Ghana making progress with fight against FGM

By Isabella Gyau Orhin

Aminata had long reached puberty, but was not menstruating. So out of frustration, her parents took her to the hospital to find out what was wrong.

To her parents surprise, Aminata has been menstruating but the blood has been retained within her reproductive tract as a result of the mutilation of her genitals when she was young as part of the culture of her people.

The World Health Organization in 1997 defined female genital mutilation (FGM) as all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons.

According to the Executive Director of Rural Help Integrated, a non-for profit advocacy organization based in Bolgatanga in the Upper East Region, Dr. Kwasi Odoi-Agyarko, this story is just one of the many side effects of the practice which was prevalent in northern Ghana.
However, he said Ghana has achieved a lot of successes in the fight against the Female Genital Mutilation (FGM), especially in the northern part of Ghana.

According to Dr. Kwasi Odoi-Agyarko, the practice for instance in the Bolga area in the Upper East Region, has reduced from 29 percent to two percent over a period of 10 years.

He explained that ten years ago all women who delivered at the Bolga regional hospital were examined and it was discovered that 29 out of 100 women who delivered had undergone FGM.

But at the end of the year 2005 only two women out of a hundred at the same place had undergone FGM. He also said 10 years ago, Navrongo had 77 percent, but as at now the figure is around 15 or 16 percent.

Dr. Odoi-Agyarko told Public Agenda in an interview that looking at the figures from specific places, the national prevalence rate of about 8-9 percent 10 years ago, may come down to about two to three percent.
“ It is likely that it is much lower, we are still computing the figures,” he said.
But Female Genital Mutilation FGM is not perculiar to Sub Sahara Africa. According to Martin Donohoe in an article titled “Female Genital Cutting: Epidemiology, Consequences, and Female Empowerment as a Means of Cultural Change,”FGM was practiced as early as 450 BCE and was widely performed throughout ancient Egypt and in many other societies and cultures.

He said Clitoridectomy , as well as hysterectomy and oophorectomy, were used in the United States and Great Britain from the early 1800s to the mid-1950s as treatments for such diverse "disorders" as masturbation, lesbianism, falling of the womb, floating womb, hysteria, emaciation, debility, nymphomania, melancholia, insanity, and seizures.

The father of modern gynaecology, J. Marion Sims, advocated the procedure. Sigmund Freud, a philosopher once opined that "elimination of clitoral sexuality is a necessary precondition for the development of femininity.

The last known medical female "circumcision" in the United States took place in Kentucky in 1952, although some cultures within the United States continue the practice today outside of the medical system.

Giving a background to the fight against the practice, Dr. Odoi-Agyarko said after the International Conference on Population and Development (ICPD) in 1994, the World Health Organisation tasked all nations to make laws against the practice of FGM. In the same year, the World Assembly of WHO also tasked countries to make efforts aimed at curbing the practice.

It is in the same spirit that the WHO in collaboration with six African countries initiated a study on female genital mutilation and obstetric outcome.

About 28, 393 women who went to hospital to deliver single babies were studied at 28 health centres between November 2001 and March 2032 in Burkina Faso, Ghana, Kenya Nigeria, Senegal and Sudan.

The women were examined before delivery to ascertain whether or not they had undergone FGM and were classified according to the WHO system.
According to the WHO, FGM I is the removal of the prepuce or clitoris, while FGM II is the removal of the Clitoris and the labia minora. Also FGM III is the removal of part or all the external genitalia with stitching or narrowing of the vaginal opening.

Findings of this study indicate that compared with women without FGM, the risks of certain obstetric complications were in women with FGM I, II and III respectively. These include caesarean section, post partum Hemorrhage or bleeding after delivery, extended maternal hospital stay, still birth or early neonatal birth, infant resuscitation and low birth weight.
The research also indicated that FGM leads to extra one or two perinatal deaths per 100 deliveries.
Three Ghanaian health centres were part of the study.

In Ghana Dr. Odoi-Agyarko said the study was based at the maternity units and obstetric departments of the Bolgatanga, Bawku and Navrongo Hospitals. Based on a pilot study, it was estimated that approximately 6,000 women would be required in order to detect a two-fold increase in the risk of outcomes such as stillbirth and early neonatal death, in women with each type of FGM, compared to women without FGM.
A total of 6,413 consenting women with singleton pregnancies presenting for delivery were consecutively recruited into the study from December 2001 to June 2003. They were followed through labour and delivery, and obstetric outcome, including duration of labour, instrumental delivery, episiotomies, perineal tears, post-partum haemorrhage and maternal deaths were recorded. The newborn infant was examined and vital status, birth weight, and other data were also recorded. They were also followed up at the two-week and at the six-week post-partum period to ascertain the presence of complications such as genital wound infections and fistulas.
The FGM prevalence rate in those specific hospitals was 38 percent made up of 7 percent of FGM type I, 30 percent of FGM type II and 1 percent of FGM type III.
Bawku had the highest FGM prevalence of 82 percent and accounted for 84 percent of all the cases of FGM Type III that were seen. FGM was significantly associated with prolonged labour and had a direct relationship with post-delivery fistulas.
Also, the association between FGM type I and FGM type II was however not significant but FGM type III was strongly associated with post delivery fistulas.
FGM type II and type III were also significantly associated with post-delivery genital wound infection while FGM Type III was strongly associated with third degree tears.

According to Dr. Odoi-Agyarko, location of residence, age, and number of births, level of education and household wealth all interact. The increased risk of adverse obstetric outcomes with FGM observed in the study occurs against the background of increased maternal morbidity and mortality. This means that FGM is likely to be responsible for substantial numbers of additional causes of adverse obstetric outcomes. Adverse obstetric and perinatal outcomes can therefore be added to the known harmful immediate and long-term effects of FGM.