Female Genital Mutilation

This column reports on a cruel and dangerous practice – female genital mutilation (FGM). Along with honor killing and bride burning, FGM is a practice to control the female - by taking away her pleasure in sex, making intercourse painful, and thereby ensuring a man’s confidence in paternity. FGM reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. As it is carried out on minors, it is a violation of the rights of children. The practice violates a person's rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.

According to Wikipedia. FGM has been going since about 800 years BCE.   UNICEF reports that at least 200 million girls and women alive today have undergone female genital mutilation in 30 countries and 3 million are at risk every year.  The practice is found in many African countries, the Middle East, India and Indonesia, among peoples who follow Islam, Christianity and animism. However, it is not mentioned in the Koran or the Bible and is not part of their religious teachings.

FGM is classified into 4 major types

•                Type 1: Often referred to as clitoridectomy, this is the 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).

•                Type 2: Often referred to as excision, this is the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva), with or without excision of the labia majora (the outer folds of skin of the vulva ).

•                Type 3: Often referred to as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoris.

. Type 4: This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

FGM is generally performed by village women using unsterilized instruments and no anesthesia. The terrified young girl is forcibly held down. Bleeding and infection are common results.  When the vaginal opening is narrowed, childbirth is often obstructed.  Extremely long labor can result in death, or an obstetric fistula – an opening between the bladder or rectum and the vagina, causing constant leakage.  This makes the woman a social outcast.  There are a few hospitals in Africa formed to repair obstetric fistulas – their dramatic story is the subject of another column.

Obviously FGM must be stopped, and this long entrenched practice must be stopped by the people in the affected societies.  England has been a leader in supporting an Africa-led movement to end FGM with a program called The Girl Generation – a social change initiative of African collectives working to end FGM in one generation.  In The Gambia, nearly 400 member organizations are working to end FGM.  In 2015 the president enacted a law banning the practice.  There are also active youth networks in Kenya and Nigeria, driving forward their own action plans to end FGM.  Similar programs will take place wherever FGM is practiced, led by young activists.   The United Nations is involved through UNICEF and UNFPA; The Population Council is also involved.

She Decides: In my last column, I wrote about Holland’s plan to make up for the Trump administration’s failure to fund international aid related to family planning. Read about it at sadjascolumns.blogspot.com.
In the week following the Netherlands’ announcement of a €10 million contribution to the Dutch-initiated family planning initiative ‘She Decides,’ 13 more countries have also stated their interest in supporting the fund. Canada, Belgium, Luxembourg, Sweden, and Finland have all formally confirmed their support, while additional countries are likely to on March 2, 2017, during an international conference for the fund hosted by Belgium. According to the Dutch Ministry of Foreign Affairs and Development Cooperation, in addition to government support, private persons have donated over €140,000 to the fund as of February 3, 2017.  You can be one of them – go to shedecides.com.

Sadja Greenwood, MD, MPH

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Having a period is unaffordable in Kenya, yet no one wants to talk about it

ZanaAfrica is fighting to get menstruation on the national curriculum as it’s revealed two thirds of Kenyan women and girls cannot afford sanitary padsHaving a period is unaffordable in Kenya, yet no one wants to talk about it

ZanaAfrica is fighting to get menstruation on the national curriculum as it’s revealed two thirds of Kenyan women and girls cannot afford sanitary pads

She Decides – How Holland is Saving Family Planning

On his first Monday in office, President Trump reinstated the ‘Mexico City policy’ that blocks US federal funds for non-governmental organizations that provide abortion counseling or referrals, advocate to decriminalize abortion or expand abortion services.  This policy was implemented in 1984 by Ronald Reagan at a UN population conference in Mexico City.  Hence the name – the Mexico City policy.  It was repealed by Bill Clinton, reinstated by George W. Bush, and repealed by Obama.  (You may remember that Trump was prochoice until it was politically valuable to be for compulsory pregnancy.  Reagan signed the bill allowing therapeutic abortion in California.)

Trump did more than just reinstate the policy, he expanded it to apply to all global health funding, not just to family planning.   Organizations helping with HIV prevention and treatment, immunization, maternal health care, Zika virus prevention et al. will also be affected.  According to Population Action International, a global family planning advocacy organization, the gag rule will apply to $9.5 billion in global health funding, as opposed to $575 million in family planning funding. 

Organizations that provide family planning and safe abortion care, such as the International Planned Parenthood Federation and Marie Stopes International, will not sign on to the gag rule’s conditions.  They point out that the new rule will not reduce abortions, but increase the number of illegal ones, as happened in sub-Saharan Africa during George W. Bush’s time in office. 

Holland has come to the rescue.  Lilianne Ploumen, Holland’s minister for foreign trade and development cooperation, has announced that it is putting 10 million euros ($10.7 million) into an international fund it launched to finance access to birth control, abortion and sex education for women in developing nations after President Donald Trump cut U.S. funding for such services. Ploumen has launched a fund "She Decides - Global Fundraising Initiative" — with a website.

Ploumen says she has received thousands of reactions — the vast majority of them positive — after announcing the fund Tuesday.  Canada has also pledged to sign on to the funding.  In a few days, individuals from all over the world will be able to pledge support through the website– “She Decides – Global  Fundraising Initiative.  I will keep you posted on this website.  Donations will be coordinated by The Rutgers Foundation, and international NGO working on sexual and reproductive rights based in the Netherlands. 

Minister Ploumen  said the withdrawal of U.S. money will create a huge funding gap that can only be filled through a robust reaction by governments, aid organizations and private donors. The fund will "prevent women and girls being abandoned," she added. "Because they, too, must be able to decide for themselves if they want children, with whom and when."  Ploumen said much more money is needed but "I'm confident we can go a long way so that essential services, not just for women, but for the whole of society, can be maintained.” The website, shedecides.eu , is open for individual donations.

At the Women’s March in San Francisco, and from reports of similar marches in Washington and throughout the world, there were many striking and meaningful posters and signs.  I am struck by the power of the two words Lilianne Ploumen selected for her new website and the generous action of the Netherlands – ‘She Decides’. 

If you are burning with indignation at Trump’s actions against women’s health or immigration policy, you can also donate to the International Planned Parenthood Federation or the ACLU.  Any amount helps.  It will be multiplied by the rest of us.

Sadja Greenwood, MD, MPH   back issues on this blog