making related to maintaining or abandoning the practice. The nature and scope of FGM were defined and its significant impact on the physical, psychological and thus social development of young girls and women was recalled.

Although more common in Africa, FGM is also practiced outside the continent. Several declarations and recommendations have been issued at global level to denounce the practice and to call for its elimination in one generation. These initiatives include the Interagency Statement on eliminating FGM, launched in February 2008, signed by the Heads of ten UN agencies and programmes, as well as the resolution adopted by the UN Commission on Status of Women in March 2008 and the resolution passed by the World Health Assembly at its 61^st session in May 2008. They all reflect strong political commitment to eliminate FGM in one generation and, to that end, deploy all necessary effort at national and international level.

Issues raised

• Lack or inadequacy of data, due to insufficient research on the subject
• Diversity and complexity of factors to be covered and elucidated
• Range of competencies / capacity-building required to carry out such multi-factor and multidisciplinary research
• Commitment of resources to support efforts and match stated goals

Key facts and figures

Some data and factual observations were provided during the session.

• The first large scale study, based on direct observation of more than 28,000 women in six African countries was conducted by an HRP group. It showed that deliveries among women who had undergone the practice (compared with deliveries among women who had not) were significantly more likely to be complicated by caesarean section, post-partum haemorrhage, episiotomies and prolonged stay in hospital. In addition, babies born to mothers who had undergone the practice (compared with babies born to mothers who had not) had a greater risk of dying during birth or of needing resuscitation immediately after birth.
• Data reported from another study showed that consultation for FGM-related infections involved girls/women between 3 months and 37 years of age
• Annual costs of FGM- related obstetrical complications in the six African countries studied are estimated to amount to US $3.7 million and range from 0.1 to 1% of government spending on health [“Female Genital Mutilation and obstetric outcome; WHO Collaborative Prospective Study in Six African Countries ( published in the journal The Lancet 2006;367:1835–1841.)” http://www.who.int/reproductive-health/publications/articles/lancetfgm.pdf ]

New initiatives, progress

• Intensified coordinated engagement of several UN Agencies and Programmes
• Increased concerted efforts to gather evidence on scope, implications and determinants of the problem
• Research- and evidence-based decision-making on policy and interventions
• Recognition of the need to provide psychological support to women concerned

Policies and programmes

• A regional action plan has been established to eliminate FGM in Africa

Country, field experience

• Eight countries in Africa have successfully integrated FGM elimination activities within their national health care and prevention programmes
• Eritrea, Ethiopia, Nigeria, Benin, Burkina Faso, Mali and Tanzania have condemned FGM as a violation of women’s rights and called for the elimination of the practice. Communities in some of these countries have passed ordinances within their areas of authority, to forbid the practice of FGM
• Four countries (Burkina Faso, Mali, Mauritania and Nigeria) have shown that the circumcisers are ready to lay down their knives to take on other income generating activities

Identified conclusions, lessons learned

• For progress and successful outcome, the FGM elimination goal must be led and interventions managed by the communities concerned; external support, however, can be key and should be made available.
• Research has shown that social change leading to abandonment of FGM is happening especially where elimination efforts are implemented within a broader human rights promotion framework.

Policy aspects/recommendations:

• All countries concerned should carry out specific studies to better understand the dynamics of FGM in their specific national context
• Set up routine data collection to allow monitoring and evaluation of progress and reporting as required by the resolutions adopted by the UN and WHO (WHA61.16)
• Strengthen research capacity worldwide on FGM

Focus and priorities for the Bamako Action Plan

• Call to Action, for all Heads of State, health personnel, community leaders and civil society, to develop and strengthen specific measures to eliminate FGM
• Mobilize resources in support of research and elimination activities

Operational recommendations

• Give women who have experienced and suffered from FGM an opportunity to speak up; provide them with support
• Encourage traditional circumcisers to give up the practice (taking into account their perceptions of potential loss of social status and/or income)
• Enrol traditional birth attendants in the FGM elimination effort; promote medical ethics to discourage the medicalization of FGM by health personnel

References - Documents

FGM Interagency Statement - 2008

World Health Organization, May 2008

Resolution WHA61.16

FGM on WHO website

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