Female Genital Mutilation Female Genital Mutilation Welcome to the programmatic area on female genital mutilation (FGM) within the Data for Impact (D4I) Family Planning and Reproductive Health Indicators Database. FGM is one of the subareas found in the women’s health part of the sexual and reproductive health section of the database. All indicators for this area include a definition, data requirements, data source(s), purpose, issues and—if relevant—gender implications. Show Full Text Female genital mutilation (FGM), also referred to as female genital cutting or female circumcision, is a harmful practice involving the partial or total removal of a girl’s or woman’s external genitalia or injury to other female genital organs for non-medical reasons. It offers no health benefits and can lead to severe health issues, including death. Additionally, it increases the risk of newborn deaths (United Nations Population Fund [UNFPA], 2024; World Health Organization [WHO], 2024a). FGM is internationally recognized as a violation of the human rights of girls and women. In every society where it is practiced, it is a manifestation of deeply entrenched gender inequality and a severe form of discrimination against females. This practice is typically performed on minors by traditional practitioners. FGM infringes upon a person’s right to health, safety, and bodily integrity. It violates the right to be free from torture and inhumane or degrading treatment and even the right to life if it results in death. In some instances, healthcare providers have become more involved in performing FGM, believing it is safer when done medically. Nevertheless, the WHO strongly advises against healthcare providers engaging in FGM and offers resources to deter the medicalization of this practice (WHO, 2024a). WHO categorizes FGM into four types: (WHO, 2010) Type I (Clitoridectomy): This involves the partial or complete removal of the clitoris and/or its protective hood (prepuce). Type II (Excision): This entails the partial or complete removal of the clitoris and the labia minora, and sometimes the labia majora. The extent of tissue removed varies among communities. Type III (Infibulation): This type involves narrowing the vaginal opening by creating a seal. This seal is formed by repositioning the labia minora and/or majora. It may or may not involve clitoral removal. Type IV: This category includes all other harmful non-medical procedures on the female genitalia, such as pricking, piercing, incising, scraping, or cauterization. Physical Health Consequences Immediate complications of FGM encompass severe pain, shock, bleeding, tetanus or infections, urinary problems, genital ulcers, tissue damage, wound infections, and fever. In extreme cases, hemorrhaging and infections can be fatal. Long-term consequences involve chronic pain, childbirth complications, infertility, anemia, the development of cysts and abscesses, the formation of keloid scars, damage to the urethra leading to urinary incontinence, painful sexual intercourse (dyspareunia), sexual dysfunction, heightened sensitivity of the genital area, and an increased risk of HIV transmission (WHO, 2024b). Psychological Consequences There is an association between FGM and adverse mental health outcomes (Abdalla & Galea, 2019). The psychological trauma associated with the procedure can cause anxiety and depression and may lead to behavioral problems in children, often associated with a loss of trust and confidence in their caregivers. Additionally, sexual issues stemming from the procedure can contribute to conflicts in marriages and may even lead to divorce. Childbirth Consequences Women who have undergone FGM face a higher risk of requiring a Caesarean section, episiotomy, and experiencing longer hospital stays. They are also more likely to suffer from post-partum hemorrhage. In the case of infibulation, the most severe form of FGM, women are at a greater risk of experiencing prolonged and obstructed labor, sometimes leading to fetal death and obstetric fistula. Babies born to mothers who have undergone extensive FGM procedures are also at an increased risk of death at birth (Rushwan, 1997). The WHO collaborative prospective study in six African countries examined the impact of FGM on obstetric outcomes. Women who had undergone FGM were significantly more likely to experience adverse obstetric outcomes, including cesarean sections, postpartum hemorrhage, extended maternal hospital stay, infant resuscitation, stillbirth, or early neonatal death, with risks escalating with more extensive forms of FGM. The study estimated that FGM could lead to an extra one to two perinatal deaths per 100 deliveries, highlighting the significant health risks FGM poses to both mothers and infants (WHO study group on female genital mutilation and obstetric outcome, et al., 2006). Perpetuation of FGM The motivations behind FGM are complex and persist for various reasons. In some societies, it is considered a rite of passage. Those who support FGM believe that it purifies the girl (by reducing her sexual desire), favorably socializes her through the instruction and training she receives during her seclusion and ensures fidelity. In others, it is seen as a prerequisite for marriage. One widely held view in some countries is that men prefer to marry circumcised women and will pay more in brides’ wealth for them, although this is by no means consistent over countries. Caldwell, Orubuloye, and Caldwell (2000) cite respect for tradition and social conformity: “the central issues are fears of making their daughters seem outside the expectations of society and possibly unmarriageable and making themselves also the objects of deep suspicion. In some communities – whether Christian, Jewish, Muslim – the practice may even be attributed to religious beliefs, though it is more a secular than a religious practice. Feminist groups have attributed the perpetuation of the practice to traditions of male dominance and of the patriarchal system. FGM Burden Approximately 200 million girls and women currently living have experienced FGM (UNFPA, 2024). The increasing prevalence of FGM is linked to the growing global population. Most of those affected by FGM reside in sub-Saharan Africa and the Arab States, but the practice is also found in specific countries in Asia, Eastern Europe, and Latin America. Additionally, migrant communities in Europe, North America, Australia, and New Zealand may also practice FGM (UNFPA, 2024). Globally, fewer than half (84) of the countries in the world have domestic legislation that either specifically prohibits FGM or allows FGM to be prosecuted through other laws, such as the criminal