ASSESSMENT OF FEMALE GENITAL MUTILATION IN NIGERIA CASE STUDY BENIN CITY
1.1 Background of the study
According to the World Health Organization (WHO), Female genital mutilation (FGM) is defined as all procedures which involve partial or total removal of the external female genitalia and/or injury to the female genital organs, whether for cultural or any other nonther apeutic reasons (World Health Organization 1998). Worldwide, government and non- governmental organizations frown at FGM having seen it as an infringement on the physical and psychosexual integrity of the female child. Nigeria was said to have the highest absolute number of cases of FGM in the world, accounting for about one-quarter of the estimated 115– 130 million circumcised women worldwide (UNICEF 2001). The prevalence rate of FGM was put at 41% among adult Nigerian women (Okeke 2012). Nigeria is a country in West Africa bordering the Gulf of Guinea between Benin and Cameroon. It has an area of 923,768.00 sq kilometers with a population of 140,431,790 according to the 2006 National Population census (National Bureau of Statistics 2006). The male constituted 71,345,488 while the female were 69,086,302 (National Bureau of Statistics 2006). This study was done in a tertiary hospital in Edo State, one of the 36 states of Nigeria. Edo State has a population of 2,398,957with the female being 1,215,487and the male 69,086,302 (National Bureau of Statistics 2006). It is majorly inhabited by the Edo’s who are noted for high level of literacy in terms of formal education and is reputed to have produced the reasonable number of professors in Nigeria (Adesina 2008).The 2008 Nigeria Demographic and Health Survey showed that 30% of female surveyed between ages 15- 40years had undergone female circumcision with the Yoruba and igbo ethnic groups having the highest percentage (58.4% and 51.4% respectively) (National Population Commission 2009).Olamijulo et al., reported the prevalence of FGM among children examined at the child welfare clinic, Wesley Guild Hospital, Ilesha, Nigeria to be 66.3%.The following states in Nigeria have prohibited this act since 1999;Abia, Bayelsa, Cross River, Delta, Edo, Ogun, Osun and Rivers. However, with increasing awareness of the complication of FGM, there is a recent ban on the practice in Nigeria as a nation in year 2015. The prevalence rate is therefore expected to progressively decline in the younger age groups. FGM practiced in Nigeria is classified into four typesas follows; clitoridectomy or Type I, this involves the removal of the prepuce or the hood of the clitoris and all or part of the clitoris. Type II or “sunna” is a more severe practice that involves the removal of the clitoris along with partial or total excision of the labia minora. Type III (infibulation), involves the removal of the clitoris, the labia minora and adjacent medial part of the labia majora and the stitching of the vaginal orifice, leaving an opening of the size of a pin head to allow for menstrual flow or urine. Type IV or other unclassified types include introcision and gishiri cuts, hymenectomy, scraping and/or cutting of the vagina, the introduction of corrosive substances and herbs in the vagina, and other forms. Consequences of female genital mutilation include increased risks of urinary tract infections, bleeding, bacterial vaginosis, dyspareunia, obstetric complications, psychological problems such as depression, anxiety, post-traumatic stress disorder, low self-esteem, etc (Behrendt and Moritz, 2005), Abdulcadir and Dällenbach, 2013), Amin et al.,., 2013), Andersson et al.,., 2012), Andro et al.Female genital mutilation is classified into four major types (WHO, 1996). The most common type of the female genital mutilation is type 2 which account for up to 80% of all cases while the most extreme form which is type 3 constitutes about 15% of the total procedures(WHO, 1996; Oduro et al., 2006). Types 1 and 4 of FGM constitute the remaining 5%. The consequences vary according to the type of FGM and severity of the procedure (Onuh et al., 2006; Oduro et al., 2006). The practice of FGM has diverse repercussions on the physical, psychological, sexual and reproductive health of women, severely deteriorating their current and future quality of life (Oduro et al., 2006; Larsen, 2002). The immediate complications include: severe pain, shock, haemorrhage, urinary complications, injury to adjacent tissue and even death (Onuh et al., 2006; Oduro et al., 2006; Larsen, 2002). The long term complications include: urinary incontinence, painful sexual intercourse, sexual dysfunction, fistula formation, infertility, menstrual dysfunctions, and difficulty with child birth (Akpuaka, 1998; Okonofua et al., 2002; Oguguo and Egwuatu, 1982). The physical and psychological sequelae of female genital mutilation have been well highlighted in many literatures (Onuh et al., 2006; Oduro et al., 2006; Badejo, 1983; Klouman et al., 2005; ACHPR, 2003; Ibekwe, 2004). Recently, there has been serious concern on the increased rate of transmission of Human Immunodeficiency Virus (HIV) following this practice (WHO, 1996; Klouman et al., 2005). The practice is also a violation of the human rights of the women and girl child. FGM categorically violates the right to health, security and physical integrity, freedom from torture and cruelty, inhuman or degrading treatment and the right to life when the procedure results in death.