A Report on the National Female Genital Mutilation Summit by Dr Comfort MOMOH MBE - FGM/Public Health Specialist

Dr Comfort MOMOH's Report on the National Female Genital Mutilation Summit

Page last updated: 03 September 2013

Female Genital Mutilation

Introduction

This report is in response to a request from the Australian Government asking for a report on the National Female Genital Mutilation Summit, following my presentation and participation at the Summit.. It contains my personal reflection on the measures outlined and topics discussed as well as factual information about the event itself.

Context

On 20th December 2012, the United Nations General Assembly unanimously passed a resolution banning the practice of Female Genital Mutilation (FGM). This was a significant milestone towards the ending of harmful practices and violations that constitute a serious threat to the health of women and girls. The measure was taken by the 194 U.N. Member States, who approved five General Assembly resolutions on the same day on advancing women’s rights, including the one on intensifying global efforts for the elimination of Female Genital Mutilations.

The FGM resolution urges countries to condemn all harmful practices that affect women and girls, in particular female genital mutilations, and to take all necessary measures, awareness-raising and allocating sufficient resources to protect women and girls from this form of violence including enforcing legislation. It calls for special attention to protect and support women and girls who have been subjected to Female Genital Mutilations, and those at risk, including refugee women and women migrants.

The Australia Government promised to stand firm with the International community and support all necessary measures to eliminate the practice of Female Genital Mutilation. In December 2012, Australia’s Prime Minister and Minister for Health, the Hon Tanya Plibersek MP, announced that increased action would be taken on FGM in Australia. For more information please visit Prime Minister of Australia website.

The National Summit on Female Genital Mutilation

The National Summit on Female Genital Mutilation held in Canberra on 9th April 2013 was one of the Government’s commitments to raise awareness in order to end the practice.

The National Summit brought together government, communities, health professionals, legal and policy experts to discuss how the country can mobilize activities, increase support and awareness in order to reduce incidence of FGM in Australia.

In her opening speech Minister Plibersek re-capped the aims of the Summit and future work and commitment by saying that “our task today is to agree on refocusing and redoubling our current efforts to protect and support women and girls who are affected by FGM, and to prevent this practice from occurring to a new generation”. I felt this clearly stated aims of our coming together.

Minister Plibersek also discussed the fact that FGM is a very sensitive and difficult topic to approach, but reiterated that the government was committed to ending the practice. Overall I felt this difficult area was dealt with sensitively and the conclusions drawn were practical.

I had the honour to be an international guest speaker and share my expertise and experience including my many roles in establishing specialised FGM clinics in England. As former vice-president of the European Network on FGM and Other Traditional Practices and as the national coordinator for developing action plans to prevent and eliminate FGM in the EU I worked harmoniously with all concerned and found the opportunity given by the meeting to establish stronger links with others truly inspiring. My personal view of the targeting of groups in order to change attitudes is included below.
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Key issues raised at the summit include:

The practice and impact of FGM was raised as a key issue and this generated discussion on awareness and understanding of FGM in the Australian environment. It also emphasised the need for a holistic approach to FGM which was a most valuable aspect of the work undertaken and to my mind was a key issue and involves many agencies working together.

The participants felt that community participation, empowerment and action should be taken as key issue and priority, and this very much reflected my own view. It is about mobilising and engaging with FGM practising communities. The discussion was focused on the possible roles and contributions of men, women and communities to support action on FGM, looking at the importance of community education, engagement and intergenerational involvement.

The role of community leaders especially women’s leadership is key to ending FGM and this has been my own experience in England. However, my view is also that male attitudes also need to be challenged and changed in order to make progress on this issue. The network of female generations needs to be convinced at every level and I would be interested to see practical plans for putting these ideas into action.

