Nurses can play a crucial role in providing care to girls and women who are victims of FGM
By Marie Jones MACN
My interest in the area was sparked over 20 years ago when I began caring for women affected by Female Genital Mutilation (FGM). I have worked as a nurse/midwife at The Royal Women’s Hospital in Melbourne for over 30 years, in a variety of areas such as antenatal/postnatal, birth centre and special care nurseries/outpatient clinics. Currently, I work as an Associate Nurse Unit Manager in the Emergency Department, and I also coordinate the African Women’s Clinic (AWC) in the Women’s Health Clinics. The AWC is a nurse/midwife-led clinic.
What is FGM?
“Female Genital Mutilation comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons” (WHO, UNICEF, UNFPA, 1997). FGM is known to be practised primarily in African, Middle East and Asian countries. Although outlawed in most countries, it continues to exist. “It is estimated that more than 200 million girls and women alive today have undergone FGM in the countries where the practice is concentrated. Furthermore, there are an estimated three million girls at risk of FGM every year. The majority of girls are cut before they turn 15 years old” (WHO 2019).
FGM is a criminal offence in Australia, and it’s illegal to take a girl/woman from Australia to perform FGM on her. Maximum penalties range between seven and 21 years of imprisonment. The World Health Organization (WHO) classifies FGM in four types. Type 1 is partial/total removal of the clitoris, Type 2 is partial/total removal of the clitoris with partial/total removal of the labia minora. Type 3 is infibulation (partial /total removal of the clitoris/labia minora and the sewing together of the labia majora allowing a small opening to pass urine and menstrual fluid). Type 4 is pricking/cutting/piercing/cauterisation of the genitals.
Effects of FGM
FGM, primarily a cultural practice, is seen as a rite of passage to ensure the woman’s chastity before marriage, fidelity within marriage, and “being clean” as the clitoris in some cultures is seen as unclean. It has no health benefits, and can result in short-term consequences such as infection, bleeding, pain, distress, urinary retention and death.
Long term effects include ongoing pain, scarring, abscesses, recurrent infections (particularly urinary), fertility complications, dysmenorrhoea, dyspareunia, inability to have penetrative sex, psychological distress, post-traumatic stress disorder and complications during pregnancy and birth (WHO 2019). FGM is a violation of the child’s human rights as well a form of discrimination against women (WHO 2019).
Nurses need to “ask the question” In my experience, affected women are very unlikely to discuss their condition. Instead, they wait for the health professional to ask if they have experienced FGM. By not asking ‘the question’, we can miss important information, which can be detrimental to their care, especially if they are pregnant.
In the AWC, my co-worker Sarah Robson (also a nurse/midwife) and I see women of all ages, about half of whom are pregnant. They may be requesting help with complications from FGM, getting married (or are married and cannot have intercourse) and requesting de-infibulation, or they may be pregnant and need to know how FGM will affect their pregnancy and birth.
Language, sensitivity and respect are of utmost importance. For example, “I see you were born in Sudan/have come from the Middle East/lived in Ethiopia, have you been affected by traditional cutting?” Reassure the woman that any information is confidential. She may also not disclose information if accompanied by a partner or family.
In Victoria, workers at FARREP (Family and Reproductive Rights Education Program), which was set up in 1997, support health professionals. They are mainly from backgrounds where FGM is practised, and support and educate affected communities. This practice can have long-lasting effects on physical and mental health of affected women, and as nurses, we not only have a duty towards their care but also to educate them and advocate for their wellbeing.
World Health Organization (2019), Female genital mutilation, https://www.who.int/reproductivehealth/topics/fgm/en/
UNICEF (1997), Female genital mutilation, https://data.unicef.org/topic/child-protection/female-genital-mutilation/