Female Genital Mutilation (FGM) is defined, by
the World Health Organization (WHO), as “all
procedures that involve partial or total removal of the external female
genitalia, or other injury to the female genital organs for nonmedical reasons”.
The term FGM is preferred by WHO and United Nations in order to convey the
irreparable physical and psychological damage done to girls and women.
In 1997, World Health Organization (WHO)
classified FGM into four types, namely, Type I (Clitoridectomy); Type II (Excision);
Type III (Infibulation); and Type IV (Unclassified). These types, which were further subdivided in
2008 by WHO, are all practiced in Nigeria. The four Types of FGM and their subtypes are
Type I: partial or total removal of the clitoris and/or
the prepuce (Clitoridectomy).
Subdivisions of FGM
Type I are: FGM Type Ia, removal of the clitoral hood or prepuce only and FGM
Type Ib, removal of the clitoris with the prepuce.
FGM Type II:
partial or total removal of the clitoris and the labia minora, with or without
excision of the labia majora (excision).
Subdivisions of FGM
Type II are: IIa, removal of the labia
minora only; IIb, partial or total removal of the clitoris and labia minora;
and IIc, partial or total removal of the clitoris, labia minora and labia
FGM 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
Subdivisions of FGM
Type III are: FGM Type IIIa, removal and apposition of the labia minora; and
FGM Type IIIb, removal and apposition of the labia majora.
covered under this definition. This is a procedure to recreate an infibulation,
for example after childbirth when defibulation is necessary.
IV: unclassified – All other harmful procedures to the female
genitalia for non-medical purposes. It
incision of clitoris and/or labia.
burning of clitoris and surrounding tissues;
cuts) of the vaginal orifice or Cutting (gishiri cuts) of the vagina;
corrosive substances into the vagina to cause bleeding or Herbs into the vagina
with the aim of tightening or narrowing the vagina.
FGM 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.
It is estimated
that over 200 million girls and women worldwide are living with or at risk of
suffering the associated negative health consequences of FGM
Every year 3
million girls and women are at risk of FGM and are therefore exposed to the
potential negative health consequences of this harmful practice.
The procedure of
FGM is painful and traumatic, and is often performed under unsterile conditions
by a traditional practitioner who has little knowledge of female anatomy or how
to manage possible adverse events.
FGM has no known
health benefits. Moreover, the removal of or damage to healthy genital tissue
interferes with the natural functioning of the body and may cause immediate and
long-term health consequences, which are listed in 11a and b.
The “Immediate & Short term complications” of
FGM are 1) severe pain and injury to tissues; 2) haemorrhage (bleeding); 3) haemorrhagic
shock; 4) infection and septicaemia; 5) genital tissue swelling; 6) acute urine
retention; and 7) fracture of bones.
The “long-term complications of FGM” are 1) chronic
vulvar pain; 2) clitoral neuroma; 3) reproductive tract infections; 4) menstrual
problems; 5) urinary tract infections; 6) painful or difficult urination; 7) epidermal
inclusion cysts; and 8) keloids.
In 2006, WHO study
group analysed the obstetric risks associated with FGM and concluded that women
living with FGM are significantly more likely than those who have not had FGM
to have adverse obstetric outcomes such as 1)
Caesarean section; 2) Postpartum haemorrhage (Postpartum blood loss of 500 ml
or more); 3) Episiotomy; 4) Prolonged labour); 5) Obstetric tears/lacerations;
6) Instrumental delivery; 7) Difficult labour/dystocia; 8) Extended maternal
hospital stay; 9) Stillbirth and early neonatal death; and 10) Infant
resuscitation at delivery.
