Zero tolerance for the scar of a lifetime

The day Folake, 13, was circumcised, she had no idea what was about to happen. She had gone to bed the previous evening only to be woken in the dead of the night by a loud bang on the door of the room where she and her 10-year-old sister slept.

The room was in inky darkness as the door crashed open and before Folake could move, she felt a large hand covering her mouth and nose while another strong hand lifted her off the bed and dragged her out of the room into the passage.

In shock and unable to protest or wriggle free, Folake  heard her sister screaming in the background, but under the pale, moon-lit night, as she was dragged out of the back door into the compound and onto the footpath leading to the main road, she  quickly became aware of some figures standing by the house.

She recognized one of those figures as her mother’s and made a vain attempt to call out to her. She was surprised that her mother made no move to rescue her from the assailant. Tears came to her eyes when she heard her mother whisper “Folake, you are going to be cut. It’s your turn.”

The rest of the events after that went by in a blur. Folake practically passed out as a result of the choking grip on her mouth and nose. When she came to, she found herself naked and spread-eagled on the floor in an unknown room.

A candle burned unsteadily nearby as she struggled hopelessly to get up, but was pinned onto floor by four women. A fifth woman knelt between her legs, bent over her lower abdomen with a razor blade in her right hand , urged her to stop struggling. “You won’t feel it. It's not going to be painful, the woman remarked.

But Folake felt it. As her flesh was being cut off, white-hot pain enveloped her entire being. The pain was more intense than she ever imagined. She bled a lot. For many days thereafter, she was in agony. She felt abused, violated and disenchanted.

Why, why? She kept asking. But there were no answers. She had gone through Type 3 form of Female Genital Mutilation and Cutting and did not know why.

Slowly she healed and time passed. She thought her ordeal was, but only became aware of how much she’d been affected psychologically and physiologically when she fell pregnant.

Folake was severely depressed and hated being vaginally examined. It was her worst nightmare.Her gynaecologist could not understand why she was so averse and so scared?

Folake did not know it, but her body was experiencing flashbacks - a reminder of what had happened to her when I was 13.

There are millions of girls and women like Folake that are victims of FGM/C. February 6, the International Day of Zero Tolerance for Female Genital Mutilation and Cutting, FGM/C, is  an awareness campaign to end the harmful practice that violates girls’ and women’s rights.

The World Health Organisation, WHO, describes female genital mutilation and comprising all procedures that involve altering or injuring the female genitalia for non-medical reasons. The practice is recognized internationally as a violation of the human rights of girls and women.  

In Nigeria and some other parts of the developing world, this practice has been described as reflecting deep-rooted inequality between the male and female sexes, and constituting an extreme form of discrimination against women and girls.

The practice also violates their rights to health, security and physical integrity, their right to be free from torture and cruel, inhuman or degrading treatment, and their right to life when the procedure results in death.

Although the practice of FGM cannot be justified by medical reasons, in many countries it is being executed more and more often by medical professionals, which constitutes ones of the greatest threats to the abandonment of the practice. 

Recent analysis of existing data shows that more than 18 percent of all girls and women who have been subjected to FGM have had the procedure performed by a health-care provider and in some countries this rate is as high as 74 percent. 

The situation of FGM/C in Nigeria according to NDHA 2013 reveals that due to its large population, Nigeria has the third highest absolute number of women and girls (19.9 million) who have undergone FGM/C worldwide (after Egypt and Ethiopia).

In it’s clinical description of FGM/C, the WHO describes it as comprising four types:  Type1: Clitoridectomy: partial or total removal of the clitoris and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris). Type2: Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia; Type3: Infibulation: narrowing of the vaginal opening through the creation of a covering seal. Type IV (Unclassified): all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

The National President, Inter-African Committee on FGM, Professor Modupe Onadeko, argues that the sensitisation against FGM/C  is now in the nurses’ curriculum at the University College Hospital, UCH, Ibadan, observes that we should not allow even one  girl to be mutilated again.

Onadeko  who argues that female circumcision is not the equivalent of male circumcision, said globally it is a violation of the girl child and the woman and has drawn criticism because of the hazards of health and complications.

“Female Genital Mutilation/Cutting has been with us for a long time. It is an accepted practice in so many cultures and it has been justified as to why it should go on, as the rites of the passage for preparing a girl to womanhood.

“I have researched and have not come across one good that comes out of FGM/C but there are numerous disadvantages.”   

Data from NDHS 2013, shows that 27 percent women 15-49 have been cut. It happens mainly before the 8th day or early teenage, during labour. An estimated 19.9 million Nigerian women have undergone FGM/C meaning that approximately 16 percent of the 125 million FGM/C survivors worldwide are Nigerians.

