sign in sign up
<<
Home , Planned Parenthood

From choice, a world of possibilities

October 2015

IMAP Statement on the elimination of female genital mutilation

Introduction and terminology Violation of human rights This Statement has been prepared by the Female genital mutilation is carried out most International Medical Advisory Panel (IMAP) and commonly on girls between the ages of 0 to was approved in June 2015. 15 years; it is also performed on adult women who are about to be married, who are pregnant Female genital mutilation (FGM) is an umbrella with their first child or who have just given birth. term that includes all procedures that involve Because children are subjected to this procedure, partial or total removal of the external female Female genital FGM also violates the rights of the child. Many genitalia, or other injury to the female genital parents and communities exert intense pressure on mutilation has no organs, for non‑medical reasons. Female genital girls to accept the practice: this means that a child mutilation violates a number of well‑established undergoing female genital mutilation is unable to health benefits, human rights principles, norms and standards, make a voluntary and informed decision that is including the principles of equality and is harmful to the free from coercion. The Convention on the Rights non‑discrimination on the basis of sex, gender, the of the Child makes explicit reference to harmful health of women right to bodily integrity, the right to life (because traditional practices, calling on all countries to the procedure can result in death), and the right take effective and appropriate measures to abolish and girls, violates to the highest attainable standard of physical and them. women’s human . ‘Female genital cutting’ (FGC) – or ‘female genital mutilation/cutting’ (FGM/C) FGM is a harmful practice that is in direct rights and every – are terms used deliberately by some activists opposition to IPPF’s values that uphold a world in specifically to encourage practising communities which all women, men and young people have effort should be to abandon the practice. The term FGM is used in access to the sexual and made to eradicate this Statement to emphasize the serious physical, and rights information and services they need; emotional and psychological consequences female genital mutilation also challenges a world the practice. associated with the procedure. in which sexuality is recognized both as a natural and precious aspect of life and as a fundamental To summarize, female genital mutilation has no human right. The Federation will continue to health benefits, it is harmful to the health of uphold this belief through sustained efforts, in women and girls, it violates women’s human rights partnership with other stakeholders, to eradicate and every effort should be made to eradicate the mutilation. practice.

Female genital mutilation challenges a world in which sexuality is recognized both as a natural and precious aspect of life and as a fundamental human right. 2 IMAP STATEMENT on the elimination of female genital mutilation

Prevalence and practice PRACTICE The World Health Organization classifies female PREVALENCE genital mutilation as follows: In July 2013, a UNICEF report estimated that • Type I: Partial or total removal of the and/ more than 125 million girls and women have or the prepuce (). been subjected to the practice and that, based on present trends, as many as 30 million girls under • Type II: Partial or total removal of the clitoris and the age of 15 may still be at risk.1 Female genital the , with or without excision of the mutilation has been documented predominantly (excision). in Africa and a few countries in Asia, such as • Type III: Narrowing of the vaginal orifice by Indonesia. Women who have had the procedure creating a covering seal through the cutting are increasingly seen in Europe, Australia, Canada and apposition of the labia minora and/or labia and the USA, primarily among immigrants from majora, with or without excision of the clitoris countries where FGM is practised. Effective (). advocacy has focused on the risks of the practice and educational campaigns have triggered public • Type IV: Unclassified – all other harmful debate: this awareness raising has also increased procedures to the female genitalia for the level of reporting and has led to the recognition non‑medical purposes, for example pricking, of human rights and legislative measures in piercing, incision, cauterization and scraping. many countries. This concerted and sustained This IMAP Statement refers to FGM that is campaigning has in turn led to a decrease in the performed on girls under the age of consent or number of girls who want the practice to continue: on women under coercion. In addition, while the women have been advocating against FGM for a norm is for the procedure to be carried out by long time and this increased reporting has helped traditional practitioners, many medical personnel to amplify women’s voices and enhance their are now performing the intervention in response efforts to mobilize to oppose mutilation. Taken to raised awareness of the negative health impacts together, this demonstrates the need for a holistic of FGM. This medicalization of FGM is strongly approach to ending the practice that involves condemned, is illegal in many countries, and health legislative change and the shifting of social norms. care providers must be dissuaded from performing Many justifications are given for FGM; the reasons the procedure. are complex, and vary by country, region and ethnicity, even within communities. It is entrenched in social, economic, cultural and political structures Adverse outcomes and understood as a social convention that is often All types of female genital mutilation have adverse accepted without question. Some of the social health consequences. Once removed, genital tissues justifications include the preservation of virginity cannot be replaced, resulting in a life‑long physical and ensuring fidelity, as well as a rite of passage change irrespective of any other complications. to womanhood in some contexts. The practice can The mutilation is often carried out by a traditional therefore be construed as an important part of practitioner or a family member, under unhygienic the cultural identity of girls and women. Religious conditions, without anaesthesia, and using justifications across Christian, Jewish, Muslim non‑surgical, unsterilized instruments such as razor and some indigenous African groups are often blades, knives or broken glass. invoked for the practice, although none of the Holy Immediate complications include pain and bleeding, Scriptures in any of these religions prescribes female during and after the procedure. Swelling and genital mutilation. Understanding these cultural oedema cause acute retention of urine and painful and societal beliefs is a critical element in any work urination, as well as painful or difficult defecation. that aims to eliminate the harmful practice. Healing may take up to eight weeks, depending on the extent of the procedure, and complications may make the healing period much longer. Long‑term or delayed complications can occur There is a need for a holistic approach to ending at any time in the lifespan of a woman who has undergone mutilation: the practice that involves legislative change and the • Infections such as perineal abscesses and genital shifting of social norms. ulcers are common, and may lead to fatal septicaemia, tetanus or gangrene. Recurrent 3 IMAP STATEMENT on the elimination of female genital mutilation

