Reducing FGM related incidence in Teesside

1. Reducing FGM related incidence in Teesside

2. What is FGM ? • Female genital mutilation (FGM) includes procedures that intentionally alter or injure female genital organs for non-medical reasons. • An estimated 100 to 140 million girls and women worldwide are currently living with the consequences of FGM. • In Africa, about three million girls are at risk for FGM annually. • The procedure has no health benefits for girls and women.

3. What is FGM ? • It is mostly carried out on young girls sometime between infancy and age 15 years. • FGM is internationally recognized as a violation of the human rights of girls and women.

4. Instruments used to practiceof FGM The practice is mostly carried out by traditional circumcisers, who often play other central roles in communities, such as attending childbirths. Increasingly, however, FGM is carried out with special knives, scissors, scalpels, pieces of glass or razor blades. Anaesthetic and antiseptics are not generally used except when carried out by medical practitioners. In communities where infibulations is practised, the girls' legs are often bound together to immobilize her for a period of 10 - 14 days, to allow formation of scar tissue.

5. Different Types of FGM • Normal Female Anatomy

6. Type 1 or Clitorectomy • Type I FGM, often termed clitorectomy, involves excision of the skin surrounding the clitoris with or without excision of part or all of the clitoris . • When performed in infants and young girls, a portion of or all of the clitoris and surrounding tissues may be removed. • If only the clitoral prepuce is removed, the physical manifestation of Type I FGM may be subtle, necessitating a careful examination of the clitoris and adjacent structures for recognition."

7. Type 2 or excision Type II FGM, referred to as excision, is the removal of the entire clitoris and part or all of the labia minora. Crude stitches of catgut or thorns may be used to control bleeding from the clitoral artery and raw tissue surfaces, or mud poultices may be applied directly to the perineum. Patients with Type II FGM do not have the typical contour of the anterior perineal structures resulting from the absence of the labia minora and clitoris. The vaginal opening is not covered in the Type II procedure."

8. Types 3 or Infibulation Type III FGM, known as infibulation, is the most severe form in which the entire clitoris and some or all of the labia minora are excised, and incisions are made in the labia majora to create raw surfaces. The labial raw surfaces are stitched together to cover the urethra and vaginal introitus, leaving a small posterior opening for urinary and menstrual flow. In Type III FGM, the patient will have a firm band of tissue replacing the labia and obliteration of the urethra and vaginal openings."

9. Real picture of type 3 FGM

10. Type 4 (no graphic available) • Type IV includes different practices of variable severity including pricking, piercing or incision of the clitoris and/or labia; stretching of the clitoris and/or labia; cauterization of the clitoris; and scraping or introduction of corrosive substances into the vagina.

11. Causes of FGM? • Where FGM is a social convention, the social pressure to conform to what others do and have been doing is a strong motivation to perpetuate the practice. • FGM is often considered a necessary part of raising a girl properly, and a way to prepare her for adulthood and marriage. • FGM is often motivated by beliefs about what is considered proper sexual behaviour, linking procedures to premarital virginity and marital fidelity. FGM is believed by some to reduce a woman's libido and help her resist "illicit" sexual acts. When a vaginal opening is covered or narrowed (type 3 above), for example, a woman is physically hindered from premarital sex. Afterwards, a painful procedure is needed to reopen the closure to enable sexual intercourse. • FGM is associated with cultural ideals of femininity and modesty, which include the notion that girls are “clean” and "beautiful" after removal of body parts that are considered "male" or "unclean".

12. Consequences • 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. • Immediate complications can include severe pain, shock, haemorrhage (bleeding), tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue

13. Long term consequences • recurrent bladder and urinary tract infections; • cysts; • infertility; • the need for later surgeries. For example, the FGM procedure that seals or narrows a vaginal opening (type 3 above) is surgically changed to allow for sexual intercourse and childbirth, and sometimes stitched close again afterwards; • an increased risk of childbirth complications and newborn deaths.

14. Legal aspect of FGM • In 1985 the government introduced the prohibition of FGM Act, Making FGM illegal in England, Ireland and Wales • In 2003 a private members bill supported by the government was legislated and was enacted in March 2004. • The Amended law is called “The Female genital Mutilation Act 2003. • This made it illegal to take girls who are UK nationals or permanent residents out of UK for the sole purpose of FGM. • Maximum prison sentence was increased to 14 years

15. What we would like to do • Raise awareness on FGM in Teesside • Empower women specially those with daughters from the concern community to allow them to make informed decisions • Educate communities particularly at risk of • Finally reduce FGM incidence within our area

16. conclusion • The WHO,repoted that Procedures are mostly carried out on young girls sometime between infancy and age 15, and occasionally on adult women. In Africa, about three million girls are at risk for FGM annually. • Between 100 to 140 million girls and women worldwide are living with the consequences of FGM. In Africa, about 92 million girls age 10 years and above are estimated to have undergone FGM. • The practice is most common in the western, eastern, and north-eastern regions of Africa, in some countries in Asia and the Middle East, and among certain immigrant communities in North America and Europe.

17. References World Health organisation (2008) Female genital Mutilation [ online] www.who.int/mediacentre/factsheet [Accessed May 2008] Index of League Somalia (2008) FGM [online] http:middle-east-info/league/somalia/M?=D [Accessed June 11 2008]

18. References continue • National clinical Group (2007) a healthier future without FGM: legal issues [online] http://www.fgmnationalgroup.org/legal_issues.htm [accessed May 2007]