Psychological Effects of Female Genital Mutilation

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Table of Contents
Chapter 1...................................................................................................................................................2
Background............................................................................................................................................2
Rationale................................................................................................................................................3
Aim..........................................................................................................................................................3
Scope of the research project.............................................................................................................3
Expected outcome................................................................................................................................4
Overview of the chapters.....................................................................................................................4
Chapter 2...................................................................................................................................................5
Literature review....................................................................................................................................5
Study Design.........................................................................................................................................8
Data Collection......................................................................................................................................9
Chapter 3.................................................................................................................................................11
Research method for analysis...........................................................................................................11
Chapter 4.................................................................................................................................................13
Findings/Result...................................................................................................................................13
Chapter 5.................................................................................................................................................15
Conclusion...........................................................................................................................................15
Ethical consideration..........................................................................................................................16
Limitation..............................................................................................................................................16
Reflection.............................................................................................................................................17
Recommendation/Implication............................................................................................................17
Chapter 6.................................................................................................................................................18
Reference............................................................................................................................................18
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Chapter 1
Background
Female genital mutilation means partial or total removal of the female genitals due to medical or
non- medical reasons (World Health Organization, 2016). This procedure has no recorded
evidence of health benefits to the females. But it can damage the genital tissue of the women or
hamper the functioning for a lifetime. It can also cause several long terms and immediate
harmful effects on their health. So far research has been done on the female genital mutilation
done due to cultural or non-medical reasons and its physical and emotional effects on the
women and girls. This research will include the psychological effects on women and girls due to
female genital mutilation is done due to medical and non-medical regions. Women who have
gone through FGM undergo a lot of complication any time in their life. It also associated with
violating human rights such as the women who have to undergo FGM willingly or unwillingly are
discriminated from men and treated in a cruel manner due to the procedure. This procedure is
practiced in many Asian and African countries. The religions that majorly promote this practice
are Islam and many Christian communities, though many Muslim countries do not practice
FGM. Apart from the physical effects, this research will mainly focus on the emotional effects on
women and children due to FGM (Perron et al.,2013).
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Rationale
Female genital mutilation was once known to be a traditional practice in the orthodox people.
The fact is it is still practiced and roughly 2million girls have gone through this procedure
between 2015 and 2017. As human rights given by the world health organization the female
have equal rights to life and decision. This practice is cruel and can cause many health issues
for a lifetime. FGM specifically does not have any health benefits, apart from only when
circumcision is required in women in special situations (Momoh, C., 2017). If FGM is a
compulsion in any religion, they must make sure it is done under the sterile condition to avoid
added on health damage. This practice is banned in many countries but apart from the political
aspect the focus of this research to study the psychological effects on women and girls and hoe
to safeguard the health of the women who have already gone through the procedure of FGM
(Abdel-Azim, S., 2013). The major effect on women after this procedure is a shock due to pain,
anxiety, and depression.
Aim
The aim of this research is to critically evaluate the psychological effects of female genital
mutilation on women and girls in the UK. The following objectives can be derived from this aim:
1. Immediate psychological effects on women and girls after they have to undergo FGM.
2. The complaints they suffer emotionally after the FGM is done and the role of the health sector
in giving them healthy life after the damage.
3. How the long term psychological effects on the women who have undergone FGM in their
past can be managed and prevent further physical or emotional damage.
The scope of the research project
This research mainly focuses on the psychological effects on the women due to female genital
mutilation. This psychological condition can arise after partial or complete removal of healthy
tissue of genitals. There are long term and short term physical effects after removing the genital
tissue, psychological conditions are among the long term effects of FGM. The immediate effect
is shocking soon after the painful removal of the tissue (Rushwan, H., 2013). There are various
other physical conditions that the female has to go through during and after FGM, few of them
may have harmful effects in long term. In this research, we aim to study the emotional effects
and critically analyze the intervention that can help them cope with the psychological effect of
FGM. The role of the government and the health practitioners in the interventions that can be
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applied in the cases where the female has undergone FGM of any type; partial, complete or due
to other reasons
Expected outcome
The expected outcome of the research will be based on the data obtained in the literature
review. On those articles will be selected that cover the inclusion and exclusion criteria and the
final articles selected for study are expected to be based on primary research and after critical
analysis of the data; there must be detailed information obtained on the emotional suffering of
the women who have undergone the procedure of FGM. It is expected that at the end of
research there would be effective ways for intervention that can help these women and girls
cope up with the psychological trauma they suffer after genital mutilation. The practice of FGM
in different religion should be stopped if it doesn’t help in the overall health of the patient
(Marshall and Raynor., 2014).
