FGM PREVALENCE FOR AFRICA,ENGLAND AND WALES

1
FGM PREVALENCE FOR AFRICA,ENGLAND AND WALES

Presented by EFUA DORKENOO, OBE
2
Presentation

• Background and definitions
• FGM prevalence among women aged 15-49
• for Africa, England and Wales
• Estimates of girls under 15 at risk of FGM in
  England and Wales
• Where the affected women and girls are
• Study Limitations
• Recommendations

3
What is FGM ?

• Comprises all procedures that involve partial
  or total removal of female external and/or injury
  to the female genital organs for cultural or any
  other non-therapeutic reasons (WHO 1995).

4
WHO 1995 CLASSIFICATION

• Type I Excision of the prepuce and part or all
  of the clitoris
• Type II Excision of the prepuce and clitoris
  together with partial
• or total excision of the labia
  minora
• Type III Infibulation - Excision of part or
  all of the external
• genitalia and stitching of the
  two cut sides together to
• varying degrees
• Type IV Pricking, piercing, incision,
  stretching, scraping, or other
• harming procedures on clitoris or
  labia, or both

5
The need for prevalence data on FGM

• Evidence base
• Policy and Planning
• Targeted interventions
• Evaluation

6
Deriving estimates on FGM prevalence in countries

• National Demographic and Health Surveys (DHS)
• Other studies

7
Who practices FGM?

• 100 140 million girls and women affected in
  more than 28 countries in Africa and parts of the
  Middle East (Yemen). 3 million girls under 15
  years undergo FGM every year (WHO, 2007)
• FGM reported amongst Bohra Muslims in
• India, Pakistan and East Africa,
• Malaysia, Indonesia and Sri Lanka.
• Iraq Kurds
• Immigrant Population in Western countries

8
Estimates of FGM Prevalence in Africa

• FGM Risk Category GROUP 1(i)
• Almost universal FGM, over 30 FGM
  Type III
• Sudan (north)
• Somalia
• Eritrea
• Djibouti

9
Estimates of FGM Prevalence in Africa (cont)

• FGM Risk Category GROUP 1(ii)
• High national prevalence . Over 75 per cent
  prevalence and predominantly Types I and II
• Egypt
• Ethiopia
• Mali
• Burkina Faso
• Gambia
• Guinea
• Sierra Leone

10
Estimates of FGM Prevalence in Africa (cont)

• FGM Risk Category Group 2
• Moderate national prevalence of FGM, 25 -74 per
  cent prevalence and predominantly Types I and II
• Central African Republic
• Chad
• Cote DIvoire
• Guinea Bissau
• Kenya
• Liberia
• Mauritania
• Senegal
• Togo

11
Estimates of FGM Prevalence in Africa (cont)

• FGM Risk Category Group 3
• Low national prevalence of FGM , under 25 per
  cent prevalence and predominantly Types I and II
• Benin, Cameroon, Ghana ,Niger, Nigeria,
  Democratic Republic of Congo, United Republic of
  Tanzania, Uganda.
• Yemen (Middle East).

12
Map of Africa showing FGM risk category for each
country
13
Estimates of prevalence of FGM in England and
Wales

• Lack of data
• A DH funded study to estimate the prevalence of
  female genital mutilation (FGM) in England and
  Wales (2006-2007).
• FORWARD, The London School of Hygiene and
  Tropical Medicine and City University, Department
  of Midwifery.

14
Objectives

• To estimate for residents of England and
  Wales
• 1. Prevalence of FGM among women aged 15 and over
• 2. The estimated numbers maternities which were
  to women who have undergone FGM.
• 3. The numbers of girls aged under 15 with or at
  risk of FGM and the type of FGM

15
Methods

• The numbers of women aged 15-49 resident in
  England and Wales and born in FGM practising
  countries were derived from the 2001 census.
• Estimated age-specific FGM prevalence rates were
  used to estimate numbers with FGM
• Attempts were made to update this using ONS
  Migration Statistics

16
Methods (cont)

• Maternities in the presence of FGM and were
  estimated by applying prevalence rates in
  mothers countries of origin to data from birth
  registration
• Numbers of girls aged under 15 who had been born
  in FGM practising countries, were derived from
  the 2001 census and from female live births from
  1993 to 2004 to mothers from FGM practising
  countries

17
Results

• It was estimated that 65,790 of the 174,528 women
  aged 15-49 resident in England and Wales and born
  in practising countries enumerated in the 2001
  census had undergone FGM.
• These estimates could not be updated as migration
  statistics were inadequate.

