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What We Fight Against

FGM  PANDEMIC

The inhuman FGM in our communities is at 96% practiced as a rite of passage from childhood to adulthood. FGM is far more prevalent among the Somali (98%), Kisii (96%), and Maasai (73%) communities. FGM is also geographically unevenly spread in Kenya and; it is more visible in rural areas (where Teresa Missions is based) than in urban areas. This is a particularly rampant societal and health injustice that we are keen to rescue at-risk girls from. Once a girl goes through FGM, she is now considered an adult who could get married even when she is too young to make such adult decisions. This automatically changes the course of their future for worse.

For educational purposes, Female Genital Mutilation (FGM) comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.

In 1997, WHO classified female genital mutilation into four different types. Since then, experience with using this classification revealed the need to subdivide these categories, to capture the varieties of FGM in more detail. Severity (which here corresponds to the amount of tissue damaged) and health risk are closely related to the type of FGM performed as well as the amount of tissue that is cut.

TYPES OF FEMALE GENITAL MUTILATION

The four major types of FGM, and their subtypes, are:


Type I.(clitoridectomy)
Partial or total removal of the clitoral glans (the external and visible part of the clitoris, which is a sensitive part of the female genitals, with the function of providing sexual pleasure to the woman), and/or the prepuce/clitoral hood (the fold of skin surrounding the clitoral glans). When it is important to distinguish between the major variations of Type I FGM, the following subdivisions are used:
Type Ia. Removal of the prepuce/clitoral hood only.
Type Ib. Removal of the clitoral glans with the prepuce/clitoral hood.


Type II.(excision)
Partial or total removal of the clitoral glans and the labia minora (the inner folds of the vulva), with or without removal of the labia majora (the outer folds of skin of the vulva). When it is important to distinguish between the major variations of Type II FGM, the following subdivisions are used:
Type IIa. Removal of the labia minora only.

Type IIb. Partial or total removal of the clitoral glans and the labia minora (prepuce/clitoral hood may be affected).
Type IIc. Partial or total removal of the clitoral glans, the labia minora and the labia majora (prepuce/clitoral hood may be affected).


Type III. (infibulation). 
Narrowing of the vaginal opening with the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora. The covering of the vaginal opening is done with or without removal of the clitoral prepuce/clitoral hood and glans (Type I FGM). When it is important to distinguish between variations of Type III FGM, the following subdivisions are used:
Type IIIa. Removal and repositioning of the labia minora.
Type IIIb. Removal and repositioning of the labia majora.


Type IV. 
All other harmful procedures to the female genitalia for non-medical purposes, for example pricking, piercing, incising, scraping and cauterization.
Pricking is often done on the clitoris
Cauterization is a technique of burning a part of the body to remove or close a part of it.


Deinfibulation refers to the practice of cutting open the sealed vaginal opening of a woman who has been infibulated (Type III). This is often done to allow sexual intercourse or to facilitate childbirth, and is often necessary for improving the woman’s health and well-being.

Despite the health risks, women undergo a narrowing of their vaginal opening again after being deinfibulated, at the time of childbirth – meaning that they may undergo a series of repeated infibulations and deinfibulations throughout the life-course.


Health risks of female genital mutilation (FGM)
FGM has no health benefits, and it harms girls and women in many ways. The practice involves removing and injuring healthy and normal female genital tissue, interfering with the natural functions of girls' and women's bodies. It can lead to immediate health risks, as well as a variety of long-term complications affecting women’s physical, mental and sexual health and well-being throughout the life-course.   
All forms of FGM are associated with increased health risk in the short- and long-term. FGM is a harmful practice and is unacceptable from a human rights as well as a public health perspective, regardless of who performs it. Some health care providers perform FGM (medicalization), but WHO is opposed to all forms of FGM and strongly urges health care providers to not carry out FGM even when their patient or their patient’s family requests it.