or penal code, child protections laws, violence against women laws or domestic violence laws (World Bank, 2021) COVID-19 Effect From 2020 to 2022, COVID-19 worsened the situation of girls and women, particularly those at risk of FGM. The pandemic deepened gender disparities, economic inequalities, and health risks for females, while also disrupting efforts to prevent FGM and other harmful practices. UNFPA predicts that COVID-19 could lead to an additional two million FGM cases over the next decade, which would have otherwise been prevented, resulting in a 33 percent setback in the progress towards eradicating FGM (UNFPA, 2024). Political Resolutions Most governments in countries where FGM is practiced have ratified international conventions and declarations that make provisions for the promotion and protection of the health of women and girls (Female Genital Mutilation (FGM) Frequently Asked Questions, n.d.). The United Nations General Assembly unanimously adopted the first-ever resolution against FGM in 2012, calling for greater global efforts to eliminate the practice (UNFPA, 2024). The Sustainable Development Goals (SDGs) include a target to end FGM by 2030. Goal 05 of the SDGs outlines specific objectives and emphasizes that eradicating FGM is a crucial element in advancing gender equality, enhancing health and well-being, promoting safe motherhood, ensuring quality education, building inclusive societies, and fostering economic growth. Challenges to Evaluating FGM Eradication (Matanda, 2020) Cultural Sensitivities and Taboos: FGM is considered a highly sensitive issue in many cultures, and open discussion is often considered taboo, affecting the reliability of responses. Methodological Limitations: Relying on self-reporting is challenging due to potential inaccuracies and the cultural understanding of FGM. Physical Examination Drawbacks: Physical examinations are not commonly done due to their intrusive nature and ethical concerns, yet they are considered a more accurate methodology. Legal and Social Pressures: Anti-FGM laws and social norms can lead to under-reporting or over-reporting, affecting data accuracy. Training Gaps Among Healthcare Providers: Limited capacity and knowledge about FGM among healthcare providers can result in incorrect reporting. Best Practices for Evaluating FGM Eradication (Matanda, 2020): Training and Standardized Protocols: There is a need for better training of healthcare providers and the use of images to improve accuracy in FGM identification and classification. Sensitive Data Collection: Using a respectful and non-intrusive approach, such as self-reporting, while being aware of its limitations is advised. Comprehensive Documentation: The need for proper documentation of the strengths and limitations of various data-collection methodologies is highlighted to assist in generating reliable data. Balanced Use of Multiple Data Sources: A combination of self-reports, physical examinations, and reports from parents or guardians can provide a more comprehensive understanding of FGM prevalence. Cultural Competence: Engaging with the community and considering contextual factors, such as the existence of anti-FGM laws and interventions, are important for accurate data collection. Measurement and Evaluation Tools: WHO’S Human Reproduction Programme has two tools available for evaluating FGM prevention and care: A Guide for FGM Measurement in the Health Sector: This guide is used for planning health sector programs that address FGM and its medicalization. It’s vital for monitoring and evaluating the impact of these programs. The guide includes standardized indicators and methodologies for developing surveillance models to capture and report data relevant to FGM. Questionnaire about Knowledge, Attitudes, and Practices: This tool is a questionnaire designed to support the evaluation of training targeted at healthcare providers. It’s used to gather information on the knowledge, attitudes, and practices of health-care providers regarding FGM. This tool aids in understanding the effectiveness of training programs and the extent to which standardized measurement tools have informed the training of healthcare providers in dealing with FGM. The ACT Framework Package on Measuring Social Norms around Female Genital Mutilation is a specialized tool by UNICEF for monitoring and evaluating social norm changes related to FGM. It centers around a social norms index derived from 10 key questions, supported by a broad selection of indicators to assess individual, societal, and network-level changes, including gender norms. The UNFPA Compendium of Indicators for Evaluating FGM is an invaluable resource for seeking to assess and enhance the effectiveness of FGM eradication programs. The UNFPA Indicator Portal and UNICEF data page on FGM contain a list of high-quality FGM indicators. ____________ References: Abdalla SM, & Galea S. 2019. Is female genital mutilation/cutting associated with adverse mental health consequences? A systematic review of the evidence. BMJ Global Health, 4(4), e001553. https://doi.org/10.1136/bmjgh-2019-001553 Caldwell JC, Orubuloye IO, and Caldwell P. 2000. Female Genital Mutilation: Conditions of Decline. Population Research and Policy Review 19: 233-54. Matanda D. 2020. Measurement of female genital mutilation/cutting status: Perspectives from healthcare providers, policymakers, programme implementers, and researchers. Evidence to End FGM/C: Research to Help Girls and Women Thrive. New York: Population Council. Rushwan H. 1997. Female genital mutilation (FGM) management during pregnancy, childbirth and the postpartum period. International Journal of Gynecology & Obstetrics, 70(1), 99–104. https://doi.org/10.1016/S0020-7292(00)00237-X UNFPA. 2024. Female genital mutilation (FGM) frequently asked questions. https://www.unfpa.org/resources/female-genital-mutilation-fgm-frequently-asked-questions WHO. 2024a. Female genital mutilation. https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation WHO. 2024b. Health risks of female genital mutilation (FGM). https://www.who.int/teams/sexual-and-reproductive-health-and-research-(srh)/areas-of-work/female-genital-mutilation/health-risks-of-female-genital-mutilation WHO. 2010. Female genital mutilation. Fact sheet No241. WHO study group on female genital mutilation and obstetric outcome, Banks E, Meirik O, Farley T, Akande O, Bathija H, & Ali M. 2006. Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. Lancet (London, England), 367(9525), 1835–1841. https://doi.org/10.1016/S0140-6736(06)68805-3 World Bank. 2021. Compendium of International and National Legal Frameworks on Female Genital Mutilation, fifth Edition.