From left: Programme Officer, UNFPA Nigeria, Damilola 

Obinna; National President, Inter-African Committee on

 FGM, Professor Modupe Onadeko, and UNICEF Chief 

Communications Officer, Douane Porter. 

Programme Officer, UNFPA Nigeria, Damilola Obinna, notes that there are three sorrowful milestones for the girl child – the day of circumcision, the wedding night  (the fear of painful sexual intercourse) and  the day she would be having her baby. “We need to stop this practice.

Studies show that FGM/C is more prevalent in the southern zones than in the northern zones.  States with the highest prevalence include Osun (77 percent), Ebonyi (74 percent) , Ekiti (72 percent), Imo (68 percent ) and Oyo  (66 percent).

There is a Federal law outlawing the practice of FGM/C in Nigeria, the Violence Against Persons

(Prohibition) Act (VAPP), 2015, the practice continues.  

Eight states of the Federation have laws prohibiting FGM/C viz: Lagos, Osun, Ondo, Ekiti, Bayelsa, Edo, Cross River and Rivers. The Child Rights Act (CRA) 2004 also prohibits FGM/C

Reasons adduced for continuation of the practice range from tradition to preserving and continuing a set of values and rituals in a community, rite of passage from girlhood into womanhood, etc.

Child Protection Specialist, UNICEF, Maryam Enyiazu, FGM/C says is performed in Nigeria for cultural aesthetic reasons. In some communities, normal female genitals are considered ugly, unclean and unattractive unless they are subjected to FGM.

She says in some communities, it is believed that the clitoris contains powers strong enough to damage a man’s penis or to kill a baby during childbirth.

Solely focusing on the medical reasons has not helped. Medicalisation leads to legitimisation of the practice. But with collective support, FGM/C can be abandoned in this generation. That is the message today and every day.

Medic recommends clitoral reconstruction for women living with FGM/C

ON the heels of calls by the UN and human rights organizations for complete ban of the practice of Female Genital Mutilation and Cutting, an Obstetrician and Gynaecologist, Dr Jasmine Abdulcadir, of the University Hospitals of Geneva (HUG), Switzerland, says women living with FGM/C should consider undergoing clitoral reconstruction.

Abdulcadir who specializes in providing services for women who have experienced FGM/C,  urges them to consider this surgery for  reasons ranging from reduction of chronic clitoral pain or to improve sexual pleasure. 

For the last two years, she has supported the work of WHO/RHR in development and implementation of a research agenda that aims to address the needs of women and girls who are at risk of and who live with FGM towards improving the evidence-base for effective policies, and their implementation.  Several women that have been cut see clitoral reconstruction as a way to improve their body image and female identity. 

"They may want to reverse a procedure that was performed without their consent or to regain a genital appearance similar to uncut women," she argues.

On what can women expect from the surgery, she says: "When FGM involves the cutting of the clitoris, it affects the clitoral glans (the visible and more external part of the organ). The majority of the clitoris (the body and crura) lies anatomically deeper and is therefore not affected by the procedure. 

"Additional structures responsible for sexual pleasure, such as the bulbs, also remain intact. This explains why women who have undergone FGM, and do not have psychosexual or other long term physical health complications, may still experience orgasm and sexual pleasure."

Abdulcadir describes clitoral reconstruction as a surgery that consists of re-exposing the clitoral body that is hidden beneath the scar tissue and recreating a more accessible clitoral glans, which can facilitate its stimulation.

"Reduction of clitoral pain and improvement of sexual function are chief among reported positive outcomes. However, the surgery is not without its complications: hematoma, wound breakdown, and post-operative decreased sexual function have been reported in the literature. The rate at which these complications occur ranges from 5.3% to 40%.

On implications for women considering clitoral reconstruction and their providers, she says there is still much unknown about the outcomes of clitoral reconstruction and urged health providers to make women who consider the surgery aware of this scarcity of scientific evidence.

"Whether considering the surgery or not, women should be offered comprehensive, multidisciplinary care including health education on female anatomy, physiology and sexuality, as well as psychosexual therapy. 

"Often, adequate psychosexual care and counselling can improve women's sexual function, body-image and identity with no need for more invasive interventions. Female sexual function is multifactorial and depends on more than the genital anatomy."

Abdulcadir says prior to undergoing any surgery, it is crucial to explore women's pre-operative symptoms, expectations, beliefs and misconceptions on the clitoris, their anatomy and sexuality. "Other possible psychological or physical comorbidities that can affect sexual function should also be screened and treated. If possible, partners should also be included in the care.

