AN INVESTIGATION INTO THE IMPACT OF FEMALE GENITAL MUTILATION ON WOMEN’S REPRODUCTIVE HEALTH IN CAMEROON

CHAPTER ONE

INTRODUCTION

Background of the study

Female Genital Mutilation (FGM), also known as female circumcision or female genital cutting, is a longstanding cultural practice that entails the partial or complete excision of the external female genitalia or other harm to the female genital organs for non-medical purposes (World Health Organisation [WHO], 2023). This tradition has endured for millennia, mostly in Africa, the Middle East, and some regions of Asia, often serving as a rite of passage, a method of regulating female libido, or a condition for marriage. Female genital mutilation (FGM) is recognised globally as a breach of human rights and a manifestation of gender-based violence, often performed on minors without permission, resulting in both immediate and enduring health repercussions. Female genital mutilation (FGM) is categorised into four primary types: Type I (clitoridectomy), Type II (excision), Type III (infibulation), and Type IV (all other detrimental treatments affecting the female genitalia for non-medical reasons, including pricking or cauterisation). The incidence of FGM varies by nation, however it persists extensively in areas like sub-Saharan Africa and some sections of the Middle East, where cultural, religious, and societal influences sustain its continuation. In nations such as Somalia, Guinea, and Djibouti, more than 90% of women and girls aged 15 to 49 have had female genital mutilation (United Nations Children's Fund [UNICEF], 2022). Notwithstanding extensive endeavours to eliminate FGM, the practice persists, impacting over 4 million girls each year (UNICEF, 2022). The health ramifications of FGM are considerable and complex. Immediate consequences include intense pain, profuse haemorrhaging, shock, and even fatal outcomes in extreme instances. The technique is often performed in non-sterile environments by untrained individuals, increasing the risk of diseases such tetanus and sepsis (WHO, 2023). In the long run, women who have had FGM may endure persistent health concerns, including as urinary and menstrual disorders, recurring infections, and childbirth-related issues. Women with FGM are much more prone to difficulties during labour and delivery, including protracted labour, postpartum haemorrhage, and perineal rips, which elevate the risk of obstetric fistula and infant distress (Banks et al., 2021). The psychological effects of FGM are significant. Women who have had female genital mutilation (FGM) have heightened susceptibility to anxiety, depression, post-traumatic stress disorder (PTSD), and sentiments of betrayal or violation, especially if the surgery was conducted without their permission during childhood (Berg & Denison, 2012). Moreover, the reduction of sexual pleasure and the onset of dyspareunia resulting from scarring and constriction of the vaginal opening may cause challenges in personal relationships and a decreased quality of life (Abdel-Azim, 2020). Initiatives to combat the practice of FGM have persisted for decades, with several international and local organisations striving to enhance awareness, legislate, and execute initiatives focused on its eradication. The WHO, UNICEF, and the UNFPA have led efforts to eliminate FGM by encouraging community education initiatives and legal measures to safeguard girls and women (UNICEF, 2022). In recent years, several nations have enacted legislation against FGM; nevertheless, enforcement is patchy, and the practice often endures owing to entrenched cultural beliefs and societal pressures. Besides health issues, FGM has considerable social and economic repercussions. Women experiencing difficulties from FGM often encounter shame, discrimination, and diminished access to school and work, hence reinforcing cycles of poverty and inequality (Shell-Duncan et al., 2018). In areas where FGM is common, limited access to healthcare worsens the issue, as women experiencing FGM-related complications may not obtain sufficient medical care due to a shortage of healthcare facilities or the lack of qualified professionals equipped to address these conditions. Notwithstanding heightened awareness and international initiatives, female genital mutilation persists, placing millions of girls at danger each. The researcher, therefore sought to investigate the impact of female genital mutilation on women’s reproductive health in Cameroon.

