Gynaecological services for women suffering from female genital mutilation complications

UNICEF and the Global Affairs Canada support girls and women who are victims of female genital mutilation in rural Afar.

Endale Engida
Fatima arrived at Ayssaita Hospital complaining of pain during sexual intercourse.
UNICEF Ethiopia/2022/NahomTesfaye
07 March 2022

25-year-old *Fatima arrived at Ayssaita Hospital complaining of pain during sexual intercourse. Like nearly all girls in Afar region, Fatima has undergone through a severe form of FGM when she was 6-month-old baby. Since then, she has had difficulty urinating properly. Growing up, she also started to feel pain especially during menstruation lasting for a week.

Fatima has been married two times. She divorced her first husband after 3 months due to difficulty having sexual intercourse. Then, her family arranged her second marriage, to a man’s 14 years her senior, married, and with children from his 1st wife.  He also encountered the same difficulties during sexual intercourse and raised the issue to Fatima’s brother, Nuru.  Fatima’s brother was determined to help his sister and he asked around and discovered that the hospital in their woreda (district) provide gynaecological service specialized in helping women subjected to infibulation.

During the physical examination, it became clear that Fatima’s vagina was completely blocked.  An ultrasound identified sandy stones in both kidneys and a thickened bladder hole for which a follow up appointment was given. She was then put on antibiotics for one week after which Dr Abreha counseled Fatima and her family for deinfibulation. During the procedure, significant retained fluid was released also easing the pain and discomfort.   

Dr. Hatse Abreha, gynaecologist at Ayssaita primary hospital, Afar region assisting girls and women with health complications due to FGM.
UNICEF Ethiopia/2022/NahomTesfaye
Dr. Hatse Abreha, gynaecologist at Ayssaita primary hospital, Afar region assisting girls and women with health complications due to FGM.

On next day she was discharged with medication, an appointment, and a medical certificate. After a careful period of outpatient follow up visits, Fatima was cured.

“We have special gratitude to Dr. Abreha for his friendly care and follow up,” brother Nuru said during a follow up visit. “We are here to teach our community not to practice FGM for girls and our own children not to be victims of FGM.”

“I won't cut my daughter in the future. I am very happy to have gone through surgery and I am thankful for the organization working on this,” Fatima said.

 “I want to see to it that these innocent girls and women are no longer victims of FGM. These types of interventions are only part of the solution and will not solve the root cause of the problem,” Dr. Abreha said.

 Nationwide, the prevalence of FGM in Ethiopia has decreased over the past 20 years, dropping from 80 per cent in the 2000 to 65 per cent in the 2016. An encouraging trend shows that while 65 per cent of women and girls aged 15–49 years were cut, 47 per cent of girls aged 15–19 years, and 16 per cent of girls under 15 years were circumcised (EDHS 2016). However, the prevalence of FGM is still highest in Somali (99 per cent ) and Afar (91 per cent ). These are also the two regions with the highest rates of type III infibulation, whereby the vaginal opening is partially sewn.

In 2014, the Ethiopian Government committed to end the practice by 2025 - refreshed its commitment to end FGM and child marriage by 2025 at the London Global Girls’ summit and has been working on public information campaigns in high prevalence regions. Penalties for carrying it out range from three to 10 years of prison.

Clinical management of FGM trained Tesfaye Tebeje, Midwifery, project- supported FGM equipment to conduct deinfibulation on a patient at Ayssaita district Hospital.
UNICEF Ethiopia/2022/NahomTesfaye
Clinical management of FGM trained Tesfaye Tebeje, Midwifery, project- supported FGM equipment to conduct deinfibulation on a patient at Ayssaita district Hospital.

For girls like Fatima who have already undergone the procedure, the gynaecological service, at the Ayssaita Woreda hospital is a life saver.

Through generous funds from the Global Affairs Canada, UNICEF has capacitated 60 health providers at hospitals, 283 working at health centres, and 850 Health Extension Workers working at health posts in Afar and Somali regions on prevention, care, and treatment of FGM.  Hospitals also received essential FGM and maternal health equipment like midwifery kits, operation lights, FGM job aids and training manuals.

The hospital, which serves mostly pastoral population of 150,000, can now treat gynaecological and obstetric cases, including provision of quality clinical management service for FGM victims. Between April- Dec 2021, the hospital treated 190 FGM cases, attended 100 deliveries and provided postnatal care service for 100 clients. In many cases, FGM victims are discharged the same day after the surgery.

*Name changed to protect privacy