Dorcas%20O%20Akeju%20OBE

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• Dorcas O Akeju OBE
• Retired Midwife-Chair of Liverpool
  National FGM Clinical Group

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• SILENT TRADITION A VIOLATION OF HUMAN RIGHTS

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Aims and Objectives

• To discuss the issues around FGM.
• Its violation against women and girls
• The Human Rights issue
• Health implication on women and girls
• The Law
• Actions for its elimination.

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DEFINITION

• FGM constitutes all procedures which involve
  the partial or total removal of the external
  genitalia organ or other injury to the female
  genital organs, whether for cultural or any other
  non-therapeutic reasons (WHO, 1995).
• 3 million girls in Africa undergo FGM every year.
• 100 to 140 million in Africa live with the
  consequences of FGM

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HISTORY OF FGM

• Dated back at least 2000 years
• Believed that it was practised as a sign of
  distinction amongst the aristocracy-Egypt
• Traces of infibulation can still be found on
  Egyptian mummies.

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Classification

• Type 1-partial or total removal of the clitoris
  and rarely the prepuce.
• Type 2-partial or total removal of clitoris and
  labial minora with or without removal of labial
  majora.
• Type 3- narrowing vaginal opening through
  creation of a covering by cutting and
  repositioning the inner and sometimes the outer
  labia with or without removal of the clitoris.
• Type 4all harmful procedures to the female
  genitalia for non medical purposes e.g pricking,
  piercing or incising, stretching,
  scraping,cauterising

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Type 11 Type 111
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Is FGM Tradition or Violation of Human Rights

• Violation of human rights principles
• Norms and Standards
• Equality and discrimination on the basis of sex.
  (Gender Inequality)
• The right to freedom from torture or cruel
• The right to life

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Reasons to justify female genital mutilation

• Religion (Muslim faith)
• Tradition-Norms, Customs, Myths, Taboos
• Preserve virginity
• Avoid sexual immorality
• Initiation rite
• Aesthetic reasons
• improve fertility and prevent mortality
• Cleanliness/Purification

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Female Genital Cutting Areas of Practice - TYPE
II Type II involves the partial or entire removal
of the clitoris, as well as the scraping off of
the labia majora and labia minora .
                                                  
                                                  
       Return to Introduction
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Prevalence of FGM

• Particularly prevalent in Africa
• Somalia
• Ethiopia
• Sudan
• Mali
• Nigeria
• Tanzania
• Sierra Leone

• Egypt
• Muslim Groups
• Australia
• Philippines
• Malaysia
• Pakistan
• Indonesia
• United Emirates
• South and North Yemen
• Bahrain
• Oman

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INCIDENCE OF FGM IN UK

• Depends on the migration of people from different
  affected countries to a city (1999- Immigration
  and Asylum Seekers Act)
• 66,000 women in UK have undergone FGM (2001
  Census figure).
• 22,000 girls are at risk of FGM
• Statistical study to estimate the Pervalence of
  FGM (FORWARD, 2007).
• Highest-London, Small numbers Wales, Northwest
  and Midlands

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Prevalence

• UNICEF-FGM/C-A Statistical overview and
  Exploration of the dynamics of change (2013)
• Data Collection England from Sept 14
• Current data-125 Acute Hospitals out of 160
  eligible Trusts
• 1,279-Active cases
• 467-New cases

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How female genital mutilation is sustained at
grassroots level
FEAR
rit
Rituals reinforcing woman-hood
Lack of Choice
Superstitions based on patriarchal ideology
Marriage partners reproductive rights
Male Fears
Womens lack of access to resources in
the community
Womens Sexuality
Womens Sexuality
F.G.M.
illiteracy
Economic aspects income status for
excisor -brideprice
Lack of government policy and action
Sanctions against women
Lack of health care
Religious Propaganda
FEAR
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FGM Women

• For many women FGM is a fact of life, a pain that
  must be borne because they must conform to social
  expectations in order to survive.
• It is a centuries-old tradition practice present
  with a number of physical, psychological and
  cultural challenges to midwifery care.

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Immediate effects

• Shock
• Bleeding
• Accidental damage to surrounding organs
• Urinary complications
• Death

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Long term effects

• Haematocolps
• Vulval Cysts / abscesses
• Rectal /Vaginal Fistula
• Pelvic inflammatory disease
• Problems childbirth

• General health
• Dysuria
• Infection
• Dyspareunia
• Infertility
• Keloid scars

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Appropriate care and Support

• Access/Setting up FGM Clinic
• Approachable
• Communication
• Counselling and advice
• Flexibility
• Safe environment.
• Sensitivity

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Counselling

• Non-judgmental and sympathetic.
• Language barrier-trained interpreter or link
  worker should be present.
• Do not rely on family members.
• Discuss potential consequences of FGM.
• Explain FGM with diagram.
• Involving partner is very important as this is
  about changing attitude.

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Actions for its Elimination

• Reconciling strategies to the distinctive
  features of each culture.
• Integrating strategies with other health and
  developments.
• Forming alliances between modern and traditional
  healers.
• Exercising discretion and tact in referring to
  deeply held beliefs.
• Seeking solutions from within countries
  complemented by international solidarity.

