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Geneva, Switzerland, World Health Organization [WHO], 2018. 458 p.Girls and women who have been subjected to female genital mutilation (FGM) need high quality, empathetic and appropriate health care to meet their specific needs. This handbook is for health care providers involved in the care of girls and women who have been subjected to any form of FGM. This includes obstetricians and gynaecologists, surgeons, general medical practitioners, midwives, nurses and other country-specific health professionals. Health-care professionals providing mental health care, and educational and psychosocial support – such as psychiatrists, psychologists, social workers and health educators – will also find this handbook helpful. It includes advice on how to: 1) communicate effectively and sensitively with girls and women who have developed health complications due to FGM; 2) communicate effectively and sensitively with the husbands or partners and family members of those affected; 3) provide quality health care to girls and women who have health problems due to FGM, including immediate and short-term urogynaecological or obstetric complications; 4) provide support to women who have mental health and sexual health complications caused by FGM; 5) make informed decisions on how and when to perform deinfibulation; 6) identify when and where to refer patients who need additional support and care; and 7) work with patients and families to prevent the practice of FGM.
Female genital mutilation as an issue of gender disparity in the 21st century: Leveraging opportunities to reverse current trends.
Ethiopian Medical Journal. 2016 Jul; 54(3):107-108.Add to my documents.
BJOG. 2018 Feb; 125(3):288.Against a background of an increasing demand for surgical intervention for the treatment of FGM/C related complications, Berg et al
Note for typesetter: Please update reference when assigned to an issue.have conducted a systematic review of 62 studies involving 5829 women, to assess the effectiveness of defibulation, excision of cysts and clitoral reconstructive surgery. Berg et al report that defibulation showed a lower risk of Caesarean section and perineal tears; excision of cysts commonly resulted in resolution of symptoms; and clitoral reconstruction resulted in most women self-reporting improvements in their sexual health. However, Berg et al highlight that they had little confidence in the effect estimate for all outcomes as most of the studies were observational and conclude that there is currently poor quality of evidence on the benefits and/or harm of surgical interventions to be able to counsel women appropriately. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
New York, New York, UNFPA, 2015. 56 p.This report, the first such published by the United Nations Population Fund (UNFPA), looks at FGM through the lens of population dynamics and the demographic dividend, based on current evidence and data. It offers quantitative information that both supports evidence-based programming, and frames financial implications for Member States and international donors. Evidence to define the size of the target population and orient actions around areas of greatest impact is of high value in developing interventions and formulating policies. UNFPA remains strongly committed to engaging with Member States, civil society, UN agencies and all other stakeholders to accelerate the elimination of FGM worldwide. Protecting girls upholds their sexual and reproductive health and rights, and enables them to realize their full potential.
Accelerating change by the numbers. 2016 annual report of the UNFPA-UNICEF Joint Programme on Female Genital Mutilation / Cutting: Accelerating change.
New York, New York, United Nations Population Fund [UNFPA], 2017 Jul. 92 p.The 2016 Annual Report for the UNFPA-UNICEF Joint Programme on Female Genital Mutilation / Cutting provides two perspectives. This main document, "By the Numbers," analyses progress in quantitative terms, using the Results Framework as a basis. It provides an account of how the budget was allocated and offers profiles of each of the 17 programme countries (excepting Yemen). The profiles present facts on the national context, summarize key achievements, and share operational and financial information.
New York, New York, United Nations Population Fund [UNFPA], 2017. 80 p.The 2016 Annual Report for the UNFPA-UNICEF Joint Programme on Female Genital Mutilation / Cutting provides two perspectives: The main document analyses progress in quantitative terms, provides an account of how our budget was allocated and offers profiles of each of the 17 programme countries. This companion booklet uses a qualitative and narrative approach to examine more specifically the challenges, complexities and achievements on the ground. It explores the innovative approaches the Joint Programme teams, partners and activists employ to deconstruct the social norms that allow FGM / C to continue in many communities.
Female genital mutilation/cutting and violence against women and girls strengthening the policy linkages between different forms of violence.