Overview of the chapters
The research is on the topic of psychological effect on female and girls due to female genital
mutilation. The reason for selecting this topic for research and the aim is explained in the
introduction in chapter 1. In chapter 2 there is a literature review on which the entire research
work is based. Study design and the detail of data collection are explained in chapter 2. In
chapter 3 the research method of analysis is explained. In chapter 4 finding and result of the
research is discussed. In chapter 5 the conclusion, limitation, and ethnic consideration are
given, along with reflection and recommendation by the researcher which qualifies the research
result. This summarizes the entire research project.
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Chapter 2
Literature review
The removal of healthy tissue from the female genitals is known as female genital mutilation.
There are of three types, circumcision, partial and complete, depending upon the amount of
healthy tissue removed. In type 1 there is partial or complete removal of prepuce and clitoris. In
type 2 there is complete removal of the clitoris and partial or complete removal of labia minora,
with or without excision of the labia majora. In type three there is the narrowing of vaginal orifice
with creating a covering seal, with or without excision of the clitoris. There is one more type of
FGM, type 4 which all the other harmful procedure is done for non- medical purpose such as
pulling, piercing, incising, cauterization etc (World Health Organization, 2013). The WHO along
with the UN have stated several time once in 1998 and once in 2002, that FGM carried out for
any reason regardless of the community pressure or done medically it has harmful effects on
the health of the women, hence should not be performed by anyone either at home or at the
hospital. There are many complaints that repeatedly turn to practitioners by women who have
undergone this procedure. Therefore it is declared as a procedure with ’health risk approach’.
When the government agencies tried to create this awareness in the countries and communities
regarding the harmful effects of this procedure they did not understand the long term health
issue and did not give up to put women through FGM. The only difference was they shifted to
the qualified expert to perform this procedure than do it at home in a traditional way. They
believed this would reduce the risk to health. This made the government aware of the strong
root of cultural roots in the communities which the awareness program could not shake.
Morris et al., in 2013 stated in their research that the most common symptom that women suffer
after FGM is depression, anxiety and post-traumatic stress disorder (PTSD). Other
psychological complaints are recurrent intrusive negative memories, nightmare, intense
helplessness, fear, along with the symptom of anger, shame, guilt, and loneliness. In research
conducts in Kurdish women in Iraq FGM affected women were reported with PTSD by 44% and
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45% reported for anxiety and 35% reported for depression. PTSD was experienced due to the
traumatic nature of the FGM and the serious complication that may be associated with it and not
just the mutilated genitalia. Also in the case when FGM affected women have to immigrate to
other countries they are further affected by PTSD, due to fear of non-acceptance and negative
effect of the past memories. They have fear of being prohibited in the new country, Cognitive
behavioral therapy can help solve this issue to a certain extent. CBT claims that the thoughts
and feeling are interconnected, how we feel and think can change our behavior and actions.
Therefore this therapy can be helpful in FGM affected women to think and act positively, and
destroy the negative chain of thoughts and emotions. The individual is trained to think positively
and to how to avoid negative threatening thoughts. This can only be done by a CBT trained
therapist by conducting one to one session with them and giving them self help material in the
form of books and audio.
In the research given by Mamoh in 2017, it is stated that female genital mutilation is the violation
of women's rights. It destroys the liberty of women and their right to health. This article mainly
focuses on the prevalence of this procedure in various communities and the effect of older
women in forcing the other girls and women in the family to go through the procedure. The older
women are usually orthodox in their behavior and therefore they believe in practicing the age-
old rituals even if it is harmful to health. The role of midwives and practitioners in decreasing this
burden of disease on the women population is by explaining them the harmful effects of this
procedure. Counseling girls of such communities and gathering them in a common place to
explain the harmful effects of the procedure and how they can avoid themselves to undergo the
procedure. This would be very effective in reducing the prevalence. Girls and women living with
FGM are more likely to develop psychiatric illness than women who are untouched by this
procedure. They are most likely to suffer from anxiety disorder, depression, and post-traumatic
stress disorder. These women need cognitive behavioral therapy to cope up with the after-
effects of the procedure (Reisel and Creighton., 2015). Experts who are trained in counseling
and providing CBT must be appointed in hospitals and suspected women must be subjected for
evaluation and assessment of psychiatric wellness. This also includes women who have gone
through type 3 and type 4 of FGM that may or may not be associated with sexual assault. These
women need a lot of motivation and guidance to gain back their morale and move ahead in life.
