Female genital mutilation/cutting is a sexual and reproductive health concern, with devastating short- and long-term impacts on the lives of women and girls. Studies have shown the negative impact of the practice on maternal and neonatal outcomes. Compared with women who have not been cut, those who have undergone FGM/C run a significantly greater risk of requiring a caesarean section, an episiotomy and an extended stay in hospital, and also of suffering postpartum haemorrhage. Death rates among babies during and immediately after birth are also higher for those born to mothers who have undergone FGM/C. It is estimated that an additional one to two babies per 100 deliveries die as a result of FGM/C.
Death rates among babies during and immediately after birth are also higher for those born to mothers who have undergone FGM/C. It is estimated that an additional one to two babies per 100 deliveries die as a result of FGM/C.
The consequences of FGM/C for most women who deliver outside the hospital setting are expected to be even more severe, especially in places where health services are weak or women cannot easily access them. Strengthening national capacity for improving the quality of reproductive health delivery systems is important in addressing FGM/C and sustaining the advances made in halting the practice.
It is important to protect women and girls who have been subjected to FGM/C and to address the adverse reproductive health consequences they have to suffer and endure. Sexual health and psycho-social counseling, prevention and treatment of reproductive tract infections, adolescent and sexual reproductive health, among others, should be an integral part of health programmes and comprehensive health service delivery to women and girls, including and especially those who have undergone FGM/C.
The impetus for positive and lasting change starts at the community level. Ending FGM/C requires a process of social change that enables communities to discuss, reflect and decide on their own to abandon the practice. Since change cannot be effectively imposed from the outside, the ultimate decision to discontinue the practice rests with the women, men and community leaders who can effect and sustain change. Community members can put into place a new social norm without feeling that their cultural traditions are being violated or that they are coerced or judged.
The decision to abandon FGM/C must be collective, widespread and explicit. This is what gives each family the confidence that others are also abandoning the practice and that no single girl or family will be disadvantaged by the decision. A community dialogue generates a collective social learning and a strengthening of ownership and responsibility for change. Part of the responsibility is to engage neighbouring communities so that abandonment can spread and be sustained, and so the social pressure to perform FGM/C is transformed into pressure to abandon it. When abandonment reaches this point, the new social convention becomes self-enforcing: it continues swiftly and spontaneously.
Even when many members of a community favour abandonment of FGM/C, a successful shift requires that they express their collective commitment through an explicit public affirmation. This gives individuals who intend to stop the practice the confidence to actually do so. It is a key step in the process of real and sustained change in communities.
The commitment may take various forms. It can be joint public pledge in a large public gathering or a written statement, publicly posted, signed by those who have decided to abandon FGM/C. Some communities collect signatures on traditional colourful cloth, while others give certificates of recognition to families choosing not to cut their daughters. Others host festivities celebrating uncut girls, including public weddings. These celebrations are a form of public social recognition and show of respect for the personal transformation each individual has undergone during the process of abandoning the practice.
Public repudiation of FGM/C is a living testimony that change is possible, that societal attitudes do shift and that communities can choose to abandon the practice. The experience of a growing number of countries has demonstrated that when individuals and communities acknowledge and embrace basic human rights, such as the right to health, dignity and bodily integrity, they spontaneously, collectively and publicly declare their abandonment of FGM/C.
Traditional and religious leaders -- influential and highly respected agents of change -- play a critical role in the abandonment of FGM/C. They have the ability to influence decisions within families and to build consensus within communities. Their position against the practice lends credibility in ending FGM/C, especially since many of their followers erroneously believe that FGM/C is a religious obligation. In many places, clarifying that the practice has no religious ground has been a significant step in opening minds and fostering long-term behavior change.
Engaging religious leaders, in particular, is essential as they are seen in many countries as holding the key to overturning the practice. Their participation in the campaign to end FGM/C takes various forms. In some communities, their approval and blessing are crucial to even start a dialogue about abandoning the practice. Some religious leaders and scholars speak out against the practice and explicitly separate FGM/C from religion in public statements, books and popular religious songs. Religious leaders from various faiths reach out to local communities to raise awareness about FGM/C and disseminate messages during Friday prayers in the mosques and at Sunday church services. Other religious leaders have come together to issue a national declaration reaffirming their collective rejection of all forms of FGM/C.
One response to the harm caused by traditional means of genital cutting is that the practice has become increasingly medicalized. To avoid the high risks of unskilled operations, families seeking the procedure go to doctors and other trained health professionals. While the level of medicalization varies from country to country, it is spreading rapidly in many places, often occurring in clinical settings and other health facilities.
'Medicalization' of FGM/C refers to situations in which FGM/C is practised by any category of health-care provider, whether in a public or a private clinic, at home or elsewhere. It also includes the procedure of reinfibulation at any point in time in a woman's life.
The medicalization of FGM/C wrongly legitimizes the practice and creates the inaccurate impression that it is beneficial for girls' and women's health. Even under sterile conditions, the procedure constitutes willful damage to healthy organs for non-therapeutic reasons and does not in any way reduce or address long-term complications, including sexual, psychological and obstetrical complications, associated with the practice.
All health professionals must be banned from performing FGM/C, which is a violation of girls' and women's right to life, right to physical integrity, and right to health. It also violates the fundamental ethical code governing health practice that specifically requires that physicians, nurses and midwives to do no harm to any patient.
The practice of FGM/C is deeply ingrained in culture and tradition. Ending the practice requires confronting the power of cultural traditions, which can be more powerful than governments in shaping people's identities, their perceived role in society and their sense of dignity.
Just as culture can be more powerful than the state, so public opinion can be more powerful than laws. Hence, the role of the media is critical in accelerating change and eliminating FGM/C. Television, radio, Internet, print publications, billboard messages, soap operas and talk shows, among others channels, are effective means to stimulate interest and public dialogue on FGM/C. Through strategic media campaigns, communities and individuals abandon the practice when they become fully aware of their rights and understand that FGM/C is harmful to women's and children's health.
Utilizing the immense power of the media is an imperative for advocating the abandonment of FGM/C and for awareness-raising among the parliamentarians, religious and cultural leaders, traditional and modern health-care providers, and other decision-makers, as well as among the practising communities. Widely disseminating the health and human rights aspects of FGM/C, including the irreversible lifelong health risks faced by women and girls, among other adverse consequences, can be and often are powerful deterrents to the practice of FGM/C.
While laws, by themselves, are usually insufficient to overturn social conventions, they can create a protective environment for women and children. Introducing national legislation that prohibits FGM/C can accelerate abandonment, particularly when a process of societal change is already under way and citizens are sensitized to the issue. The purpose of a legislation is to make explicit the State's disapproval of the practice.
Legislation can also send out a clear message of support to those who have renounced or would wish to renounce the practice and, thus, act as a deterrent. Legislation against FGM/C should take into account the reality of the lives of children and women, and should include measures that support and assist those who have undergone FGM/C, and hold perpetrators accountable. The enforcement of laws is also important, as is the need to base them on the foundation of human rights. This is an approach that views FGM/C as a human rights violation, stresses the importance of participation of those directly or indirectly affected by the law, and enables them to recognize and claim their rights.