2017 Feb; New York, New York, UN Women, 2017 Feb. 20 p.Violence against women and girls (VAWG) manifests in different forms. These include intimate partner violence, non-partner sexual violence, sexual exploitation and trafficking, and harmful practices such as female genital mutilation/cutting (FGM/C) and child, early and forced marriage, among others. Programmes to end harmful practices and programmes to end intimate partner violence and non-partner sexual violence are often planned and implemented separately, despite all being rooted in gender inequality and gender-based discrimination against women and girls. While this is intended so that programmes can be tailored accordingly, it can result in isolation of initiatives that would otherwise benefit from sharing of knowledge and good practices and from strategic, coordinated efforts. This policy note explores policy and programming interlinkages and considers entry points in the areas of (i) national legislation, (ii) prevention strategies, (iii) response for survivors, and (iv) data and evidence, for increased coordination and collaboration to advance the objectives of ending FGM/C and other forms of VAWG, in particular intimate partner violence and non-partner sexual violence. The note builds on the background paper “Finding convergence in policy frameworks: A background paper on the policy links between gender, violence against women and girls, and female genital mutilation/cutting” (available below). This policy note is intended for multiple audiences, including those directly involved in policy development, planning and implementing initiatives, those providing technical support, and advocates for ending all forms of VAWG, including FGM/C. This work is the result of a collaboration of UN Women with the UNFPA–UNICEF Joint Programme on FGM/C.
Response to 'WHO classification of FGM omission and failure to recognise some women's vulnerability to cosmetic vaginal surgery'
Journal of Family Planning and Reproductive Health Care. 2017 Feb 24; 1.Add to my documents.
Obstetrics and Gynecology. 2016 Nov; 128(5):958-963.Female genital mutilation comprises all procedures that involve partial or total removal of the external female genitalia or injury to the female genital organs for nonmedical reasons. Health care providers for women and girls living with female genital mutilation have reported difficulties in recognizing, classifying, and recording female genital mutilation, which can adversely affect treatment of complications and discussions of the prevention of the practice in future generations. According to the World Health Organization, female genital mutilation is classified into four types, subdivided into subtypes. An agreed-upon classification of female genital mutilation is important for clinical practice, management, recording, and reporting, as well as for research on prevalence, trends, and consequences of female genital mutilation. We provide a visual reference and learning tool for health care professionals. The tool can be consulted by caregivers when unsure on the type of female genital mutilation diagnosed and used for training and surveys for monitoring the prevalence of female genital mutilation types and subtypes.
Journal of Women's Health. 2011 Nov; 20(11):1655-1661.Background: The practice of female genital cutting (FGC) is widespread in Nigeria and varies from one ethnic group to another. In 1994, Nigeria joined members of the 47th World Health Assembly in a resolution to eliminate the practice, and since then, several steps has been taken to achieve this objective. Methods: Nigeria joined members of the 47th World Health Assembly sixteen years ago in a resolution to eliminate female genital mutilation. This study uses data from 420 women aged 15-49 years who had at least one surviving daughter to investigate changes in FGC prevalence among mothers and daughters. The sample was systematically selected through stratified random sampling across the six states of southwest Nigeria. Focus group discussion, and an in-depth interview with fourteen women considered to be specialist in FGC were also held to compliment data generated from the interview. Results: The analysis indicated an FGC prevalence rate of 75% and 71% for mothers and daughters, respectively. It further indicated that the practice is rooted in tradition despite the fact that 52% of the respondents are aware of the health hazards of FGC. Educated mothers were found to be less likely to favor the cutting of their daughters. Conclusions: It is suggested that educational campaigns aimed toward parents should be intensified. Legal recourse, prohibition of operations, improvement in women's status, and sex education are also suggested as means of eradicating the practice.
London, United Kingdom, IPPF, 2001.  p.This statement by IPPF focuses on female genital mutilation (FGM). It discusses the rates of FGM in different parts of the world, the typical age range, and describes the different classifications of FGM. It also touches on the health consequences as well as the roles of family planning associations (FPAs).
