A conversation with a colleague at a recently held nursing and midwifery conference in Dubai piqued my interest in female genital mutilation (FGM). As controversial and thought-provoking as the topic is, I believe it is relevant to the health system here in Jamaica, our country being a part of a global village and a melting pot of culture.

What do we know about female genital mutilation?

Globally, an estimated 200 million women and girls have undergone FGM and approximately 3.6 million women and girls are at risk annually. Additionally, it is estimated that 63 million girls are likely to undergo FGM by 2050. Female genital mutilation is female circumcision that is done for non-medical reasons. It is a cultural practice, usually performed by an older woman in the community. There are four types and involves the partial or total removal of the female external genitalia.

Despite being a harmful cultural practice, it is quite prevalent in several parts of the world, such as the Middle East, Asia, some European countries, and parts of Africa where religion, beliefs, and customs supersede modern health practices. In some cultures FGM is performed as a rite of passage into womanhood for girls and a means to preserve the girl’s virginity. For some ethnic groups it represents a symbol of modesty, cultural identity, cleanliness, community acceptance, and marital eligibility.

Possible effects of female genital mutilation

While the practice may be prevalent, it must be noted that it is a pervasive violation of human rights which predisposes millions of women and girls to serious health risks. Women and girls are often scarred physically, emotionally, and psychologically. The psychological effects may result in anxiety, depression, and post-traumatic stress disorder (PTSD). Further, health risks may include:

a) bleeding because the area is vascular

b) severe pain due to tissue damage and nerve involvement

c) susceptibility to infections since the procedure is usually done under non-aseptic conditions, utilising unsterile ‘rusty’ blades and other cutting implements

d) difficulty urinating

e) sexual dysfunction and other reproductive system disorders, such as infertility, and complications during childbirth that are usually associated with scarring. Scarring results in vaginal stenosis, a condition which negatively affects the dilation of the vaginal wall. This increases the need for operative deliveries and high risk for maternal and infant morbidity and mortality.

In addition to the serious health risks there are social implications that are of paramount importance because women and girls, having survived this procedure, are likely to suffer discrimination, stigmatisation, marginalisation, and have difficulties developing meaningful intimate relationships. Besides, the practice is also viewed as a manifestation of gender inequality, violence against women and girls, and the suppression of women.

Female genital mutilation eradication efforts

Of note is that FGM violates the Convention on the Elimination of all Forms of Discrimination against Women, the Universal Declaration of Human Rights, and the Convention on the Rights of the Child. On the positive side, however, the United Nations (UN), the European Union, and the African Charter on Human and Peoples’ Rights have adopted human rights-based approaches to cauterise this pervasive practice. This includes measures such as:

i) education programmes to promote awareness, empower women and girls, and educate communities about the harmful effects of FGM

ii) the enforcement of laws

iii) campaigns to recruit community change agents since this practice is deeply ingrained in culture and religion.

Further, a key strategy to combating FGM was the adoption of the UN Sustainable Development Goals (SDGs), target 5.3, in 2015. This target focuses on the elimination of harmful practices for women and girls, including FGM, by 2030.

To achieve continued success in the eradication of FGM, a comprehensive approach is necessary. It requires collective efforts to counter social norms and cultural justifications for this practice as well as the combination of community involvement, education, and the enactment of legislations surrounding FGM. In addition, women and girls must be empowered to be aware of and assert their rights. Efforts require open dialogue on FGM within communities, even as the world takes on this mammoth task to protect the rights of women and girls and eradicate FGM.

By and large, strides have been made to raise consciousness and advocate for the elimination of FGM; however, more work is required. The formidable barriers of religion, culture and beliefs, and resistance to change pose serious challenge to any progress in this area. This is further compounded by complex dynamics of migration and acculturation which sees the proliferation of this practice to other countries. It highlights the need for a collaborative, coordinated global response to address this pervasive violation of human rights.

Working collaboratively between communities and with various government and non-governmental organisations to raise awareness, enact legislation, and engage with affected communities is truly the way forward to achieve further success for the elimination of FGM.

Dr Adella Campbell is associate professor and dean in the College of Health Sciences, University of Technology, Jamaica.