NO FOR MEDICALIZATION OF FGM / FGC CASE STUDY IN EGYPT Dr. MOHAMED FARID OB.& GYN CONSULTANT MOHP - EGYPT
Medicalization of FGM / FGC means : Having the operation performed by health professionals in clinical settings-in the belief that it is safer. Department of Gender and Women’s Health Department of Reproductive Health and Research Family and Community Health World Health Organization Geneva
Recently, in EGYPT, more families seek the advices of medical personnel, in an attempt to avoid the dangers of unskilled operations performed in unsanitary conditions.
However, The “medicalization” of FGM / FGC-which is willful damage to healthy organs for non-therapeutic reasons – is unethical . Moreover, the performance of FGM / FGC by a health professional is a violation of the ethical code governing health practice, which specifically requires that physicians, nurses and midwives “do not harm”.
The world Health Organization (WHO), the international Council of Nurses (ICN), the International Confederation of Midwives (ICM) and the Federation of Gynecologists and Obstetricians (FIGO) have all declared their opposition to the medicalization of FGM / FGC, and have advised that it should not be performed by health professionals or in health establishments under any circumstances.
FGM / FGC STATUS among women of reproductive age ( 15-49)IN EGYPT EDHS 1995&2000& 2005
According to EDHS 2005, over the next decade in Egypt, there will be a steady decline in the proportions of young adult women who are circumcised. However, the survey suggests that, in 2015, around 5 in 10 girls will continue to be circumcised by their 18th birthday, unless further changes occur in the attitudes supporting the practice, and further actions combating FGM/FGC are undertaken on the national level.
The proportion of girls who are currently circumcised or expected to be circumcised in the future decreases with the mother’s educational attainment and with wealth status. Notably, 36% of girls in the highest compared to 85% of girls in the lowest wealth class.
Reasons for Support of FGM/FGC amongEgyptian Families ( EDHS 2005 ): • Around 70% of ever-married women age 15-49 think that the husband prefers the wife to be circumcised. • Around 60% of women see FGM/FGC as ensuring that a woman will remain faithful to her husband. • 50% of women agree that FGM/FGC prevents adultery. • 45% of women do not believe that FGM/FGC has any adverse consequences on women’s health or may lead to girl’s death.
MOHP 2005 National Study on Prevalence of FGM/FGC among girls aged 10-18 years in Egypt 50.3%. • EDHS 2005 : Prevalence of FGM/FGC among girls aged 10-17 years 65.5%.
Prevalence of FGM/FGC among school girls according to the level of education of Mothers and Fathers
The Egyptian Ministerial FGM/FGC Decrees: • First (1959) : FGM/FGC should not be performed in the Clinics of Ministry of Health. • Second (1994) : FGM/FGC should not be performed by non-medical practitioners and in places other than equipped facilities in public and central hospitals. - Third (1996) : It is prohibited to perform FGM/FGC in any Health facility (public or private), except for the highly indicated cases which should be approved by the head of OB.&GYN Department.
BODOUR The 11 year Victim young Egyptian Girl Who was Killed on 21/6/2007 during the practice of FGM/FGC by a doctor, in rural Upper Egypt. Bodour was the spark which mobilized the Egyptian community towards the elimination of FGM/FGC in Egypt. (The beginning of the End)
* Fourth (28 / 6 / 2007): It is prohibited for any one of the health service providers (Physicians and Nursing staff) , and others (paramedical or related personnel), to perform any excision, deformation or any type of surgical intervention for any natural part of the external female genital organs (what is called female circumcision), whether in governmental & non-governmental establishments, or in any other premises.
Continued Those professionals who perform these actions are considered violating the laws and regulations of the ethical code governing the medical profession. Moreover, they will be subjected to penalties and punishment from both the Ministry of Health and the Medical Syndicate.
According to the Egyptian criminal law, mutilation of any part of the human body is a crime, whether intended or occurring as a consequence of negligence or ignorance .
If the person who performs this operation is not a doctor whether it is a daya or nurse or others, in this case two crimes have been committed, intentional wound inflicting, and illegal practice of medicine. Both crimes merit severe punishment, ( 3-7 years in jail ), for performing actions resulting in permanent infirmity.
Nowadays, a higher committee headed by the First Lady and including the Ministries of Justice & Health and Interior, was formulated to prepare an Egyptian legislation for incriminating FGM/FGC. This law will be presented to the Egyptian parliament ( People’s Assembly ) for approval and prompt implementation.
FGM/FGC is a deeply rooted social tradition in Egyptian families. The last decade witnessed the dominance of performing the practice by health professionals, due to the following reasons: 1) Socio-Cultural Background of the practitioner. 2) Religious Attitudes. 3) Uphold good social tradition.
Continued 4) Gain Social Acceptance, especially in rural Upper Egypt . 5) FGM/FGC is not included in medical curricula, therefore, health professionals are not sufficiently aware of the harmful effects of the practice, especially the remote sexual and psychic consequences. 6) Until one month ago, There is no legal action or actual punishment for those who perform the practice, except after notification of a major complication threatening life or even death of the girl.
Continued 7) Income Generating (Economic Cause). 8) With Increased awareness of the harmful effects of FGM/FGC and greater access to health care services; health care workers my find themselves under pressure from individuals and families to carry out FGM/FGC.
Policy Guidelines for the Prevention of Medicalization of FGM/FGC (I) Health Professionals must be expressly forbidden to perform FGM/FGC. (II) Any health professional found performing, or reported to have performed, FGM/FGC should be brought to the attention of the appropriate authorities for professional discipline and / or legal action.
Continued (III) The presence of FGM/FGC and related complications should be noted as a matter of routine in the clinical records of health service clients. (IV) Health information systems should include appropriate data on FGM/FGC.
Continued (V) Health workers must not, under any circumstances, close up (re-infibulate) an opened vulva in a girl or woman with type III FGM/FGC. (VI) Health workers need to be given the administrative and legal authority to refuse a demand for re-infibulations, regardless of the client’s cultural and social background.
Continued (VII) Health professionals need to be given appropriate training and support to enable them to counsel families who expect them to perform FGM/FGC. (VIII) Medical syndicates & concerned NGOs and Human Rights Organizations should have a clear and concrete role in abolishing attempts for medicalization of FGM/FGC.
(IX) Medical School Curricula should include appropriate information about FGM/FGC. It is hoped that bringing FGM/FGC into mainstream education for health professionals will increase the pressure for elimination of the practice, by lifting the veil of secrecy surrounding…..it.(X) Religious & media and Health institutions should have a consensus on a unified message that FGM/FGC is a violation of the human rights of girls and women; and it is a grave threat to their health.
(XI) Adopting the socio-cultural perspective as the main issue for the awareness and behavior change campaigns against FGM/FGC. (XII) Target Audience for media campaigns should include men & young girls & community leaders & opinion leaders & decision makers and health professionals.
(XIII) Developing and up-scaling the Knowledge and skills of Religious Leaders and media personnel in all FGM/FGC perspectives ( Health & Social & Statistical & & Religious & Legislative and Communication Sciences).
(XIV) Up-scaling the communication skills of all direct and indirect stakeholders, from the stage of IEC to BCC. (XV) Ensuring the sustainability of a strong political commitment at all levels.