As stated by Kaplan et al., in 2013 these women would have the most harmful experience
during the pregnancy and such complication must be handled critically. This is possible only
when the staff in health care is trained to identify and resolve their issues. This itself could make
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them feel better that their complaint or damage do have a solution to a certain extent and would
not completely keep them away from having a family. The human rights are given by the WHO
is the basic right to each individual, it also states that health is complete wellbeing of mental and
physical health and not merely absence of symptoms. Thus, women must equally be able to live
a life of their choice and with health. Female genital mutilation is mostly practiced in middle-
class countries. The main drawback in implementing any intervention is there are not many
trained CBT expert to counsel these women and help them live a healthy life. These countries
have a lack of education and access to the basic necessity of life, therefore they would not be
able to understand the harmful effect of this procedure (Iavazzo et al.,2013). The practitioners in
such countries are not trained enough to handle the complication arising in women that have
undergone the procedure of FGM.
In an article given by Andro et al in 2014, they have mentioned that there are certain countries
especially in Africa and the Middle East which medically allow certain types of FGM. The health
care providers in those countries think that certain form of FGM is not harmful. They might be
performing this procedure in order to get accepted amongst the large population that believes
that FGM is an important cultural ritual and performing FGM does not harm. This negligence
from the health care providers has made the public think that this procedure is not harmful and
rather beneficial and safe for women and girls. They are financially incapable to undergo
investigation and not educated to understand and analyze the harmful effects of this procedure.
The international agencies now take this as an international issue and are working forcefully
towards stopping the procedure. FGM affects the mind and the body and hence is an important
aspect in affecting the overall health and wellbeing. Many medical agencies have taken the
stand to abandon such a procedure that has no medical use and a health practitioner must
refrain from practicing it.
In countries like Africa and middle Asian countries FGM is practiced since years like a traditional
procedure on women and especially girls at an early age. It is also practiced in the regions
where the Africans and Asian have immigrated. Amongst the Muslim population is done abiding
by the religion but in the African community, it is done unbounded by the community. All types of
FGM involve cutting off the neural innervations that supply to the genital organs such as vulva,
vagina, and clitoris. The most common factor in any type of FGM is cutting the clitoris. These
neural innervations are disturbed due to the cutting of these organs and thus the brain and the
spinal cord would respond in a certain way. This response could turn into any physical mental or
emotional troubles. As knowing all physical complaint do affect the mind at cretin level it could
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act as slow poison and eventually affect the mental wellbeing and behavior sometimes in life. It
could also modify the sensory perception of the mind (Yasin et al.,2013). Most of the research
done so far has focused mainly on the complication that arises during pregnancy and delivery in
women who have undergone FGM. There are many types of research on this topic and less
information is available on psychological complication after FGM.
Ouldzeidoune et al.,2013 stated in their research about the FGM have done in young girls as it
is most widely seen in young girls despite the efforts of the government agencies put in the
awareness program. It is widely seen in the west due to the immigration of people from the
African and Asian countries to the west. In the light of providing health and care to the women
the most recent trend approach is the reconstruction of the clitoris which is usually removed in
any type of FGM. This procedure would be only beneficial in type 1, as in other types there are
more loss more organs than the clitoris. It constitutes good practice with regard to this type of
surgery. The multidisciplinary approach is required in this procedure as it is a reconstructive
surgery on the clitoris reconstruction. Each woman might have gone through this procedure
differently and therefore they would require individual counseling for the same. Literature shows
that FGM affects the physical, mental and sexual health of an individual. Clitoral reconstructive
surgery can enhance their sexual as well as mental health. The could be more sexually satisfied
but this requires an individual approach. The team of expert that is involved in the reconstructive
surgery must include a surgeon, a gynecologist, a midwife, a psychotherapist, a social worker,
and a sexologist. The integrated approach is required in the implementation of this approach.
This surgery has good scope in improving the physical and mental condition of women but it
might not always give positive results in each case hence counseling and multidisciplinary
approach is required in handling such cases where a psychologist, counselor, and a
gynecologist would work out the process and explain the women who have suffered from FGM.
Study Design
There are two methods to collect data for the research, the primary method of study and a
secondary method of study. The primary method of study is when the data is collected directly
from the subjects and the secondary method of study is when the data is collected from articles
that were prepared on the basis of the primary method of study and are already published. The
source of data can be academic books, articles, new journals and reports (Abusharaf, R.M. ed.,
2013). Data obtained from these sources are known as secondary data for the study. This is
also called as a qualitative method of study. In which various articles relevant to the topic would
be selected and studies to form the research. In this research secondary method of data
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collection will be used to study psychological effects on women and girls after female genital
mutilation.
