June 2019, the UNICEF Nigeria supported Facebook
conference will discuss the topic on “Ending
FGM through Strategic partnership with key sectors such as Health, Education,
and Law Enforcement”. This Facebook
conference is part of a multidisciplinary approach to eliminate the harmful
practice of Female Genital Mutilation (FGM) in this generation in line with the
This Facebook Event will last from 5pm-7pm
Nigerian time (GMT +1). I will attend to
your questions and contributions from 6:31 to 7:00pm. Please feel free to share the
event or tag your friends to participate.
For the sake of
those joining us for the first time, I shall present a brief overview of Female
Genital Mutilation (FGM).
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 described in 7a-d.
FGM Type I: partial or total removal of the clitoris and/or the prepuce
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 majora.
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 clitoris (infibulation).
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
Reinfibulation is covered under this definition. This is a procedure to
recreate an infibulation, for example after childbirth when defibulation is
Type IV: unclassified – All other harmful procedures to the female
genitalia for non-medical purposes. It
Piercing or incision of
clitoris and/or labia.
Cauterisation by burning
of clitoris and surrounding tissues;
Scraping (angurya cuts)
of the vaginal orifice or Cutting (gishiri cuts) of the vagina;
Introduction of 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
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 community.
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.
Despite its 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”.
Healthcare 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.
FGM remains 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
Strategic partnership with key sectors such as Health, Education, and Law
FIRST LET US DISCUSS PARTNERSHIP WITH THE HEALTH SECTOR:
Research suggests that there are several ways to win health care
professionals’ support as allies in FGM abandonment efforts having in mind
their programmes and organizational structures.
First, training programs for these professionals, particularly those
living in areas where FGM is widely practiced, should focus on what FGM is, why
it is practiced, its health impacts, and ways to prevent it.
Trainings must also sensitize health care practitioners to the fact
that FGM is a violation of girls’ and women’s rights to health and conflicts
with the “do no harm” principle of medical practice.
Second, these professionals, as a focus of FGM abandonment programs,
should be given the opportunity to reflect on their own beliefs and think
critically about how these views may fuel the continuation of the practice.
Health professionals’ associations and health regulatory agencies
should have clear guidelines and standards for providers that outline the
sanctions on those who perform FGM.
These organizations should also offer opportunities for health care
professionals to contribute to community efforts to promote the abandonment of
Community health outreaches should include sensitization of the people
on the dangers of Female Genital mutilation on the health of girls and
Health-care providers should be equipped with the reasons why FGM
should not be performed by health-care providers and how to resist requests to
do so from parents;
Health-care providers should be equipped with how to recognize and
manage complications of FGM, including suitable obstetric care; and how to
counsel women and families on FGM-related issues.
Guidelines should be in place, including medical, ethical and legal
information, such as how to counsel and care for girls and women who have
undergone FGM, including counselling against reinfibulation.
Deeply rooted discriminatory norms and practices that underlie FGM,
including sexual concerns and eventual religious underpinnings, should be
addressed, where relevant, when designing training programmes and developing
Necessary actions in this area are: appropriate national authorities
should develop national guidelines for various health-care providers on how to
deal with issues related to FGM, including how to care for complications and on
how to resist pressure to perform any form of FGM, including reinfibulation.
Training modules on FGM for inclusion in pre-and in-service curricula
and training, including refresher courses and updates for all health-care
providers, should be developed including nurses, midwives, medical doctors and
other health outreach workers.
Training of health-care providers should be integrated at the
community level with other community-based activities promoting the abandonment
Health-care providers should be informed without delay about human
rights and ethical perspectives as well as the harmful consequences of FGM, and
that performing FGM, including reinfibulation, would give rise to civil and
Appropriate ethical guidelines on FGM should be incorporated into the
training curricula of health-care providers.
The Ministry of Health and professional regulatory bodies should issue
a joint policy statement against FGM.
The application of existing laws and policies should address the role
health-care providers play in the elimination of FGM and forbid the performance
of any type of FGM, including reinfibulation.
