Female genital mutilation (FGM)
WHAT is FGM?
Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.
Procedures
Female genital mutilation is classified into four major types. 1. Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris). 2. Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are "the lips" that surround the vagina). 3. Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris. 4. Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

WHO
Who is at risk?
Procedures are mostly carried out on young girls sometime between infancy and age 15, and occasionally on adult women. In Africa, about three million girls are at risk for FGM annually.
Between 100 to 140 million girls and women worldwide are living with the consequences of FGM. In Africa, about 92 million girls age 10 years and above are estimated to have undergone FGM.

WHERE
The practice is most common in the western, eastern, and north-eastern regions of Africa, in some countries in Asia and the Middle East, and among certain immigrant communities in North America and Europe.

Even daughters of immigrants from countries where FGM/C was traditionally practised, and living in western countries such as Australia, Canada and the United States as well as Western Europe, are sometimes unable to escape the grip of tradition . Many are operated on within their borders or taken back to Africa to be excised . Various forms of FGM/C are also reported to exist in parts of Asian countries such as India, Indonesia and Malaysia as well as in Jordan, Occupied Palestinian Territory (Gaza), Oman, Yemen and in certain Kurdish communities in Iraq . Therefore, the practice is widespread.

FGM is Practiced Globally * FGM is practiced in at least 26 of 43 African countries7; the prevalence varies from 98 percent in Somalia to 5 percent in Zaire. A review of country-specific Demographic and Health Surveys (DHS) shows FGM prevalence rates of 97 percent in Egypt8, 94.5 percent in Eritrea9, 93.7 percent in Mali 10, 89.2 percent in Sudan 11, and 43.4 percent in the Central African Republic.12 * FGM is also found among some ethnic groups in Oman, the United Arab Emirates, and Yemen, as well as in parts of India, Indonesia, and Malaysia.13 * FGM has become an important issue in Australia, Canada, England, France, and the United States due to the continuation of the practice by immigrants from countries where FGM is common.14
Why is female genital mutilation carried out?
Female genital mutilation conforms to several cultural beliefs.
The aim of the process is to ensure the woman is faithful to her future husband. Some communities consider girls ineligible for marriage if they have not been circumcised.
Girls as young as three undergo the process, but the age at which the operation is performed varies according to country and culture.
Girls who have not been circumcised may be considered ‘unclean’ in many cultures, and can be treated as harlots by other women. Many men believe the folklore which says they will die if their penis touches a clitoris.
Complications Are Common and Can Lead to Death
The highest maternal and infant mortality rates are in FGM-practicing regions.17 The actual number of girls who die as a result of FGM is not known. However, in areas in the Sudan where antibiotics are not available, it is estimated that one-third of the girls undergoing FGM will die.18 Conservative estimates suggest that more than one million women in Centrafrican Republic (CAR), Egypt, and Eritrea, the only countries where such data is available, experienced adverse health effects from FGM.19 One quarter of women in CAR and 1/5 of women in Eritrea reported FGM-related complications.20 Where medical facilities are ill-equipped, emergencies arising from the practice cannot be treated. Thus, a child who develops uncontrolled bleeding or infection after FGM may die within hours.21
Immediate Physical Problems * Intense pain and/or hemorrhage that can lead to shock during and after the procedure. A 1985 Sierra Leone study found that nearly 97 percent of the 269 women interviewed experienced intense pain during and after FGM, and more than 13 percent went into shock.22 * Hemorrhage can also lead to anemia. * Wound infection, including tetanus. A survey in a clinic outside of Freetown (Sierra Leone) showed that of 100 girls who had FGM, 1 died and 12 required hospitalization. Of the 12 hospitalized, 10 suffered from bleeding and 5 from tetanus.24 Tetanus is fatal in 50 to 60 percent of all cases.25 * Damage to adjoining organs from the use of blunt instruments by unskilled operators. According to a 1993 nationwide study in the Sudan, this occurs approximately 0.3 percent of the time. 26 * Urine retention from swelling and/or blockage of the urethra.
Long-Term Complications * Painful or blocked menses. In 1983, 55.4 percent of women surveyed in Baydhaba, Somalia, reported abnormal menstruation.27 * Recurrent urinary tract infections. A 1983 study in the Sudan revealed that 16.4 percent of women who had the operation experienced recurrent urinary tract infections.28 * Abscesses, dermoid cysts, and keloid scars(hardening of the scars). * Increased risk of maternal and child morbidity and mortality due to obstructed labor. Women who have undergone FGM are twice as likely to die during childbirth and are more likely to give birth to a stillborn child than other women.29 Obstructed labor can also cause brain damage to the infant and complications for the mother (including fistula formation, an abnormal opening between the vagina and the bladder or the vagina and the rectum, which can lead to incontinence).30 Among 33 infibulated mothers followed at Somalia's Benadir Hospital in 1988, all required extensive episiotomies during childbirth. Their second-stage labor was 5 times longer than normal, 5 of their babies died, and 21 suffered oxygen deprivation because of the long, obstructed labor.31 * Infertility. In the Sudan, 20-25 percent of female infertility has been linked to FGM complications.32 * Some researchers describe the psychological effects of FGM as ranging from anxiety to severe depression and psychosomatic illnesses.33 Many children exhibit behavioral changes after FGM, but problems may not be evident until the child reaches adulthood.34 However, little research has been done on this subject. * FGM is likely to increase the risk of HIV infection – often the same unsterilized instrument is used on several girls at a time, increasing the chance of spreading HIV or another communicable disease.35 http://www.path.org/files/FGM-The-Facts.htm http://www.guttmacher.org/pubs/journals/2313097.html