Therapeutic support and FGM : Current issues

In this section we address some of the current issues around therapeutic support for women and girls living with FGM.

Lack of reliable studies

First of all, we must understand that there is currently little research focusing specifically on FGM and mental health, and there are even less in developing countries. Most research was done on migrant girls and women in developed countries. In this way, it is difficult to draw conclusions on FGM consequences on mental health as the migratory journey and the confrontation with new social norms and beauty standards have a strong influence on the perception of herself, on the general well-being and mental health of concerned women (23). Indeed, as stated by Helen Smith and Karin Stein, migration exposes women to new information and cultural norms and can then challenge their identity and beliefs (10). Furthermore, researches as they are led within members of diaspora concerned by FGM, only concerned a restricted number of women.

Adelufosi A. et al , in their paper (6) concluded that future studies need to focus on well-designed interventional for the management of the psychological consequences of women and girls living with FGM.

It is also important to notice the lack of studies on psychological consequences of FGM on young girls and on their evolution, variations all over the life and through ages of girls and women concerned. Thinks to such researches we would be able to study at which periods psychological disorders use to appear. For instance, it seems that girls cut at a very young age in their home country but who grow up in another socio-cultural environment where social norms condemn FGM and laud a standardize model of intact female genitalia are more susceptible to develop disorders (18).

Lack of adequate therapies

There is evidence that many girls and women who have undergone FGM present various forms of mental health problem, but there is not enough adequate therapy to help them navigate through life and heal the trauma. A study done by the WHO on health consequences of female genital mutilation (14) expressed that the alarmingly high rates of psychiatric disturbance among circumcised women provide important evidence that researchers, as well as clinicians, have an obligation to focus more attention on the urgent needs of survivors.

The fact that there were no guidelines to mental health cases caused by FGM made it difficult to help the survivors. The authors of Female Genital Trauma: Guidelines for Working Therapeutically with Survivors of Female Genital Mutilation (16) also realised that there was a gap in the literature and training, namely a lack of good practice guidance for working therapeutically with survivors of FGM. The guidelines they wrote and shared to be accessible to other practitioners aim to remedy to this lack

Lack of services and difficulties in seeking help in Africa

Mental health is still not openly discussed in many societies and there is great deal of stigma attached to that. In most parts of the African continent, people’s attitudes towards mental illness are still strongly influenced by traditional beliefs (22) or mental health is simply not given enough importance. This causes delays in seeking appropriate care for mental health problems causing conditions to worsen.

In her opinion piece, Venoranda Rebecca Kuboka says that adolescent girls and young women find it difficult to seek help when they experience traumatic situations (24). Culture narratives suggest brushing horrifying experience off and move on. As a matter of fact, girls suffer in silence of fear, shame, stigma and victimisation associated with their experiences. She underlines that as Kenya commited to end FGM by 2022, there is need to focus on providing psychosocial support to FGM survivors which is currently unavailable.

African survivors of FGM advocated for mental health services as they are one of their biggest need and urged governments and charities to provide support for dealing with long-term trauma (26). “We don’t have mental health services for survivors of FGM — that is a big thing that is missing in Africa”, Virginia Lekumoisa, a survivor from Kenya. Their point of view is that if more survivors received mental health support they would be strong enough to add their voice, speak up and help end the practice.

Therapeutic approaches presented above come from the work of European psychotherapists because there is a complete lack of resources for excised women above all in Africa. Nevertheless, Helen Smith et Karin Stein (10) present in a 2017 article the example of support services in Somaliland ensured by midwives concerned by FGM and thus more able to understand women’s experiences and share their own ones. If they observe that women develop coping mechanisms such as the use of religion, religious activities, confidence to friends, many women do not seek help. Poverty, lack of access to services for technical or financial reasons, by fear or shame to speak out urge them to hide their problems.

