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Training urged as midwives deal with female genital mutilation cases

There have been "quite a number" of women who underwent female genital mutilation and who have turned up at the hospital to give birth, a conference on FGM organised by the Malta Union of Midwives and Nurses heard this morning.

Antoinette Saliba, senior midwife and university lecturer said the patients were often "anxious and so afraid".

There was no local policy on how these cases should be tackled. For example, there was no policy on how to go about the reversal of the infibulation (the sewn vagina) before the woman gave birth. This could be done at various stages including during pregnancy or during the first stages of labour. It was against the law for the vagina to be re-sutured after birth, even though some husbands requested this.

Ms Saliba spoke about the importance of eduction and also the need to incorporate training on FGM for midwives that was currently obtained through experience.

Laura Pullicino, a nurse who works with the Jesuit Refugee Services, said she was involved in a project with the UNHCR during which she spoke to women and men and explained to them that FGM was not accepted in Europe and why.

During group sessions men and women were shown a video clip of the procedure. The clip showed a girl, about five years old, screaming as she was held down by women while her genitals were cut and sewn shut. "You could see the tears in the eyes of the women even after so many years.

Some women were angry that their culture was being questioned but some recognised that it should not continue. Women spoke about the strong social pressure they felt to undergo FGM as otherwise they were isolated by their community. The women spoke about their experience during intercourse with some husbands slitting them with a knife.

Group sessions with men revealed that some men said this was done to control their women to ensure they were not promiscuous. When they were shown the video clip some men could not take the images. It turned out they never witnessed an FGM procedure.

They defended their tradition but were open to discussion. One man said that, now that he saw how it was done, he would never send a woman for the operation.

Ms Pullicino said there was the need for more sensitivity from healthcare professionals in Malta and she gave the example of a gynaecologist who asked: "What can I do for her? Why did she let them do it to her in the first place?"

She spoke about the need for more training and education.

Labour MP Chris Fearne urged nurses and midwives to report any cases of female genital mutilation which they knew of and that would soon become a crime under Maltese law.

In September, Dr Fearne tabled a private members bill in Parliament to make FGM illegal in Malta. This will also apply to cases where Maltese girls are taken abroad for the procedure to be carried out overseas.

The bill is being given a second reading next week and is expected to become law since there seemed to be consensus in Parliament, he said.

Dr Fearne, a paediatric surgeon, said nurses and midwives were duty bound to report any cases they became aware of. Failing to do so made them, and anyone who did not report such a case, liable to a fine and the new law would exempt them from patient confidentiality in such cases.

He said it was important to educate people that FGM was not a good thing and to "scare" anyone from performing it in Malta or on a Maltese citizen. He said the World Health Organisation estimated that between 150 million and 200 million women in the world were living with the consequences of FGM but little was known as the western world tended to ignore this.

"But now we were seeing migrant communities coming into Europe and the subject needs to be discussed," he said.

"This is not a stand against something from a foreign culture but against something that is intrinsically wrong," he said.

FGM is a common cultural ritual carried out in many African countries. There are three man types of FGM carried out on young girls. One includes snipping off the clitoris, another removes the clitoris and the inner labia and, in the most severe case, the outer labia are also removed and there is the fusion of the wound.

Women suffer in future as intercourse is painful with some men not managing to penetrate their wives and resorting to creating a slit with a knife. This also creates complications during labour with two per cent of babies dying because of FGM.

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