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ACTIONS FOR FGM

• International
• Regional
• National
• Community activists

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International

• Declaration of Human Rights-10th Dec 1848
• International Covenant on Civil and Political
  Rights 10 Dec 1966 into force 23rd March 1975
• Convection on the Rights of the Child 20 Nov
  1989
• Committee on the Elimination of all Forms of
  Discrimination against Women-1990

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International Contd

• The Convention on the elimination of all forms of
  Discrimination against women(1979)
• The African Charter on Human and Peoples Rights
  (1981)
• United Nations General Assembly-Declaration on
  Elimination of Violence against Women (1993)
• The Convection on the rights of the Child(1989)
• The World Health Assembly resolution on the
  elimination of FGM (2008

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Regional Treaties

• European Convection for the protection of Human
  Rights and Fundamental Freedoms (Nov 1950.)
• American Convection on Human Rights (July 1978)
• African Charters on the Rights and Welfare of the
  child. (Nov 1999)

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The Working Group on Traditional Practices-Africa

• Economic and Social Council of the United
  Nations- NGO working group (ECOSOC Geneva 1977)
• Somali Womens Democratic Organisation formed
  1977
• Symposium on The Changing Status of Sudanese
  women (1979)
• Inter-African Committee (IAC- 1984)

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National Strategy

• Developing services
• Working with the communities especially the women
  in understanding the Law
• Raising awareness amongst the communities in
  general
• Educational programme for professionals
• Safeguarding issue

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FGM and the Law
1985 Act Prohibition of Female Circumcision Child
rens Act 1989- (Safeguarding) Child Assessment
Orders Emergency Protection Removal and
Accommodation Human Rights Act 1998 Who is
involved? All professionals involved in the care
of the child. Midwives, health visitors, School
Nurses, GPs, Teachers and Social Services. FGM
BILL-2003 How is the law enforced? The Children
Act 2004
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FGM ACT 2003

• Act 2003 brought into force 3/3/04
• To close the loophole of FGM Act 1985
• Section 1 states it is criminal offence to
  excise, infibulate or otherwise.
• Act refers to girls also applies to women
• Also an offence if a person in UK advises his UK
  National brother to carry out FGM over the phone.

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Penalties For Offence

• Section 5 of the FGM Act 2003- on Conviction or
  indictment to imprisonment for a term not
  exceeding 14 years or a fine or both

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Prosecution

• Use of Expert witness e. g. Medical professional
  Specialist in FGM.
• International Evidence-may be from passports or
  Flight records.
• Victim evidence which has become very difficult
  leading to non-charging.
• Use of video(but permission is needed
• Referral system/partnership working..
• NO WITNESS-NO PROSECUTION!!!

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Challenges re-Prosecution

• Victims may see it as conforming to the Norm
  and may not report it.
• May not report it if it will not affect their
  stay status
• Need to recognise the diversity of the victims.
• It is a silent thing within the practising
  communities.

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Partnership working/Europe/International-End FGM

• FORWARD-Charity-London/campaigner against FGM
• Nancy McKenna-Charity working in Africa to
  support girls and women-empowerment/DVD-The
  Cutting Tradition.
• Cathy Holland-works with girls at the village of
  Pokot-Kenya-DVD-I will never be cut
• IKWRO-Iranian and Kurdish Womens Rights
  Organisation

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Partnership contd

• Equality Now-charity org working with UK
  Government to collect data on FGM
• The Bristol community Development Programme.
• Kudistan report on FGM-Germany.
• Communities in the Dutch responding to FGM.
• FGM work in the Middle Eastern Community Diaspora.

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Partnership Working

• Liverpool FGM and Multi-Cultural Women Health
  Advisory Group-set up 1999 www.fgm-liverpool.org
• Forced Marriage/Honour Based Violence Group
• FORWARD-based in London www.liverpooluk.org.uk
• FGM National Clinical Group-www.fgmnationalgroup.o
  rg
• FGM Forum-Home Office

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CONCLUSION/THREE FEMINI SORROW-POEM

• THE DAY OF CIRCUMCISION
• HER WEDDING NIGHT
• THE DAY SHE WILL BE HAVING HER BABY

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Conclusion
To eliminate FGM is about partnership working
between the women and professionals. Having
empathy for the women who have been circumcised
and understanding the issues around tradition and
cultural.
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CONCLUSION CONTD

• This violation of womens rights cannot be
  abolished without placing it firmly within the
  context of efforts to address the social and
  economic injustice of women. If women are to be
  considered as equal and responsible members of
  the society, no aspect of their PHYSICAL,
  PSYCHOLOGICAL OR SEXUAL INTEGRITY CAN BE
  COMPROMISED.
• Toubia,N 1995
• THANK YOU FOR LISTENING/ANY QUESTIONS OR
  VIEWS!!!

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References

• Integrating the prevention and the Management of
  the Health complications into the curricula of
  Nursing and Midwifery-WHO/RHR/01
• Female Genital Mutilation an overview WHO (1998)
• Summary of International and regional human
  rights relevant to the prevention of violence
  against women-WHO/GCH/WHM/99.3 Geneva (1999)
• Female Genital Mutilation-WHO (2008)
• FGM Act-2003 HSMO

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Resources/Videos

• The Cutting Tradition-Safe Hands (Nancy
  McKenna-47mins
• FGM-National Clinical Group/resource and
  training-appx 40mins
• DH-FGM (2006)-30mins
• Not with my daughter FGM in Europe (41mins)
• The Broken Silence film by esther heller
• Moolaade-a film by Ousmane Sembene-120mins

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