Dorcas O Akeju OBE
Retired Midwife-Chair of Liverpool &
National FGM Clinical Group
SILENT TRADITION: A VIOLATION OF
HUMAN RIGHTS
•
•
•
•
•
•
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.
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

 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.
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
Type 11
Type 111
•
•
•
•
•
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
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
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 .
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
 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
•
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
•
•
•
How female
genital mutilation
is sustained at
grassroots level
FEAR
Rituals
Lack of Choice reinforcing
Superstitions
Marriage
womanbased on
partners
hood
patriarchal
reproductive
rights
ideology
Male Fears
Women’s lack of access
to resources in the
community
rit
F.G.M
.
illiteracy
Economic aspects:
income +status
for excisor
-brideprice
Lack of
government
policy
and action
Religious
Propaganda
Lack of
health
care
Sanctions
against
women
FEAR
•
•
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.
Immediate effects
• Shock
• Bleeding
• Accidental damage to surrounding
organs
• Urinary complications
• Death
Long term effects
• Haematocolps
• General health
•
• Dysuria
Vulval Cysts /
abscesses
•
Rectal /Vaginal
Fistula
• Pelvic inflammatory
disease
• Problems childbirth
• Infection
• Dyspareunia
• Infertility
• Keloid scars
•
•
•
•
•
•
•
Access/Setting up FGM Clinic
Approachable
Communication
Counselling and advice
Flexibility
Safe environment.
Sensitivity
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.
•
•
•
•
•
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.
 International
 Regional
 National
 Community
activists
•
•
•
•
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
•
•
•
•
•
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
•
•
•
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)
•
•
•
•
Economic and Social Council of the United
Nations- NGO working group (ECOSOC
Geneva 1977)
Somali Women’s Democratic Organisation
formed 1977
Symposium on “The Changing Status of
Sudanese women” (1979)
Inter-African Committee (IAC- 1984)
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
FGM and the Law
1985 Act
Prohibition of Female Circumcision
Children’s 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, GP’s, Teachers and Social
Services.
FGM BILL-2003
How is the law enforced?
The Children Act 2004
•
•
•
•
•
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.
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
•
•
•
•
•
•
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!!!
•
•
•
•
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.
•
•
•
•
FORWARD-Charity-London/campaigner against
FGM
Nancy McKenna-Charity working in Africa to
support girls and women-empowerment/DVDThe Cutting Tradition.
Cathy Holland-works with girls at the village of
Pokot-Kenya-DVD-”I will never be cut”
IKWRO-Iranian and Kurdish Women’s Rights
Organisation
•
•
•
•
•
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.
Partnership Working
• Liverpool FGM and Multi-Cultural Women Health
Advisory Group-set up 1999 www.fgmliverpool.org
• Forced Marriage/Honour Based Violence Group
• FORWARD-based in London
www.liverpooluk.org.uk
• FGM National Clinical Groupwww.fgmnationalgroup.org
• FGM Forum-Home Office
•
THE DAY OF CIRCUMCISION
•
HER WEDDING NIGHT
•
THE DAY SHE WILL BE HAVING HER BABY
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.
This violation of women’s 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!!!
•
•
•
•
•
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
•
•
•
•
•
•
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