Traditional practices and social attitudes that directly affect the health of woman and children exist in one form or another in most countries. In societies where women's needs have been subordinated to those of men, traditional practices often serve to reinforce their disadvantage, with direct or indirect effects on their health.
All societies have evolved norms of care, feeding and related behaviours with variations according to sex. These "norms", often referred to as traditional practices have social and cultural origins or are based on empirical observations of individuals or society and their well being. The health effects of traditional practices may be beneficial, harmful or benign. While many traditional practices have no rationale they may have a profound health effect, particularly those relating to female children.
As laid down in the World Health Organisation's mandate, health in it's wider sense is the right of every individual and in trying to adhere to this human right, WHO is promoting activities which help to combat and eradicate harmful traditional practices which affect the health of women and children.
WHO activities with regard to these traditional practices are carried out as part of the Organisation's broader programmes of Maternal and Child Health and Family Planning, Safe Motherhood and Adolescent Health in close collaboration with the United Nations agencies and non-governmental organisations.
Female genital mutilation is a collective name given to a series of traditional surgical operations performed on the female genitals in several countries in the world. It is a cultural practice and not a disease. It is an issue with recognised implications for the health and human rights of women and children. As such it has been a concern of the WHO and other agencies since the early 1950s.
However, it is only since 1976 that concerted efforts have been made by Member States and by the Organisation - particularly it's Regional Offices for Africa and Eastern Mediterranean - to gather information, generate awareness of the adverse health effects of the practice and to implement recommendations made in various regional meetings, seminars and conferences.
We, as health professionals, are aware that FGM is a public health issue because of the undisputed and grave consequences for the physical and psychological effects particularly on normal sexual function, FGM affect their reproductive health in a way which lasts all their lives, since none of the procedure are reversible.
We know that all forms of FGM cause immediate consequences such as haemorrhage, infection, urinary problems, shock, pain and trauma. The health consequences for the most severe forms include menstrual problems, reproductive tract infections that can result in infertility, difficulties during childbirth for mother and infant, and sexual dysfunction, for both women and men. All forms of the practice carry the risk of transmission of hepatitis, HIV/AIDS and tetanus.
Although it is practised in many societies with diverse cultures and religions, there is no definite proof that circumcision of girls is required by any religion. At present, it is estimated that between 85 million and 114 million girls and women in the world are genitally mutilated. Most of them live in 26 African countries, a few in Asian countries and increasing numbers in Europe, Australia, Canada and the United States of America. It is estimated that at least two million girls every year are at risk of genital mutilation. The information on total prevalence and rates by type of operation is incomplete (Toubia, 1993). It is estimated, for example, that more than 80% of women in Somalia, Djibouti and North and Central Sudan have undergone infibulation. Most of the studies and reports contain inadequate biased samples and use unclear or faulty methods of data collection. The only country with nation-wide data is Sudan, where three countryside surveys included questions of FGM.
For several years increased attention has been focused on FGM by women's organisations, human rights groups, and national and international media. National authorities in many countries in Africa, working with the network of NGOs, the Inter African Committee for the Elimination of Harmful Traditional Practices and others, have developed programmes to educate and inform and persuade them to abandon mutilation. Combined efforts have been made to convert men in order to ensure a positive effect for the campaign by women. Many lessons have been learned, resulting in an approach which recognises that change can best be achieved by working with the people who are most concerned and affected by this problem and by collaborating with national and/or local organisations and using the skills and experience of those who are close to communities where FGM is practised.
Although it is now generally accepted that the initiative for abolition of FGM must be taken by women from the societies that practice it, it is also recognised that national and local initiative can benefit greatly by outside support. For the past 15 years, WHO's role has included technical and financial support for national surveys, for the relevant training of health workers, and, for grassroots initiatives.
The World Health Organisation recognised that the genital mutilation of women represents a serious health hazard for women, reinforces the iniquity suffered by women in the communities where it is practised and must seriously be addressed if the health, social and economic development needs of women are to be met. This position is reflected in the WHO statement on its position and activities in various resolutions of the World Health Assembly, the Regional Offices of the Organisation and reports of technical and scientific groups of experts convened by the Organisation.
