Female Genital Mutilation (FGM) as a global health issue

Answer

FEMALE GENITAL MUTILATION AND ROLE OF NURSES IN ERADICATING IT

Introduction

Female Genital Mutilation (FGM) entails removing a section or a whole genital organ of a female for cultural purpose. It encompasses the procedures involved in partial or total removal of external female genitalia or other injury to the female genital organs whether for cultural or other non-medical reasons (Elnashar & Abdelhady, 2007). According to Johansen et al. (2018), there are four types of FGM that include clitoridectomy, excision,  infibulation, and FGM type 4 that involves random piercing, burning or scratching of the clitoris, labia and other adjacent tissues with the aim of causing bleeding and or tightening the vagina (Karlsen et al., 2020).  The choice of FGM type varies from one community to the other. However, most African communities practice clitoridectomy and excision.  Powel et al. (2004) argued that FGM practices are taken seriously in different communities since it is done for various sociocultural purposes. In these cultures, FGM is part of the rites of passage and gives a sense of ethnic and gender identity to the woman/girl involved. Other continued reasons for continuing practice of FGM according to Glover et al (2017) include the quest for respect and honor in the community, acceptance among peers and the belief that it is the only way through which a girl graduates to womanhood. Despite these benefits, FGM has elicited heated debate among social and healthcare workers. Reports have indicated that the practice has numerous detrimental effects on the health and social practice. Therefore, this paper examines the impacts of FGM on health and social care practice. It also examines pertinent contemporary evidence regarding FGM as a global issue. Further, it describes major areas of FGM as global health effects on mental health practice, and describes the contemporary and future challenges of FGM as a global health issue in mental health practice.

Impacts of Female Genital Mutilation on Health and Social Care Practice

FGM causes a number of health complications to its victims.  According to Mutanda (2016), the severity of these health problems depends on factors varying from the type of FGM procured, the expertise of the clinician involved, the sanitation conditions of the location in which it is performed and the overall health status of the victim of the procedure. Complications do happen in all types of FGMs, but are most likely with infibulation. These problems include pain and trauma from the process of cutting a section or a whole sex organ, and it is an extremely painful experience to the victim (Chen 2019). These problems as argued by Kasim, Shaaban, El Sadak, and Hassan (2012) may result in permanent trauma in the victim and later develop into psychological disorders thereby negatively affecting her social life.

 FGM may cause vaginal infections and consequently, loss of life. Given that most cases of FGM are administered in dirty environments by a traditional physician who has limited knowledge of the female anatomy, management of serious errors or emergencies becomes a problem (Reisel and Creighton 2015). At this event, the victim may get infected or even bleed excessively leading to organ damage or even death. In addition, studies have revealed that female genital mutilation causes menstrual problems due to the blockage of vaginal opening and this may result in dysmenorrhea, unpredictable menstrual circle and difficulty in discharging menstrual blood (Salam et al. 2016). In most cases, this challenge severely influences persons suffering from FGM type 3 as their vaginal opening is narrowed by stitching. This condition affects the general health of the victim.

Another critical impact of FGM is the complication during childbirth due to excess pain and the narrowing of the birth canal. The damaged vaginal tissue left after mutilation would not be flexible enough to allow passage of the new born (Cottingham et al. 2009). This would make labor more devastating that it should be. Furthermore, this would cause obstetric fistula due to blocked labor increasing the risk of death to the mother and child. Kiragu (1995) mentioned that countries with a high prevalence of FGM also have some of the highest maternal mortality rates in the world’’ other immediate challenges of FGM include severe pain during the process, tetanus, wound infection, fever and ulceration of the genital region.

  Furthermore, FGM leads to sexual disorders negatively affecting her intimate social life. The fact that FGM involves injuring or mutilation of sensitive sexual organs shows clearly that the victim would not have a normal sex life again. This condition would deprive the victim the refreshing effects of sex driving the victim into low self-esteem hence posing a great danger to the victim’s social life. Furthermore, Blockage of menstrual flow especially in FGM type 3 destabilizes the thinking process of the victim. This would damage her self-esteem and make social relationship a disaster.

With respect to social practice, studies have indicated that FGM makes it difficult for females and other social care practitioners to care for their children the best way they would prefer. For some victims, FGM has compromised the bond and consequently attachment between a child and mother. For this reason, Rasheed, Abd-Ellah, and Yousef (2011) stated that FGM has a significant effect on relationships across societies. Other social practitioners have stated feeling resentful towards their infants because of the physical pain they endured because of FGM during childbirth. The relational effect in numerous women and social care practitioners continue to improve their determination to fight against the practice, with a sense of duty that they require to safeguard their infants and clients. Resilience has also been intensified by the growing fear that women and social care practitioners experience that their daughters and clients respectively may be subjected to FGM in case they do not safeguard them. Findings of a report by Rasheed, Abd-Ellah, and Yousef (2011) shown that FGM hinder the ability of women to trust others. This further increase the fear that such persons feel and bar them from socializing and minimizing chances for support and action

