OUTLINE

1. Introduction
2. Current situation of FGM in Nigeria
3. Types of FGM
4. Health effects of FGM
5. Roles of health workers in combating these effects
6. Health workers as advocates

INTRODUCTION

The UNICEF Endcuttinggirls Team sincerely welcomes you all to this Facebook conference where she hopes to discuss extensively on the topic which has been unanswered in the heart of many.

The Facebook conference is to help us reach to more people educating them on the need for FGM abandonment, aid those inactive users of twitter participate in our conference and also help us answer pending questions.  For this reasons we will give a detailed introduction to FGM so that people participating in our conference for the first time will not be left out.

This conference will last for one hour and you can mention friends to participate. Your questions will be attended to from 5:40pm till 6:00pm. We would be glad to attend to all pressing questions about the ROLES OF HEALTH WORKERS IN THE CAMPAIGN TO END FGM.

INTRODUCTION

FGM: This is an acronym for Female Genital Mutilation. According to World Health Organization (WHO) it can be defined as all procedures which involve partial or total removal of the external female genitalia and/or injury to the female genital organs for nonmedical reasons. This practice is often carried out on young girls between infancy and age 15, and occasionally on adult women.

WHERE THIS PRACTICE IS DONE      

The practice can be found in communities around the world

• Africa: 29 countries: Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Cote d’Ivoire, Democratic Republic of Congo, Djibouti, Egypt, Ethiopia, Eritrea, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Togo, Uganda and Zambia.
• Asia: India, Indonesia, Malaysia, Pakistan and Sri Lanka.
• Middle East: Oman, UAE, Yemen, Iraq, Iran, Palestine and Israel.
• South America: Columbia, Ecuador and Peru.
• Diaspora populations: Australia, Canada, Europe, USA and UK

What is the situation of FGM in Nigeria?

• Prevalence of girls and women aged 15-49years who have undergone FGM in Nigeria is (25%) (2013 Nigeria Demographic Health Survey – NDHS).
• 17% of girls aged 0-14 have undergone FGM/C (NDHS 2013)
• 9 million Nigerian women have undergone FGM (NDHS 2013)
• 20 million are estimated to have undergone FGM/C (UNICEF 2013)
• Approximately 10% of the 200 million FGM survivors worldwide are Nigerian. (WHO 2016)
• Most prevalent among Yoruba women (55%), followed by Igbo women (45%). (NDHS 2013)
• 32% of urban women have undergone FGM, as compared with rural women (19%). (NDHS 2013)
• More women having undergone FGM in the southern zones than in northern zones. (NDHS 2013)

Globally, over 3 million girls and women are estimated to be at risk of FGM annually and More than 200 million girls and women alive today have been cut in the 29 countries in Africa and Middle East where FGM/C is concentrated

TYPES OF FGM:

Type I (Clitoridectomy): 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 II (Excision): This is the partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are “the lips” that surround the vagina).

Type III (Infibulation): narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris.

Type IV (Unclassified):  All other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

RISK FACTORS ASSOCIATED WITH FGM/C

There are various factors that affect/ predisposes one to FGM but this will be categorized to three various groups;

• Social risk factors
• Demographic risk factors
• Economic risk factors

These factors affect the lifestyle of the girl child/ woman thus; predisposing her to FGM. These factors include health, education, wealth and religion. This can in other words influence the individuals’ personality, attitudes and lifestyle.

EFFECTS OF FGM               

The type of FGM done determines the severity.

• Severe pain
• Serious bleeding
• Infection of the wound
• Trauma
• Problems urinating
• Tetanus and other infectious diseases, such as HIV, from unsterilized cutting tools
• Infections (such as genital abscesses)
• Problems having sex. (g. pain).
• Depression and anxiety
• Painful and prolonged menstrual periods
• Urinary problems
• Vesico Vaginal Fistula (VVF) or Recto Vaginal Fistula (RVF).

This can happen when the urethra or rectum is damaged during FGM/C. Fistula causes incontinence and other problems, including odors, and can cause girls and women to become social outcasts.

• Death

ROLES OF HEALTH WORKERS IN COMBATING THE EFFECTS OF FGM

All over the world, there have an increasing commitment by communities and governments to eliminate FGM – but it is not enough as the support of health workers in the global effort to end FGM is critical.

Reasons why Health Workers should be mobilized

1. Health workers which include midwives, nurses, doctors, scientists, pharmacists, and community health extension workers play a pivotal role in mobilizing against the practice of FGM as they relate with the patients directly.
2. Front-line health workers (nurses, midwives and obstetric and gynaecologists) have inside knowledge of the social dynamics in the communities they serve and the social norms that perpetuate FGM, and they can speed up the rapid decline in support for the practice.  Their patients know and trust them.
3. Health workers also have a deep understanding of the harmful consequences of this practice.  They see the urinary, menstrual, and obstetric complications — including haemorrhage, infection and death — caused by it.  They also witness the emotional wounds FGM inflicts, trauma which often lasts a lifetime.
4. Health workers can use their influence, not only in the communities where they work, but also with their colleagues to accelerate the abandonment of FGM everywhere.  They can protect the sexual and reproductive health of those who have already undergone FGM.
5. Health workers are also uniquely well-positioned to lead the effort to resist a disturbing trend that has emerged in many countries: The medicalization of FGM.   Around one in five girls have been cut by a trained health-care provider.  In some countries, this can reach as high as three in four girls.

HOW CAN WE RAISE HEALTH WORKERS AS ADVOCATES?

1. Financial and Social Protection: As much the fact that these frontline health workers have the knowledge and understanding to navigate cultural sensitivities and convince families not to cut their daughters, we must also note that they face a lot of financial and social pressures to perform FGM. To aid curb this pressure and empower health workers, the United Nations Population Fund (UNFPA) has combined two global programs, the UNICEF/UNFPA Joint Programme on eliminating FGM: : Accelerating Change, which is active in 16 countries, and the Global Midwifery Programme, which is active in 65 countries. Through this joint initiative, UNICEF/UNFPA is doing sensitization, training, and skill-building for midwives so that they can act as role models, counsellors, and advocates for the abandonment of FGM. The Joint Programme is now in Phase III (2018 to 2021)
2. Global E-learning platform: In the article and video on “Engaging Health Workers in the Global Movement to End Female Genital Mutilation” Lal said, “A multimedia e-learning module for midwives are on the way”. To help increase number of health workers as advocates, stakeholders are also encouraged to create E-platforms for their health workers were recent information on FGM abandonment and assisting mutilated girls are uploaded.

CONCLUSION

We know that health workers cannot do this alone. The Endcuttinggirls Young Advocacy Network through the UNFPA/UNICEF Joint Programme on eliminating FGM: Accelerating Change, are committed to supporting efforts to provide health workers with the skills and information they need to accelerate the abandonment of FGM – and to treat the complications that arise from the practice.

Social norms, especially in tightly knit communities, can exert tremendous power over people’s lives. But social norms can also change when people use their power … when health workers, leaders, experts, and, most of all, girls and families, speak out and act, and then there will be solution.

At this point we will give room for questions ad it would be answered in the order with which they appeared in the comment section.

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