Female genital mutilation (FGM)

The majority, though not all, of the references are to The Lancet which requires (free) registration.

While the debates rage about patriarchy and people apportion blame, we sometimes seem to forget the individual who has suffered.

The immediate consequences of FGM can be any combination of the following:

• severe pain,
• shock,
• haemorrhage,
• infection.

Longer term problems are likely to be:

• chronic pelvic infection,
  
• chronic urinary tract infections,
• pain,
• cysts,
• psychological problems,
• sexual problems,
• infertility and
• obstetric complications for both mother and infant.

The WHO has recently completed a large study into the obstetric outcome for women who have undergone FGM. It has shown that there is a significant risk that the baby will be stillborn or will need resuscitation.

In order to combat the practice it isn't sufficient to address just a single issue. Intervention has to happen on a number of different fronts in order to combat this assault on women as soon as possible. Addressing women's rights alone will just take too long. And the most important avenue has to be basic education: hygiene, health etc - including women's rights. The effect that fertility is adversely affected by FGM and that there are detrimental consequences on the newborn baby is very important in traditional societies and these points should be made widely known. Encouragement of those who are already opposed to the practice, enlisting the help of local leaders, development of alternative rites of passage ceremonies - all can help.

What has been shown not to help has been the provision of alternative livelihoods to the providers, criminalisation or the medicalisation of the procedure.

We also need to recognise that it isn't solely a problem for the developing world. Migrants, refugees and asylum seekers have brought the problem to the developed world. According to the 2000 United States census, 881,300 African migrants come from countries where FGM/C is widely practiced. It is estimated that as many as 3,000 to 4,000 girls are "cut" every year in the UK. A clinic set up in Guy's and St Thomas', London, found that acute and chronic physical complications were present in 86% of women with type III genital mutilation.

There is still a long way to go, so every possible approach should be used including, of course, addressing women's rights.