Furthermore, the mere development of mental health services in Africa is very poor and does not ensure an adequate support for people suffering psychological disorders as stated in The Lancet for instance (20; 22). Indeed, the budget allocated to mental health is weak, hardly reaching 1% against 6 to 12% in Europe and North America, and the structures as well as practitioners are rare, mainly in cities, hard to reach for most of the population. Psychiatry still suffer important prejudices and is always today associated with madness. Psychiatric trouble perceived as supernatural are supposed to be cured by traditional or spiritual medicine.

Need of training for health care workers

Women and girls who have undergone FGM do not all suffer the same way, with the same symptoms or cases. It would be important to look at each case as a unique experience. Social context, the type of procedure, social and emotional needs vary. Vloeberghs et al. (12) mention three categories of FGM survivors with mental health issues.

  1. The adaptive overcome the FGM experience
    2. The disempowered feel angry and defeated
    3. The traumatized feel pain, sadness with chronic stress

These cases should be seen differently and the approach to treatment and management should be different as well. Thus, professionals should be able to adapt their reaction, the therapy they propose to each specific situation and woman they receive.

A study on Mental health problems associated with female genital mutilation recommends that “when treating women who experienced FGM one must be able to discern the various types of FGM, be knowledgeable about the related symptoms and the effects these may have on the woman, and have awareness regarding the taboo surrounding the practice” (4). The same study also advises health professionals to consider that the FGM survivor could have gone through other forms of violence and traumatic experience that could as well affect her mental health. Thus, being trained on FGM also means being trained on gender-based violence and in European or North American contexts, have knowledge on migratory journey and asylum seeking.

(4) Knipscheer et al., Mental health problems associated with female genital mutilation, BJ Psych Bulletin (2015), 39, 273-277. Access here

(6) Adelufosi et al., “Cognitive behavioural therapy for post‐traumatic stress disorder, depression, or anxiety disorders in women and girls living with female genital mutilation: A systematic review”, International Journal of Gynaecology and Obstetrics, 2017;136 Suppl 1:56‐59. Access here

(10) Helen Smith and Karin Stein, “Psychological and counselling interventions for FGM”, Int J Gynecol Obstet 2017; 136 (Suppl. 1): 60–64. Access here

(12) Research blog by Serene Chung for 28 Too Many, The psychological effect of FGM, 2016. Access here

(14) OMS, Chapitre 7 : Santé mentale et MGF, in Prise en charge des filles et des femmes vivant avec une mutilation génitale féminine : un guide clinique, 2018. Access here

(16) Christie Coho, Roxana Parra Sepulveda, Leyla Hussein and Cabby Laffy, Female Genital Trauma: Guidelines for Working Therapeutically with Survivors of FGM, December 2019. Access here

(18) Sharif Mohamed, F., Wild, V., Earp, B. D., Johnson-Agbakwu, C., & Abdulcadir, J. (2020). Clitoral reconstruction after female genital mutilation/cutting: a review of surgical techniques and ethical debate. Journal of Sexual Medicine, 17(3), 531–542. Access here

(20) Lansana Gberie, “Mental illness: Invisible but devastating. Superstitution often blamed for acute mental health diseases”, Africa Renewal, December 2016 – March 2017. Access here

(22) Osman Sankoh, Stephen Sevalie, Mark Weston, “Mental Health in Africa”, The Lancet, Volume 6, Issue 9, September 01, 2018. Access here

 (23) International Center for Research on Women, “Mental Health and Ending Female Genital Mutilation and Cutting: Opportunities in U.S. Foreign Policy and Programs”, 2017. Access here

(24) Venoranda Rebecca Kuboka, “Long-term mental effects of FGM not addressed enough”, the-star.co.ke, 2020, February 5th. Access here

(26) Nellie Peyton for Thomson Reuters Foundation, “FGM Survivors Across Africa Call for Mental Health and Trauma Support”, June 18, 2019, globalcitizen.org. Access here

« The Community of Practice on Female Genital Mutilation » is part of the « Building Bridges between Africa and Europe to tackle FGM » project, supported by the « UNFPA-UNICEF Joint Programme on the Elimination of FGM ». The project is coordinated by AIDOS in partnership with GAMS Belgium.

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