Observations on the Australian Commitments and efforts to Ending FGM

  • The Australian Government decided to boost community awareness and education campaigns and review Australia’s legal framework in an effort to stop the practice of FGM in Australia. In my view this is a vital first step to ending FGM.
  • The Australian Government has announced it will provide $500,000 in grants to fund organisations to run education and awareness activities and support change within communities from my point of view this is a realistic financial commitment. I would hope that it would be a first step and continuing government money would be made available for this vital work.
  • New research and data collection on FGM will help to build the evidence needed to support women and girls affected by FGM in Australia. I would hope that data collection would be efficient and cost effective in order that the practical outreach work can begin in a timely fashion.
  • The Attorney-General will review the current legal framework in Australia, and provide advice on whether any changes are required to ensure full protection against FGM in Australia or abroad. Legislation is an important element in action against FGM.
  • All of the above represent necessary and important steps on the pathway to ridding society of FGM and I was most impressed by the programme outlined.

Conclusion

The Australian Government promised to continue working with states and territories to push ahead with reforms that are necessary to address FGM in Australia and to continue to work with all concerned at local, national and international level to change attitude and mind-set.

From my point of view, education is vital as a precursor to any legal action because it saves suffering, time and money. My impression was that the conference accepted this practical point of view.

FGM is about safeguarding women and girls who are at risk of FGM, we all have a role to play in challenging long held beliefs and in changing lives. I believe that it is the responsibility of all caring professionals, government, non government organisations and FGM practising communities to protect future generations of women from the practice of FGM. It is necessary to back up education with the strong arm of the law.

Another concern of mine is the ability to create links between changes in attitude in the west and in other FGM practicing countries which may be more difficult to bring about change in.

I am pleased to be able to share my knowledge and experience of FGM from my work in the UK, with the hope that it will support action on FGM in Australia. To further support sharing of information, I have included references to some additional FGM resources in the Appendices below, including information on school education, clinical guidelines and government measures which may be of interest and value to multiple sectors.

Recommendations

  • All concerned must work together in and outside Australia to help end FGM and challenge attitudes.
  • The Australian Government need to increase partnership working and collaborate with a wider audience.
  • FGM should not be seen in isolation, an holistic approach should be applied.
  • Training and supporting all professionals is essential and information must be consistent across all the health and social services.
  • Clarity is needed on guidelines/protocols and a clearer pathway for FGM in order to improve access and care for women and girls who have undergone FGM.
  • Someone or a body is needed to coordinated FGM activities in Australia as a whole. This is a special concern to me. I would like to see the practicalities of the decisions made at the Summit detailed and budgeted as a next step.
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Appendix 1

The following represents background information which may be of used to yourselves and related organisations.

‘The Practice of Female Genital Mutilation’

The term "female genital mutilation" refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other reasons. FGM varies across cultures, ethnic groups and tribal affiliations. There is also some variation in the type and timing of FGM within cultures, ethnicities and tribes.

There are four main types of FGM. Type 1, also known as "clitoridectomy," is the excision of the clitoral prepuce (or "hood") and may also involve excision of all or part of the clitoris. Type 2 is the excision of the clitoris and may also involve excision of all or part of the labia minora (the smaller, inner vaginal lips). Type 3, also known as "infibulation," involves excision of part or all of the external genitalia and the stitching or narrowing of the vaginal opening. Type 4 refers to all other genital procedures. See further information below.

FGM has no medical or health benefit. FGM procedures are irreversible and their effects last a lifetime, although the health impacts of FGM may be reduced in some cases.

Communities that practice FGM put forward many reasons and beliefs for the practice. Some of the most common beliefs about FGM are that it promotes chastity, prevents promiscuity, and helps to secure a good marriage for one's daughter.

FGM is commonly performed by traditional birth attendants, local women or men, or female family members. Such individuals do not have formal medical training and usually perform FGM without anesthesia or sterilization.

