The health consequences of FGM/Cutting in Somaliland: Action is needed

Author (Amplifying Civil Society voice on GBV coalition members in Somaliland)

Female Genital Mutilation/Cutting (FGM/C) refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons (Inter-agency statement 2008)[1]. It is recognized internationally as a violation of the human rights of girls and women and constitutes an extreme form of discrimination against women due to the severe health consequences; the pain and risks involved. It’s a deeply rooted cultural practice in many Sub-Saharan African countries, in Somaliland the prevalence of FGM/C is 99.8% (NAFIS 2014)[2] in girls and women aged above 15 years.

WHO classifies the FGM/M practice into four types; Type I, also called clitoridectomy, Type II, also called excision, Type III, also called infibulation and Type IV which includes all other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping or cauterization. Types II and III are widely practiced in Somaliland and these present severe health consequences that have been well documented in several medical reports.

Generally, the immediate health complications include shock, hemorrhage, infections and psychological consequences while the long term health risks consist of chronic pain, infections, fistula, keloids formation, primary infertility, birth complications, and danger to the new born.

In Somaliland, the following complications are common as reported by the several health service providers and gynecologists from centers such as Edna maternity hospital and NAFIS support centers:

De-infibulations at the time of marriage; The infibulation opening that had until then permitted the passage of urine and vaginal secretions is no longer able to permit intercourse, so de-infibulation should be performed at marriage and child birth. Repeated de-infibulation causes damage to the surrounding tissues.

Infertility; because of the constant stagnation of menstrual blood and other vaginal secretions that have accumulated in the vaginal cavity, the resulting pelvic inflammation may obstruct the fallopian tubes and block the normal travel of the ovum along the tubes, preventing it from becoming fertilized by the male spermatozoa.

During Pregnancy It is not uncommon for an infibulated and pregnant woman to attend the antenatal clinic for follow up of the pregnancy or other related complaints and find that the opening of the infibulation will not admit the introduction of even one finger into the vagina for diagnostic and exploratory purposes. Such women will require a de-infibulation during pregnancy if complications are to be avoided at the time of delivery (Edna hospital report 2014)[3]

During Labour and Caesarian Delivery: Some women arrive at the maternity hospital in labour with a very small infibulation opening. If the vagina is seen to be too rigid and scarred, and thought to be a possible cause of severe vaginal lacerations or third degree tears, it is likely that an elective caesarian section will be decided upon. If keloids have formed and are too large, a caesarian section might be the best option to deliver the child.

Prolonged second stage of labour; because the vagina, perineum and the labia have all undergone mutilation that has left extensive scar formation, the vaginal canal becomes inelastic and the pelvic floor muscles rigid. This prevents the normal and gradual dilation of the vagina as well as the descent of the presenting part of the child during the second stage of labour.

There are risks of contracting HIV and Hepatitis C when large groups are cut on the same day using the same unsterilized instruments.

Public health facilities in the country are inadequate to support the poor girls and women thus severing the above complications. Private Service providers like Edna maternity hospital in Hargeisa, Allaale hospital in Borama and Non-Governmental Organizations like NAFIS FGM/C support centers in Borama, Hargeisa and Burao, provide counseling, referral and medical support but their services are overwhelmed by the demand.

The Amplifying Civil Society voice on GBV coalition members in Somaliland are proposing the following actions to be taken by the government and other stakeholders to minimize and or fully relieve our girls from this harmful practice.

Since FGM/C is performed for non-medical and non-religious reasons, there is need to abandon the practice. Decision makers should take proactive actions to outlaw FGM/C practices.

Robust awareness of the dangers of FGM/C should be conducted and support centers established, equipped to provide psychosocial, medical and any other support to the women and girls affected by FGM/C. Finally, parents and guardians should take a positive role of saving their girls for this harmful practice.

 

[1] World Health Organization. Eliminating female genital mutilation: an interagency statement. OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO. Geneva; 2008.

[2] According the prevalence, perception and attitude research implemented by NAFIS Network in 2014

[3] Edna maternity hospital report in 2014