1.) What are some of the initiatives the World Health Organization is implementing in order to reduce the practice globally?
In 2008, the World Health Assembly passed resolution WHA61.16 on the elimination of FGM, emphasizing the need for concerted action in all sectors – health, education, finance, justice and women’s affairs.
WHO efforts to eliminate female genital mutilation focus on:
- strengthening the health sector response: developing guidelines, tools, training and policy to ensure that health professionals can provide medical care and counselling to girls and women living with FGM and that they take action to prevent FGM;
- building evidence: generating knowledge about the causes and consequences of the practice, the health and economic costs of FGM, and why health care professionals carry out procedures, how to eliminate it, and how to care for those who have experienced FGM;
- increasing advocacy: developing publications and advocacy tools for international, regional and local efforts to end FGM within a generation.
New guidelines were published last year (2016): http://www.who.int/reproductivehealth/topics/fgm/management-health-complications-fgm/en/
A clinical handbook will be released in early 2018
You can find WHO resources and publications at the following link:
2.) Are the organizations working to end FGM receiving support from local governments? In what ways do the local governments support your initiatives?
WHO works with governments through ministries of health and also with professional associations in countries who are training health care providers.
3.) From your experience, is the practice growing or diminishing? Are attitudes changing?
There is evidence that the practice is being abandoned or declining in some communities and that attitudes are shifting especially among the younger generation, however, it is a deep rooted social norms, and it takes time to change to change social norms.
Building on work from previous decades, in 1997, WHO issued a joint statement against the practice of FGM together with the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA).
Since 1997, great efforts have been made to counteract FGM, through research, work within communities, and changes in public policy. Progress at international, national and sub-national levels includes:
- wider international involvement to stop FGM;
- international monitoring bodies and resolutions that condemn the practice;
- revised legal frameworks and growing political support to end FGM (this includes a law against FGM in 26 countries in Africa and the Middle East, as well as in 33 other countries with migrant populations from FGM practicing countries);
- the prevalence of FGM has decreased in most countries and an increasing number of women and men in practising communities support ending its practice.
Research shows that, if practicing communities themselves decide to abandon FGM, the practice can be eliminated very rapidly.
In 2007, UNFPA and UNICEF initiated the Joint Programme on Female Genital Mutilation/Cutting to accelerate the abandonment of the practice.
In 2008, WHO together with 9 other United Nations partners, issued a statement on the elimination of FGM to support increased advocacy for its abandonment, called: “Eliminating female genital mutilation: an interagency statement”. This statement provided evidence collected over the previous decade about the practice of FGM.
In 2010, WHO published a “Global strategy to stop health care providers from performing female genital mutilation” in collaboration with other key UN agencies and international organizations.
In December 2012, the UN General Assembly adopted a resolution on the elimination of female genital mutilation.
Building on a previous report from 2013, in 2016 UNICEF launched an updated report documenting the prevalence of FGM in 30 countries, as well as beliefs, attitudes, trends, and programmatic and policy responses to the practice globally.
In May 2016, WHO in collaboration with the UNFPA-UNICEF joint programme on FGM launched the first evidence-based guidelines on the management of health complications from FGM. The guidelines were developed based on a systematic review of the best available evidence on health interventions for women living with FGM.
To ensure the effective implementation of the guidelines, WHO is developing tools for front-line health-care workers to improve knowledge, attitudes, and skills of health care providers in preventing and managing the complications of FGM.
4.) What are the biggest health risks that come from procedure?
Female genital mutilation is classified into 4 major types.
Type 1: Often referred to as clitoridectomy, this is the partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals), and in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).
Type 2: Often referred to as excision, this is the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva), with or without excision of the labia majora (the outer folds of skin of the vulva ).
Type 3: Often referred to as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoris (clitoridectomy).
Type 4: This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.
No health benefits, only harm
FGM has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls’ and women’s bodies. Generally speaking, risks increase with increasing severity of the procedure.
Immediate complications can include:
- severe pain
- excessive bleeding (haemorrhage)
- genital tissue swelling
- infections e.g., tetanus
- urinary problems
- wound healing problems
- injury to surrounding genital tissue
Long-term consequences can include:
- urinary problems (painful urination, urinary tract infections);
- vaginal problems (discharge, itching, bacterial vaginosis and other infections);
- menstrual problems (painful menstruations, difficulty in passing menstrual blood, etc.);
- scar tissue and keloid;
- sexual problems (pain during intercourse, decreased satisfaction, etc.);
- increased risk of childbirth complications (difficult delivery, excessive bleeding, caesarean section, need to resuscitate the baby, etc.) and newborn deaths;
- need for later surgeries: for example, the FGM procedure that seals or narrows a vaginal opening (type 3) needs to be cut open later to allow for sexual intercourse and childbirth (deinfibulation). Sometimes genital tissue is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing both immediate and long-term risks;
- psychological problems (depression, anxiety, post-traumatic stress disorder, low self-esteem, etc.);
For more information see health complications of female genital mutilation.
Please also see this fact sheet