FGM can be classified into four different types:
  • Type one Excision of the prepuce, with or without excision of part or all of the clitoris. When it is required to differentiate between the variations of type 1 FGM, the following subtypes are suggested (WHO 2008).
Type 1a: Removal of the prepuce only
Type 1b: Removal of the prepuce and the clitoris
  • Type two Excision of the clitoris with partial or total excision of the labia minora.
Subtypes:
Type 2a: Removal of the labia minora only
Type 2b: Partial or total removal of the clitoris and the labia minora
Type 2c: Partial or total removal of the clitoris, the labia minora and the labia majora
  • Type three Excision of part or all the external genitalia and stitching/narrowing of the vaginal opening also known as infibulation.
  • Type four- Unclassified, this includes pricking, piercing or incising of the clitoris and/or labia, stretching of the clitoris and/or labia cauterisation by burning of clitoris and surrounding tissue.

‘Dangers of Female Genital Mutilation’

FGM can be potentially very dangerous for women and girl's health and psychological wellbeing, which can lead to severe health problems that last a life time.

FGM causes gynecological, urological, and obstetric problems in women. Indeed, FGM doubles the risk of the mother's death in childbirth and increases the risk of the child being born dead by three to four times.

During and immediately after the FGM procedure, women can experience significant pain and may suffer hemorrhage, shock, infection, urine retention, and injury to adjacent tissue, and ulceration of the genital region. In extreme cases, women may die from severe hemorrhage.

Intermediate complications from FGM include delays in wound healing, excessive scarring and the formation of keloids which is the thick, swollen skin covering the scar, pelvic infection and recurrent urinary tract infection.

The long term complication includes emotional/psychological and physical, infertility and problems with labor and delivery.

The use of non-sterile tools to perform FGM may also put women at risk for HIV infection or other serious blood borne diseases. Scarring from infibulation or more extreme kinds of Type 2 FGM can prolong or obstruct labour, which in turn can lead to further complications, including extreme perineal tearing, uterine inertia , post partum wound infections (wound sustained around the vulva following delivery), and in some cases to fetal distress or fetal death in labor. Individuals who undergo FGM frequently suffer psychological trauma, such as flashbacks to the procedure and its aftermath, anxiety, fear, insomnia, nightmares, depression, anger, difficulty with intimacy and establishing relationships, and phobias related to sexual relations or touching the genital area.
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Appendix 2 - Papers Published by Comfort Momoh (MBE)

2011 - Protecting pupils from female genital mutilation
British Journal of School Nursing. April 2011 vol 6 No 3

2010 - A day in the life of a female genital mutilation/public health specialist; Midwives August 2010

2010 - Female Genital Mutilation: A global concern, The Practicing Midwife-volume 13. Number 4 April

2010 - Female Genital Mutilation: Trends in Urology Gynaecology and Sexual Health. Volume 15 Issue 3 May/June

2005 - Female Genital Mutilation – Book (November) Publishers-Radcliffe Medical Press (01235528820)
ISBN- 1-85775-693-2

2005 - Female Genital Mutilation; More Common than you think Nursing in Practice Jan/Feb Number 20 pages 57-59

2004 - Current Opinion in Obstetrics and Gynecology vol 16:477- 480 No 6 December

2004 - Attitudes to Female Genital Mutilation. British Journal of Midwifery vol 12, No 10.

2003 - Tackling the Taboo. Nursing Times. 99, 15: Feature pages 40-41.

2003 - The Social Context of Birth. FGM: Chapter 8 edited by Caroline Squire: Radcliffe Medical Press

2002 - INSIGHT 2002 Chapter 7 FGM in UK
Women’s health-important development in primary care edited by Chris Barclay APS Publishing.

2001 - NT PRACTICE SOLUTIONS
Nursing Times November 8, volume 97, No 45 page 35.

2001 - FGM: Analysis of the first twelve months of a Southeast London specialist clinic
British Journal of Obstetrics & Gynaecology. 108:186-191.

2000 - FGM also known as Female Circumcision
Information for Health Professionals.

1999 - FGM: The Struggle Continues
Practice Nursing, Vol. 10 No 2 pp31-33.

1998 - FGM (Female Circumcision)
Midwives Journal, Vol. 1 No 7: 216-217

1997 - Female Genital Mutilation also known as Female Circumcision: Information for Health Professionals
1st Edition Guy’s and St Thomas Foundation Trust

Appendix 3

FGM Resource Material from the United Kingdom
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