Female Genital - WHO
00388-WHO-Teachers Guide-Cover17/10/015:16 pmPage 1WHO/FCH/GWH/01.3WHO/RHR/01.16Dist.: GeneralOriginal: EnglishA Teacher’s GuideAn estimated 100-140 million girls and women in the worldtoday have undergone some form of female genitalmutilation (FGM), and 2 million girls are at risk from thepractice each year. Female genital mutilation violates thehuman rights of girls and women and it is a grave threat totheir health. The great majority of affected women live in subSaharan Africa, but the practice is also known in parts of theMiddle East and Asia. Today, women with FGM are increasinglyfound in Europe, Australia, New Zealand, Canada and theUnited States largely as a result of migration. The range ofcomplications – physical, psychological and sexual – associatedwith female genital mutilation is wide and some are severelydisabling. Skilled and sensitive management by healthworkers is required, yet FGM is rarely mentioned or covered indetail in the training curricula of health personnel. WHO iscommitted to filling these gaps in professional education.Nurses and midwives are often the primary care givers, and inmany circumstances they may be the only trained healthworkers available. The set of training materials (teacher’sguide, student’s manual and policy guidelines) have beenproduced to build the capacity of health personnel to preventand to manage the health complications of FGM. It is hopedthat bringing FGM into mainstream education for healthprofessionals will increase the pressure for the elimination ofthe practice.World Health OrganisationDepartment of Gender and Women’s HealthDepartment of Reproductive Health and ResearchFamily and Community HealthWorld Health OrganizationGenevaFemale Genital Mutilation A Teacher’s GuideFemale GenitalMutilationFemale GenitalMutilationIntegrating the Prevention and theManagement of the HealthComplications into the curricula ofnursing and midwifery.A Teacher’s GuideDepartment of Gender and Women’s HealthDepartment of Reproductive Health and ResearchFamily and Community HealthWorld Health OrganizationGeneva
WHO/FCH/GWH/01.3WHO/RHR/01.16Dist: GeneralOriginal: EnglishFemale GenitalMutilationIntegrating the Prevention and theManagement of the HealthComplications into the curricula ofnursing and midwifery.A Teacher's GuideDepartment of Gender and Women’s HealthDepartment of Reproductive Health and ResearchFamily and Community HealthWorld Health OrganizationGeneva
FEMALE GENITAL MUTILATIONTEACHERS GUIDE3TABLE OF CONTENTSACKNOWLEDGEMENTSFOREWORD.4.5Session 1: Assessment to identify physicalcomplications due to FGM . . . . . . . . . . . . . . . . . . 79Session 2: Management of clients with physical.6complications of FGM . . . . . . . . . . . . . . . . . . . . . 83Who is the Teacher’s Guide for? . . . . . . . . . . . . . . . . . .6Session 3: Using counselling skills . . . . . . . . . . . . . . 89How is the Teacher’s Guide organized? . . . . . . . . . . . 6Session 4: Identifying psychosocial and sexualINTRODUCTIONHow should the modules be used? . . . . . . . . . . . . . . 7Teaching/learning activities . . . . . . . . . . . . . . . . . . . . . 7Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9complications of FGM . . . . . . . . . . . . . . . . . . . . . 93Session 5: Management of girls or womenwith psychosocial and sexual complicationsof FGM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96SUMMARY OF SESSIONS . . . . . . . . . . . . . . . . . . . . . . . . 11Session 6: Demonstrating referral skills . . . . . . . . . . 99Session 7: Use of family planning in theMODULE 1: INTRODUCTION TO FEMALEGENITAL MUTILATIONpresence of FGM . . . . . . . . . . . . . . . . . . . . . . . . . 101Session 8: The procedure for opening up typethree FGM (infibulation) . . . . . . . . . . . . . . . . . . 104General objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Essential competencies . . . . . . . . . . . . . . . . . . . . . . . 21Session 1: Analysing and influencing traditions . . . . 23Session 2: Description and background of FGM . . . 29Session 3: Complications of FGM . . . . . . . . . . . . . . 43Session 4: Professional ethics and legalimplications of FGM . . . . . . . . . . . . . . . . . . . . . . . 