Female genital mutilation: what every paediatrician should know
Creighton SM, Hodes D
Female genital mutilation (FGM) is almost always performed on children and consequently paediatricians should have a central role in the detection and prevention of FGM. FGM has no health benefits and can cause lifelong damage to physical and psychological health. Extensive migration of FGM practising communities means that FGM is now a global problem. Paediatricians worldwide need to be familiar with the identification and classification of FGM and its impact upon health as well as current trends in practice. However information about FGM is hampered by the secrecy surrounding the procedure and a lack of rigorous evidence based research. This review summarises what is currently known about the health aspects of FGM and how paediatricians should manage children with FGM in their clinical practice.
Meaning-making of female genital cutting: children’s perception and acquired knowledge of the ritual.
Schultz JH, Lien IL.
Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway.
How do girls who have undergone female genital cutting understand the ritual? This study provides an analysis of the learning process and knowledge acquired in their meaning-making process. Eighteen participants were interviewed in qualitative indepth interviews. Women in Norway, mostly with Somali or Gambian backgrounds, were asked about their experiences of circumcision. Two different strategies were used to prepare girls for circumcision, ie, one involving giving some information and the other keeping the ritual a secret. Findings indicate that these two approaches affected the girls’ meaning-making differently, but both strategies seemed to lead to the same educational outcome. The learning process is carefully monitored and regulated but is brought to a halt, stopping short of critical reflexive thinking. The knowledge tends to be deeply internalized, embodied, and morally embraced. The meaning-making process is discussed by analyzing the use of metaphors and narratives. Given that the educational outcome is characterized by limited knowledge without critical reflection, behavior change programs to end female genital cutting should identify and implement educational stimuli that are likely to promote critical reflexive thinking.
“Never My Daughters”: A Qualitative Study Regarding Attitude Change Toward Female Genital Cutting Among Ethiopian and Eritrean Families in Sweden
Johnsdotter S, Moussa K, Carlbom A, Aregai R, Birgitta Essén B
To explore attitudes toward female genital cutting (FGC) in a migration perspective, qualitative interviews were conducted with men and women from Ethiopia and Eritrea in Sweden. We found firm rejection of all forms of FGC and absence of a guiding motive. Informants failed to see any meaning in upholding the custom. We conclude that children of Ethiopian or Eritrean parents resident in Sweden run little risk of being subjected to FGC. A societal structure prepared to deal with suspected cases of FGC with a high level of alertness should be combined with a healthy sceptical attitude toward exaggerations of risk estimates.
Lancet. 2010 Oct 9;376(9748):1222; discussion 1222.
What is the AAP’s real view on medical involvement in ritual cutting of children?
Comment on Lancet. 2010 Jul 3;376(9734):15.
Norra MacReady (July 3, p 15) is incorrect that the American Academy of Pediatrics (AAP) moved quickly to control the damage caused by the toning down of its 1998 policy on female genital mutilation.
The lead author of the revised policy, published on April 26, 2010, posted an e-letter on May 13 defending “the compromise of a ‘nick’”. The following day, the AAP President claimed that the 2010 policy needed to be read to be understood. The AAP did not release a statement saying that it did not end …
Prevalence of female genital mutilation among female infants in Kano, Northern Nigeria.
Garba ID, Muhammed Z, Abubakar IS, Yakasai IA.
Department of Obstetrics and Gynaecology, Bayero University/Aminu Kano Teaching Hospital, PMB 3452, Kano, Nigeria.
OBJECTIVES: To determine the prevalence and type of female genital mutilation (FGM) among female infants, reasons and attitude of the mothers to the practice. DESIGN: A cross sectional descriptive study. SETTING: Tertiary centre in Kano Northern Nigeria. METHOD: A Pretested questionnaire was administered for mothers of female infants presenting for routine immunization in Aminu Kano Teaching Hospital (AKTH). A total of 250 questionnaires were administered, but only 200 were properly filled and this was used for the analysis. MAIN OUTCOME MEASURES: Prevalence and type of FGM, reason for and attitude of mothers towards FGM. RESULTS: Twenty-six infants had FGM during the period of study, giving a prevalence rate of 13 %. The mean age at cutting was 8 days ± 7.3. The commonest type of FGM was type I accounting for 96.2 % of the cases. Tradition/culture was the commonest reason for mutilation accounting for 73.1 %, other reasons included; religious in 11.5 %, hygienic in 11.5 % and to preserve virginity in 3.8 %. Traditional barbers were the commonest operators in 80.8 % of cases, followed by the nurse/midwife in 15.4 % of cases. The fathers were the main decision makers in 46.2 %, followed by both parents in 26.9 % and grandparents in 15.4 % of the cases. 84 % of mothers were not in support of the practice. Thirteen percent of the clients would circumcise all their daughters. Forty-eight percent of the clients were of the opinion that FGM cause harm to the victims. Four percent of those whose daughters were yet to be circumcised will do so later. CONCLUSION: Female genital cutting is still practiced in our environment. Educational enlightenment is fundamental in changing public opinion as well as in offering reasonable alternative to FGM. Campaign against the practice of FGM should be encouraged to eradicate its practice.
Female circumcision in Somalia: anthropological traits
Grassivaro Gallo P, Abdisamed M.
In 1981, 2497 subjects (comprising women and girls) were interviewed in Somalia, mostly in Mogadish, about female circumcision. In this study there are presented the principle cultural trends which are connected with the custom and which have arisen from the research. Even today, the practice of female circumcision is universal in Somalia; the percentage of circumcised women was 99.3%. Infibulation is the commonest type of circumcision used (75.7%). The age of circumcision varies from birth to 15; the average being 7.5. The type of circumcision does not seem to be influenced by some environmental variables (e.g. birth place of parents or place of circumcision), it is primarily determined by the population of the individual region. Infibulation is accepted to the greatest extent by the pastoral populations of the middle/northern regions, principally in Ogaden and in the 4 Somalian regions on which it borders: Togdheer, Nugal, Muddug, Galgadud. In the southern regions (Upper, Middle, Lower Giuba) amongst rural populations or populations with a cattle/cultivation economy, there are also attenuated types of circumcision: sunna and clitoridectomia (20 to 30%). The evolution of the practice was studied by data of the subjects, of their mothers and of their daughters. From this analysis there was no indication toward non-circumcision. There is, however, a movement towards the attenuated forms of circumcision. The fundamental key to such an attenuated operation for a child seems to be the presence of the same attenuation in previous generations.