Given WHO's commitment to advance the health and protect the lives of women and children, including their psychological, physical and reproductive health, the Organisation is promoting and supporting the development of country-oriented programmes that would aim at eliminating traditional practices harmful to the health and well-being of women and children, including FGM.
In 1976, the Director-General of WHO stated that there was a need to combat superstition and practices detrimental to the health of women and children, and he drew particular attention to what was then referred to as female circumcision.
WHO supported the Working Group on Female Circumcision formed in 1977 by 20 members of NGOs and continued to take part in the meetings and discussions of the NGO Working Group of Traditional Practices set up under the NGO Committee on the Status of Women.
The first major step to deal with FGM was the 1979 Khartoum Seminar on Traditional Practices, organised by the WHO Regional Office for the Eastern Mediterranean. Representatives from 10 countries from Eastern Mediterranean and African Region attended the meeting. FGM was discussed during this Seminar as a harmful traditional practice. This was the first interregional and internal attempt to exchange information of female circumcision and other traditional practices, to study their implications and to make specific recommendations on the approach to be taken by the health services. The Seminar proposed the establishment of a national commission to co-ordinate activities including legislation, the intensification of general education and the sensitisation of midwives and traditional birth assistants. The adoption of a clear-cut policy was also recommended for the creation of legal measures against FGM.
In 1982, WHO made a formal statement on its position regarding FGM (referred to in the statement as female circumcision) to the UN Committee on Human Rights. The recommendations made at Khartoum meeting were re-emphasized and WHO expressed its readiness to support national efforts aimed at eradicating the practice. In this statement, WHO expressed its unequivocal opposition to the medicalization of the practice by health professionals in any settings.
In 1983, during the 36th World Health Assembly, WHO, together with the NGO Working Group, convened an informal meeting on the subject with the African delegates to the WHA.
In 1989, WHO Headquarters, together with its Regional Offices for Africa and for the Eastern Mediterranean, joined UNICEF and the United Nations Fund for Popular Activities(UNFPA) in co-sponsoring a seminar in Dakar in collaboration with the NGO Working Group and the government of Senegal. The Dakar Seminar gave further impetus to the establishment of national committees in all the countries where female circumcision is practised. It set up an Inter African Committee to act as a bridge between the different groups working among the people and those providing support for their activities.
The subject of female circumcision, along with other harmful practices, was also subsequently discussed during the WHO Regional Workshop on Women, Health and Development jointly sponsored by WHO, UNFPA and UNICEF in November 1984 in Damascus, Syrian Arab Republic.
In 1987, WHO co-sponsored the Inter-African Committee Regional Seminar in Addis Ababa and papers on the position of WHO in FGM and other traditional practices were presented by WHO HQ and its Regional office staff of Eastern Mediterranean and Africa.
In 1988, the WHO Regional Committee for the Eastern Mediterranean adopted a resolution in the 35th session, stating that women's health must be safeguarded by ensuring the elimination of harmful traditional practices.
In 1989, at the Safe Motherhood Conference in Niamey, organised by the World Bank, UNFPA, WHO and UNICEF, called for eradication of harmful practices, including FGM.
In 1990, WHO co-sponsored Inter African Committee (IAC) regional conference in Addis Ababa which proposed changing the terminology from "female circumcision" to "female genital mutilation."
The efforts and sincere commitment of the IAC and the NGO Working Group on Traditional Practices Affecting the Health of Women and Children has led to the formation of z4 national committees which carry out activities for the eradication of this practice with the support of U N agencies and NGO's.
In 1991, WHO participated in the first UN Seminar on Traditional Practices affecting the Health of Women and Children held in Ouagadougou, Burkina Faso. The seminar was organised by the United Nations Centre for Human Rights in Co-operation with the government of Burkina Faso under the United Nations programme of Advisory Services in the field of Human rights. It was at this meeting that the recommendation to change the terminology from "Female Circumcision" to "Female Genital Mutilation" was adopted.
In 1991, WHO provided funds to IAC for national committees to undertake research studies on the influence on the choice of contraceptive methods in one French speaking and one English-speaking country, i.e., Djibouti and Sierra Leone, research studies are in progress to date.