African Journal of Reproductive Health. 2008 Apr; 12(1):7-11.Add to my documents.
[Geneva, Switzerland], World Health Assembly, 2008 May 24. 3 p. (WHA61.16; A61/VR/8)This document presents the text of the Sixty-first World Health Assembly agenda item on female genital mutilation.
[Geneva, Switzerland], United Nations, Office of the High Commissioner for Human Rights, 2002. 5 p. (E/CN.4/RES/2002/52)Reaffirming that discrimination on the basis of sex is contrary to the Charter of the United Nations, the Universal Declaration of Human Rights, the Convention on the Elimination of All Forms of Discrimination against Women and other international human rights instruments, and that its elimination is an integral part of efforts towards the elimination of violence against women. Reaffirming the Vienna Declaration and Programme of Action adopted in June 1993 by the World Conference on Human Rights (A/CONF.157/23) and the Declaration on the Elimination of Violence against Women adopted by the General Assembly in its resolution 48/104 of 20 December 1993. Recalling all its previous resolutions on the elimination of violence against women, in particular its resolution 1994/45 of 4 March 1994, in which it decided to appoint a special rapporteur on violence against women, its causes and consequences. Noting all General Assembly resolutions relevant to elimination of violence against women. Welcoming the Beijing Declaration and Platform for Action adopted in September 1995 by the Fourth World Conference on Women (A/CONF.177/20, chap. I), follow-up action by the Commission on the Status of Women on violence against women and the outcome of the twenty-third special session of the General Assembly, entitled "Women 2000: gender equality, development and peace for the twenty-first century". (excerpt)
Eliminating female genital mutilation: an interagency statement. OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO.
Geneva, Switzerland, World Health Organization [WHO], 2008. 41 p.The term 'female genital mutilation' (also called 'female genital cutting' and 'female genital mutilation/cutting') refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. Between 100 and 140 million girls and women in the world are estimated to have undergone such procedures, and 3 million girls are estimated to be at risk of undergoing the procedures every year. Female genital mutilation has been reported to occur in all parts of the world, but it is most prevalent in: the western, eastern, and north-eastern regions of Africa, some countries in Asia and the Middle East and among certain immigrant communities in North America and Europe. Female genital mutilation has no known health benefits. On the contrary, it is known to be harmful to girls and women in many ways. First and foremost, it is painful and traumatic. The removal of or damage to healthy, normal genital tissue interferes with the natural functioning of the body and causes several immediate and long-term health consequences. For example, babies born to women who have undergone female genital mutilation suffer a higher rate of neonatal death compared with babies born to women who have not undergone the procedure. (excerpt)
Washington, D.C., World Bank, 2004 Nov. 132 p.It is estimated that 98 percent of Somali women and girls have undergone some form of genital mutilation. About 90 percent have been subjected to the most drastic form. Since the 1991 collapse of its central government, Somalia has lacked established institutions, infrastructure, human resources and a secure environment suitable for development programs. Despite a harsh and uncertain environment, a vibrant civil society has been born in Somalia. Hundreds of NGOs, including women and youth groups, are actively involved in assisting victims of war, displaced persons, ethnic minorities, orphans, returned refugees, drought-stricken nomads and rural communities. These civil society groups receive significant humanitarian and development assistance from U.N. agencies and 40 international NGOs operating in Somalia. The Somalia Aid Coordination Body (SACB) was established to coordinate and facilitate information sharing among donor agencies, mostly based in Nairobi, Kenya. FGM/FGC eradication programs andactivities are coordinated through the SACB FGM/FGC Task Force, which meets every month. This assessment is aimed at guiding the World Bank, UNFPA and their partners in current and future anti-FGM/FGC initiatives. Programmatic and policy issues which emerged during the assessment are reflected in the relevant sections of the report. (excerpt)
Coordinated strategy to abandon female genital mutilation / cutting in one generation: a human rights-based approach to programming. Leveraging social dynamics for collective change.