"Alternative therapies for improving the sexual health and wellbeing of women living with FGM/C

Women with FGM type III (infibulation) can suffer from superficial dyspareunia (pain during intercourse) and should be offered deinfibulation, a procedure to re-open the vaginal opening after infibulation has been performed. 

"This helps facilitate penetration during sexual activity, hence reducing painful intercourse. It also facilitates urination, menstruation and childbirth. Health education focusing on cultural myths on the clitoris, women's anatomy and physiology, and FGM, as well as associated psychosexual therapy are alternative and effective therapies to improve sexual health that can be proposed to women living with FGM and their partners," she argued.

We can stop FGM/C in our time, says Aishat Buhari

WIFE of the Nigerian President, Mrs Aisha Buhari, has said that the practice of Female Genital Mutilation/Cutting (FGM/C) can be ended within a generation. 

Buhari, who spoke in Abuja, at the formal launch the national response to eliminate the practice, in Nigeria urged the wives of Governors of states where the harmful practice is rampant, to be the voice of the campaign to end FGM/C in their various states.

The event was a collaboration between the Federal government and the Joint UNFPA/UNICEF Programme on FGM/C Abandonment, in partnership with several civil society organizations.

“We are mothers and women and have the primary role to use our privileged positions to make lives better for Nigerians, especially women and girls.

“I urge you to be vocal on the need for FGM/C to end in Nigeria and take action that will enable this to happen,” Buhari noted.

FGM/C is an extremely harmful traditional practice, documented in 28 countries in Africa, Asia and the Middle East.

 It comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.

The practice exposes girls and women to severe and sometimes life-threatening health complications, including hemorrhage, tetanus, sepsis, urine retention, sexual dysfunction and infertility; women who have undergone FGM/C are twice as likely to die during childbirth, and their babies are more likely to during or just after birth. 

UNICEF Nigeria Representative, Jean Gough, stated: “Not one of the myths surrounding this practice has any basis in truth. The only truth is that on every level this is a harmful and brutal practice that has a detrimental impact on the health and the human rights of women and girls.”

Also speaking, UNFPA Nigeria Representative, Mrs. Ratidzai Ndhlovu described FGM as an       extreme form of violence against women and girls.

“It violates her reproductive rights and her bodily integrity. To end this harmful practice, we must understand not only where and how it is practiced, but also the social dynamics that perpetuate it, so we can use that knowledge to persuade practitioners to end the practice,” she argued. 

The national response to accelerate change and eliminate the practice within a generation – estimated at 20 years – will be based on information gathered in a study on the beliefs, knowledge, and practices of FGM/C that was conducted last year by UNICEF, UNFPA and partners in six high-prevalence states: Ebonyi, Ekiti, Imo, Osun, Oyo and Lagos.

The findings of the study highlight the need for sustained communication with communities and collaboration with the media to promoting the social change needed for FGM/C abandonment.

Data from the National Demographic Health Survey 2013, shows 25 percent of women in Nigeria have undergone FGM/C, although the practice is slowly declining. 

Little is known about the origin of FGM/C, which predates contemporary world religions. It is widely practiced in Nigeria, where an estimated 19.9 million Nigerian women have undergone the procedure. 

A new global target and call to action to eliminate Female Genital Mutilation (FGM) by 2030 was launched on February 6, International Day of Zero Tolerance for FGM by UNFPA Executive Director, Prof. Babatunde Osotimehin, and UNICEF Executive Director, Anthony Lake.

Zika virus: Restricting pregnancy is discriminatory

Don't restrict women's access to sexual and reproductive health services in contravention of international standards, the UN High Commissioner for Human Rights, Zeid Al Hussien, warned last week in New York.

The UN is averse to the advice to women to delay getting pregnant due to the possible link between the rampaging Zika virus and neurological disorders affecting newborns.

It says upholding women’s human rights was essential if the response to the Zika health emergency would be effective.

Telling women to delay getting pregnant ignores the reality that many women and girls simply cannot exercise control over when they become pregnant, especially in environments where sexual violence is so common.

For instance, in situations where sexual violence is rampant and sexual and reproductive health services are unavailable, efforts to halt Zika crisis will not be enhanced by stopping women from getting pregnant.

The UN says amid the continuing spread of the virus, authorities must ensure that their public health responses were pursued in conformity with human health-related rights obligations.

It wants governments ensure that women, men and adolescents have access to comprehensive and Health services must be delivered in a way that ensures the woman’s informed consent, respect for her dignity and the guarantee of her privacy.

`Laws and policies that restrict her access to these services must be urgently reviewed in line with human rights obligations in order to ensure the right to health for all in practice.