pelvic infections can cause chronic pelvic and Dangers of medicalization back pain. FGM increases the risk of urinary tract infections, which can ascend to the bladder and The practice is increasingly performed by health kidneys, and can lead to life‑threatening renal providers in clinical and other health care settings. failure and septicaemia.2 This medicalization gives the erroneous impression that FGM is beneficial to the health of women • Female genital mutilation may increase the risk and girls. But FGM – wherever it takes place, of HIV transmission and other blood‑borne and whether it is performed by traditional or infections such as hepatitis B and C. This risk can medical providers – is harmful and has no benefits arise from the use of unsterilized instruments whatsoever. It is against the code of medical for FGM procedures, the management of practice and medicalizing the procedure does FGM‑related obstetric complications or from not reduce or address the harmful effects and genital tract trauma associated with intercourse. complications resulting from the practice. The • Chronic local irritation and inflammation may World Health Organization, together with seven worsen the scarring and narrowing, resulting other agencies and six professional in decreased urine flow, retention of urine and organizations, issued a global strategy in 2010 to Medicalization also retention of menstrual blood in the stop health care providers from performing FGM.9 3 (haematocolpos). FGM may also result in urinary IPPF endorses the joint statement by the World of female genital 4 incontinence and . Health Organization and other United Nations mutilation • The resultant anatomical abnormalities cause agencies on the elimination of the harmful practice difficult and prolonged labour, of FGM and the UN Resolution on intensifying is strongly increasing both maternal and neonatal efforts to eliminate FGM.10, 11 condemned, is morbidity and mortality. Women who have undergone any form of female genital mutilation illegal in many are at significantly higher risk of obstetric countries, and complications such as perineal tears, are more likely to require and instrumented health care delivery, and in some cases a surgical procedure providers must be may be necessary to open the lower genital tract (defibulation). Complications can make The World Health dissuaded from a necessary, or induce a post‑partum haemorrhage, requiring an Organization, together with performing the extended stay in hospital.5 Additionally, the babies of mothers affected by FGM types II and seven other United Nations procedure. III have an increased risk of dying at birth.6 The World Health Organization estimates the annual agencies and six professional cost of FGM‑related obstetric complications to the health systems in six African countries to be organizations, issued a global US$3.7 million.7 strategy in 2010 to stop • The cutting of highly sensitive genital tissue, health care providers from especially the clitoris, excessive scar formation (keloid) and pain can adversely affect sexual performing FGM. sensitivity and pleasure.8 The negative impact of the procedure on a girl’s psychological and psychosexual development can last well into womanhood. , and fear of have been observed. Unprotected nerve endings may lead to severe pain and tenderness over the scar tissue, leading to pain during intercourse (), even if the vaginal opening is sufficient to allow penetration: in other words, these complications can also occur in FGM types I and II. Attempts at penetration through the narrowed vaginal opening may cause laceration and haematoma, requiring medical intervention. 4 IMAP STATEMENT on the elimination of female genital mutilation