New York, New York, UNICEF, 2007.  p. (Technical Note)The coordinated strategy presented in this technical note describes a human rights-based approach to female genital mutilation/cutting (FGM/C) programming. The note aims to provide guidance to programmers who are supporting large-scale abandonment of FGM/C in Egypt, Sudan and countries in sub-Saharan Africa. To provide a more comprehensive understanding of FGM/C as a social convention, this coordinated strategy includes an in-depth examination of the research documented by the UNICEF Innocenti Research Centre in 'Changing a Harmful Social Convention: Female genital mutilation/cutting', Innocenti Digest. Its focus is limited to the social dynamics of the practice at the community level, and it applies game theory, the science of interdependent decision-making, to the social dynamics of FGM/C. This strategy does not cover everything that occurs at the community level, but rather, looks at the practice from the perspective of a particular type of social convention described by Thomas C. Schelling in The Strategy of Conflict. It introduces an innovative approach to FGM/C programming that is intended to bring about lasting social change. (excerpt)
The convention on the rights of the child and the cultural legitimacy of children's rights in Africa: Some reflections.
African Human Rights Law Journal. 2005; 5(2):221-238.The Convention on the Rights of the Child has been almost universally ratified. The author argues that its implementation depends to a large extent on the level of cultural legitimacy accorded to children's rights norms in a society. In Africa, children are seen as a valuable part of society. Despite this, cultural practices that are detrimental to children exist, such as female genital mutilation and inappropriate initiation rites. The Convention is underpinned by four principles: non-discrimination, participation, survival and development and the best interests of the child. Each of these principles can come into conflict with cultural practices. However, culture is not static and harmful practices can be overcome. This requires that the reasons for the existence of a practice are clearly understood, that solutions are found in consultation with practising communities and that adequate social support is given to individuals who choose to abandon the practice. (author's)
[New York, New York], UNICEF, .  p.Female Genital Mutilation (FGM) is defined as procedures involving partial or total removal of female genitals or other injury to female genital organs. In Somalia, FGM prevalence is about 95 percent and is primarily performed on girls aged 4-11. FGM can have severely adverse effects on the physical, mental, and psycholsocial well being of those who undergo the practice. The health consequences of FGM are both immediate and life-long. Despite the many internationally recognized laws against FGM, lack of validation is Islam and global advocacy to eradicate the practice, it remains embedded in Somali culture. (excerpt)
Lancet. 2007 Mar 31; 369(9567):1069-1070.During the past 2 years, substantial progress has been made in changing attitudes towards female genital mutilation in countries such as Guinea, Egypt, Tanzania, Kenya, and Senegal. But the practice remains widespread across Africa. Wairagala Wakabi reports. In Guinea, where 97% of all women undergo female genital mutilation, about 150 communities made a declaration to collectively abandon the practice at the beginning of this year. Attitudes towards the harmful procedure are also changing in other countries in Africa such as Egypt, Tanzania, Kenya, and Senegal. But despite this growing momentum against the practice, it is still prevalent in these countries and it remains widespread in at least 28 countries on the continent. Poor education and low levels of income among women in African countries, coupled with inadequate governmental support in efforts to eradicate the practice, mean it will take longer to stamp out. Human rights activists place much of the blame for slow progress at the door of governments. "The struggle to have communities in Africa abandon female genital mutilation is taking too long because it's only civil society who have taken it seriously. Governments are yet to take up the matter to the expected level", says Faiza Mohamed, Africa regional director of women rights group Equality Now, which works with 23 organisations in 16 African countries. (excerpt)
BMJ. British Medical Journal. 2006 Jul 15; 333(7559):106-107.In this week's BMJ, Elmusharaf and colleagues present a study of the agreement between self reports of female genital mutilation and the findings of clinical examination in a cohort of girls and another of women. They report that girls and women were inaccurate in describing what had been done to them, and that the actual mutilations did not readily fit into the World Health Organization's classification system. These findings have implications for research and, more broadly, for tackling the problem of female genital mutilation worldwide. They suggest that we need to re-examine our current conceptualisation of female genital mutilation with a view to defining a valid and reliable definition and classification system. (excerpt)
Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study.