18
Results (cont)

• The estimated number of maternities to women who
  had undergone FGM increased from 6,256 in 2001 to
  9,032 in 2004 rising from 1.06 per cent of all
  maternities in 2001 to 1.43 per cent in 2004.

19
Figure 2 Map showing estimated percentage of
maternities to women with FGM in England and
Wales, 2001 and 2004

20
Results (cont.)

• It was estimated that there are at least 24,000
  girls under the age of 15 with or at high risk of
  Type III FGM and nearly 9,000 at high risk of
  Type I or Type II.

21
Where are the affected women and girls ?

• Considerable geographical variation
• Cardiff, Manchester, Sheffield, Northampton,
  Birmingham, Oxford, Crawley, Reading, Slough,
  Milton Keynes and many London boroughs having
  estimated prevalences of more than two per cent
  of maternities to women with FGM by 2004.

22
Discussion

• These are the first systematic estimates of the
  prevalence FGM in England and Wales, but they are
  subject to a number of biases. To gain a clearer
  picture, a survey is needed

23
Conclusion

• Despite their limitations, these estimates
  suggest that the numbers of women living in
  England and Wales with FGM are substantial and
  are increasing.

24
Recommendations

• 1. To provide more reliable estimates of the
  prevalence of FGM in England and Wales, a survey
  should be undertaken.
• 2. Research needs (a) research with women
  and families from practicing countries (b)
  health and social workers (c) the health
  complications particularly the psychological and
  the sexual aspects of FGM and (d) on the
  perception of women with FGM on health services.

25
Recommendations (cont)

• Routine data collection by health and social
  services is needed in order to inform the
  provision of better care and service provision
  for girls at risk of undergoing FGM.
• All Strategic Health Authorities, Primary Care
  Trusts, Acute Trusts and Foundation Hospitals
  should ensure that services including
  commissioning of services in all areas respond to
  the health needs of women and girls with FGM.

26
Recommendations (cont)

• FGM care and prevention should be mainstreamed
  into existing strategies including, sexual health
  strategies and Maternity Improvement Partnership
  working for example, through Local Area
  Agreements.

27
Recommendations (cont)

• FGM is primarily an issue of violence against
  women and an abuse of girl children. Thus FGM
  should be given equal status with other forms of
  child abuse. All Social Services, Health,
  Education and the Police Child Protection Units
  should update their child protection policy and
  procedures to include FGM.

28
Recommendations (cont)

• FGM prevention and care should be fully
  mainstreamed into the government child care
  provisions through the implementation of Every
  Child Matters and into the National Service
  Framework for Children, Young People and
  Maternity Services (NSF).

29
Recommendations (cont)

• All education and training programmes on child
  abuse and reproductive and sexual health care
  should incorporate FGM .
• FGM education should be incorporated into the
  core curricula of professionals in social,
  health, education and the police.

30
Recommendations (cont)

• FGM prevention should be integrated into the work
  of the joint Home Office and Foreign and
  Commonwealth Office Unit on Forced Marriages as
  FGM occurs in similar context

31
Recommendations (cont)

• The voluntary sector and community groups
  involvement is crucial to address issues of
  prevention as well as delivery of services that
  take FGM issues into account. Thus community
  action on FGM should be strengthened and promoted
  for all the FGM practising communities.

32
Recommendations (cont)

• FGM prevention should be integrated into the
  broader government policy and national strategy
  aimed at addressing Violence against Women (VAW).
  
• Performance indicators on FGM for the various
  sectors should be identified for monitoring the
  progress of implementation of policy.

33
Resources

• Department of Health DVD for health professionals
• Useful websites, technical materials and
  guidelines
• WHO - http//www.who.int/reproductive-health/
• BMA, RCOG, RCN,RCM
• NGO

34
Acknowledgements

• Study on FGM Prevalence in England and Wales
• Principal investigators
• Efua Dorkenoo - FORWARD
• Linda Morison - LSHTM
• Prof. Alison McFarlane- City University
  Department of Midwifery
• FORWARD (for full report of study)
• Department of Health
• ONS Staff

35
(No Transcript)