Module 6 – 6 Special issue FGM

6. Special issue FGM

6.1 Present situation:

125 million women and girls are affected by FGM (UNICEF 2013)
Each year, 3 million are added, which are more than 8.000 victims per day!
FGM is practised in 29 African countries as well as in the Middle East
In Austria about 6.000-8.000 women are affected by FGM, about 1.900 live in Vienna

6.2 Practice of FGM

Age at the time of practicing FGM: Regionally very different: at the age of 7-8 days after birth, between 5-10 years, before wedding night or during the first pregnancy
Performing persons: Circumcisors, traditional birth attendants, midwives, physicians
Traditional techniques: Are taking place out of hospitals and under unhygienic conditions, will be carried out without disinfectants and without anaesthesia
Medicalisation: The intervention/procedure is performed in health care facilities by qualified medical professionals.

[Insert “00-FMGC_infographiclow-res” as pop up; Link:

http://www.unicef.org/protection/files/00-FMGC_infographiclow-res.pdf]

6.2.1 Definition

„…all procedures, which aim to remove outer (female) genitalia partly or completely for cultural or non-therapeutic reasons.“

Additional terms: FGM/C – Female Genital Mutilation/Cutting, Female Circumcision

6.2.2 Forms

Type I: „Clitoridectomy“: Exzicion of the foreskin with the whole or a part of the clitoris peak

Type II: „Excision“: Removal of the clitoris peak and foreskin together with a part or complete removal of the small labia and sewing up until urethra.

Type III: „Infibulation“: most extreme form of FGM, also „pharaonic“ circumcision- complete removal of the clitoris peak and the labia minora as well as the inner side of labia majora. Both sides of the vulva will be sewed subsequently.

Type IV: diverse, non-classifiable practices, e.g. piercing, cut or tear of the clitoris

Source of the images: http://www.wikiwand.com/de/Weibliche_Genitalverst%C3%BCmmelung

http://creativecommons.org/licenses/by/2.0/

6.2.3 Reasons for FGM/C

Sexual reasons, traditional reasons, purity/religious reasons, economic reasons, medical reasons, myths.

6.2.4 Complications of FGM

Acute: bleedings, shock, urinary retention, infections, bone fractions, psychic acute trauma

Chronic: sexual problems, menstrual disorders (can last up to 10 days), urinary complications, urinary and faecal incontinence, pelvic inflammatory disease, scarring problems, and psychic long-term effects

6.2.5 Legal aspects of FGM in Austria

Criminal law provides that „mutilation or any other injury of genitalia, which is suited to have long-lasting impairment of sexual sensation” cannot be agreed to (§ 90 Abs. 3 StGB).

Committing the crime in a foreign country will be persecuted by criminal law if a contributive offender/perpetrator and his victim are Austrian citizens and have their residence or common domicile in the country itself (§ 64 Abs. 1 Z 7 StGB).

Health care workers are asked to complain to the police if they have the suspicion that bodily injury is performed on minors!

6.2.6 Refibulation

Refibulation means sewing up again the vagina after delivery with only leaving a tiny opening. For this purpose, the scar edges are removed and the remaining tissue is sewed together once again. In Austria this procedure is banned by law.

6.2.7 Defibulation

Defibulation, to reverse infibulation of FGM type III, is the surgical procedure to open up the closed vagina for reasons of sexual intercourse or giving birth.

6.2.8 Information for professionals

FGM is a taboo subject and often not allowed to speak about. Therefore, the physician/ health care worker should address the subject very carefully and sensitively.
If the doctor discovers the mutilation by medical examination, emotional reactions like dismay or pity may occur. They could be experienced as stigmatising and should be avoided.
The physician/ health care worker should address his observation, that FGM has been performed, after medical examination to the woman patient as objective as possible!
He/she can ask the woman, if she needs further information or if she wants to talk about it. If yes, the physician/ health care worker can explain to her, which form of circumcision has been performed and ask her, if she has any complaints.
A setting “from woman to woman” should be considered.
A trustful relationship must be developed!

6.2.9 FGM and pregnancy/birth

A narrowed introit may complicate medical examination and vaginal drug administration or make it even impossible.
Higher risk for extended delivery and oxygen deficiency of the child with consecutive brain damage.
Increased rate of childbirth injuries (perineal tears, tears of urethra).
Women fear that a caesarean section means something bad and often suppose, that Austrian physicians prefer conducting caesarean section births.
Frequently, repeated consultation meetings are necessary to provide detailed (health) education. It is very important to convey possible complications with type 3 infibulation sensitively and comprehensibly.

6.2.10 Women affected by FGM

Often feel stigmatised and have feelings of shame talking about FGM, they also fear vaginal examinations.
Have difficulties to recognize the difference between episiotomy and defibulation, want to know what is happening after giving birth (De-fibulation vs. Re-fibulation).
The question, if spontaneous delivery is possible, is frequently asked
Feel happy and comfortable when examined by a female physician/ health care worker
Conducting a sensitive conversation (asking about concerns and problems, not addressing the topic of FGM directly, no reduction on consequences of FGM)
Most women do not seek assistance because of FGM, but because of another concern (diverse other diseases)