TWEET CONFERENCE SCRIPT: Enhancing the quality of FGM-related health services in Nigeria – 04.04.2019

Female Genital Mutilation comprises of all procedures that involves all partial or total removal of all or part of the external Female Genitalia or other injury to the external genital organs for non-medical reasons.

The practice is mostly carried out by traditional circumcisers and in many settings, health care providers perform FGM due to the erroneous belief that the procedure is safer when medicalized. The World Health Organization (WHO) has classified FGM into four types, and they are all practiced in Nigeria.

Type I: partial or total removal of the clitoris and/or the prepuce (Clitoridectomy).

Subgroups of Type I FGM are: type Ia, removal of the clitoral hood or prepuce only; type Ib, removal of the clitoris with the prepuce.

Type II: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).

Subgroups of Type II FGM are: type IIa, removal of the labia minora only; type IIb, partial or total removal of the clitoris and labia minora; type IIc, partial or total removal of the clitoris, labia minora and labia majora.

Type III: narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation).

Subgroups of Type III FGM are: type IIIa, removal and apposition of the labia minora; type IIIb, removal and apposition of the labia majora.

Reinfibulation is covered under this definition. This is a procedure to recreate an infibulation, for example after childbirth when defibulation is necessary.

Type IV: unclassified – all other harmful procedures to the female genitalia for nonmedical purposes, for example, pricking, piercing, incising, scraping and cauterization. Type IV also includes the practice of “massaging” or applying petroleum jelly, herbal concoctions or hot water to the clitoris to desensitize it or pushing it back into the body, which is common in many parts of Nigeria, especially Imo State.

FGM is internationally recognized as a violation of human rights of girls and women. It is deeply rooted in culture with reasons including easing childbirth, improving marriage prospects, preventing premarital sex amongst others. But it has been proven that FGM has NO HEALTH BENEFITS, and it harms girls and women in many ways.

Short term complications include; severe pain, excessive bleeding, genital tissue swelling, fever, infections e.g tetanus, shock, urinary problems etc. Long term complications include; painful urination, urinary tract infection, Vaginal discharge, itching, bacterial vaginosis, scar tissue and keloid formation, painful menstruations, depression, anxiety amongst others.

Over 200 million girls and women alive today have been cut in 30 countries in Africa, the Middle East and Asia where FGM is concentrated. More than 3 million girls are estimated to be at risk for FGM annually. FGM is widespread in Nigeria. According to the Nigeria Demographic and Health survey (NDHS), overall FGM prevalence is 25% among women 15 t0 49 years.

In Nigeria FGM, States with the highest prevalence of FGM includes: Osun (77%), Ebonyi (74%), Ebonyi (74%), Ekiti (72%), Imo (68%), Oyo (66%), Lagos (35%) (NDHS 2013). The role of the health sector in the campaign to end Female Genital Mutilation cannot be overemphasized.

To explain the role of the health sector in eliminating FGM in Nigeria and how enhancing the services they provide would go a long way to end this practice. I will be dividing the services the health sector provides into two broad group;

a. Pre – mutilation services and

b. Post-Mutilation services

These FGM related health services are rendered by Doctors, Nurses, midwives and other health personnel.

  • Pre-Mutilation services are services that can be rendered to women or girls who have not been cut and includes; health education, counselling of pregnant mothers and their spouses etc.
  • Post-Mutilation Services are services that can be rendered to women or girls who have been cut and includes; counselling, Therapy, Deinfibulation for women that have undergone infibulation, reporting of offenders.

De-infibulation refers to the practice of cutting open the sealed vaginal opening in a woman who has been infibulated which is often necessary for improving health and well-being as well as to allow intercourse or to facilitate childbirth.

In order to enhance the quality of FGM-related health services in Nigeria, special attention has to be given to the training and equipping of health personnel with skills necessary to the delivery of these services.

The government and other parastatals have a huge role to play in this training and making these services available and accessible. Health personnel should be trained from time to time and be given up to date information about FGM especially as regards Medicalization as a lot of people erroneously believe it is beneficial.

By educating Health personnel ,they would be able to also provide adequate information to their patients about the dangers of FGM especially expecting mothers, couples amongst others. Counselling is one of the major services that health personnel have to provide especially to FGM survivors as regards how to cope with the long and short term effects of FGM.

Some women who have undergone FGM suffer from psychological problems including; depression, post-traumatic stress disorder (PTSD) amongst others, it is essential that hospitals have health personnel (psychiatrists) that can manage these conditions.

Providing health personnel with adequate counselling skills and emotional intelligence training is hence also a vital part of improving the quality of health services provided by them. Special health education about FGM should also be given in antenatal clinics to expecting mothers.

If need be counselling sessions should be organized for families of women who think that their families won’t agree not to cut their girl child

Health personnel should also be willing and prepared to answer all questions that their patients may have as regards FGM. Hospitals should be provided with materials, equipments and manpower to carry out FGM related procedures such as de-infibulation, vesico-vaginal fistula surgeries etc.

  • Health personnel should also be informed that they should inform the appropriate authorities about people who still went on to cut their girl child as laws have been made against FGM in Nigeria
  • Health personnel in Nigeria are generally viewed as trustworthy people whose opinions are mostly always respected. Hence by providing correct and adequate information about FGM to their patients they can help to eliminate FGM.

Currently in Nigeria, there are 12 -13 National Obstetric and Fistula centres. Women with obstetric fistula cases can receive free fistula repair surgeries.

Patients with Fistula cases can also receive psychotherapy sessions before re-integration into the society. One of such centres is the National Obstetric and Fistula centre Abakaliki, Ebonyi State, one of the five focus States for the @UNICEF_Nigeria and UNFPANigeria Joint Programme on FGM.

Women with infertility issues from FGM can have their babies delivered via Artificial reproductive techniques in some tertiary hospitals in Nigeria but at an expensive cost.  

De-infibulation surgeries are available for FGM survivors who had undergone FGM Type III. It involves re-opening the infibulated genitalia. This surgery is performed by plastic surgeons in Tertiary hospitals here in Nigeria.  

Vagina reconstruction surgeries are available at some Tertiary hospitals in Nigeria performed by plastic surgeons.  

At this point, I will end the presentation to give room for questions and contributions from participants. Thank you all for reading my tweets

To learn more about the @endcuttinggirls Campaign, please visit endcuttinggirls.org for information.  You may also follow our social media handles on Facebook, Twitter, Instagram and YouTube, using @endcuttinggirls

Together we will end FGM in this generation.

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