This research will be based on the qualitative method of analysis as it the information obtained
cannot be expressed and analyzed in the numerical form. In this study, the immediate and long
term psychological effects of female genital mutilation will be studied along with the
interventions that can help to improve the effects of emotions and other psychological effects on
the women and girls who have undergone FGM any time in their lives. The contribution and role
of government in addressing the issue related to female genital mutilation.
The data will be collected from the Google scholar using various keywords. Which will form the
literature review of the research? Literature review forms the basis of research done by a
secondary method in which the data is collected from the existing work done and published in
recent times (Keck et al,2014). The researcher gets a broader understanding of the topic and a
chance to critically evaluate the information and select only that data which cover all the
inclusion and exclusion criteria and is most relevant to the topic. The secondary method of
research gives scope to re-evaluate the data and this might bring up new conclusion and
derivation that was not noticed in the earlier research. The published work is available to study
to the public and this avoids duplication and maintains the authenticity of the data.
Data Collection
The search engine used for data collection for this research is Google scholar. Combination of
keywords was used to obtain data relevant to the topic of research. This would give articles from
which desirable data can be obtained and used for analysis and study. Various combinations of
keywords gave many articles for study. Using keywords
pycological+effect+due+to+female+genital+mutilation 2,19,500 articles were available for study.
This was further narrowed by limiting the search to articles published after 2013, this gave
17,000 articles were obtained. Then applying the inclusion and exclusion criteria 130 articles
were selected. Out of the 130 articles, only those articles were selected that were most relevant
to the aim of the research and could give the expected outcome.
Inclusion and exclusion criteria are the qualities of the research that must be included in the
published data and the qualities that should not be included in the data selected for research
(Jina and Thomas., 2013). These were considered while selecting the data for the study, the
basic requirement was the articles selected should be based on the primary method of research
where data is directly obtained from the women who have been through any type of female
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genital mutilation and the research is published after 2013. This would enhance the quality of
research and avoid the limitation of secondary research that is biased in selected the study
data. The main step in the secondary method of data collection is selecting the most relevant
articles and reading it thoroughly. The conclusion of the primary published research and the
current research may vary, but this would increase the scope and knowledge of the topic and
help in positive intervention in women suffering from the psychological effect due to partial or
complete genital mutilation.
Inclusion criteria:
 Only articles published after 2013 can be included in the literature review
 The articles included should be based on primary research
 Only the most relevant data to the research aim and topic must be included.
 Internationally published and reviewed articles by the experts must be included.
Exclusion criteria:
 Any article published before 2013, even if relevant to the topic should not be included.
 Articles based on the secondary method of research should not be used for the literature
review.
 Articles which are only partially relevant to the topic should not be included, the aim is to
study the psychological effect after FGM
 articles that have illegal compliance or unethical issues should not be included in the
research study
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Chapter 3
Research method for analysis
The combination of keywords used on Google scholar gave more than 150 articles for
reference, out of these few articles were not included in the research study as it was based on
the secondary method of research. Only the articles that covered all the inclusion and exclusion
criteria were included in the research, thus 7 research articles were selected for the study. The
literature review comprises of these articles and their study in detail. The method of analysis
used in the research is thematic analysis as the type of research is qualitative. Various themes
were selected as per the research question and analysis was done based on these themes.
Thematic analysis is useful in the qualitative analysis where the research results cannot be
expressed in the numeric form (Macfarlane and Dorkenoo., 2014). The information available
has the same base as the topic but various other information in those research cannot be used
as it is not included in the inclusion criteria. The themes selected as per the research aim are as
follows.
1. The effect in the psychological aspect of women and girls who have undergone female
genital mutilation in their lives. There are other physical factors that are adversely affected
circumcision, partial or complete female genital mutilation but in this research, the focus is only
on the immediate and long term psychological effects on women and girls.
2. The government along with the WHO has given few human rights to protect each individual
and their rights. This procedure is violating any rights of women, such as discrimination and
cruelty. The government agencies have banned this practice, what further can be done to
especially help the women overcome the psychological effect.
3. There is definitely scope of improvement in this sector. As such a practice that has no health
benefit must be stopped, circumcision might have a health benefit to avoiding infections but
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there is no other benefit and therefore the role of government and health sector is to be
ascertained in further improvements.
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