Mental Health Disorders in Circumcised Reproductive-age Women, Legal Dimensions and Prevention Strategies: A Narrative Review / Distúrbios de saúde mental em mulheres circuncidadas em idade reprodutiva, dimensões legais e estratégias de prevenção: uma revisão narrativa

Abstract Objective: Female genital mutilation/cutting (FGM/C) can affect women's lives through various physical, psychological, social and even sexual mechanisms. According to the World Health Organization guidelines for managing the health effects of FGM/C, further research into its psychological effects and preventative measures is required. In this study, a comprehensive review of the mental health consequences of circumcised women of reproductive age has been conducted with a special focus on providing preventive solutions. Methods: A comprehensive search of the Web of Science, PubMed(MEDLINE), Proquest ,Scopus and Google scholar was carried outfrom 2000 to 2022. The second stage of search was conducted in grey literature. To facilitate a systematic approach to search the literature, the PECO framework, was adopted. Results: The result of this narrative review study showed that, the most common mental health disorder in reproductive age circumcised women were depression, anxiety and post-traumatic stress disorder. Some studies found a significant relationship between parents' education level and circumcised girls, so that parents of the circumcised women had a low level of education. Two studies considered religious beliefs, tradition, cleanness, sexual desire control and virginity as the reasons for FGM/C. Conclusion: All forms of FGM/C may be harmful to one's health. Women, who have undergone widespread forms of circumcision, are more likely to develop mental disorders. As the psychosocial effects of circumcision can affect the sexual experience of circumcised women, addressing this issue, emphasizing its legal aspects, and providing preventative solutions can improve physical, mental, social, and even sexual health in circumcised women.

Gender-based violence in a rural Nigerian community during the COVID-19 era: a call for policy action

Introduction: gender-based violence (GBV) is a global pandemic which is deeply rooted in culture, hence the need to contextually understand its occurrence and patterns in rural settings. The objective of this study assessed respondents´ attitude, prevalence, the perceived risk factors, patterns and predictors of GBV in Ife-Odan, Osun State, Nigeria. Methods: cross-sectional study design was used and multi-stage sampling method employed to recruit 450 consenting adults. A pretested interviewer-administered, semistructured questionnaire was used for data collection. Both descriptive and inferential statistics were carried out. Results: mean age (±SD) of the respondents was 30.73±7.0, 58.7% of them were females and 88.0% had negative attitude to GBV. Prevalence of any form of GBV was 16.2%. Predominant GBV types included intimate partner violence (IPV) (58.3%), female genital mutilation (FGM) (31.1%), Sexual violence (6.9%) and incest (3.4%). Perceived risk factors of GBV included cultural acceptance, substance abuse, lack of punishments for GBV offenders, indecent female dressing styles, social media influences, effects of COVID-19 lockdown and male dominance. However, gender (AOR=7.82; 95%CI=2.35-8.17), marital status (AOR=3.23;95%CI=1.82-3.78), religion (AOR=5.02;95%CI=1.78-9.63) and attitude (AOR=4.23; 95%CI=2.267-5.82) were the significant predictors of past GBV experiences in the study setting. Conclusion: gender-based violence (GBV) is prevalent in the study setting, with IPV being the most common. There is need for policymakers to focus on cultural transformation by designing a robust awareness campaign against GBV in rural Nigerian communities. Traditional and religious leaders should be sensitized and involved in the campaign programs using all available channels of communication. Laws prohibiting perpetration of GBV need to be fully implemented.

