1. FEMALE GENITAL MUTILATION Amber Blumling BSN, RN, CEN PA ENA Horizon’s Conference 2016

2. LEARNING OBJECTIVES What is Female Genital Mutilation (FGM) Different types of FGM Health consequences of FGM Identify at risk populations Global initiatives to end FGM Resources in the U.S. for victims of FGM http://godandwheatgrass.com/2015/02/no-tolerance-female-genital-mutilation-story/

3. WHAT IS FGM?

4. WHAT IS FGM All procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons (WHO, UNICEF, UNFPA, 1997) Classified into Type I-III based on anatomical extent of the cutting Type IV - All other harmful procedures to the female genitalia for non-medical purposes

5. Type I Type IIType III Normal All Images from: http://pediatrics.aappublications.org/content/102/1/153http://pediatrics.aappublications.org/content/102/1/153 TYPES OF FGM

6. PREVALENCE OF FGM

7. Unicef, 2013 Percentage of girls and women aged 15 to 49 years who have undergone FGM/C

8. TOP 10 AT RISK IMMIGRANT GROUP IN THE U.S. ACCORDING TO U.S. CITIZENSHIP AND IMMIGRATION SERVICES 1. Egypt 2. Ethiopia 3. Somalia 4. Nigeria 5. Liberia 6. Sierra Leone 7. Sudan 8. Kenya 9. Eritrea 10. Guinea

9. STATISTICS ON FGM IN THE U.S. 507,000 U.S. women and girls who had undergone FGM/C or were at risk of the procedure (PRB’s data analysis U.S. Department of Citizenship &Immigration Services) Egypt, Ethiopia, and Somalia accounted for 55 percent of all U.S. women and girls at risk in 2013 Combination of high FGM/C prevalence rates and a relatively large number of immigrants Girl with immigrant parents from high risk areas are at high risk and often cut while on vacation to family country of origin

10. WHY FGM CONTINUES

11. CULTURAL BELIEFS BEHIND FGM Rite of passage Preserving chastity Ensuring marriageability Religion Hygiene Improving fertility Enhancing sexual pleasure for men Tradition http://28toomany.org/about-28toomany/what-we-do/

12. HEALTH CONSEQUENCES OF FGM

13. SHORT-TERM HEALTH CONSEQUENCES Severe pain Hemorrhage Shock Genital tissue swelling Infections HIV Urinary problems Psychological consequences Death http://period4isujackb.weebly.com/victims.html

14. LONG-TERM HEALTH CONSEQUENCES Pain from tissue damage and scarring Infections Chronic Genital Infections Chronic Reproductive Tract Infections UTI HIV Dysuria Menstrual Problems Keloids Sexual Health, Obstetric, & Perinatal Complications Psychological Consequences https://blacknotwhitedippedinchocolate.wordpress.com/2013/08/

15. GLOBAL INITIATIVES TO END FGM

16. UNITED NATIONS INTERNATIONAL HUMAN RIGHTS LAW Human Rights Instruments Universal Declaration of Human Rights Civil and Political Rights Covenant Economic, Social and Cultural Right Covenant Treaties Children’s Rights Convention Convention on the Elimination of all Forms of Discrimination against Women Banjul Charter European Convention Declarations Declaration on the Elimination of Violence Against Women Programme of Action of the ICPD Beijing Declaration and Platform for Action Note: Under international human rights law, governments are bound to refrain from violating people’s rights and ensuring that rights are universally enjoyed in their jurisdictions. Governments are held responsible for failing to take steps to prevent the practice of FGM

17. CHANGING CULTURAL NORMS Local Campaigns Advocacy National Laws against FGM Enforcement of punishment for parents and practitioners Campaigns International World Health Organization United Nations Children’s Fund (UNICEF) United Nations Population Fund (UNFPA)

18. U.S. INITIATIVES TO END FGM

19. U.S. LAW ON FGM Congress passed in 1996 making it illegal to perform FGM/C 23 states have laws against the practice Against the law to perform FGM/C in the United States on a girl under the age of 18 or to send or attempt to send her outside the United States so FGM/C can be performed.

20. RESOURCES IN THE U.S. U.S. Citizenship & Immigration Services www.uscis.gov 1-800-994-9662 Equality Now Americas Office www.equalitynow.org 212-586-0906 info@equalitynow.org U.S. Aid www.usaid.gov compliance@usaid.gov U.S. Administration for Children and Families - Office of Refugee Resettlement www.acf.hhs.gov 202-401-9246 U.S. Department of Health and Human Services - Office on Women’s Health www.womenshealth.gov 800-994-9662 Federal Bureau of Investigation www.fbi.gov 202-324-3000

21. LIFE AFTER FGM

22. UNICEF SPEAKING OUT AGAINST FGM https://youtu.be/Pjy8jRRGHcU

23. Questions?

24. REFERENCES Center for Reproductive Rights. (2006). Female genital mutilation: A matter of human rights. Retrieved from http://www.reproductiverights.org. http://www.reproductiverights.org Council on Child and Adolescent Health. (1998). Female genital mutilation. Pediatrics, 102 (1). Retrieved from http://pediatrics.aappublications.org/content/102/1/153 http://pediatrics.aappublications.org/content/102/1/153 Daughters of Eve. (2015). About FGM. Retrieved from http://www.dofeve.org/about-fgm.html.http://www.dofeve.org/about-fgm.html Equality Now. (2015). Female genital mutilation (FGM). Retrieved from http://www.equalitynow.org. Nuor, N. (2008). Female genital cutting: A persisting practice. Reviews of Obstetrics & Gynecology, 1(3), 135-139. NHS Choices. (2015). Female genital mutilation. Retrieved from http:www.nhs.uk. Orchid Project. (2016). Orchid project. Retrieved from http://orchidproject.org.http://orchidproject.org U.S. Citizenship & Immigration Services. (2016). Female genital mutilation or cutting (FGM/C). Retrieved from https://www.uscis.gov/humanitarian/female-genital-mutilation-or-cutting-fgmc https://www.uscis.gov/humanitarian/female-genital-mutilation-or-cutting-fgmc World Health Organization. (2014). Female genital mutilation. Retrieved from http:www.who.int/mediacentre/factsheets/fs241/en/. World Health Organization. (2016). Classification of female genital mutilation. Retrieved from http://www.who.int/reproductivehealth/topics/fgm/overview/en/ http://www.who.int/reproductivehealth/topics/fgm/overview/en/ World Health Organization. (2016). Female genital mutilation. Retrieved from http://www.who.int/mediacentre/factsheets/fs241/en/http://www.who.int/mediacentre/factsheets/fs241/en/