46Session 5: Human rights and FGM . . . . . . . . . . . . . 49MODULE 4: MANAGEMENT OF WOMEN WITHFGM DURING PREGNANCY, LABOUR, DELIVERYAND THE POSTPARTUM PERIODGeneral objectives . . . . . . . . . . . . . . . . . . . . . . . . . . 109Essential competencies . . . . . . . . . . . . . . . . . . . . . . 109Session 1: Assessment and management ofwomen with complications due to FGMMODULE 2: COMMUNITY INVOLVEMENT INTHE PREVENTION OF FEMALE GENITALMUTILATIONduring pregnancy . . . . . . . . . . . . . . . . . . . . . . . . 111Session 2: Obstetric complications due to FGMduring labour and delivery . . . . . . . . . . . . . . . . . 115Session 3: Assessment and management ofGeneral objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Essential competencies . . . . . . . . . . . . . . . . . . . . . . . 53Session 1: Beliefs, values and attitudes . . . . . . . . . . . 55Session 2: Traditional beliefs, values and attitudeswomen with FGM during labour anddelivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117Session 4: Management of women with FGMduring the postpartum period . . . . . . . . . . . . . . 122towards FGM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62Session 3: Strategies for involving individuals,families and communities in the preventionof FGM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66Session 4: Strategies for involving politicaland government leaders in the preventionof FGM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71APPENDIX :1: Case studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1272: Taking History of a Womanor Girl with FGM – Checklist . . . . . . . . . . . . . . . 1313: Physical Examination of a Womanor Girl with FGM – Checklist . . . . . . . . . . . . . . . 132MODULE 3: MANAGEMENT OF GIRLS ANDWOMEN WITH FGM COMPLICATIONS4: Counselling a Woman or Girlwith FGM – Checklist . . . . . . . . . . . . . . . . . . . . . 1335: The Procedure for Opening up Type IIIGeneral objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Essential competencies . . . . . . . . . . . . . . . . . . . . . . . 77FGM (Infibulation) – Checklist . . . . . . . . . . . . . 1346: Teaching and learning resources . . . . . . . . . . . . 136
4FEMALE GENITAL MUTILATIONTEACHERS GUIDEACKNOWLEDGMENTSThis document is part of a set of training materials (Teacher’s Guide, student manual andpolicy guidelines) which have been prepared by the World Health Organization (WHO) tofacilitate training for health personnel on female genital mutilation.Acknowledgement goes to the technical team – Ms Efua Dorkenoo O.B.E., Ms StellaMpanda and Ms Feddy Mwanga who prepared the materials.The project would not have been successful without the technical inputs from thefollowing nurses and midwives; we would therefore like to acknowledge the importantcontribution made by the following: Ms Buthina Abdel Gadir Mohamed, Ms NikkiDenholm, Ms Fadwa Affara, Ms Comfort Momoh, Ms Lisbet Nybro Smith, Ms KowserOmer-Hashi, Ms Fathia Ibrahim, Dr Christine Adebajo, Ms Yasin S.Ceesay, Dr OmangondoO. Ngenge, Dr Gaynor D. Maclean, Ms Valerie J. Tickner, Ms Emma Banga and Dr NaemaAl-Gasseer. The contribution from nurses, midwives and doctors who helped with fieldtesting of the materials as well as input received from the International Council of Nurses(ICN) and the International Confederation of Midwives (ICM) are greatly appreciated.Thanks to Dr Heli Bathijah for her review comments and to Mr Simeon Obidairo for hiscontribution to the human rights section. Thanks also to Sue Armstrong and JillianAlbertolli for assisting with the editing.The project could not have been successful without funding support from UNFIP, DFID,and AUSAID. The Organization gratefully acknowledges their timely support.Clinical photographs: Dr Harry Gordon“Tradition! Tradition!” Efua Dorkenoo, FORWARD (1992)Cover photograph: Courtesy of A.I.Design: Mr Caleb Rutherford – eidetic Copyright World Health Organization, 2001This document is not a formal publication of the World Health Organization (WHO),and all rights are reserved by the Organization. The document may, however, be freelyreviewed, abstracted, and translated in part or whole, but not for sale nor for use inconjunction with commercial purposes.Department of Gender and Women’s HealthDepartment of Reproductive Health and ResearchFamily and Community HealthWorld Health OrganizationGeneva
