ISSUES IN REPRODUCTIVE HAELTH

Harmful traditional practices (HTPs)

Traditions are long-established patterns of actions or behaviors, often handed down within a
community over many generations. These customs are based on the beliefs and values held by
members of the community. Traditions are often protected by taboos, which are strong social
prohibitions (or bans) relating to human activity or social custom based on moral judgment and
religious beliefs. This means that traditions are not easy to change, because people adhere to
these patterns of behavior, believing that they are the right things to do.

Harmful traditional practices are those customs that are known to have bad effects on people’s
health and to obstruct the goals of equality, political and social rights and the process of
economic development.

COMMON TYPES OF HARMFUL TRADITIONAL PRACTICES IN NIGERIA

 Female genital mutilation

 Early/ forced marriage
 Hot bath
 Gishiri cut
 Breast ironing etc

FEMALE GENITAL MUTILATION(FGM)

DEFINITION: The World Health Organization (WHO) defines female genital mutilation (also
called ‘female genital cutting’ or ‘female circumcision’) as any procedure which involves the
partial or total removal of the external female genitalia or which causes any other injury to the
female genital organs whether for cultural or any other non-therapeutic reasons. Instruments used
include knives, scissors, razors, and pieces of glass. Occasionally sharp stones and cauterisation
(burning) are used.

TYPES OF FGM

In 1997, WHO classified female genital mutilation into four different types. The Severity (which
here corresponds to the amount of tissue damaged) and health risk are closely related to the type
of FGM performed as well as the amount of tissue that is cut.

The four major types of FGM are:

Type I: Partial or total removal of the clitoris and/or the prepuce (Clitoridectomy)

Type II: Partial or total removal of the clitoris and the Labia minora, with or without the
excision of the Labia majora (excision)

Type III: Narrowing of the vaginal orifice with creation of a covering seal by cutting and
appositioning the Labia minora and/or the Labia majora, with or without excision of the clitoris
(infibulation).

Type IV: Unclassified: All other harmful procedures to the female genitalia for non-medical
purposes, for example, pricking, piercing, incising, scraping and cauterization.

Deinfibulation refers to the practice of cutting open the sealed vaginal opening of a woman who
has been infibulated (Type III). This is often done to allow sexual intercourse or to facilitate
childbirth, and is often necessary for improving the woman’s health and well-being.
Type 1 and 2 are the commonest types and constitute approximately 80 percent of all cases. Type
3 is about 15 percent of all female genital cutting and is the most severe in terms of health
complications.

REASONS / INDICATIONS OF FGM

 As a right of passing into motherhood

 First time during pregnancy
 preservation of chastity and purification
 family honor, hygiene, esthetic reasons,
 protection of virginity and prevention of promiscuity,
 modification of sociosexual attitudes (countering failure of a woman to attain orgasm),
 increasing sexual pleasure of husband,
 enhancing fertility and increasing matrimonial opportunities.
 Other reasons are to prevent mother and child from dying during childbirth and for legal
reasons (one cannot inherit property if not circumcised).

MEDICALIZATION OF FGM

Medicalization” of FGM refers to situations in which FGM is practiced by any category of health
care provider, whether in a public or a private clinic, at home or elsewhere. It also includes the
procedure of infibulation at any point in time in a woman’s life.

FGM can never be “safe,” however, and there is no medical justification for the practice. Even
when the procedure is performed in a sterile environment by a health care provider, there is risk
of health consequences immediately and later in life. Under any circumstances, FGM violates the
right to health, the right to be free from violence, the right to life and physical integrity, the right
to non-discrimination, and the right to be free from cruel, inhuman or degrading treatment.

When performed in a clinical setting, FGM violates medical ethics as well and may confer a
sense of legitimacy to FGM or give the impression that it is without health consequences, which
can undermine efforts towards abandonment.

COMPLICATIONS / CONSEQUENCES OF FEMALE GENITAL MUTILATION OR

CUTTING
SHORT-TERM COMPLICATIONS OF FGM

 Severe pain. Cutting the nerve ends and sensitive genital tissue causes extreme pain. The
healing period is also painful.
 Excessive bleeding (haemorrhage). Can result if the clitoral artery or other blood vessel
is cut.
 Shock. Can be caused by pain, infection and/or haemorrhage.
 Genital tissue swelling. Due to inflammatory response or local infection.
 Infections. May spread after the use of contaminated instruments (e.g. use of same
instruments in multiple genital mutilation operations), and during the healing period.
 Urinary problems. These may include urinary retention and pain passing urine. This
may be due to tissue swelling, pain or injury to the urethra.
 Impaired wound healing. Can lead to pain, infections and abnormal scarring.
 Death. Death can result from infections, including tetanus, as well as haemorrhage that
can lead to shock.
 Mental health problems. The pain, shock and the use of physical force during the event,
as well as a sense of betrayal when family members condone and/or organize the
practice, are reasons why many women describe FGM as a traumatic event.