Member The key role of Member or stigmatization for deciding not to support Associations FGM. Associations • Member Associations should ensure that all have a pivotal Member Associations have a pivotal role to play in women, including those who have undergone the elimination of FGM at community and national FGM, have access to comprehensive sexual and role to play in levels. This practice has deep cultural roots; this reproductive health services, including testing means that sustained action is essential to achieve for reproductive tract infections and sexually the elimination a permanent impact, as behaviour change is a transmitted infections, contraception and complex process. Member Associations should sexuality education. of female genital gather all possible information on the prevalence, mutilation at dynamics and characteristics of FGM in their own • Member Associations should provide countries. In the context of their social and cultural information to all clients seeking care at community and background, they should then review their current the service delivery point about the serious national levels. awareness‑raising activities, familiarize themselves risks during childbirth for women who have with the available resources and like‑minded undergone female genital mutilation. Pregnant stakeholders to advocate against FGM, and develop women who have undergone FGM should be strategies to eliminate the practice through services advised to deliver in a clinical setting, where and advocacy. possible, so that complications can be managed properly. SERVICES • Member Associations should identify Here are the key elements for services that Member psychosexual complications so that appropriate Associations can focus on to contribute to the counselling and support can be provided. elimination of female genital mutilation: Young women and their partners may require premarital counselling to address • Member Associations have a key role to the psychosexual complications commonly play in counteracting the trend towards the associated with FGM. medicalization of FGM. Standards for ethical and medical practice for health professionals • Member Associations should provide counselling should include prohibiting an individual for the woman and, with her informed consent, from practising female genital mutilation. health professionals with the appropriate Implementing this standard is mandatory within training should, whenever possible, try to repair all Member Associations to ensure that FGM the abnormal anatomical condition caused by is not carried out in any Member Association FGM. If available, appropriate referrals should be clinic or environment, by any staff or provider. made for defibulation services. Member Associations should work with national • Member Associations should integrate FGM professional organizations to raise awareness of within services for sexual and gender‑based the need to reduce the incidence of FGM. violence in those contexts where it is practised. • Member Associations should be trained to • Member Associations should report all provide empathetic counselling about, and care FGM‑related sexual and reproductive health for, the physical and psychological complications service provision via IPPF’s global service of FGM in countries where it is practised. statistics and to their national authorities where Women who have been subjected to FGM the law requires such reporting. Data relating and are suffering from chronic complications to the prevalence of FGM and the health may require specialist counselling and/or consequences reported by those affected should surgical treatment. Women and girls who be collected routinely from clinical service have undergone the procedure must not be records; this information can be utilized as an stigmatized or discriminated against, but must advocacy tool to support policy and behaviour receive care and support. An appropriate referral change. system should be in place if comprehensive care is not possible at the service delivery point. ADVOCACY Procedures requested after childbirth that are associated with FGM, such as reinfibulation Here are the key elements for advocacy that (reinstatement of the mutilation), must be Member Associations can focus on to contribute to refused and strongly condemned. Likewise, the elimination of female genital mutilation: women and girls who have not undergone the • Member Associations should use ‘Sexual Rights: practice should not be subject to social sanctions An IPPF Declaration’ and ‘IPPF Charter on Sexual 5 IMAP STATEMENT on the elimination of female genital mutilation

and ’ as advocacy tools • Member Associations should be aware of the to lobby for changes in legislation that will importance of engaging and partnering with protect the human rights of women and girls, religious and secular community leaders in order and eliminate all harmful and/or discriminatory to secure a supportive environment for change practices.12, 13 Member Associations should in the community. These leaders can generate use UN reporting mechanisms – including social support for change by providing strong the Universal Periodic Review mechanism of arguments against the practice. the Human Rights Council, the Committee • Member Associations working in countries on the Elimination of Discrimination against where FGM is practised within immigrant Women as well as shadow reports – to hold communities should mobilize these their governments accountable for developing communities, and engage them meaningfully legislation to prohibit FGM and holding their in the process of behaviour change by sharing governments to account for implementing these accurate information and education about FGM. laws.14 • Member Associations should conduct research • Member Associations should advocate for into trends relating to the medicalization of creating and/or enforcing legislation that FGM, and be actively involved in advocacy criminalizes the practice of FGM; for increased campaigns to eliminate the practice within awareness among service providers, parents health settings. and women themselves in order to develop and enhance understanding of the human rights • Member Associations should encourage women and health consequences related to FGM; for and girls to participate in discussions about FGM provision of medical and psychosocial support issues, and include female health workers and to those already affected; and for referrals for women representatives from local communities, recourse to justice. including grandmothers (who are key decision makers and sometimes cutters). Member • Member Associations should build on the Associations should encourage alternative global call to action for the elimination of initiation rituals that preserve positive social FGM, through coherent collaboration with norms. governments, civil society, religious groups, and women’s and young people’s organizations. • Member Associations should engage with men and boys as they are key players in eliminating • Member Associations should adopt an the practice. This form of social dialogue evidence‑based advocacy strategy. The current provides opportunities to educate the whole evidence base shows that the elimination of community about women’s human rights, the FGM requires a multi‑pronged approach; this effects of FGM on women’s bodily integrity and should be based on best practices from areas relationships, and the role of FGM legislation. where a decline has been identified and as showcased in UNICEF’s 2013 report.15‑19 • Member Associations, where appropriate, should initiate broader programmes aimed at • Member Associations should devise and improving the reproductive health of women to implement strategic activities at all levels include discussion of female genital mutilation – from the local community level to the and actions to stop the practice. Service regional level. Member Associations should providers should use every opportunity to collaborate with governmental and other counsel women and their partners, and parents non‑governmental organizations working of young children, about the harmful effects of on the issue, such as professional medical perpetuating the practice, without stigmatizing associations and parliamentarians, to achieve women who have already undergone optimum contributions towards the elimination mutilation. of the practice through advocacy, information, education and research. UN reporting mechanisms should be used to hold governments accountable for developing legislation to prohibit female genital mutilation, and hold governments accountable for implementing such laws. IMAP STATEMENT 6 IMAP STATEMENT on the elimination of female genital mutilation on the elimination of female genital mutilation

References Acknowledgements 1 United Nations Children’s Fund (2013) Female Genital Mutilation. Geneva: World We would like to express great Female Genital Mutilation/Cutting: A Health Organization. Available at

Edited and designed by www.portfoliopublishing.com