FEMALE GENITAL MUTILATIONTEACHERS GUIDE5FOREWORDAn estimated 100 to 140 million girls and women inalone covered in detail, in the training curricula ofthe world today have undergone some form of femalenurses, midwives and other health professionals. WHOgenital mutilation, and 2 million girls are at risk fromis committed to filling these gaps in professionalthe practice each year. The great majority of affectededucation by producing a range of training materials towomen live in sub-Saharan Africa, but the practice isbuild the capacity of health personnel to prevent and toalso known in parts of the Middle East and Asia. Today,manage the health complications of FGM.women with FGM are increasingly found in Europe,These materials are dedicated to all the girls andAustralia, New Zealand, Canada and the United Stateswomen who suffer – very often in silence – theof America, largely as a result of migration frompersonal violation and pain of FGM, and to thosecountries where FGM is a cultural tradition.committed to their care and the relief of their suffering.FGM covers a range of procedures, but in the greatThough much has been achieved over the past twomajority of cases it involves the excision of the clitorisdecades in lifting the veil of secrecy surrounding FGM,and the labia minora. At its most extreme, thethere is still an enormous amount to be done toprocedure entails the excision of almost all the externalprovide quality services to those affected, and togenitalia and the stitching up of the vulva to leave onlyprevent other little girls and women from adding toa tiny opening. Whatever form it takes, FGM is atheir numbers. It is hoped that bringing FGM intoviolation of the human rights of girls and women; andmainstream education for health professionals willit is a grave threat to their health.increase the pressure for elimination of the practice,The complications of FGM – physical, psychological,and sexual – require skilled and sensitive managementwhile at the same time throwing out a lifeline to thosewho have felt isolated with their problems for so long.by health care workers, yet FGM is rarely mentioned, letDr Tomris TürmenExecutive DirectorFamily and Community HealthWorld Health Organization, Geneva
6FEMALE GENITAL MUTILATIONTEACHERS GUIDEINTRODUCTIONThis document has been prepared by WHO as ateaching guide for those responsible for the training ofModule 1: Introduction to FGMThis is the foundation module. It can be integratednurses and midwives. It was developed in response to ainto medical/surgical nursing and courses inproposal on female genital mutilation (FGM) in whichgynaecology, community health and midwifery innurses and midwives expressed the need for acquiringplaces where FGM is practised. The module may alsoknowledge and skills that would assist them to preventbe used with health personnel and other relevantthe practice and to manage girls and women withgroups during workshops or in-service education toFGM complications. The Teacher’s Guide is intendedraise awareness on FGM.for use in conjunction with the student manual andthe policy guidelines.The Teacher’s Guide and the student manualprovide strategies for the prevention of FGM and theModule 2: Community involvement in the preventionof FGMThis module can be integrated into communityknowledge and skills necessary for nurses andhealth nursing and community midwifery courses inmidwives to manage clients with FGM complications.places where FGM is practised.Besides covering theory and principles, they providestep by step guide to assessment, counselling, referralof clients, and to the opening up of Type III FGM. Thepolicy guidelines is intended for use primarily by thoseresponsible for developing policies and directingnursing and midwifery practice.Module 3: Management of girls and women withFGM complicationsThis module can be integrated into child health,human growth and development, and gynaecologycourses for both nurses and midwives. The practicalskills can be learned in maternal and child health