Women's health. The issue of unspoken abuse.

Abstract

The UK banned female genital mutilation in 1985 with the Prohibition of Female Circumcision Act but there were reports in 1993 that doctors were conducting the procedure and that procedure was being performed abroad. The Children Act 1989 section 47(1) designates investigation and protection of children at risk. Since thousands of British women may have been affected by genital mutilation (FGM) it is important that nurses be aware and understand the issues and not fear that their concern will be considered racist. Prevention requires sensitivity of communication and the Royal College of Nursing document is helpful in directing management of cases. The practice has been commonly accepted in African societies for hundreds of years until recently. African womens groups such as FORWARD the National Alliance for Women of African Descent and Akina Mama wa Africa have considered the practice as an abuse of health and human rights of girls and women. The practice was used in the UK until recently to control the sexuality of mentally ill women and to remedy masturbation activity. Continued practice of FGM is related to its lost believed significance as a requirement for Muslim religion even though it is not specifically mentioned in the Koran. There is maternal concern that daughters might not be acceptable mates for husbands without the operation. The African Charter on the Rights of Welfare of the Child states that harmful traditional social and cultural practices affecting children must be halted by governments. The Charter was adopted by the Organization of African Unity in 1990. The damage from FGM has been reported by the World Health Organization as increased risk (twice the risk) of maternal death in childbirth and increased risk (3-4 times the risk) of neonatal mortality. In Somalia the estimate for maternal death is 1 out of 100 among women who have been mutilated which includes to 80-90% of all Somali women. Other deleterious side effects are difficulties with menstruation and menopause trauma during sexual penetration and urinary tract infections. Psychological effects include unbearable pain and terror humiliation and feeling betrayed by mothers. Mutilation can be excision either with or without removal of the labia minora (85% of cases) or infibulation or cutting of the labia majora to form a hood over the urethra and the vagina and leaving a matchstick size opening for urine and menstrual blood passage.