Abordaje biopsicosocial de la mutilación genital femenina en la Gambia / Biopsicosocial boarding of the feminine genital mutilation in the Gambia

RESUMEN En el presente trabajo de revisión se expone cómo, según los últimos datos de UNICEF, alrededor de tres millones de niñas y mujeres cada año son sometidas a algún tipo de mutilación genital femenina en África, lugar en el que el arraigo social y cultural sobre el que se sustenta y retroalimenta esta práctica se debe a la experiencia de sus mayores, a la de sus propias madres y abuelas, con mensajes religiosos confusos y leyes poco rigurosas. El proceso de socialización que moldea las actitudes de las niñas y las mujeres las prepara para aceptar el dolor y el sufrimiento como parte inevitable de la vida de una mujer y como una obligación a cumplir para ser aceptadas en la sociedad. Sin embargo, las mujeres que lo practican no necesitan una justificación y cuando se les pregunta, remiten a la tradición, a la religión y a cuestiones estéticas, sanitarias o de protección. Es necesario contar con una mirada antropológica del fenómeno para obtener una comprensión de su significación que permita abordar el tema con conocimiento y respeto y así trabajar para conseguir un cambio en la sociedad que conduzca a la eliminación de las causas de vulneración del derecho a la salud y para que se luche por terminar con esta práctica. Por ello, el objetivo del presente estudio es exponer elementos inherentes a la mutilación genital femenina en la República de la Gambia, desde la perspectiva biopsicosocial, de manera que los resultados del estudio se conviertan en una herramienta útil para los profesionales en contacto con la población en riesgo. El estudio se desarrolla en el contexto de la Universidad durante el período noviembre 2020-febrero 2021.

ABSTRACT This review work shows how, according to the latest UNICEF data, around 3 million girls and women each year are subjected to some type of Female Genital Mutilation (FGM) in Africa where the social and cultural roots on which FGM is supported and fed back, it is due to the experience of their elders, their own mothers and grandmothers, with confusing religious messages and lax laws. The socialization process that shapes the attitudes of girls and women prepares them to accept pain and suffering as an inevitable part of a woman's life, and as an obligation to fulfill in order to be accepted in their respective societies. However, the women who practice it do not need a justification and when asked, they refer to tradition, religion and aesthetic, health or protection issues. It is necessary to have an anthropological view of the phenomenon to obtain an understanding of its significance that allows to approach the subject with knowledge and respect and thus work to achieve a change in society that leads to the elimination of the causes of violation of the right to health and fight to end the practice of FGM. Therefore, the objective is to expose the practice of Female Genital Mutilation from a biopsychosocial perspective in the Republic of the Gambia, so that it is a useful tool for professionals in contact with the population at risk. The study is developed in the context the University during the period November 2020-February 2021.

Female genital mutilation and male involvement: Insights of men and women in two counties in Kenya

This qualitative study, conducted in Meru and Kajiado counties in Kenya, explored the perceptions and attitudes of men and women regarding male involvement in FGM in order to inform the design of male involvement strategies in FGM abandonment. We used focus group discussions to collect the data which was then subjected to thematic analysis. Three main themes emerged from the data: i) culture and the role of men; ii) perceived awareness and knowledge of FGM among men, and iii) credible and customised education and engagement. The study found widespread agreement on the importance of male involvement in FGM abandonment. Culture played an important role in determining the extent of involvement, or lack thereof. We conclude that while culture needs to be respected it ought to be challenged to avoid the continued harm to girls. The potential of men as a collective to bring about change was evident, and policy makers and NGOs should utilise the power of male collectives to support efforts to abandon FGM

Acercamiento sociocultural a la mutilación genital femenina / Sociocultural approach to the feminine genital mutilation

RESUMEN La mutilación genital femenina se inscribe dentro de las prácticas tradicionales perjudiciales, reconocidas como forma de violencia contra las mujeres y las niñas. Tema extremadamente complejo, delicado y politizado, difícil de entender a través de definiciones normativas, clasificaciones y delimitaciones geográficas. Su desconocimiento, por parte de los profesionales de la salud, puede contribuir a un manejo inadecuado de las pacientes. El trabajo tiene como objetivo argumentar sobre aspectos socioculturales de la Mutilación Genital Femenina, esenciales para su manejo integral por el profesional de la salud. Se recomienda el enfoque, llamado "las cinco P": prevalencia, prevención, protección, persecución y provisión de servicios. Además, se deben evitar las actitudes de reproche o victimización hacia la paciente, así como no promover la medicalización de la práctica.