Licensed health-care practitioners must be subject to the maximum
available criminal penalties that apply to anyone performing FGM. Offending
practitioners may be suspended or their licences withdrawn if they perform FGM.
Strengthen monitoring, evaluation and accountability Monitoring and
evaluation are essential for improving health-care providers’ approaches to FGM
and for refining plans to promote abandonment of the practice.
SECOND, LET US REVIEW HOW TO PARTNER WITH THE EDUCATION SECTOR
Addressing a complex issue such as FGM in a way that will bring about
sustainable change requires a comprehensive and context-sensitive response
involving many and varied education organizational structures .
Coordination across all levels is needed to understand the
perspectives of these different structures, what constrains and enables them to
act, and what support, training and resources they need.
It is clear from previous research undertaken by @28TooMany that the
inclusion of FGM education in schools is an essential element in addressing the
This view is also reflected in other studies; for instance, a survey
of secondary-school teachers in North Central Nigeria (2015) put forward the
opinion of the participating teachers that awareness of FGM and its
implications should be taught in schools (Adeniran et al, 2015).
In the education sector, there are also different union and
associations that sees to the overall development of teachers. Some of these unions and association includes:
Teachers Union, International School Educators of Nigeria, and Association of
Christian Schools International.
Teachers’ union is one important structure to partner with in the
education sector to end FGM in Nigeria.
Teachers’ union represent the collective of teachers as employees. As
such, they have strong legitimacy among teachers and play a key role in setting
the standards, codes of conduct and practice, and employment terms of teachers.
As teachers play a key role in preventing and responding to FGM,
teaching unions can support their members to access appropriate training and
support on FGM, raise awareness about FGM and advocate at a national policy
Teachers’ unions are therefore key partners in both changing teachers’
behaviours and experiences and in looking at the wider system of education to
strengthen support, capacity and readiness to address FGM.
With growing pressure on teachers worldwide to measure progress in
more limited ways, such as enrolment, attendance or learning outcomes, teacher
report that the well-being and wider development of learners can be sacrificed
(UNAIDS IATT, 2015).
Working with teachers’ unions can help education systems to give
teachers the mandate to better promote students’ social and emotional well-being
and create safer learning environments to this end.
Teachers’ unions should be involved in raising awareness of FGM among
their members, producing tools and materials and training teachers.
The Federal and State Ministries of Education could do more to support
teachers to address FGM by reviewing the school curriculum to accommodate FGM
and other harmful practices affecting the wellbeing of children.
The Federal and State Ministries of Education (F/SMOE) could, for
example, provide better and more training, professional guidance, stronger
teacher resources, as well as clear written codes of conduct and ethics on FGM
and harmful practices.
Work is also being done by various NGOs in Nigeria to ensure that FGM
education is included in school curricula. The Girls’ Power Initiative provides
information for adolescent girls both in their centres and by conducting
lessons in selected schools. This outreach programme aims to educate girls on
gender and reproductive-health issues, including issues around Gender Based Violence
and FGM, and aims to train teachers to further this work by continuing lessons
and running GPI clubs in their schools (GPI, 2016).
The Centre for Healthcare and Economic Empowerment for Women and Youth
(CHCEEWY) also attempts to advance FGM education in the school curriculum in
Plateau, Benue and Enugu States, where it operates. In partnership with others,
it trains teachers to deliver the Family Life and HIV Education and Family Life
and Emerging Health Issues programmes, which are approved by the Federal
The formation of clubs in schools to continue this education is
proving successful and being supported by a number of international donors such
as Oxfam (CHCEEWY, 2016). @28Toomany
The Child Health Advocacy Initiative (CHAI) advocates for more FGM
education in schools and through clubs in Lagos, Osun, Ekiti, and Ogun States,
where it works. @28Toomany
The Center for Social Value and Early Childhood Development (CESVED)
also raises awareness in schools and holds workshops for school head-teachers
in Cross River State (Augustine, 2016).