BMJ. British Medical Journal. 2006 Jul 15; 333(7559):124.The objective was to assess the reliability of self reported form of female genital mutilation (FGM) and to compare the extent of cutting verified by clinical examination with the corresponding World Health Organization classification. Design: Cross sectional study. Settings: One paediatric hospital and one gynaecological outpatient clinic in Khartoum, Sudan, 2003-4. Participants: 255 girls aged 4-9 and 282 women aged 17-35. Main outcome measures: The women's reports of FGM the actual anatomical extent of the mutilation, and the corresponding types according to the WHO classification. All girls and women reported to have undergone FGM had this verified by genital inspection. None of those who said they had not undergone FGM were found to have it. Many said to have undergone "sunna circumcision" (excision of prepuce and part or all of clitoris, equivalent to WHO type I) had a form of FGM extending beyond the clitoris (10/23 (43%) girls and 20/35 (57%) women). Of those who said they had undergone this form, nine girls (39%) and 19 women (54%) actually had WHO type III (infibulation and excision of part or all of external genitalia). The anatomical extent of forms classified as WHO type III varies widely. In 12/32 girls (38%) and 27/245 women (11%) classified as having WHO type III, the labia majora were not involved. Thus there is a substantial overlap, in an anatomical sense, between WHO types II and III. The reliability of reported form of FGM is low. There is considerable under-reporting of the extent. The WHO classification fails to relate the defined forms to the severity of the operation. It is important to be aware of these aspects in the conduct and interpretation of epidemiological and clinical studies. WHO should revise its classification. (author's)
Lancet. 2006 Jun 3; 367(9525):1799-1800.In today's Lancet, the WHO study group report a multicentre prospective study of the obstetric outcome in women who have had genital mutilation. Their study strengthens the evidence base about complications of such mutilation. For a subject with many important confounding factors, we congratulate the researchers for the study design and tenacity in execution. The finding of a causal relation between complications and type of mutilation indicates that the more brutal the type of procedure, the worse the complication. Yet, as has been advocated, there can be no justification for even excision of the prepuce in type I female genital mutilation. Advocating mild forms of cutting can raise the possibility of a dubious refocusing to appease cultural sensitivity sentiments. (excerpt)
Female circumcision, AIDS discrimination to be monitored - Committee on the Elimination of Discrimination Against Women.
UN Chronicle. 1990 Jun; 27(2): p..The eradication of female circumcision and avoidance of discrimination against women victims of acquired immunodeficiency syndrome (AIDS) were the subjects of two general recommendations adopted at the ninth annual session of States Parties to the 1979 Convention on the Elimination of All Forms of Discrimination Against Women. The 100 States Parties were asked to report to the Committee on the Elimination of Discrimination Against Women-the 23-member body which monitors compliance with the instrument-on measures taken to eliminate female circumcision which, it stated, has "serious health and other consequences for women and children". (excerpt)
New York, New York, UNICEF, 2005 Nov.  p.FGM/C is a fundamental violation of human rights. In the absence of any perceived medical necessity, it subjects girls and women to health risks and has life-threatening consequences. Among those rights violated are the right to the highest attainable standard of health and to bodily integrity. Furthermore, it could be argued that girls (under 18) cannot be said to give informed consent to such a potentially damaging practice as FGM/C. FGM/C is, further, an extreme example of discrimination based on sex. The Convention on the Elimination of All Forms of Discrimination against Women defines discrimination as "any distinction, exclusion or restriction made on the basis of sex which has the effect or purpose of impairing or nullifying the recognition, enjoyment or exercise by women, irrespective of their marital status, on a basis of equality of men and women, of human rights and fundamental freedoms in the political, economic, social, cultural, civil or any other field." Used as a way to control women's sexuality, FGM/C is a main manifestation of gender inequality and discrimination "related to the historical suppression and subjugation of women," denying girls and women the full enjoyment of their rights and liberties. (excerpt)