FGM and Associated Health Problems (Page 9)

Article: Lucy Adoma Yeboah (January 30, 2008)

TWENTY-EIGHT-YEAR-OLD Hawa was sent away by her husband after a little over three months in the matrimonial home. When neighbours wanted to know her offence, her husband refused to talk but only said he was fed up with her.
Surprisingly, that was not the first time, but the third, that the beautiful, hard-working and respectful Hawa was being sent away by a husband, a situation people in her community found difficult to understand.
Hawa’s predicament elicited speculations. Some opined that she likely was not much of a cook. Some went so far as to say she might be a thief who was stealing from her husband. Other reasons assigned were that Hawa might be wetting her bed or was probably married to a spirit being, which made it difficult for men to keep her.
These rumours went on for a long time till Hawa thought she could bear it no more and decided to end it all.
One hot afternoon, a labourer in her father’s house found her lying semi-unconscious and foaming at the mouth and in the nostrils. When she was rushed to the nearest hospital, it was detected that she had taken in poison. Fortunately, the poison was not strong enough to kill her.
Hawa now preferred death to marital agony. Unknown to others, she had undergone female genital mutilation (FGM) during childhood and this resulted in keliod scars around her genitalia. This made it impossible for a man to have sexual intercourse with her. Which man would want to have such a woman for a wife?
Another scenario: Lamisi lost her two children. Her third child survived only because a female teacher in the community was smart enough to send her to hospital for a caesarian section two weeks to the time of delivery.
Lamisi, also a victim of FGM, had scars around her genitalia which, although allowing painful sexual intercourse, failed to stretch out at childbirth to enable a baby to come out naturally.
At a day’s training workshop on information and communication on FGM organised for journalists by the Ghanaian Association for Women’s Welfare (GAWW) in Accra on January 17, 2008, the President of the association, Mrs Faustina Ali, said it was believed that between five and nine per cent of Ghanaian women had undergone FGM. Some reports put the figure between nine and 15 per cent.
According to the World Health Organisation (WHO), FGM, often referred to as 'female circumcision', entails all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons.
Types
Different types of female genital mutilation known to be practised today include Type I — excision of the prepuce, with or without excision of part or all of the clitoris; Type II — excision of the clitoris with partial or total excision of the labia minora; Type III — excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation), and Type IV that also involves 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; scraping of tissue surrounding the vaginal orifice (angurya cuts) or cutting of the vagina (gishiri cuts).
It is worthy of note that the introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purpose of tightening or narrowing it and any other procedure that falls under the definition given above also constitutes FGM under Type IV.
The WHO states that the most common type of female genital mutilation is the excision of the clitoris and the labia minora which accounts for up to 80 per cent of all cases, adding that the most extreme form is infibulation, which constitutes about 15 per cent of all procedures.
Mrs Ali quoted from a recent research conducted by the Navrongo Health Institute on the extent of practice among the Kasena Nankanas in the Upper East Region in 1995 which revealed that about 77 per cent of all women of reproductive age living in the northern part of that area had undergone FGM, while 85 per cent of women in the same age group in the Bawku area had also undergone the practice.
She pointed out that the practice continued in other areas of the Upper East, Upper West, Northern and Brong Ahafo regions by some ethnic groups.
Some of the groups mentioned were the Kasena Nankanas, Bulsas, Busangas, Kantonsis, Kusasis, Wallas, Sisalas, Lobis, Dagartis, Grunshies and Moshies.
It is important to note that migrants from areas of the country and other West African countries where FGM is practised, continue with the practice wherever they settle.
Reasons
Reasons given by those who practise FGM include reducing a woman's desire for sex and thereby reduce the chances of sex outside the marriage.
Some view the clitoris and the labia as male parts on a female body, thus their removal, it is claimed, enhances the femininity. It is also believed that unless a female has undergone this procedure she is unclean and will not be allowed to handle food or water.
Some groups believe that if the clitoris touches a man's penis the man will die. It is also claimed that if a baby's head touches the clitoris the baby will die or the breast milk will be poisonous. Additionally, there is the belief that an unmutilated female cannot conceive. For her to be fertile, therefore, she must be mutilated.
People in such communities also believe that bad genital odours can only be eliminated by removing the clitoris and labia minora, adding that it prevents vaginal cancer.
In the past there was also the belief that an “unmodified” clitoris could lead to masturbation or lesbianism, among other anti-social acts.
Health consequences of FGM
Addressing the journalists at the workshop, Dr Isaac Koranteng of the Department of Obstetrics and Gynaecology at the Korle-Bu Teaching Hospital (KBTH) said FGM was a cultural practice that started in Africa approximately 2000 years ago.
According to him, immediate and long-term health consequences of female genital mutilation vary according to the type and severity of the procedure performed.
Immediate complications include severe pain, shock, haemorrhage, urine retention, ulceration of the genital region and injury to adjacent tissues. Haemorrhage and infection can cause death.
He said more recently, concerns have been raised about the possible transmission of the human Immunodeficiency Virus (HIV) due to the use of the same instrument in multiple operations.
Long-term consequences, according to Dr Koranteng, include cysts and abscesses, keliod scar formation, damage to the urethra resulting in urinary incontinence, dyspareunia (painful sexual intercourse) and sexual dysfunction and difficulties with childbirth.
In the area of psychosexual and psychological health, he pointed out that genital mutilation may leave a lasting mark in the life and mind of the woman who has undergone it. In the longer term, women may suffer feelings of incompleteness, anxiety and depression.
Who practises FGM?
In cultures where FGM prevails, female genital mutilation is practised by followers of all religious beliefs including animists and non-believers. FGM is usually performed by a traditional practitioner with crude instruments and without anaesthesia and this can negatively affect the girl or woman.
It is considered primarily as a cultural practice, not a religious practice. But some religions do include FGM as part of their religious practices. This practice is so ingrained in such cultures that FGM is synonymous with cultural identity. In effect, elimination of the practice would be tantamount to eliminating the cultural belief that a girl will not become a woman without this procedure.
Prevalence and distribution of FGMIt was made known at the workshop that most of females who have undergone genital mutilation live in 28 African countries, although some also live in Asia and the Middle East. Those who practise it are also increasingly being found in Europe, Australia, Canada and the USA, primarily among immigrants from these countries.
Today the number of girls and women who have undergone FGM globally is estimated at between 100 and 140 million. It is estimated, too, that each year two million girls are at risk of undergoing FGM.
The age at which FGM is performed varies from area to area. It is performed on infants a few days old, on female children and adolescents and, occasionally, on mature women.
Speaking of the Law and Human Rights, Ms Chris Dadzie, a former Director of the Commission on Human Rights and Administrative Justice (CHRAJ), said there were laws against FGM in Ghana but that there was the need for awareness of the legislative framework to promote the translation of the law into practical policies and institutional arrangements.
Ms Dadzie also pointed out that the enactment of laws does not in itself address substantive issues which systematically undermine and constrain the ability of affected persons to participate equally and effectively in societal life.
She said there were many laws including the 1992 Constitution making provisions for the eradication of specific forms of social injustice, including FGM, adding that unfortunately the practice had persisted.
She also pointed out omissions in previous laws which targeted only practitioners and left out other parties who played a primary role in commission of the offence such as parents, guardians, families and members of the community.
She explained that both practitioners and participants of FGM were liable and could be sentenced to a minimum of five years and a maximum of 10 years’ imprisonment.