LONG-TERM COPLICATIIONS OF FGM (OCCURRING AT ANY TIME DURING

LIFE)

 Pain. Due to tissue damage and scarring that may result in trapped or damaged nerve
endings.

 Chronic genital infections. With consequent chronic pain, and vaginal discharge and
itching. Cysts, abscesses and genital ulcers may also appear.
 Chronic reproductive tract infections. May result in chronic back and pelvic pain.
 Urinary tract infections. If not treated, urinary tract infections can ascend to the
kidneys, potentially resulting in severe complications. An increased risk of repeated
urinary tract infections is well documented in both girls and adult women who have
undergone FGM.Painful urination. Due to obstruction of the urethra and recurrent urinary
tract infections.

 Vaginal problems. Discharge, itching, bacterial vaginosis and other infections.

 Menstrual problems. Obstruction of the vaginal opening may lead to painful

menstruation (dysmenorrhea) and difficulty in passing menstrual blood, particularly
among women with Type III FGM.

 Excessive scar tissue (keloids). Excessive scar tissue can form at the site of the cutting.
  Sexual health problems. FGM damages anatomic structures that are directly involved in
female sexual function, and can have an effect on women’s sexual health and well-being.
Removal of, or damage to, highly sensitive genital tissue, especially the clitoris, may
affect sexual sensitivity and lead to sexual problems, such as decreased sexual desire and
pleasure, pain during sex, difficulty during penetration, decreased lubrication during
intercourse, and reduced sexual pleasure. Scar formation, pain and traumatic memories
associated with the procedure can also be related to sexual dysfunction.

 Childbirth complications (obstetric complications). FGM is associated with an

increased risk of caesarean section, postpartum haemorrhage, episiotomy, difficult
labour, obstetric tears/lacerations, instrumental delivery, prolonged labour, and extended
maternal hospital stay.

 Obstetric fistula. A direct association between FGM and obstetric fistula has not been
established. However, given the causal relationship between prolonged and obstructed
labour and fistula, and the fact that FGM is also associated with prolonged and obstructed
labour, it is reasonable to presume that both conditions could be linked in women living
with FGM.

 Perinatal risks. Obstetric complications can result in a higher incidence of infant

resuscitation at delivery and intrapartum stillbirth and neonatal death.

 Mental health problems. Studies have shown that girls and women who have undergone
FGM are more likely to experience post-traumatic stress disorder (PTSD), anxiety
disorders, depression and somatic (physical) complaints (e.g. aches and pains) with no
organic cause.

 Vesico vaginal fistula(VVF) or Recto vaginal fistular (RVF)

Even though FGM may be accepted and carry cultural significance in some settings, the practice
is always a violation of human rights which can adversely affect the health and well-being of
girls and women.

NATIONAL POLICY & PLAN OF ACTION FOR THE ELIMINATION OF FEMALE

GENITAL MUTILATION IN NIGERIA

Female Genital Mutilation (FGM) is a violation of the right to life, health, and dignity of women
and girls. Nigeria being a signatory to international human rights treaties and conventions that
prohibit such acts against women and girls has shown commitment to the elimination of FGM in
Nigeria. An expression of this commitment is the signing into law of the Violence Against
Persons (Prohibition) Act in the year 2015. Prior to this, national policies have been adopted
toward the elimination of this practice in Nigeria.
In 1994 Nigeria joined other members of the 47th World Health Assembly to resolve to
eliminate FGM (WHA 47.10). Steps taken so far to achieve this include:
 establishment of a multi-sectoral Technical Working Group on Harmful Traditional
Practices (HTPs) ,
 conduct of various studies and national surveys on HTPs,
 launching of a Regional Plan of Action,
 formulation of a National Policy and plan of action which was approved by the Federal
Executive Council for the elimination of FGM in Nigeria.
In order to eliminate FGM in Nigeria, it is necessary to promote awareness of the problem by
educating the policy/decision makers, the general public, health workers and those who carry out
the practice on all its health and psychosocial consequences. This calls for the active
involvement of political leaders, professionals, development workers, local communities and
their leaders, and women’s group and organizations.