Given that some
types of FGM involve the removal of sexually sensitive structures, including
the clitoral glans and part of the labia minora, some women may experience the
following 1) Dyspareunia (pain during sexual intercourse); 2) Decreased sexual
satisfaction; 3) Reduced sexual desire and arousal; 4) Decreased lubrication
during sexual intercourse; 5) and Reduced frequency of orgasm or
For many girls and
women, undergoing FGM can be a traumatic experience that may leave a lasting
psychological mark and cause a number of mental health problems, which include
1) Post-traumatic stress disorder (PTSD); 2) Anxiety disorders; and 3)
The practice of FGM
is prevalent in 30 countries in Africa and in a few countries in Asia and the
Middle East, but also present across the globe due to international migration
FGM is practiced for a variety of sociocultural
reasons, varying from one region and ethnic group to another. The primary
reason is that it is part of the history and cultural tradition of the
In many cultures, FGM constitutes a rite of
passage to adulthood and is also performed in order to confer a sense of ethnic
and gender identity within the community. In many contexts, social acceptance
is a primary reason for continuing the practice.
Other reasons for practicing FGM include
safeguarding virginity before marriage, promoting marriageability (i.e.
increasing a girl’s chances of finding a husband), ensuring fidelity after
marriage, preventing rape, providing a source of income for circumcisers, as
well as aesthetic reasons (cleanliness and beauty).
Some communities believe that FGM is a religious
requirement, although it is not mentioned in major religious texts such as the
Koran or the Bible.
FGM practice is
deeply rooted in a strong cultural/social framework. It is endorsed by the
practicing community & supported by loving parents who believe that
undergoing FGM is in the best interest of their daughter.
sustaining the practice of FGM vary greatly from one community to another,
although there are many common themes such as ending promiscuity or the
maintaining culture tradition of the community.
FGM functions as a self-enforcing social
convention or social norm. In societies where it is practiced, it is a socially
upheld behavioural rule. Families and
individuals continue to perform FGM because they believe that their community
expects them to do so.
While FGM is de facto violent, although it is not
intended as an act of violence. It is considered to be a necessary step to
enable girls to become women and to be accepted, together with the rest of the
family, by the social group of which they are part.
cultural importance, we need to acknowledge the fact that FGM is a harmful
traditional practice that violates the rights or girls and women. These include 1) Principles of equality and
non-discrimination on the basis of sex; 2) Right to life (when the procedure
results in death); 3) Right to freedom from torture or cruel, inhuman or
degrading treatment or punishment; and 4) Rights of the child. Therefore, FGM has to be eliminated.
When FGM is
conducted by healthcare providers this is also known as the “medicalization of
FGM”; The medicalization of FGM refers to “situations
in which the procedure (including re-infibulation) is practised by any category
of health-care provider, whether in a public or a private clinic, at home or
elsewhere, at any point in time in a woman’s life”.
providers who agree to perform FGM are violating the fundamental medical
ethical principle or duty of non-maleficence (“do no harm”) and the fundamental
principle of providing the highest quality health care possible.
widespread in Nigeria with regional and ethnic variations in prevalence.
According to the
Multiple Indicator Cluster Survey (MICS 2016 -2017), 18.4% of women aged 15-49
years had undergone FGM, a decrease from 27% in 2011. The decrease was also observed in the five
states where the UNFPA-UNICEF Joint Programme on FGM Elimination (UNJP) is
working, namely, Ebonyi: 62.3 % to 43.2%; Ekiti: 66.2% to 62.6%; Imo: 58.4% to
51.6%; Osun: 73.4% to 67.8 %; and Oyo: 71% to 55%).
According to the
MICS (2016-2017), the FGM prevalence among daughters aged 0-14 years increased
from 19.2% (in 2011) to 25.3% (in 2016-2017).
In the five UNJP intervention states, FGM prevalence decreased in three
States, namely, Ebonyi (6.4% to 5.2%), Imo (33.4% to 22.2%), and Oyo states
(32.9% to 29.6%). While, a slight increase was seen in Ekiti (40.3% to 41.7%)
and Osun (33.4 to 34.6%).
According to the
MICS (2016-2017), 21.6% of women surveyed were in support of the continuation
of FGM, a very slight decrease from 21.8% in 2011. In the five UNJP intervention states a
decrease was observed in Ebonyi (11.8% to 3.8%) and Ekiti (50.2% to 31.4%); while
an increase was seen in Imo (27.8% to 29.6%); Oyo: (21.2% to 30.3%); Osun:
(34.8% to 38.5%).
