According World Health Organization (WHO) Female Genital Mutilation (FMG) is defined as the procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons (1). It is a huge public health problem.
It affects women and girls around the world. Based on the organization data more than 200 million are affected and 3 million are estimated to be at risk (2). This number is predicted to increase to about four million by 2050 as the population where FGM is accrued annually(3). Several form have been determined and are practiced across 30 countries in Africa and also in the Middle East and Asia (4). Moreover, FMG is a threat to the health of women and girls, including psychological, sexual and reproductive health (5). Adverse consequences of FGM are from increasing vulnerability to HIV / AIDS, to damage to the urethra or anus and acute urinary retention (6,7).National data from African countries revealed that the prevalence is high within the continent. In some countries like Burkina Faso, Egypt, Ethiopia, Mali, Somalia and Nigeria it can reach 70% (8).
Moreover, about 92 million women and girls have undergone this practice and it is concentrated in sub Saharan region (1). In Nigeria, literature the national prevalence is 41% among adult women. Although in some areas it can rise to 77%.For instance, the prevalence is 65%, 68%, 77%, respectively for south west, south east, and sousouth area (9) In the north part of the country, we encounter the severe form (10). Often used as a way to control women’s sexuality, the practice is closely associated with girls’ marriageability (11). Mothers chose to subject their daughters to the practice to protect them from being ostracized, beaten, shunned, or disgraced (12).
FGM was traditionally the specialization of traditional leaders’ traditional birth attendants or members of the community known for the trade. There is, however, the phenomenon of “medicalization” which has introduced modern health practitioners and community health workers into the trade.Many challenges are cope with ending this practice in Africa. One of the most but not the least challenge is the traditional practice which take a great part in maintaining this behavior. Indeed, population is particularly refractory and conservative about dropping the FMG. This practice is explained by the role played by the high priestesses of excision. They are responsible for safeguarding the interests of their institutions. From their point of view excision is a creation of the ancestors.
Also in certain region this procedures is considered as source of livelihood in some societies. In addition, from the excised perspective, this practice is not only perceived as a compulsory passage in their education but also as a mean to get married. In this case victims might not necessarily be conscious that they are victims.Furthermore people perceived FMG as a part of their social belonging and in line with community identity. Girls grow up knowing that FGM is part of their tradition or identity and because they want a continuation of this into the next generation, when they become parents, they are more likely to have their children undergo FGM as well.
Having a breakthrough in such cultures may pose challenges as wellTo tackle this public health issue a numerous interventions have been done. Amongst them, a health promotion and a policy interventions have been reported by the grey literature. Concerning the health education intervention ”the impact of health education attitudes towards female genital (FMG) in a rural Nigeria community” (2008) (13), the authors argue that this intervention could reduce the practice of FMG. Indeed, they determine trough a study in three stage (pre intervention stage, intervention stage and post intervention stage) factors that can influence the practice of FMG and also they appraise the impact of their education sessions among Shao community in Nigeria. After interviewed 412 respondents (male and female), they found that they were no association between the socio-demographic components in the pre and post-intervention stage.
Although, this study showed that age, gender and educational status of respondents. Moreover, they study suggested that legislation, female literacy and empowerment, educating men and providing an income-generating activities for traditional excisors. Additionally, the comparison of pre and the post-intervention, showed a statistical significance of the target population who had no intention to excise children girl.The results of this study must be used taking into consideration the limitations it entails.
First, response bias can influence the result. FMG is a sensitive subject and respondent might not be honest on their answer. Lastly, the absence of a control group during the before and after the intervention could lead to believe that the results of the intervention are not only due to the change in the new policy implemented.
In brief, health education is an effective intervention to stop the FMG practice.The second intervention is related to policy. In “Impact of the complete ban on female genital cutting on the attitude of educated women from Upper Egypt toward the practice” (2013) (14), the author claim that after 5 years of implementation of the law against FMG in Egypt, it did not reduced the prevalence of FMG than expected. This intervention turned out to be less effective and should be bolstered by interventions that impacts on behavior change.To buttress their argument, they carried out trough program review, comparison of two groups with the same features before and after a ban of FMG. This survey demonstrated that of women who had at least 1 daughter excised was statistically significant lower in 2011 than in 2006. Similarly, the family pressure was the main argument for acting FGC among respondents. Additionally, there was a low but statistically significance percentage of families pressured to perform FGM in 2011 compared to those in 2006.
This study as the first one is not free of limitations. Likewise the first survey the main limitation as discussed above remains the response bias and the control group.To conclude, implementation of the law against FMG should be reinforce with other strategies to drop FMG practiceWork need to be done to halt FMG. To do so we think that the core competencies of public could help to tailor the problem according to the setting.First partnership, collaboration and advocacy might decrease this procedure. As the As FMG reflects inequality between the sexes and constitutes an extreme formof discrimination against women laws for the elimination of female genital mutilation should be strengthened and associate with other activities.
A particular interest needs to be addressed not only constitutional recognition of the rights of girls and women but also for child protection laws.The second aspect to break down the FMG practice could be through communication.Tradition and custom play a great role in Africa culture as it shapes the behavior of the population. A multidisciplinary approach might block this bad traditional practice through community-led action. Furthermore, the process of empowering education and improving not only men and women but also traditional excisors awareness of complications of FGM could help to reduce the burden of the phenomenon. The study showed that women refused now to exposed their daughter in such practice (15). The more educated a women are the more likely she will refuse the practice of this tradition. The third component to overcome this public health issue could be diversity and inclusiveness.
Research and survey based on solid data must be done to document the phenomenon. Countries will have to tailors policies and interventions according to their findings in order to roll back this practice in the continent. In addition, capacity building should also be a leverage to cut down FMG.
Indeed, it could be used as a powerful mean to reshape the mindset of the population during their passage in the primary health care services. Lastly, leadership as a strong powerful tool to cut down FMG practice could be used.Governments have legal obligations to respect, protect and promote human rights, and can be held accountable for failing to fulfill these obligations. Accordingly, governments need to take appropriate legislative, judicial, administrative, budgetary, economic and other measures to the maximum extent of their available resources.
These measures should not to be words written instead it should act whereby the decreased of this practice find a consistent basis. In conclusion, it is a need to abolish an unhealthy practice that can impact hugely on women and girls lives. The work to be done might be a pathway to help health decision-makers to tackle this problem at its roots.