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  1. 1
    326566

    Care of girls and women living with female genital mutilation. A clinical handbook.

    World Health Organization [WHO]

    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.
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  2. 2
    322363

    Ethical concerns in female genital cutting [editorial]

    Cook RJ

    African Journal of Reproductive Health. 2008 Apr; 12(1):7-11.

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  3. 3
    325496

    Eliminating female genital mutilation: an interagency statement. OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO.

    United Nations. Office of the High Commissioner for Human Rights [OHCHR]; Joint United Nations Programme on HIV / AIDS [UNAIDS]; United Nations Development Programme [UNDP]; United Nations. Economic Commission for Africa; UNESCO

    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)
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  4. 4
    316770

    Eradication of female genital mutilation in Somalia.

    UNICEF

    [New York, New York], UNICEF, [2006]. [9] 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)
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  5. 5
    302019

    Female genital mutilation and obstetric outcome [letter]

    Eke N; Nkanginieme KE

    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)
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  6. 6
    291184
    Peer Reviewed

    Female genital mutilation.

    Kelly E; Hillard PJ

    Current Opinion in Obstetrics and Gynecology. 2005; 17:490-494.

    The purpose of this review is to aid the healthcare practitioner in caring for children, girls, and women who have undergone female genital mutilation or who are at risk for female genital mutilation. The bulk of the literature published in the area of female genital mutilation over the past year addresses the laws, social needs, immigration status and assimilation of African women who immigrate into western countries. Clinicians continue to publish case reports of complications and the surgical management of type III female genital mutilation during labor. Additionally, as people continue to try to eliminate female genital mutilation through human rights campaigns and the legal system, they have also become increasingly aware that understanding the motives behind this traditional practice may be an avenue towards change. The fundamental understanding of female genital mutilation will allow the clinician to address the emotional and physical needs of the children, girls, and women who have undergone this traditional practice or who are at risk for undergoing this practice. This understanding will allow the practitioner to individualize the history and physical examination, and to provide appropriate management with recognition and treatment of complications. Increased knowledge of the laws against female genital mutilation will allow the healthcare provider to educate and advise at-risk girls and women as well as their parents. (author's)
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  7. 7
    142782

    Female genital cutting: World Health Organization fact sheet.

    World Health Organization [WHO]

    Washington, D.C., United States Agency for International Development [USAID], [1999]. [6] p. (HRN-A-00-98-000001-00)

    Female Genital Mutilation (FGM) involves a partial or total incision of the external female genitalia or other injury to the organ whether for cultural, religious or other non-therapeutic reasons. There are different types of FGM known to be practiced today, with excision of the clitoris and labia minora accounting for up to 80% of all cases and infibulation as the most extreme form, which constitutes 15% of all procedures. All these procedures are irreversible, and harmful to the health of women and girls, and their effects last a lifetime. Its immediate and long-term health consequences vary according to the type and severity of the procedure performed. In cultures where it is an accepted norm, FGM is performed by a traditional practitioner without anesthesia and proper sterilization among girls of various ages for different psychosexual, sociological, hygiene and aesthetic, myths and religious reasons. Over 130 million individuals have undergone FGM with an estimated 2 million girls at high risk of being subjected with this practice annually most especially in 28 African countries. International organizations, nongovernmental organization and other interested partners have worked towards the elimination of FGM, but the overall progress have been slow which can be due to lack of coordination of prevention programs and limitation of resource investment. UN interagency teams, on the other hand, direct its efforts at changing the public view through education and awareness campaign on the harmful health effects of FGM.
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  8. 8
    106773

    Together building a space for women. Female genital mutilation.

    International Planned Parenthood Federation [IPPF]

    London, England, IPPF, [1992]. [8] p.

    African and Arab women have developed programs against female genital mutilation (FGM). The International Planned Parenthood Federation supports these women as they train, educate, and inform other women about the harmful effects of FGM. The three types of FGM are sunna (foreskin of the clitoris is cut), excision (removal of the entire clitoris and usually the labia minora), and pharaonic or infibulation (removal of the clitoris, labia minora and majora, and sewing together the two sides of the vulva, leaving a small opening for urine and menstrual blood to pass). In Arab countries, Sub-Saharan Africa, Malaysia, and Indonesia, girls from one week old to adolescence are subject to FGM. Female natives of these countries who have migrated to Europe, Australia, or the US are also subject to FGM. More than 100 million living females have suffered FGM. Reasons for FGM differ and are linked to religion, culture, health, and morality. None of the reasons are based in science, logic, or religion, however. Short term risks of FGM include severe hemorrhage, tetanus and other infections, septicemia, shock, or death. It is often the case that several people hold the girl down with legs apart while an untrained traditional birth attendant or old woman performs FGM under unhygienic conditions, during which they use no anesthesia and unsterile instruments (e.g., broken glass). Chronic pelvic urinary tract infections, difficult intercourse, infertility, pregnancy loss, complications during delivery, and psychological and/or psychosexual problems are common long-term effects. Rapid economic growth, universal education, and global cultural changes have affected attitudes against FGM and efforts to rid the world of FGM. The World Health Organization released a statement condemning the practice of FGM by any health provider. Heads of State of Benin, Burkina Faso, Djibouti, Kenya, Mali, and Senegal have issued statements against FGM.
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  9. 9
    080798