Now let us talk about “Ending FGM through provision
and accessibility of social and legal services.”
FGM is a form of extreme harm against women and
girls and leads to severe short and long term physical and psychological
consequences and may require access to quality services to address their heath,
legal and social needs. .
FGM may lead to psychological and mental health
problems because it is an extremely traumatic experience for girls and women,
which stays with them for the rest of their lives. In some cases these FGM
survivors may not have spoken about their experience for many years, and while receiving
psychological counselling many have reported feelings of betrayal by parents,
incompleteness, regret and anger.
Now there is increasing awareness of the severe
psychological consequences of FGM for girls and women, which can become evident
in mental health problems. The results from research in practicing African
communities show that women who have had FGM have the same levels of
Post-Traumatic Stress Disorder (PTSD) as adults who have been subjected to
early childhood abuse, and that the majority of the women (80%) suffer from
affective (mood) or anxiety disorders.
The fact that FGM is ‘culturally embedded’ in a
girl’s or woman’s community does not protect her against the development of
PTSD and other psychiatric disorders. Therefore, there is a need to ensure that
mental health support is made available to assist girls and women who have
undergone FGM, as well as treatment for any physical symptoms or complications.
It is therefore important to ensure that that the
provision of these services, especially social and legal services are integral
parts of the campaign to end FGM in Nigeria.
However, since no single agency or statutory body can meet the multiple
needs of someone affected by FGM, a multi-agency response is required.
In Nigeria, some of the main social services
required by women and girls living with FGM, or at risk of FGM, include
referral to social services for psychosocial counseling, counseling, and
shelter. The provision of these services
are the responsibilities of the Ministry of Health (MOH), Ministry of Women
Affairs and Social Development (MWASD), and other related agencies.
In Nigeria, some of the main social services
required by women and girls living with FGM, or at risk of FGM, include main
legal services include judicial counseling and assistance. These The provision of these services are the
responsibilities of Ministry of Justice, law enforcement agencies (Nigeria
Police Force, Nigeria Security and Civil Defence Corps), the judiciary and
other related agencies.
In Nigeria, the
legal and policy framework has created a conducive environment at national
level and state levels to support the campaign to end FGM in Nigeria, as can be
show as follows
Constitution of the Federal Republic of Nigeria (1999) does not specifically
refer to violence against women and girls, harmful traditional practices or
FGM; however, Articles 15(2) and 17(2) prohibit discrimination and set out
equality of rights respectively, and Article 34(1) provides that every
individual is entitled to respect for the dignity of their person and,
accordingly, no one ‘shall be subject to torture, or to inhuman or degrading
the Child Rights Act (CRA-2003) does not specifically refer to FGM, section
11(B) states that “No child shall be subjected to any form of torture, inhuman
or degrading treatment”. . The CRA 2013,
as a federal law, is only effective in the Federal Capital Territory of Abuja,
and, as such, the remaining states must pass mirroring legislation to prohibit
FGM across the country. Currently, 24
States of Nigeria have passed their Child Rights Laws, and in some cases the
prohibition of FGM is clearly stated.
Violence Against Persons (Prohibition) Act, 2015 (the VAPP Act), aims to
eliminate gender-based violence in private and public life by criminalizing and
setting out the punishment for acts including rape (but not spousal rape),
incest, domestic violence, stalking, harmful traditional practices and
FGM. The VAPP Act 2015 states that ”a
person who performs female circumcision or genital mutilation or engages
another to carry out such, commits an offence punishable by 4 years
imprisonment or to a fine of N200,000 or both.
The VAPP Act, as a federal law, is only effective in the Federal Capital
Territory of Abuja, and, as such, the remaining states must pass mirroring
legislation to prohibit FGM across the country.