Currently, The UNCEF-UNFPA Joint Programme is building the capacity of
in and out of school girls with life skills that will enable them resist any
form of FGM and educate their peers and family members on the consequences of
In Nigeria, FGM has, finally being included being included in the
Junior Secondary School (JSS 3) Curriculum. It is under Social Studies
(Sub-Theme Culture and Social Values), and the topic on FGM is treated under
the harmful traditional practices.
In Nigeria, FGM has also being included being included in the
Curriculum for Out of School Boys and Girls. FGM is treated under the harmful
THIRD, LET US REVIEW HOW TO PARTNER WITH THE LAW ENFORCEMENT AGENCIES
To best address the
issue of FGM, the law enforcement (@PoliceNGR) should work as part of a broader
As part of this
interagency approach, law enforcement (@PoliceNGR should “be educated about
violence against women and girls and be trained on how to appropriately
intervene in cases of violence against women and girls.”
@PoliceNGR and other
Law enforcement agencies such as Nigeria Security and Civil Defence Corps
(NSCDC) should include FGM as part of their in service training programmes for
should ensure that their officers at different organizational structures are
well equipped with information on how best to handle FGM cases when brought to
their table. Establishing gender desks alone are insufficient; there should be
routine technical/training support to designated officers on enforcing the law without
compromising the safety of informants, or undermining the cultural
sensitivities of the people.
Against Persons (Prohibition) (VAPP) Bill was signed into Law on 28th
May 2015 as the VAPP Act. The legislation contains provisions banning various
forms of gender-based violence, including FGM. The VAPP Act 2015 law
criminalizes “harmful traditional practices,” a term defined broadly to include
FGM. This includes “all traditional behaviour, attitudes and/or practices,
which negatively affect the fundamental rights of girls and women (VAPP Act
2015). Any person who performs FGM, engages, incites or abets another person to
carry out FGM is on conviction, subject to a punishment of 4 years imprisonment
or a fine of NGN200,000 (VAPP Act 2015). An attempt to commit any form of FGM
on conviction be liable to a punishment of 2 years imprisonment or a fine
NGN100,000 (VAPP Act 2015).
Various states in
Nigeria has domesticated the VAPP Act 2015 and in states where the it is yet to
be domesticated, the Child Rights Law (CRL) and other anti-FGM laws still
prohibits the practice of FGM. The VAPP Act 2015 and other laws against FGM
empower the Law enforcement Agencies in Nigeria (Police, NSCDC, etc.) to arrest
any individual involved in the practice of FGM.
make it easy for community members and other stakeholders to report suspected
cases of FGM, and ensure that the reporter’s identity is not revealed to the
Having in mind the
organizational structure of the @PoliceNGR, the Community stakeholders should
have a good working relationship with the closest police station in other to
report cases of FGM.
dialogue sessions, @PoliceNGR can be invited too to speak about the laws
prohibiting the practice of FGM, its provisions and how cases can be reported
surveillance team should also work closely with law enforcement agencies
(Police, NSCDC, etc.) at the community or village level to effectively track
down new cases of FGM.
Often times, FGM
survivors, those at risk and witnesses cannot report to the police directly for
fear of social backlash. Anti-FGM
Advocates should be available to provide the cloak of anonymity by receiving
the information and sharing with law enforcement. For advocates to be able to
do this, they must be committed, trustworthy and reliable. Law enforcement will
take advocates serious if their information is credible and devoid of malice.
So they must ensure the credibility of the information received. Also, the
members of the community must trust us to keep their confidentiality, and trust
that we will take prompt steps to when aware of a threat. Advocates and
Community stakeholders must also follow up on cases and reports that the law
enforcement agencies are handling.
We must appreciate
the fact that the work of policing is an onerous one. The officers can get overwhelmed
by a heavy workload. Following up
constantly helps to ensure that cases don’t fall through the cracks. When a FGM
case is taken to court, advocates and community stakeholders need to be there
too to provide both moral and technical support to the prosecutors and the FGM
In conclusions, partnership with key sectors such as Health, Education
and law Enforcement is required to accelerate the elimination of FGM given the
structure, system and personal available within these sectors to provide FGM
prevention, protection and care services to women and girls in Nigeria.