WHO's roadmap for Zika vaccine development

The World Health Organisation, WHO, has begun mapping existing Research & Development efforts for Zika in order to prioritize medical products and approaches that should be fast-tracked into development.

The global health body said such products will be reviewed by expert advisory committees as soon as possible.

At least 12 groups working on Zika vaccines all in the early stages of development, but availability of licensed products could take a few years.

Currently, most research that could be useful for Zika has been carried out on other flaviviruses – such as dengue or yellow fever.

The WHO had earlier invited interested companies to submit potential products to its Emergency Assessment and Listing procedure.

Diagnostics are a top urgency in order to ascertain the presence of the Zika virus as opposed to other similar diseases caused by flaviviruses with mosquito vectors.

This procedure, once a product has been accepted, guarantees acceptable levels of quality and performance and allows UN agencies, NGOs and countries to procure the product with confidence.

Some studies are being carried out on prophylactic therapeutics that would work in the same way as prophylaxis for malaria.

WHO is also working on establishing regulatory support networks to fast-track approval of clinical trials in countries.

Advocacy on timely samples and data sharing among groups undertaking R&D studies on Zika, to ensure the best science is brought to bear on research and development.

The  WHO’s R&D efforts on Zika are part of the overall work on a roadmap – the R&D Blueprint - for better R&D preparedness based on the experience of the R&D work carried out during the West-Africa Ebola outbreak.

The roadmap will enable roll-out of an emergency R&D response as early and as efficiently as possible for emerging diseases for which there are no, or few, countermeasures. In December 2015, WHO held a consultation to identify a short-list of pathogens to be prioritized immediately for R&D preparedness. Zika was identified as a serious risk, needing further action as soon as possible.

Lassa fever: 2nd death in Lagos

Lassa fever reservoir, the Multimammate rat.

A second death from Lassa fever virus infection has been confirmed by the Lagos State Commissioner for Health, Dr. Jide Idris. He said the deceased, a 27-year-old lady,died few hours after admission at Ijede General Hospital where she presented with fever, vomiting, diarrhoea and body weakness.  

The unnamed lady had earlier travelled to Edo State on 24 December, 2015 and returned to Lagos on 2 January, 2016. 

She took ill on 14 January, 2016 and received care in one private hospital and three churches before she being referred  23 January  The case was confirmed as Lassa Fever on January 26, 2016.

The remains of the patient has been kept in the morgue in leak proof body bag. She is to be buried after due consultation with her family. 

Ninety (90) persons have been line-listed as contacts of the last confirmed case as at January 26, 2016 and contact tracing is on-going.

Meanwhile, Lagos State had recorded 20 suspected cases of Lassa fever as at 26 January since the outbreak of the disease in November, 2015. 

Fourteen  suspected cases tested negative, four cases were confirmed positive of Lassa Fever, while the results of two suspected cases are pending. One case was confirmed on the 15 January 2016, two on 18 January 2016 and one case confirmed on 26 January, 2016.  The Lagos state health ministry has line-listed 537 contacts of the confirmed cases and 534 (99 percent) of the contacts are currently being monitored.

Meningitis kills 22 in Ghana

AT least 22 persons have been confirmed dead from bacterial meningitis in Ghana, following an outbreak that has lasted three months in the former Gold Coast country.The deaths were recorded in the northern Bole district and central Ghana. The pneumococcal (Meningococcal)  form of meningitis  occurs when bacteria invade the bloodstream and infect the membranes protecting the brain and the spinal cord (the meninges).

Although the outbreak has been contained experts warn that it remains highly contagious. Strict surveillance measures are being enforced. In the Bole district of Ghana’s northern region, health authorities are establishing measures to ensure reported cases are contained.

The dry season, with strong dusty winds and cold nights make people more prone to respiratory problems. The disease mainly affects children and young adults aged 1-30.

Transmission is airborne so infected persons can transmit it to others through droplets of respiratory or throat secretions, especially sneezing and coughing and inhalation. Early diagnosis is an important step of ensuring treatment and preventing the disease from spreading.

Symptoms include stiff neck, high fever, headaches, vomiting and sometimes seizures. Even when the disease is diagnosed early and adequate therapy instituted, 5-10 percent of patients die, typically within 24-48 hours of onset of symptoms, according to WHO. Most victims suffer irreversible neurological consequences.

The largest recorded outbreak of epidemic meningitis was recorded in Africa in 1996, with over 250,000 cases and 25,000 deaths registered. 

The current WHO recommendation for outbreak control is to mass vaccinate every district that is in an epidemic phase, as well as those contiguous districts that are in alert phase. It is estimated that a mass immunization campaign, promptly implemented, can avoid 70 per cent of cases.