Female Genital Mutilation (FGM):
silent distress…
Professionals, volunteers and individuals coming across FGM
for the first time can feel shocked, upset, helpless and unsure of
how to respond appropriately to support victims and protect
those at risk of FGM practice.
Peggy Mulongo
DipHI MSc RMN
NESTAC
www.nestac.org
NESTAC who we are…
We represent the “New Step for African Community”, a
charitable organisation aimed at supporting refugees, asylum
seekers and other immigrants from the new emerging
communities, especially from African origin.
Our focus:
- Educate through Cross-cultural awareness trainings/events
- Support, Advocate and Empower clients to fulfil their potential
- Research, Inform and Share learning on Cultural issues
- Health and wellbeing, using trans-cultural therapeutic approach
Our vision:
Fully Integrated Active Citizens , sharing good values, and having
fair and equality of opportunities.
www.nestac.org
Our Health and Wellbeing
Programme…
• FGM PROJECT
• CULTURAL COUNSELLING
• DROP-IN CLINICS
(ROCHDALE, SALFORD, NORTH MANCHESTER)
• HEALTH AND WELLBEING ACTIVITIES
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What is Female Genital Mutilation?
(FGM)
The terms “Female Genital Mutilation", "female
genital cutting“; female circumcision” and "female
genital mutilation/cutting" refer to all procedures
involving partial or total removal of the external
female genitalia or other injury to the female genital
organs for non-medical reasons
Adapted from World Health Organization 2008
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Types of FGM
Type I (clitoridectomy): Excision of the prepuce, with partial or
total removal of the clitoris.
Type II (Excision): Excision of the prepuce and clitoris together
with partial or total excision of the labia minora.
Type III (Infibulation): excision of part or all of the external
genitalia and stitching or narrowing of the vaginal
opening. 15% of all cases. It involves the use of thorns,
silk or catgut to stitch the two sides of the vulva.
Type IV : All other harmful procedures including pricking,
piercing or incision of the clitoris and/or the labia;
stretching of the clitoris and or the labia; cauterisation
or burning of the clitoris and surrounding tissues,
scraping of the vaginal orifice or cutting (Gishiri
cuts) of the vagina and introduction of corrosive
substances or herbs into the vagina.
source: WHO 2008
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Who is at risk?
From shortly after birth to the labour of the first child
Pregnant women
Babies
Children and young girls
Adulthood
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Who is at risk?
 3 million girls undergo FGM every year
 About 140 million girls and women have already undergone
FGM
 A girl born to a mother who has already undergone FGM
between 0-14 years may be at increased risk
 A girl born to a father who comes from an affected
community
 Immigrant communities in Europe, America and Australia
from affected communities
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Communities at Risk
In some places, FGM as being practised by specific ethnic groups, rather than by a
whole country
 28 practising countries in Africa
Djibouti (98%); Somalia (97%); Sierra Leone (90%); Ethiopia (79.9%);
Sudan (90%); Guinea (98.6%); Egypt (97%).
 Amongst some Bedouin women in Israel
 Malaysia, Indonesia and Bohra Muslim populations
in parts of India and Pakistan
 The Middle East (Yemen, Oman, Iraqi Kurdistan)
 Ethiopian Jews
 In the UK, 6500 girls are at risk of FGM every year
(Dorkenoo et al, 2007).
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Prevalence of FGM 15-49 yrs
'Below 10 per cent
'10 - 40 per cent
'41 - 70 per cent
'More than 70 per cent
Source: UNICEF- October 2010- global databases based on data from MICS, DHS and other national surveys, 1997-2009.
How is FGM carried out?
 Generally carried out by an elder woman in the community,
with non-medical training
 Non-sterile instruments without anaesthetic are used
(razor
blade, knife, sharp piece of glass, scissors)
 Iodine or Mixture of herbs often placed on the wound to
stop the bleeding
 Increased use of health professionals to avoid the health
complications
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Socio-cultural context of FGM
•
•
•
•
•
•
•
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CULTURAL AND/OR TRADITION –
RELIGION – VIEWED AS RELIGIOUS
OBLIGATION
MARRIAGE- CONTROL OF SEXUALITYACCESS
FAMILY HONOUR
INITIATION INTO WOMANHOOD
PURITY, CHASTITY,
AESTHETICS AND HYGIENE –
GENDER IDENTITY
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FGM is a social convention
Many women believe that FGM is necessary to ensure acceptance
by their community; they are unaware that FGM is not practised in
most of the world.