ABSTRACT The feminine genital mutilation is registered among the harmful traditional practices recognized as form of violence against the women and the girls. Complex topic, the fact that was politicized, difficult to understand through normative definitions, classifications and geographical delimitation. Its ignorance, on the part of the professionals of the health, can contribute to an inadequate handling of the patients, as part of their integral attention. The work takes as an objective to argue on sociocultural aspects of the Feminine Genital Mutilation, essential for its integral handling for the health professional. The approach, called "five P" is recommended: predominance, prevention, protection, pursuit and provision of services. Moreover, the reproach attitudes must be avoided or victimization towards the patient, expression of a euro-central and paternalistic look towards the different, unexpected or unknown; as well as not to promote the medicalization of the practice.

Mutilación genital femenina: un riesgo incrementado por la indiferencia social / Female genital mutilation: an increased risk by social indifference

Resumen La Mutilación Genital Femenina (MGF) constituye una grave violación a los derechos humanos, de la mujer y de la niñez. Si bien se considera una práctica ancestral en algunas culturas, y es justificada y reproducida bajo el relativismo cultural, es un problema que requiere una mayor atención de las instituciones en general y de la salud pública en particular. Colombia es uno de los pocos países en el continente que reporta casos de prácticas de mutilación; sin embargo, el problema es mundial, no solo por los altos flujos de migración de población en alto riesgo en Europa y Norteamérica, sino porque es un imperativo global erradicar de una de las peores formas de violencia contra la mujer.

Abstract Female genital mutilation constitutes a grave violation of human, women and children rights. It is considered an ancestral practice in some cultures, where it is justified and reproduced under the cultural relativism. It is a problem that requires greater attention of the institutions in general and public health in particular. Colombia is one of the few countries in America that reported cases of mutilation practices. However, the problem is global by large flows of high risk migrants to Europe and North America. Its eradication is a global imperative because it is one of the worst types of violence against women.

The Pattern of Female Genital Mutilation in Port Harcourt, Southern Nigeria.

Aims: Female genital mutilation is a harmful traditional practice which is an infringement on the sexual and reproductive rights of women and girls and has profound psychosocial as well as reproductive health morbidities. This study aimed at measuring the change in the incidence of the female genital mutilation in Port Harcourt, South-South Nigeria. Study Design: A cross-sectional study. Place and Duration of Study: Department of ObstetricGynaecology of the University Port Harcourt Teaching Hospital (UPTH) between 1st January and 31st January 2009. Methodology: Five hundred clients were selected randomly and agreed to participate in the study. They were interviewed using a structured questionnaire and examined clinically. Data management was with SPSS 15.0 for Windows statistical software. Results: The prevalence of female genital mutilation (FGM) was 34%. Four hundred and eighty one (96.2%) were aware of female circumcision generally. Ninety five (55.8%) of those circumcised, had it done in infancy. Thirty seven percent of the practitioners of female circumcision were traditional birth attendants while 14.7% were trained health professionals. The commonest reason for female circumcision included reduction of sexual passion/promiscuity and conformity with tradition. Type 1 female genital mutilation was the commonest (58.2%). Among those clients aged 50 years and above, 78.8% had FGM while 9.1% of those aged 10 – 19 years had FGM. This showed a downward trend. Conclusion: Female circumcision is a harmful traditional practice which has remained a serious health problem. Its prevalence is still high in our environment. This study suggests that it is on a downward trend.