Relevant Contemporary Evidence Regarding FGM as A Global Health Issue

Medicalization of FGM among practicing communities is an emerging problem in the fight against this vice. This is a scenario where medical practitioners either nurses or doctors get involved in administering FGM. Doucet et al. (2017) in his research among the Sudanese people stated that some nurses in the communities involved practice medicalized FGM.  Some did it willingly so as to gain favors from the general communities while some were forced to do so. This is a challenge in the fight against FGM as the process is being sanitized by the medical practitioners in administering it. Moreover, the people’s mindsets about FGM among communities that practice it are difficult to change. Muthumbi, Svanemyr, Scolaro, Temmerman, & Say (2015) argued that in some communities where FGM is practiced, women who successfully escaped this vice experience traumatic encounters that the pain of undergoing the FGM process. This makes women and girls sneak out and undergo mutilation hiding it from the authorities making it even more difficult to eliminate the vice.

How Key Areas of FGM as A Global Health Impacts on Mental Health Practice

The practice of FGM is not only a health concern, but also a mental problem globally. Precisely, Karlsen et al. (2019) contended that the psychological influence of female genital mutilation is that it makes a female never to go back to her mental stability after undergoing the painful experience of mutilation. Principally, this causes a permanent psychological mark that would disturb the victim throughout her life.  According to Kizilhan (2011), some of these mental problems encompass post-traumatic stress disorder (PTSD). Essentially, the pain that one undergoes in the process of FGM is unforgettable. It is a permanent mark on the victim that keeps on reappearing causing emotional grief, withdrawal, fear and anxiety to the subject. Waigwa, Doos, Bradbury-Jones and Taylor (2018) contended that this problem never goes away but instead changes the victim’s life. Special and consistent counseling is required to help the victim find a way of recollecting herself to gain mental stability.

The victim’s self-esteem is highly damaged and depressed. Isman et al. (2013) stated that the survivors of FGM develop mixed feeling of sadness, guilt and increased fatigue. This is largely due to physical damages and afterward problems that happen to the victim’s sex organs Osinowo and Taiwo (2003) reported that the problem of self-mistrust influences the individual’s ability to work and make decisions independently, and may make the victims suicidal. In this condition, one’s mental state is compromised and needs help in the quest for mental normalcy.

Obianwu et al. (2018) reported that women who went through FGM tend to have psychological settings that make them introvert, uncommunicative and distrustful. He further stated that it difficult for such persons to develop trust with other people because they feel betrayed by their closes confide, who in this case are their mothers. Marcusán, Singla, Secka, Utzet and Le Charles (2016) noted that FGM victims portray similar characteristics as those by people who were mistreated while young.  With this condition, these women may experience challenges in their relationships and their marriages may never work indicating a stressful future for them. Humphreys (2007) concluded that victims of FGM who returned to school are likely to have low concentration span in the class, and thus are likely to perform dismally in academics.  In another study, Sarayloo et al. (2019) observed a sample of 66 women immigrated from Sudan, Somalia, Ethiopia, Eritrea, and Kenya. Out of his sample, eleven suffered from Post-Traumatic Stress Disorder and twenty two had symptoms linked to anxiety and depression. 

Furthermore, FGM may make a woman uncomfortable when having sexual intercourse leading to inability to fulfill her role of bearing child which is the major role of a woman in certain communities.  In this case, Muthumbi (2015) stated that these women may be seen as curse and be rejected from her marital home. This experience may cause more psychological problems than the trauma caused by FGM.

Current and Future Challenges of FGM as A Global Health Issue In Mental Health Practice

FGM would keep causing mental health problem for members the communities that continue practicing it. Presently, the problems of trauma from the pain from mutilation, stress from the feeling of betrayal by close family members and the self-distrust is on the rise. Karlsen, Carver, Mogilnicka, & Pantazis, (2019) states that the pain experienced in the process of mutilation develop serious psychological wounds that may take a life time to heal. As this is the case, many of the victims are becoming introverts that are unable to initiate their own projects as others grapple with other more disastrous outcomes. However, much future may be bright as many communities are learning to avoid these practices, there is going to be a disconnect between the younger and the old generations among communities practicing FGM. This would therefore bring to the younger generation the pain of being disinherited by their old generations. The pain may cause mental and psychological challenges which need to be handled on time.

Conclusion

In conclusion, although the international bodies and organizations such as World Health Organization and United Nations Children’s Fund put up efforts to fight this vice, it should be known that it is difficult to eliminate FGM from the face of the world (Ibrahim 2012). In some communities, women that have not undergone this practice are more traumatized and stressed. This is because they are looked down up on by society and they are isolated. It should, therefore, be a collective responsibility of all governments and community leaders to support in teaching these communities about the medical dangers brought forward by FGM. The problem of medicalization of FGM is another elephant that requires a combined effort by governments of all nations to fight.