    Circumcision in women [editorial]

    Ruminjo J

    East African Medical Journal. 1992 Sep; 69(9):477-8.

    Female circumcision detracts from physical, emotional, and social health in Africa were more than 2 hundred million women and girls have been subjected to it. Female circumcision is performed in infancy among the Yoruba of Western Nigeria, close to puberty among some Kikuyu of Kenya, and even later in some Western African tribes. Milder procedures are commonly encountered in Africa including Kenya, but in Somalia and Sudan infibulation is the circumcision of choice. Vaginal examination is impossible in such women. The resultant genital mutilation and complications include shock from hemorrhage and pain and injury to adjacent structures. Local infection is common and may be accompanied by recurrent urinary tract infection, pelvic inflammatory disease, septicemia, tetanus, and possibly transmission of the human immunodeficiency virus. Long term complications of infibulation include poor urine flow and cysts. Acquired gynatresia may result in hematocolpos, dyspareunia, and even apareunia with associated infertility. Circumcising women in a health facility with anesthesia and antibiotics serves to institutionalize circumcision of women and to introduce a monetary incentive. UN Commission on Human Rights has focused on the issue of human dignity and freedom from degradation that is the right of every female. An Inter-Africa Committee on Traditional practices affecting the health of women and children was formed following a 1979 WHO seminar held in Sudan. Legal decrees and presidential censure in Kenya and Senegal have played a limited role in halting this practice, as have youth organizations. Christian evangelization has made a major impact in Kenya with support for the education of women.
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  10. 10
    037386

    A traditional practice that threatens health--female circumcision.

    WHO CHRONICLE. 1986; 40(1):31-6.

    A traditional practice that has attracted considerable attention in the last decade is female circumcision, the adverse effects of which are undeniable. 70 million women are estimated to be circumcised, with several thousand new operations performed each day. It is a custom that continues to be widespread only in Africa north of the equator, though mild forms of female circumcision are reported from some Asian countries. In 1979 a Seminar on Traditional Practices that Affect the Health of Women and Children was held in the Sudan. It was 1 of the 1st interregional and international efforts to exchange information on female circumcision and other traditional practices, to study their implications, and to make specific recommendations on the approach to be taken by the health services. There are 3 main types of female circumcision: circumcision proper is the mildest but also the rarest form and involves the removal only of the clitoral prepuce; excision involves the amputation of the entire clitoris and all or part of the labia minora; and infibulation, also known as Pharaonic circumcision, involves the amputation of the clitoris, the whole of the labia minora, and at least the anterior 2/3 and often the whole of the medial part of the labia majora. Initial circumcision is carried out before a girl reaches puberty. The operation generally is the responsibility of the traditional midwife, who rarely uses even a local anesthetic. She is assisted by a number of women to hold the child down, and these frequently include the child's own relatives. Most of the adverse health consequences are associated with Pharaonic circumcision. Hemorrhage and shock from the acute pain are immediate dangers of the operation, and, because it is usually performed in unhygienic circumstances, the risks of infection and tetanus are considerable. Retention of urine is common. Cases have been reported in which infibulated unmarried girls have developed swollen bellies, owing to obstruction of the menstrual flow. Implantion dermoid cysts are a very common complication. Infections of the vagina, urinary tract, and pelvis occur often. A women who has been infibulated suffers great difficulty and pain during sexual intercourse, which can be excruciating if a neuroma has formed at the point of section of the dorsal nerve of the clitoris. Consummation of marriage often necessitates the opening up of the scar. During childbirth infibulation causes a variety of serious problems including prolonged labor and obstructed delivery, with increased risk of fetal brain damage and fetal loss. A variety of reasons are advanced by its adherents for continuing to support the practice of female circumcision, but the reasons are rationalizations, and none of the reasons bear close scrutiny. The campaigning against female circumcision is reviewed.
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