Short-term health risks of FGM
Severe pain. Cutting the nerve ends and sensitive genital tissue causes extreme pain. The healing period is also painful.
Excessive bleeding (hemorrhage). Can result if the clitoral artery or other blood vessel is cut.
Shock. Can be caused by pain, infection and/or hemorrhage.
Genital tissue swelling. Due to inflammatory response or local infection.
Infections. May spread after the use of contaminated instruments (e.g. use of same instruments in multiple genital mutilation operations), and during the healing period.
Human immunodeficiency virus (HIV). The direct association between FGM and HIV remains unconfirmed, although the cutting of genital tissues with the same surgical instrument without sterilization could increase the risk for transmission of HIV between girls who undergo female genital mutilation together.
Urination problems. These may include urinary retention and pain passing urine. This may be due to tissue swelling, pain or injury to the urethra.
Impaired wound healing. Can lead to pain, infections and abnormal scarring.
Death. Death can result from infections, including tetanus, as well as hemorrhage that can lead to shock.
Mental health problems. The pain, shock and the use of physical force during the event, as well as a sense of betrayal when family members condone and/or organize the practice, are reasons why many women describe FGM as a traumatic event.
Early adulthood. Once a girl or woman has undergone FGM, she is regarded as ready for the next rite of passage, marriage even at a young age.


Long-term health risks of FGM (occurring at any time during life)
Pain. Due to tissue damage and scarring that may result in trapped or unprotected nerve endings.
Infections and HIV. Given that the transmission of HIV is facilitated through trauma of the vaginal epithelium which allows the direct introduction of the virus. Many other infections can be transmitted due exposed tissues and open wounds.
Chronic genital infections. With consequent chronic pain, and vaginal discharge and itching. Cysts, abscesses and genital ulcers may also appear.
Chronic reproductive tract infections. May cause chronic back and pelvic pain.
Urinary tract infections. If not treated, such infections can ascend to the kidneys, potentially resulting in renal failure, septicaemia and death. An increased risk of repeated urinary tract infections is well documented in both girls and adult women who have undergone FGM.
Painful urination. Due to obstruction of the urethra and recurrent urinary tract infections.
Vaginal problems. Discharge, itching, bacterial vaginosis and other infections.
Menstrual problems. Obstruction of the vaginal opening may lead to painful menstruation (dysmenorrhea), irregular menses and difficulty in passing menstrual blood, particularly among women with Type III FGM.
Excessive scar tissue (keloids). Excessive scar tissue can form at the site of the cutting.
Sexual health problems. FGM damages anatomic structures that are directly involved in female sexual function, and can therefore also have an effect on women’s sexual health and well-being. Removal of, or damage to, highly sensitive genital tissue, especially the clitoris, may affect sexual sensitivity and lead to sexual problems, such as decreased sexual desire and pleasure, pain during sex, difficulty during penetration, decreased lubrication during intercourse, and reduced frequency or absence of orgasm (anorgasmia). Scar formation, pain and traumatic memories associated with the procedure can also lead to such problems.
Childbirth complications (obstetric complications). FGM is associated with an increased risk of caesarean section, postpartum hemorrhage, recourse to episiotomy, difficult labor, obstetric tears/lacerations, instrumental delivery, prolonged labor, and extended maternal hospital stay. The risks increase with the severity of FGM.
Obstetric fistula. A direct association between FGM and obstetric fistula has not been established. However, given the causal relationship between prolonged and obstructed labor and fistula, and the fact that FGM is also associated with prolonged and obstructed labor, it is reasonable to presume that both conditions could be linked in women living with FGM.
Perinatal risks. Obstetric complications can result in a higher incidence of infant resuscitation at delivery and intrapartum stillbirth and neonatal death.
Mental health problems. Studies have shown that girls and women who have undergone FGM are more likely to experience post-traumatic stress disorder (PTSD), anxiety disorders, depression and somatic (physical) complaints (e.g. aches and pains) with no organic cause.
Early marriages. Early adulthood leads to early marriage which ruins an otherwise brighter futures for young girls. 



Conclusion
FGM is considered normative tradition and of cultural significance in most community settings in Kenya even though this practice is always a violation of human rights, with the risk of causing trauma and leading to problems related to girls’ and women’s mental health and well-being. 
Anyone found engaging in this unlawful practice either actively or passively is committing a crime and is liable to face justice in the court of law.


Teresa Missions is actively involved in fighting this injustice: rescuing the at-risk girls, rescuing girls from early forced marriages and offering moral and legal support for these at-risk girls.