Female Genital Mutilation: A reproductive health concern

 The practice of female genital mutilation (FGM) is thought to be 2000 years old and continues today in many areas of Africa, the Mid-East, and Asia.  An estimated 100-132 million women have undergone the procedure, and 2 million more are subjected to it each year during infancy, childhood, or adolescence.  The World Health Organization has defined four categories of FGM.  Type 1 entails removal of the prepuce and, sometimes, all or part of the clitoris.  In type 2, the clitoris is removed along with all or part of the labia minora.  Type 3 (infibulation) involves removal of the clitoris, some or all of the labia minora, and the sealing of the labia majora with only a small opening remaining for the flow of urine and blood.  Type 4 is a general category that includes other operations on the external genitalia as well as procedures done to the vagina.  The FGM procedure itself can lead to shock, death, and infection.  Long-term physical effects of infibulation include difficulty in urinating, in having sexual intercourse, and in delivering a baby.  The psychological and psychosexual consequences of FGM remain to be identified.  FGM is still practiced because it affords status to women in certain cultures.  Efforts to eradicate the practice have been made by international agencies, governments, and grassroots community advocates.  Public education as well as legislative action are important tactics as are working to educate health care providers and providing alternatives to FGM as well as alternative employment opportunities to FGM practitioners.  In Western countries, anti-FGM efforts are centered on women in immigrant and refugee communities.  Research efforts are underway in order to provide an understanding of FGM that will allow the design of effective eradication strategies.  Community input will be vital in designing and conducting such campaigns.

Johns Hopkins Bloomberg School of Public Health,Center for Communication Programs,Population Information Program