In addition to the National Laws, we also State laws that prohibit the
practice of FGM in Nigeria. In this
presentation, we want to highlight the laws in the five states where the UNFPA-UNICEF
Joint Programme on Eliminating FGM is taking place such follows…
Female Circumcision and Genital Mutilation (Prohibition) Law 2004;
Against Women Law, 2016 (Oyo State);
FGM (Prohibition) Law (2017); and
State Violence Against Persons (Prohibition) Law, 2018;
In addition to the above laws, the existence of “Medical and Dental
Practitioners (Disciplinary Tribunal) Rules” and “National Health Act 2014”
also protects the girls and women from being subjected to FGM by medical practitioners
as described in 33a and b.
Regarding medical malpractice, the Medical and Dental Practitioners
(Disciplinary Tribunal) Rules, 2004 (the Medical Act), sets out in Section 16
under ‘Penalties for Professional Misconduct’ that, where a registered person
(i.e. a medical practitioner) is found guilty of professional misconduct by the
medical Disciplinary Tribunal or is convicted by any court of law or tribunal
for an offence considered incompatible with the status of a medical practitioner,
they may be subject to penalties. Although this does not explicitly refer to
FGM, if such an action is considered as medical malpractice, it would thus fall
under the scope of this law.
In addition, the National Health Act 2014 under Section 48(1)
addresses the removal of tissue, blood or blood product from the body of
another living person. The action is liable to prosecution unless it is done
with the informed consent of that person, for medical investigations and treatment
in emergency cases (where the consent clause may be waived) and in accordance
with prescribed protocols by the appropriate authority. Section 48(2) also
states, ‘A person shall not remove tissue which is not replaceable by natural
processes from a person younger than eighteen years.’
The availability of FGM-related social and legal services essential in
ensuring the accessibility of services to persons subjected to FGM and/or those
at risk of undergoing the practice. However, there are some challenges that
prevent them from accessing these services.
in Nigeria where the culture of silence still surrounds FGM, in many
quarters, a lot needs to be done to encourage women/girls to speak out when
subjected or of threatened with this harmful practice. Therefore, the public
needs to be aware that a survivor has the freedom and the right to disclose an
incident to service providers.
In Nigeria many women and girls who need FGM-related services may not
have the financial willpower to access such services. Therefore there is a need to ensure that some
of these services are provided free-of-charge, or subsidized as the case may
be. The people also need to become aware
of the existence of these services.
To address these challenges, there is also a need to harmonize the
process involved of providing FGM-related legal services, by all government and
non-government stakeholders at various levels, by establishing a Standard
Operating Procedures (SOP) & Referral Pathway for service provision.
These referral pathways, with Standard Operating Procedures (SOPs), will
serve for case management and by extension make easier for FGM survivors to access
FGM-related legal services
The provision of these FGM-related services must focus on two linked
aspects of care: (a) Provision of sensitive and appropriate services for
survivors of FGM; and (b) Safeguarding girls at risk of FGM. The nature of FGM services will vary
depending on local prevalence of FGM, and in each case there must be clear
referral pathways to FGM services.
These organizations providing FGM-related services must thereafter
commit to disseminate the SOPs and referral pathways in communities where they
operate to ensure knowledge and improve access of FGM survivors to services (health,
social and legal) and support.
At the bottom of the referral pathway, an FGM survivor may disclose
her experience or threat of FGM to a trusted family member or friend. She may
also seek help from a trusted individuals or organization.
Anyone the survivor tells about her experience has a responsibility to
give honest and complete information about services (including legal) available
and encourage her to seek help where available.
As earlier mentioned above, the survivor has the freedom to report the
incident/event to anyone. She may seek help from community leaders, social
workers, health workers or friends.
For each FGM case, the provider need to ensure that a written consent
form is completed by the survivor describing the incident in her own words.
If the survivor is trying to escape FGM, she would still provide
information on the event and provide her consent before protection or any other
services are offered. Also, if the survivor is illiterate, her exact words
should be written and read loudly to him/her to understand before he/she can
indicate signature with a thumbprint.
Referrals should be made among the various government and
non-government actors from those who first got the report to the actual legal
Where legal services are needed, the consent of the survivor has to be
gotten and then referred to appropriate agency to provide security, protection
and legal services, complete the incident form and document incident.