andWho is the Teacher’s Guide for?The Teacher’s Guide is intended for use primarilyby the teachers of nurses and midwives who areproviding basic, post-basic or in-service training. Itwill also be of use to those responsible for educatingand training medical students, clinical officers, publichealth officers, and other health care providers.How is the Teacher’s Guideorganized?The guide consists of four modules on FGM forteachers to integrate into their different courses. Themodules are as follows:family planning clinics. Counselling skills can bepractised also in youth centres and in schools, wherecounselling services are part of health programmes foryoung people. This module may also be used insexually transmitted diseases (STDs) and HIV/AIDSprogrammes in areas where FGM is practised.Module 4: Management of women with FGM duringpregnancy, labour and delivery, and the postpartumperiodThis module can be integrated into midwifery andobstetric courses. The practical skills can be learned inantenatal clinics, maternity units, labour wards, andpostnatal clinics.Each module is organized as follows:
FEMALE GENITAL MUTILATIONTEACHERS GUIDE brief introduction to the issues coveredTeachers are advised to: how the module can be used the general objectives basic qualifications for the module – i.e. the use this teaching guide in conjunction with thestudent manual, and the “policy guideline” use the suggested time allocations, session contents,knowledge and skills students will need to have inteaching and learning activities and resources asorder to understand the moduleguidelines and make adjustments as necessary toessential competencies – i.e. the knowledge and skillssuit the situationstudents are expected to acquire from the module 7 suggested teaching methods, teaching aids, andreference materials.use case studies drawn from real life locally wherepossible, or else use those provided in the guideline make use of appropriate reference materials andteaching resources available locally.Each module is divided into separate sessions, orlessons, which are listed in the introductory section tothe module. In addition, tables summarising the sessionsTeaching/learning activitiesBecause FGM is an extremely sensitive subject, it isin each module are given at the beginning of theimportant that students have the opportunity to shareTeacher’s Guide. They include the following information:their own experiences, ideas, beliefs and cultural values as suggested timings for each sessionmuch as possible. Besides being an effective method of lists of topicslearning, this helps to reduce anxieties. The teaching teaching/learning activitiesmethods proposed in this guide are therefore designed to teaching/learning resourcesbe participatory. Suggestions for teaching/learning evaluation methods.activities include:How should the modules be used?The contents of the four modules may beThe lecture –This is a brief talk, used to introduce a session orintegrated into existing training curricula for nursestopic or provide new information. It can also be used toand midwives and in medical training. The modulessummarise ideas given by students after a group discus-may also be used as complete courses during in-servicesion or assignment. However, such talks by teacherseducation. They may also be adapted for use withshould be kept to a minimum to allow students as muchhealth personnel and other relevant groups duringtime as possible to participate and share their own ideas.workshops or in in-service education to raise theirawareness on FGM.Small group discussions –These are exercises in which students divide up intoThe contents of the summary of eachgroups of six to eight people to discuss an issue betweenmodule may be integrated into thethemselves and come up with a common viewpoint.training curricula of nurses andStudents should be given a specific assignment to workmidwives, and the contents in eachon, time to complete it, and instructions on presentation.session may be used during teachingAfter the groups have presented their work, the teacher/and learning sessions.facilitator should summarise. Small group discussionsare particularly good for teaching about sensitive issues.