In l992, WHO Technical Discussions on Women, Health and Development, proposed more courageous steps be taken by national and international communities to eliminate mutilation practices particularly Female Genital Mutilation.
In l992, WHO also participated and presented a paper of WHO's Role and Policy on harmful Traditional Practices, including FGM,at the First International Conference organised by FORWARD in London. The London Declaration on FGM was the outcome of this meeting.
In l992, the Netherlands Constancy for Maternal Health and Planning organised a congress on Female Circumcision to debate whether the Netherlands' government should allow medicalization of the milder form of FGM for the country's Somali immigrants. WHO was invited to participate and took a very active role in opposing such a measure by the government of the Netherlands on the basis of health and women's and girl child's rights. WHO's position opposing medicalization of any form of female genital mutilation was reaffirmed and understandably contributed to a decision of "No" on this issue.
In 1993, WHO, at its 46th World Health Assembly, passed Resolution WHA46.18 and issue a Press Release of Female Genital Mutilation.
In 1994, the 93rd session of WHO Executive Board in January adapted a resolution on traditional practices harmful to the health of women and children and recommended it to 47th WHA in May 1994. The resolution was subsequently adopted by the Word health Assembly with very minor changes.
Strategies are being developed by WHO within its mandate to support efforts to end Female Genital Mutilation.
A family Health Division Working Group was established and a booklet is being prepared to highlight the potential role of the OB/GYNs and National FIGO societies in eradicating FGM.
A briefing session on FGM for the World Health Assembly to raise the country's delegations' awareness in the area of FGM, its related health and psychosocial issues and the WHO's commitment to eradicating this practice in collaboration with non-governmental and governmental agencies, other interested parties and UN agencies. WHO distributed a briefing package at this session which included fact sheets on FGM, other advocacy material, and poster.
To conclude, I would like to inform this august body that WHO is intensifying its effort to meet the challenge of eradicating this harmful traditional practice and opposing its medicalization in collaboration with national, international and particularly, non-governmental organisations.
The long-term goal of WHO activities in the area of FGM is to ensure it's complete elimination. To meet with this overall objective, strategies followed would be:
o To reduce the morbidity and mortality rates for women and children through the eradication of harmful traditional practices, especially of FGM;
o To promote traditional practices that are beneficial to the health of women and children;
o To play an advocacy role by emphasising the importance of action against harmful practices at international, regional and national levels, and;
o To play a co-ordinating role in research and development amongst international agencies, NGO's and countries.
Although there is today considerably more knowledge about the epidemiology and consequences of FGM, thanks, in part, to the activities of a number of NGOs working in countries where it is widespread, there are, nonetheless, major gaps in understanding both about the extent of the problem and the kinds of interventions that can be successful in eliminating it. Therefore, the work of WHO will focus on increasing available knowledge and developing instruments for use at country level for research on the extent of the practice and interventions that are successful in overcoming it.
The WHO action to meet with these objectives would be to:
o develop research instruments for use at country level by health professionals and others to determine the extent of the practice, its types in different social groups and areas, and its immediate and long-term health consequences on girls, women and their future infants;
o Establish and maintain a network of collaborating centres and affiliated groups to assist in the collectionof such information;
o Establish a global monitoring and reporting system including a database at WHO which will be continuously monitored and updated;
o Disseminate information on the epidemiology nature and consequences of FGM (a Global Factbook on FGM) to policy makers, health authorities and other influential leaders in health and other sectors and specialised agencies;
o Collect and disseminate all available information on ways on overcoming the practice.
I do hope that the deliberations and outcome of this International Conference will help not only the women and girls of the immigrant communities in Europe, North America, Australia and elsewhere in whom this practice is prevalent but also their sisters back in the countries of origin who are thus more at risk to be subjected to this practice in view of their traditional social cultural environment.
I would be happy to take this opportunity to thank the London Black Women Health Action Project for giving me the opportunity to participate and share experiences in the area of FGM. WHO would be happy to lend its technical support to your organisation toward eradicating this harmful traditional practice.
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