As people the world over raise their voices against female genital mutilation (FMG) this week, Dr. Flavia Bustreo of the World Health Organization considers FMG in the wider context of violence against women and girls.
Every day, in every part of the world, women and girls suffer acts of violence, mostly at the hands of men. It happens in rich countries and poor, in every age group and in every stratum of society.
All too often people turn a blind eye to these crimes, or wrongly accept them as part of everyday life. Female genital mutilation (FGM) is a form of violence against women experienced by 125 million girls and women alive today. This horrible practice persists because it is tolerated in some communities. It has no health benefits and is a gross violation of human rights.
1 in 3 women experience violence
As dreadful as it is, FGM is just one aspect of a global tidal wave of violence against women and girls. In 2013, the World Health Organization published global figures showing that 1 in 3 of all women experience some kind of physical and/or sexual violence in their lifetimes, much of it from close partners.
Personally, I was shocked by these findings. Consider for a moment what they mean for every woman reading this article. We likely all know someone - a sister, a friend, a co-worker - who has been or will become a victim. Perhaps we have ourselves suffered violence.
Professionally, my WHO colleagues and I are concerned because this is a public health issue of epidemic proportions and a blatant violation of human rights. FGM, emotional abuse by partners, human trafficking, forced and early marriages, honour killings - violence against women and girls takes many forms and it is linked to many negative health outcomes including depression, anxiety disorders, gynaecological problems, unwanted pregnancies and, all too frequently, death. Women and girls suffer in all countries, often as a result of deeply rooted gender inequality.
Health sector response
Last week, Member States of the WHO Executive Board reacted by agreeing on action to strengthen the health system's response to violence - in particular against women, girls and children. Countries have recognized both the urgency of the issue and the pivotal role that the health sector plays in addressing it, and at the World Health Assembly in May, they will be formally asked to commit to action. Health workers are frequently the first to witness the physical and psychological effects on victims, many of whom seek treatment for injuries or present with sexually transmitted infections or unwanted pregnancies.
Often a woman is unwilling to say she has been a victim of violence or does not want to take action against the perpetrator. In any event, health workers should be prepared to deal with the situation - and often they are not. A key role is to offer a safe space where victims feel able to speak openly about their problems. Health workers need the resources and training to identify the problem, listen empathically and then respond appropriately, providing confidential assistance that goes beyond essential medical care. They can also play an important role in offering access to social and others services for women exposed to or at risk of violence.
FGM highlights the need for proper guidance and resources. Health workers need specialized training to treat victims of FGM expertly and provide appropriate counselling. They need to understand the immediate effects, such as shock, severe pain and bleeding, and the potential longer-term consequences - such as an increased risk of childbirth complications and newborn deaths. Above all, they need to divorce themselves totally from the practice. It is shocking that more than 18% of all FGM is performed by health professionals, a practice that WHO strongly opposes.
Whatever type of violence against women and girls health professionals encounter, they require strong backing from political leaders, legislators and the community, as well as the training to tackle the problem. This is vital to help end impunity for the perpetrators and achieve justice, dignity and good health outcomes for their victims.
Support for countries and health workers
WHO is supporting countries that want to shape their own health sector response to the problem. We are developing standards and guidelines for health professionals, such as our clinical handbook and forthcoming new guidelines for health workers on FGM, training curricula for health care providers, and other tools to support the health system in addressing violence. We are also collecting evidence on strategies that either prevent the problem before it occurs or effectively address it when it does.
Important as they are, these activities are just a start. This is a deeply rooted problem that spans continents and requires a co-ordinated inter-sector response. While recent research has helped, we still need more and better data to understand the magnitude and nature of the problem in all countries. Robust research shines a light into dark places, and is often a catalyst for action.
In the health sector, we must do more to equip health practitioners everywhere with knowledge, skills and tools to prevent and respond to violence against women and girls. And lastly, but perhaps most importantly, political commitment at the highest level is essential to reinforce efforts to end it in all its forms. This has been a key factor in those countries already making progress on the issue.
We know that 1 in 3 of all women suffer, with terrible consequences for them, their families and society as a whole. There is no time to waste in defeating these ubiquitous and abhorrent crimes. International Day against Female Genital Mutilation is a good place to start.