Female circumcision, deadly rituals of genital mutilation & bull; hello healthy

Female genital mutilation, or more commonly known as female circumcision, has always been seen as an ancient ritual that is commonly practiced in a number of countries in Africa and the Middle East, according to data from the World Health Organization (WHO).

The latest global survey from UNICEF for the first time notes that now this phenomenon is also widespread in Indonesia. The survey, published in February 2016, reported that 60 million women and girls are estimated to have experienced the dangerous procedure. Quoted from The Jakarta Post, this puts Indonesia in third place, after Egypt and Ethiopia, in terms of the high incidence of female circumcision. This has led to an estimate of the number of women and girls worldwide who have accepted this ritual practice soaring to 200 million (from 130 million previously) in 30 countries where female genital mutilation has been practiced since 2014.

Tradition and religion are closely related to the practice of female circumcision

Female genital mutilation is defined as any form of procedure that involves removing, cutting, or removing part or all of the female external genitalia, or causing injury to the female genital organs for non-medical reasons.

The reasons why female genital mutilation is performed varies from region to region, and over time, including the initiation of a combination of socio-cultural factors in family and community values, for example:

• Social pressure to conform to what the people around them have been doing for generations, as well as the need to feel accepted as an obedient member of society and fear of being excluded from social relationships.
• This practice is seen as part of a girl's celebration of puberty and is important as a cultural heritage of society.
• Although the practice of female circumcision is not an obligation of any religious ritual, there are still many religious doctrines that justify and allow this practice to be practiced.
• In many societies, female circumcision is a prerequisite for marriage, and sometimes a prerequisite for having reproductive rights and having children. The community also thinks that genital mutilation will increase the fertility rate of women and promote the safety of the baby.
• Female circumcision is seen as the guarantor of female virginity before marriage and fidelity to the partner during marriage, as well as increasing male sexual arousal.

Female circumcision is commonly practiced among girls under 11 years of age, regardless of the dangers, because society views its social benefits as outweighing future health risks.

What is the procedure for female circumcision?

Female genital mutilation is usually performed by elders in the community (usually, but not always, women) appointed by the community to carry out the task, or with the assistance of a traditional midwife. This practice may also be practiced by a traditional healer or traditional birth attendant, a male barber, or sometimes a family member.

In certain cases, medical professionals provide services for the practice of female circumcision. This is called the "medicalization" of female circumcision. According to a recent UNFPA estimate, about 1 in 5 girls receive female circumcision treatment provided by a professional healthcare provider.

The practice of female circumcision is carried out using knives, scissors, scalpels, pieces of glass, or even razors. Anesthetics and antiseptics are not commonly used in traditional procedures, unless they are performed under the supervision of a medical practitioner. After the infibulation procedure (cutting the entire clitoris, labia minora, and part of the labia majora), the girls' legs will generally be tied together so that the child cannot walk for 10-14 days, allowing scar tissue to form.

Why is female circumcision considered dangerous?

Despite community beliefs and reasons for adopting it, the female circumcision procedure is not safe - even when it is performed by a trained health care provider in a sterile environment. The medicalization of female circumcision only provides false guarantees of safety and there is no medical justification for doing this.

Female genital mutilation has serious implications for women's sexual and reproductive health. The severity of the impact of female circumcision will depend on a number of factors, including the type of procedure, the expertise of the practitioner, environmental conditions (sterility and safety of the practice site and equipment used), and the level of resistance and general health of each individual receiving the procedure. Complications can arise in all types of genital mutilation, but the most dangerous is infibulation, aka type 3.1 female circumcision.

1. Complications that may cause death

Immediate complications include chronic pain, shock, bleeding, tetanus or infection, urinary retention, ulceration (open wound that doesn't heal) in the genital area and damage to surrounding tissue, wound infection, bladder infection, high fever, and sepsis. Heavy bleeding and infection can become so serious as to cause death.

2. Difficulty getting pregnant or complications during childbirth

Some women who receive female circumcision may find it difficult to get pregnant, and those who do get pregnant can experience complications during childbirth. A recent study found that, compared to women who had never had a female circumcision procedure, those who received this procedure faced a greater chance of requiring a cesarean section, episiotomy and longer hospital stays, as well as postpartum hemorrhage.

Recent estimates from WHO, UNICEF, UNFPA, World Bank and UNDP report that some of the countries with the highest incidence of female circumcision in the world also have high rates of maternal mortality, and high rates of maternal mortality.

3. Infant death at birth

Women undergoing infibulation procedures are more likely to have labor which is longer and full of obstacles, sometimes leading to infant mortality and obstetric fistulas. Fetuses of mothers who have had genital mutilation have a significantly increased risk of death at birth.

4. Long-term consequences

Long-term consequences include anemia, formation of cysts and abscesses (pus-filled lumps due to bacterial infection), formation of keloid scar tissue, damage to the urethra resulting in prolonged urinary incontinence, dyspareunia (painful sexual intercourse), sexual dysfunction, increased risk of HIV transmission, and also other psychological effects.

5. Psychic trauma

Children who receive female circumcision at an older age may experience trauma that causes a number of emotional problems in their life, including:

• Depression
• Worry
• Post-Traumatic Stress Disorder (PTSD), or a prolonged reconstruction of the experience
• Sleep disturbances and nightmares

Psychological stress from the experience may lead to behavioral disorders in children, which is closely related to loss of trust and instincts of affection for caregivers.

Female circumcision is considered as an act of child abuse and violates human rights

In some countries, the female genital mutilation procedure is performed during the early life of the baby, which is a few days after birth. In other cases, this procedure will be performed during childhood, the period preceding marriage, after marriage, during the first pregnancy, or just before the first delivery.

Dr. Babatunde Osotimehin, executive director of UNFPA, was quoted by the BBC, stressing that the practice of female circumcision is a human rights violation of the right to life, bodily integrity and personal health. Furthermore, Osotimehin emphasized that all forms of female genital mutilation are acts of child abuse.

Culture and tradition are the backbone of human well-being, and arguments around culture cannot be used to justify violence against people, men and women. Any form of female genital mutilation by any method is unacceptable from a public health perspective, and constitutes a violation of medical ethics.