Job Osazuwa

Female genital mutilation (FGM), simply referred to as female circumcision, has existed for centuries in virtually all parts of Nigeria. It is a traditional belief that preaches chastity among the women folks. But it has been kicked against by both local and international organisations, including health experts, who described the practice as a violation of the right of girls and women.

Unfortunately, the unhealthy action has continued unabated in Nigeria and gravely affecting women and girls in an unquantifiable manners. The victims are left to endure the physical and psychological effects as they undergo the cruel “surgery.” It is a cut that becomes irreversible immediately the deed is done. It becomes an ordeal that lasts the victim her lifetime to contend with.

Contrary to the general notion that the practice now thrives only in the rural areas, it is still being practised even among the educated families, who invite these “cutters” from the villages to circumcise their girls in the cities.

Gynaecologists and other experts have repeatedly warned of the health implications associated with FGM. They maintained that the exercise has no single medical benefit to the female child.

There is also the concern of the unhygienic environment, which the exercise is performed and the unsterilised instruments the traditionalists use in cutting the girls’ private part, particularly the clitorises. No hospital carries out the practise, except among the unregistered one and done in a clandestine manner.

The World Health Organisation (WHO) defines FGM as partial or total removal of the external female genitalia and/or injury to the female genital organs, whether for cultural or any other non-therapeutic reasons.

Different studies revealed that FGM is practised in more than 28 countries in Africa. Its burden is mostly felt in Nigeria, Egypt, Mali, Eritrea, Sudan, Central African Republic, and northern part of Ghana.

In Nigeria, Osun, Ebonyi, Ekiti, Imo, Abia and Oyo states stand taller in the prevalence of FGM.

Over the years, the elimination of female circumcision in Nigeria has been on the front burners in the activities of WHO, United Nations International Children Emergency Fund (UNICEF), Federation of International Obstetrics and Gynecology (FIGO), African Union (AU), the Economic Commission for Africa (ECA), and many women organisations. Sadly, data from the National Demographic Health Survey revealed that 24.8 per cent of Nigerian girls and women aged 15 to 49 have been circumcised, with states in the South East region accounting for 45 per cent; and southwestern states accounting for up to 55 per cent. The report also showed that cutting occurs mostly at early childhood with 82 per cent of women in Nigeria getting circumcised before the age of five.

Incidentally, in Nigeria FGM is only condemned but no real protection by government is given to victims. Women who refuse surrendering their female children for circumcision are usually victimised and intimidated by their families or husband’s families, until they succumb. Only those who run away to places they are out of reach can escape it. According to investigations, traditional birth attendants in the rural areas, who believe it is for the good of the female folk, usually carry out the practice. The promoters have continued to emphasise, though with no empirical evidence, that FGM is for the preservation of chastity and purification, family honour, protection of virginity and prevention of promiscuity.

But UNICEF says FGM does irreparable harms to the victim. It can result in death through severe bleeding, pain and trauma and overwhelming infections. The world body, which described the act as routinely traumatic, calls on people to say a resounding “NO” to FGM anywhere it is practised.

To curtail the ugly development, UNICEF, in collaboration with the Human Right Clinic, University of Lagos recently hosted the first ever Frown Awards in Lagos, to celebrate people who are advancing the abandonment of FGM in Nigeria.

Speaking in Lagos, on behalf of UNICEF, a child protection specialist, Maryam Enyiazu, reiterated that FGM was a gender-based violence against women and girls, which needed to be tackled by all.

“UNICEF is proud to be part of this partnership and is committed to continue supporting government and other stakeholders at all levels to accelerate efforts for the total elimination of FGM in Nigeria by 2030 as stipulated by Sustainable Development Goal 5.3, which is to “eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation,” she said.

On the health dangers, experts say female circumcision is associated with haemorrhage, infection, acute urinary retention due to trauma, damage to the urethra or anus, chronic pelvic infection. Other health implications are tetanus, sexual dysfunction and infertility, prolonged labour, leading to fistulae formation, and increased prenatal morbidity and mortality, among others. Victims are also bound to suffer mental and psychological agony, which is deemed the most serious complication because the problem does not manifest outwardly for help to be offered.

WHO has stated that more than 200 million girls and women have undergone FGM in 30 countries, Nigeria inclusive, where the practice is prevalent, while about three million girls are at risk annually.