1.2 Statement of the problem

Female Genital Mutilation (FGM), characterised as the partial or complete excision of the external female genitalia or other harm to the female genital organs for non-medical purposes, persists as a widespread concern in several regions globally. Notwithstanding global and local efforts to eradicate this practice, it is estimated that over 200 million girls and women now living have experienced some kind of female genital mutilation (FGM), especially in areas like as Africa, the Middle East, and Asia (World Health Organisation [WHO], 2023). The continuation of FGM is mostly driven by cultural beliefs, societal pressures, and gender inequity, resulting in severe repercussions for women's reproductive health. The health consequences of FGM are vast and often enduring, including immediate issues such as acute pain, haemorrhaging, and infections, as well as long-term impacts including birthing difficulties, heightened risk of infant mortality, and psychological trauma (WHO, 2023). Research indicates that women who have had FGM are at an increased risk of problems during labour and delivery, potentially resulting in obstetric fistula, perinatal distress, and maternal death (Berg et al., 2019). Furthermore, FGM may result in the formation of cysts, persistent pelvic infections, and sexual dysfunction, significantly affecting a woman's quality of life and psychological health (Banks et al., 2021). Despite the considerable health hazards linked to FGM, there exists a deficiency in comprehending its comprehensive effects on women's reproductive health, especially in areas where data collecting is constrained or cultural traditions obstruct candid discourse.  Hence, the need to  investigate the impact of female genital mutilation on women’s reproductive health in Cameroon.

1.3 Objective of the study

The broad objective of the study is to investigate the impact of female genital mutilation on women’s reproductive health in Cameroon. The specific objectives is as follows

To assess the prevalence of  FGM  among women in Cameroon

To examine the perceived reasons for female genital mutilation in Cameroon

To identify the reproductive health complications associated with FGM in Cameroon.

To investigate the impact of FGM on fertility rates and reproductive functions among affected women in Cameroon

To recommend strategies for improving reproductive healthcare for women affected by FGM

1.4 Research questions

The following questions have been prepared to guide the study

Is there a prevalence of  FGM  among women in Cameroon?

What are  the perceived reasons for female genital mutilation in Cameroon?

What are the reproductive health complications associated with FGM in Cameroon?

What is the impact of FGM on fertility rates and reproductive functions among affected women in Cameroon?

What are the strategies for improving reproductive healthcare for women affected by FGM?

1.5 Significance of the study

The findings from this study can help inform public health strategies aimed at reducing the prevalence of FGM and mitigating its harmful effects. By revealling the most common health complications and the demographic characteristics of women who are most at risk, this research can guide the development of targeted healthcare interventions. These interventions may include specialized medical care for FGM-related complications, mental health support, and comprehensive reproductive health services tailored to the needs of affected women.

Findings of the study will also be significant to the academic community as it will contribute to existing literature, add to library resources and serve as a guide to future researchers.

1.6 Scope of the study

The study focus on  the impact of female genital mutilation on women’s reproductive health in Cameroon. Empirically, the study will assess the prevalence of  FGM  among women in Cameroon,  the perceived reasons for female genital mutilation in Cameroon, identify the reproductive health complications associated with FGM in Cameroon, investigate the impact of FGM on fertility rates and reproductive functions among affected women in Cameroon and recommend strategies for improving reproductive healthcare for women affected by FGM.

Geographically, the study is delimited to women in Douala, Cameroon.

1.7 Limitation of the study

Like in every human endeavour, the researchers encountered slight constraints while carrying out the study. The significant constraint are: 

Time: The researcher encountered time constraint as the researcher had to carry out this research along side other academic activities such as attending lectures and other educational activities required of her.

Finance: The researcher incurred more financial expenses in carrying out this study such as typesetting, printing, sourcing for relevant materials, literature, or information and in the data collection process.

Availability of Materials: The researcher encountered challenges in sourcing for literature in this study. The scarcity of literature on the subject due to the nature of the discourse was a limitation to this study.

1.8 Definition of terms

Female Genital Mutilation (FGM): The practice of partially or totally removing the external female genitalia or causing other injuries to the female genital organs for non-medical reasons. It is a harmful cultural tradition that is often carried out on young girls and can lead to severe health complications.

Reproductive Health: A state of complete physical, mental, and social well-being in all matters relating to the reproductive system. It includes the ability to have a safe and satisfying sexual life, the capability to reproduce, and the freedom to decide if, when, and how often to do so.

Short-term Complications of FGM: Immediate health issues that arise shortly after the procedure, such as severe pain, excessive bleeding, infection, and shock. These complications can lead to more serious medical conditions if not promptly treated.

Long-term Complications of FGM: Health problems that persist or emerge long after the FGM procedure, including chronic pain, infections, painful menstruation, sexual dysfunction, infertility, and complications during childbirth.

Psychological Effects: The mental and emotional impact experienced by women and girls who have undergone FGM, which can include anxiety, depression, post-traumatic stress disorder (PTSD), and a decreased sense of self-worth.

Sexual Well-being: The state of being physically, emotionally, mentally, and socially healthy in relation to sexuality. FGM can negatively impact sexual well-being by causing pain during intercourse, reduced sexual desire, and lack of sexual satisfaction.