8FEMALE GENITAL MUTILATIONTEACHERS GUIDEBuzz group discussions –These are brief discussions between two or threestudents, designed mainly to encourage participation.Students may work singly or in groups on theseassignments, but a crucial part of the exercise issharing their analysis with the class.Students just turn to their neighbours to discuss agiven subject for a short time before sharing theirthoughts and ideas with the whole class. This exerciseRole play and drama –For these activities, students are given a range of rolescan be used at any time in a session, as appropriate,to play in mini dramas in order to give them insightsand is particularly useful for preventing boredominto different people’s situations and points of viewduring long sessions.regarding FGM. They may, for example, be asked to playthe role of a nurse counselling clients in a clinic, orPlenary, or large group, discussions –These are sessions in which the teacher engages thediscussing family planning options with an excisedwoman. A role playing exercise should be well-planned;whole class in brainstorming about an issue, or instudents should understand the objective and knowdiscussing the feedback from small group work. Largewhat it is they are expected to act. After acting theygroup discussion can be used to evaluate the students’should be given time to share their feelings and percep-understanding of the session. They can also be used astions before their fellow students give their comments.forums for debating controversial issues.Besides allocating roles directly, teachers may wish towork together with students on translating stories orThe summary –actual case studies into dramas they can act out.This is a very important activity. At the end ofevery session, the teacher should summarise what hasbeen taught, and relate this to the stated objectives ofStory telling –This is used to explore attitudes and values. Thethe session. The teacher may ask the class to do themodules include stories that illustrate many differentsummary or answer questions on the session they haveaspects of FGM which the teacher or student can telljust completed in order to check that they haveto the class.understood everything.Simulation games and exercises –Case studies –For this exercise, students are given theopportunity to share real-life case studies from thecommunity or clinic with others in the classroom.Where this is not feasible, fictional cases can be usedfor classroom discussion.These are make-believe situations in which theteacher asks a student to perform a procedure. Theseexercises are particularly effective at teaching skills. It isimportant that the teacher makes it clear exactly whatskill is being taught. In each module there is anindication of where simulation games and exercisesmay be used.Scenarios and situation analysis –For this activity, students are given ca
FEMALE GENITAL MUTILATION 5 TEACHERS GUIDE FOREWORD Dr Tomris Türmen Executive Director Family and Community Health World Health Organization, Geneva. This document has been prepared by WHO as a teaching guide for those responsible for the training
Promoting genital autonomy by exploring commonalities between male, female, intersex, and cosmetic female genital cutting J. Steven Svoboda*1 Attorneys for the Rights of the Child, Berkeley, CA, USA All forms of genital cutting – female genital cutting (FGC), intersex genital cutting,
Ritual female genital mutilation: management of women during the reproductive years Introduction The term female genital mutilation (FGM), also called female genital cutting or female circumcision, includes all procedures . modifications were incorporated in order to avoid ambiguities
Gross anatomy of female genital organs-1. Gross anatomy of female genital organs-2. Development of female genital organs and tract. Histology. Normal Pap smear under microscopy. . Pathology of female reproductive system Ovaries- neoplastic diseases, cysts (torsion), endometriosis, hemorrhagic corpus
Female genital mutilation/cutting (FGM/C) is an umbrella term for any procedure of modification, partial or total removal or other injury to the female genital organs for non-medical reasons [1]. In 1990 the Inter-African Com-mittee on Traditional Practices Affecting the Health of Women and Children adopted the term 'female genital mutilation'.
Female Genital Surgeries in Africa By THE PuBlIC POlICy ADVISORy NETwORK ON FEMAlE GENITAl SuRGERIES IN AFRICA western media coverage of female genital modifications in Africa has been hyperbolic and one-sided, presenting them uniformly as mutilation and ignoring the cultural complexities that underlie these practices.
20 ‘‘(41) FEMALE GENITAL MUTILATION.—The 21 terms ‘female genital mutilation’, ‘female genital 22 cutting’, ‘FGM/C’, or ‘female circumcision’ mean the 23 intentional removal or infibulation (or both) of either 24 the whole or part of the external female genitalia for 25 non-medical reasons. External female
children, because of the observation in adults that most genital warts contain HPV types 6/11 (and less commonly types 16 and 18) while warts on the hands contain HPV types 1-4 [8, 9]. If genital warts in children are caused solely by sexual abuse, the same HPV types should be found in genital warts in children and adults.
Female Genital Mutilation (FGM) also known as Female Genital Cutting (FGC) is a severe violation of girl‟s and women‟s human rights. Waris Dirie –Desert Flower –“Female Mutilation has no cultural, no traditional and no religious aspect. It is a crime which seeks justice.” FGM is p
