FEMALE GENITAL MUTILATION DI Sean Mc Mahon SHEFFIELD

FEMALE GENITAL MUTILATION DI Sean Mc. Mahon SHEFFIELD PPU

AIM • To raise understanding around the subject of female genital mutilation

Learning Outcomes • • • Identify and define what FGM is. Identify where in the world it is prevalent Understand the cultural reasons for process Outline the legal position. Understand the warning signs and post procedural effects.

What is it !! • FGM - female circumcision or female genital cutting, is defined by the World Health Organisation (WHO) • "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons” (1)

Four Types • Type I – Removal of the tip of the clitoris. • Type II – Total removal of the clitoris and surrounding labia. • Type III – Removal of clitoris and labia and sewing up of the vagina leaving only a small opening for urine and menstrual blood ( known as infibulation). • Type IV – Pricking, piercing or incising of the clitoris and/or labia; stretching of the clitoris and/or labia, cauterisation by burning of the clitoris and surrounding tissue.

Justification!!! • In cultures that practise FGM reasons exist as to why this is done. These may seem misplaced in a developed society but are embedded in these society beliefs. – Belief will reduce a women's desire for sex/will reduce the chance of sex outside the marriage. (Honour) – Some view the clitoris and the labia as male parts on a female body, thus removal of these parts enhances the femininity of the girl. – Unless a female has undergone this procedure she is unclean and will not be allowed to handle food or water.

– Belief that if the clitoris touches a man's penis the man will die. As well as the belief that if a baby's head touches the clitoris that the baby will die or the breast milk will be poisonous. – The belief that an un-mutilated female can not conceive (Mutilated to become fertile) – Prevents vaginal cancer. – An unmodified clitoris can lead to masturbation or lesbianism. (Was a western belief) – Prevents the face from turning yellow. (2)

The Legislation – FGMA 2003 • Person guilty if he excises, infibulate or otherwise mutilate the whole or any part of a girls labia majora, minora or clitoris. • To aid, abet, counsel, or procure the performance by another person of any of those acts on that other person’s own body.

• No offence if – • Surgical operation required for physical or mental health. • For a reason connected with labour or birth • If the procedure is committed outside the UK by UK national or permanent resident then can be prosecuted in the UK as if had happened here (3)

FGM Position • In the UK this is considered child Abuse and is breach of the Childs Human Right. • Section 47 of the Children Act 1989, local authorities are charged with the “duty to investigate … if they have reasonable cause to suspect that a child who lives, or is found, in their area is suffering, or is likely to suffer, significant harm”. Harm is defined in the Act as the illtreatment of a child (including sexual abuse and non-physical forms of ill-treatment) (4)

Practised in 28 African countries and few in Middle East. (Yemen, Northern Iraq) Also some Southern American communities. With immigration has spread into Europe Some countries 98% prevalence rate Others Kenya, Nigeria, Togo 20 – 50 % Bohra Muslim in India and Pakistan Muslim Populations of Malaysia and Indonesia Occurs within ethnic groups as opposed to whole country Could occur as newborn, during childhood, adolescence at marriage or during first pregnancy

Estimated that between 100 and 140 million girls undergone FGM In Africa about 101 million girls age 10 years and above are estimated to have undergone FGM 3 million girls year in Africa estimated to undergo FGM. Estimated that up to 7, 000 girls a year are at risk of FGM in the UK and 74000 have undergone the procedures. (5)

Religious or not ? Many who practice FGM do so because they mistakenly believe it to be a Muslim requirement. It has become a "law by custom" in many Muslim countries. Neither of the two main sources of the Islamic Shariah law – the Quran and the Sunnah – specifically mention female circumcision Most Islamic scholars agree that it is not an Islamic religious rite.

Unlike other Honour Based Violence this act is closely choreographed ritual that aims to situate a girl with the traditions of her community and its ancestors In many cultures this has become such an entrenched part of culture that many woman enthusiastically endorse the practise Over the past three or four decades, FGM has increasingly emerged amongst ethnic minority groups in many countries, including the United Kingdom. This increase has been contemporaneous with the arrival of immigrants, economic migrants, asylum seekers, refugees and students from FGM-practising countries (such as Somalia, Sudan, Djibouti, Nigeria, Eritrea, Ethiopia and Sierra Leone). (7)

Historical Context • Now considered in West to be foreign phenomena wasn't always the case. – clitoridectomy (the surgical removal of the clitoris) was a recognized practice in 19 th century Britain in the management of epilepsy, sterility and masturbation (Kandela, 1999) – Dr A. J. Bloch (1894), a US surgeon wrote ‘Sexual perversion in the female’, referring to female masturbation as a “moral leprosy” cured by “liberating the clitoris from its adhesions” – some of the ‘clinical opinions’ demonstrated attitudes towards women similar to those in many other parts of the world today

When at risk !! • During school holidays. When families may take their children abroad. Many will not be aware that being taken abroad for procedure. (8) • UK communities at risk – Kenyan, Somalian, Sudanese, Egyptian, Nigerians as well as non African Yemeni, Kurdish, Indonesian and Pakistan • The two most common forms seen in the UK are type II and type III (infibulation)

What are the Signs that may occur? ? Being part of community that practise the procedures. Knowing that family is making preparations for child to take a holiday, arranging vaccinations or planning an absence from school. The Child may also talk about ‘special procedure/ceremony’ that is going to take place

Indicators that Has Occurred • • Prolonged absence from school Noticeable behaviour change on return Long periods away from classes or other activities Possible bladder and menstrual problems Difficulty in sitting and look uncomfortable. Complain of pain between legs May talk about something someone did to them that they are not allowed to talk about.

Risks? ? • Short term health complications – Severe pain and shock, infection, excessive bleeding, urine retention, haemorrhaging and worst case death • Long term health complications. – Chronic pain, infection, cysts and abscesses, menstruation difficulties, damage to the reproductive system, infertility, complications in pregnancy and childbirth, sexual dysfunction and psychological damage such as PSD.

Education 29 countries in Africa and the Middle East, where the practice of FGM is concentrated 36 % of girls 15 -19 have been cut compared 53 % of women aged 45 -49 The decline is particularly sharp in some countries: Kenya women aged 45 -49 are three times more likely to have been cut than girls aged 15 -19

• (1) www. forwarduk. org. uk/resources/keyissues/fgm 13/05/2012 1249 • (2) www. wolvesdreams. tripod. com/FGM 13/05/2012 1315 • (3) ww. legislation. gov. uk/ukpga/2003/31/contents 13/05/2012 13. 22 • (4) Great Britain, laws and statutes (1989) Children Act 1989 (chapter 41). London: Her Majesty's Stationery Office (HMSO).

• (5)www. nspcc. org. uk/inform/. . . /femalegenitalmuti lation_wdf 58610. pdf 13/05/2012 1400 • (6) Video clips taken from Operation Azure (Metropolitan police) FGM educational awareness video. • (7)www. homeoffice. gov. uk/publications/crime/FG M • (8) www. fco. gov. uk/en/travel-and-livingabroad/when-things-go-wrong/fgm/