•
FGM THRIVES ON SOCIAL APPROVAL AND
CONFORMITY THROUGH STRONG SOCIAL PRESSURE
•
FAILURE TO CONFORM OFTEN LEADS TO SOCIAL
EXCLUSION, OSTRACISM, STIGMA ETC.
•
FGM IS A RULE OF BEHAVIOUR ENFORCED THROUGH
REWARDS, BENEFITS AND SOCIAL SANCTIONS
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Health issues
Short term effects:
 Severe pain and shock
 Urine retention
 Immediate fatal haemorrhaging
Infection
Injury to adjacent tissues
Long term effects:
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Difficulty conceiving –Infertility
Keloid formation and Chronic pain
Painful cramps during menstruation
Cysts and neuromas
Difficulty passing urine, recurrent UTIs Psychological damage
Increased risk of Vesico Vaginal Fistula
Uterus, vaginal and chronic pelvic infections
Complications in pregnancy and child birth
Bleeding (due to repeated de-infibulations / infections)
Sexual dysfunction / genital phobia/ painful sexual intercourse.
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Emotional consequences
14
Research have proven that negative mental health
consequences are related to:
• severe forms of FGM, immediate post-FGM complications,
chronic health problems and/or loss of fertility secondary to
FGM, non-consensual circumcision in adolescence or
adulthood.
Resulting to:
• psychological and psychosomatic disorders including Post
Traumatic Stress Disorder (PTSD), anxiety, depression, and
memory loss.
OUR DROP-IN CLINICS...
Trans-cultural Therapy
15
• Women are offered a culturally adapted therapy to address
FGM issues affecting their emotional wellbeing
• Tailored cultural counselling sessions are offered and arranged
for sufferers and those at risk, in strict confidentiality
• Boyfriends / partners are referred for cultural counselling they are usually supportive when the reality is explained to
them
• Peer mentors training is offered to people from practicing
communities to help support their peers emotionally
Our Clients…
16
• Women receiving psychosocial therapy in our clinics report
feelings of betrayal by parents, incompleteness, regret and
anger.
• Women describe how FGM is an extremely traumatic experience,
the long-lasting emotional damage this causes in their lives, and
how hard it is to suffer in silence.
• “It is all about values, culture and traditions” they say.
• They hope that as they become more informed about health
consequences and cross the threshold from traditional Africa to
the modern society, their silence will give place to a strident
scream against FGM.
Interacting with Health Services in UK
 Many feel shy, ashamed and lose their confidence
when examined
 “We feel different from other women & wonder
what doctors think of us”
 “Because of FGM many women have difficulty to
visit their doctors”
 “It is embarrassing especially when we are asked
why we did this to ourselves, we don’t have an
answer”
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FGM Law & Child Protection
Female Genital Mutilation Act
2003
 Makes it a criminal offence to:
• Excise, infibulate or otherwise
mutilate the whole or any part of a
girl or woman’s labia majora, labia
minora or clitoris.
• Aid, abet, counsel or procure a girl
to mutilate her own genitalia; or
• Aid, abet, counsel or procure a nonUK person to mutilate a UK
national’s or permanent resident’s
genitalia outside of the UK.
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The context of FGM in Greater Manchester
Greater Manchester FGM Forum
• FGM prevalence document in Greater Manchester
•
FGM leaflet to be distributed across Greater Manchester
• FGM e-learning package:
http://www.endthefear.co.uk/media/uploads/fgm/story.html
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CONTACT US
IF YOU NEED FURTHER INFORMATION
PLEASE CONTACT US THROUGH:
E-MAIL:
TEL:
WEB:
INFO@NESTAC.ORG
01706 868993
WWW.NESTAC.ORG
THANK YOU ALL!!!!!
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