In each case where a referral is made, a follow up is necessary to
ensure that services are provided, and also to ensure client satisfaction and
All members of the organizations that receive the referrals must also
be properly oriented on the guiding principles in the SOP for service
Upon receiving initial report of a girl-child or woman who is
threatened with FGM, the person who has this information should contact and
make referrals to relevant agencies and organization for child protection. Amongst
these relevant agencies and organization for child protection are the key
actors will be Ministry of Health, Ministry of Women Affairs and Social
Development (SMWASD), Ministry of Justice, National Human Rights Commission, International
Federation of Women Lawyers (FIDA), Child Protection Network (CPN), Legal Aids
Council, and others agencies providing similar services, especially Civil
Society Organizations. These agencies
will make sure to abide by the procedures for caring for child survivors and
should also utilize the applicable laws in the state to ensure protection of
In the case of a child facing the complications of FGM, the service
provider should also follow the steps and guide in the SOP and referral pathway
to ensure access to urgent medical intervention.
On documentation, reporting and information management the SOP should
adopt a format that will ensure that information on incident is systematically
recorded and stored in a safe place.
Organizations who are signed on to this SOP should ensure that their
staff members are oriented on how to complete the forms and interact with the
survivor in line with the guiding principles.
Actors for this SOP must attend a Quarterly Review Forum to be to
review successes, discuss challenges, share lessons learnt and work out the way
There should be Annual or Biennial review of the SOPs. However, the
referral pathways will continue to be reviewed as necessary by the actors as
necessary to maintain relevance and focus.
In Nigeria, traditional and community leaders are major decision
makers whose positions and opinions influence community behavior. Therefore,
FGM response and legal services must integrate the actions and perceptions of
this social group. Efforts will be made to educate, sensitize and include
community and religious leaders who are FGM champions in the overall FGM
response in the state as active actors in the referral pathways.
The Federal and State Governments should ensure that adequate funding
is available for anti FGM programmes to disseminate clear and accurate
information around the law, as well as the services available for FGM survivors
and those at risk.
The Nigeria Police Force, Nigeria Security and Civil Defence Corps
(NSCDC) and the judiciary need adequate support and training around the law and
should be encouraged to apply sentences provided for by the legislation.
The Ministry of Justice and Judiciary should be encouraged to use
Mobile Courts in fast-tracking the prosecuting of offenders. After serving their sentences, the convicted offenders and families are counseled to become change
agents. This system has been found to be very effective in Burkina Faso.
The Judiciary could be encouraged to make sure any prosecutions
relating to FGM are clearly reported, including by local media such as
community radio, and made available in local languages.
The increased involvement of Community and religious leaders in
education around the law, including their responsibilities and the importance
of the law in protecting women and girls in their communities, should be
Effective monitoring and collection of data around enforcement and
cases of FGM would help to inform strategies and programmes.
Mandatory reporting of instances of FGM by medical staff in hospitals
and health centers is recommended to ensure that now girl/women is left behind.
Where they are currently unavailable and a need is identified,
appropriate protection measures (for example, emergency telephone lines or safe
spaces, including temporary shelters) should be put in place for girls and
women at risk of FGM.
Laws could be printed and widely distributed in local languages, to
make them more widely available to the public, including in forms that can be
used in areas of low literacy.
Local community radio and other media channels, including mobile phone
technology and social media platforms, should also be considered for
dissemination of information on the law and social services available in
Whatever the reason
provided, FGM reflects deep-rooted inequality between the sexes. This aspect,
and the fact that FGM is an embedded sociocultural practice, has made its
complete elimination extremely challenging. As such, efforts to prevent and
thus eventually eradicate FGM worldwide must continue, in addition to
acknowledging and assisting the existing population of girls and women already
living with its consequences whose health, social and legal needs are currently not fully met.
At this juncture, I will like to stop and I will welcome questions and
To learn more about the @endcuttinggirls Social Media Campaign to end
FGM, please visit endcuttinggirls.org and follow our social media handles on Facebook,
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