The National Demographic Health Survey (NDHS 2013) revealed that there were variations across Nigeria’s six zones and 36 states. South East and South West had the highest prevalence (49 per cent and 47.5 per cent respectively). This is further evidenced in South-East and South-West having the highest prevalence by state (74.2 percent and 76.6 per cent respectively). North-East is the zone with the lowest prevalence, at 2.9 per cent, while Katsina has the lowest prevalence, at 0.1 per cent.

According to the survey, one in four Nigerian women from ages 15 to 49 has been circumcised. It also showed that South-West is now leading with 41.1 per cent, followed by South-East with 32.5 per cent, South-South 23.3 per cent, North-West 19.3 per cent, North-Central 8.6 per cent and North-East 1.4 per cent.

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Myths on health benefits

Contrary to the belief that FGM helps to ease childbirth and prevent promiscuity, a study carried out for WHO in 2006 in six African countries (including Nigeria) reported that women, who had undergone FGM, had significantly more problems at childbirth than those who had not undergone FGM. The identified problems include: Caesarean section, postpartum haemorrhage, episiotomy, extended maternal hospital stay, resuscitation of the infant and inpatient perinatal death’.

The study also highlighted other complications caused by FGM as sepsis, an increased risk of stillbirth, urinary tract infections, hepatitis, pelvic inflammatory diseases, infertility, a higher risk of HIV, obstructed labour, which results most times to vesico vaginal fistula (VVF), and recto-vaginal fistula (RVF).

In his contribution to the possible risks associated FGM, a consultant obstetrician and gynaecologist at Emmanuel Faith Clinic, in Alimosho area of Lagos State, Odunayo Akintola, said it baffled him why FGM was still being encouraged by some families. He described it as a sin against humanity.

He said despite his concerted efforts to enlighten couples of no medical relevance of the practice, some still sneak out to perform it.

“It is more painful when we receive the educated ones and watch them arguing blindly with you why they must circumcise their babies. Though the awareness is increasing, unlike some the decades ago, a lot still need to be done,” he said.

According to him, beginning from the mutilation process, FGM is highly risky for the girl-child, warning that the victim could bleed to death. He added that the child might contract infections in the process.

According to him, “we have received cases of people contracting HIV and other infections from the procedure. The truth is not far-fetched because the “cutters” use same instruments to mutilate several girls brought to them.

“In most cases, an important part of the vagina – the clitoris – is removed and the girl is subjected to a lifetime torture.”

In 1995, WHO developed four broad major categories of FGM operations. They include:

Type one: This is the partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals), and in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).

Type two: Often referred to as excision, this is the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva), with or without excision of the labia majora (the outer folds of skin of the vulva).

Type three: Known as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoris (clitoridectomy), leaving a small hole for urine and menstral flow.

Type four: This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

Efforts to eradicate FGM

On February 6, 2016, the United Nations Population Fund (UNFPA) and UNICEF launched a new global target and call to action to eliminate FGM by 2030 during the International Day of Zero Tolerance for FGM. However, for this to be achieved, experts and stakeholders in the health care sector believe that there must be a concerted effort by the government, community leaders and families to end the unhealthy practice.

Before then, in 2007, UNFPA and UNICEF initiated the Joint Programme on Female Genital Mutilation/Cutting to accelerate the abandonment of the practice. Also, in 2008, WHO, together with nine other United Nations partners, issued a statement on the elimination of FGM to support increased advocacy for its abandonment, called: “Eliminating female genital mutilation: an interagency statement.”

Also, in 2010, WHO published a “Global strategy to stop healthcare providers from performing female genital mutilation” in collaboration with other key United Nations UN agencies and international organisations. Similarly, in December 2012, the UN General Assembly adopted a resolution on the elimination of female genital mutilation.

A general medical practitioner based in Lagos, Adibe Moses, dismissed the myth that retention of the clitoris could cause promiscuity and stillbirth, corroborating others experts’ position that the notion had been disproved by scientific studies.

He said: “FGM has no benefit to the survivor, except sorrow and complications. It is a criminal offence but the cultural belief attached to it in many communities has made the practice more difficult to eradicate. But we can achieve better result if we all come out boldly to speak against it.

“As doctors, we can only speak on the health complications that might arise from FGM, but what about the emotional trauma, low self esteem and the rest? Among my patients, no one has been able to convince me of the benefits of female circumcision, except cultural beliefs. Those cultural beliefs are nothing but mere perceptions.”