Comparison of Demographic and Health Surveys (DHS) on FemaleGenital Mutilation prevalence in African countries / 国際保健医療

<B>Background</B><BR>Female Genital Mutilation (FGM), which can be considered as one of the harmful effects for the health of pregnant women and violence to women, is performed widely as a social custom in some African countries. Therefore, this study aims to clarify the situation of FGM prevalence and a recent trend of African countries by using published health statistics.<BR><B>Method</B><BR>Demographic and Health Survey (DHS) full reports in African countries written in English in which topic of FGM is included and whose comparison was possible between the latest report and the one about ten years ago were obtained. And, indicators regarding FGM were compared by countries and years.<BR><B>Results</B><BR>Of six countries, the prevalence of FGM in five countries had a trend of decline, and their FGM prevalence rates were higher in rural areas than urban. In these countries, wider decline was seen in younger population. For example, in Tanzania, the prevalence changed from 13.5% to 7.1% in 15-19 years old, and from 22.2% to 21.5% in 45-49 years old between 1996 and 2010, respectively. On the other hand, the FGM prevalence of Nigeria was higher in urban areas than rural, and increased in younger women. Some DHS reported the variety of FGM prevalence by places and ethnic groups even in a country.<BR><B>Conclusions</B><BR>In many countries, the decline of FGM prevalence in young women could lead us to expectation of more decreased prevalence in the future. The health education to the young, who will become mothers, could be effective. However, since some countries have different characteristic features in the trend of FGM prevalence, it was suggested that sociocultural background should be individually considered for effective interventions.

Mutilación sexual femenina, características de esta práctica: Features of this practice / Female sexual mutilation:

La práctica de la mutilación sexual femenina (MSF), escisión o circuncisión está abundantemente tratada en la literatura por autores de ciencias sociales, profesionales de la salud, la religión, la literatura, activistas de los derechos de la mujer y víctimas de esta práctica de violencia que se ejerce sobre muchas niñas y mujeres africanas. OBJETIVO: identificar los diversos factores que mantienen su realización y la frecuencia con que se presentan consecuencias físicas y secuelas psicológicas. MÉTODOS: se realizó un estudio descriptivo prospectivo longitudinal, de la totalidad de las pacientes que concurrieron al Servicio de Ginecoobstetricia del Hospital Point G Centro Universitario y de nivel III de atención, entre diciembre de 2006 a diciembre de 2007. El universo de trabajo estuvo constituido por las mujeres a las que se les había realizado la escisión y que luego de ser informadas dieron su consentimiento a ser incluidas. RESULTADOS: se encontró una prevalencia de un 90 por ciento de esta práctica en las pacientes estudiadas. El ama de casa, analfabeta, casada y musulmana, predominó en la muestra estudiada. El 60,8 por ciento de las encuestadas ignoran las complicaciones de su realización. En todos los casos encontramos lesión cicatricial. El 89 por ciento de las pacientes reconocieron trastornos psicosexuales. La tradición y la religión fue el motivo esgrimido para la realización a sus hijas con una diferencia significativa (p<0,001). CONCLUSIONES: es una práctica cultural que perpetúa las injusticias sociales y económicas de las mujeres, alejadas de la atención internacional, violando los derechos humanos.

The practice of female sexual mutilation (FSM), excision or circumcision is abundantly treated in literature by social sciences authors, health professionals, religion, women rights activists and the victims of this violent practice carried out on many African girls and women. OBJECTIVE: to identify the different factors involved in this practice, and frequency of physical consequences and psychological sequelae. METHODS: we made a longitudinal, prospective and descriptive study of all patients seen in Gynecology and Obstetrics Service of the Point G Hospital-University Center, and of III level care, from December, 2006 to December, 2007. Sample included the women with excision and after to be informed they gave its consent to inclusion. RESULTS: we found a 90 percent prevalence of this practice in study patients. In study sample there was a predominance of housewives, illiterates, married, and Muslims. The 60,8 percent of polled patients ignore complications of this practice. In all the cases we found a cicatricial lesion. The 89 percent of patients recognized the presence of psychosexual disorders. Tradition and religion were the causes stated for the carrying out of their daughters with a significant difference (p <0,001). CONCLUSIONS: it is a cultural practice perpetuating the social and economic injustices of women, moved away from international attention, violating thus the human rights.