Female genital mutilation (FGM) France
Initial findings of survey on FGM and disability (Excision et Handicap, ExH)
It is estimated that in 2004 around 53,000 adult women residing in France had been subjected to female genital mutilation (FGM). This practice exposes women to chronic healthproblems, in addition to difficulties in their daily sexual and emotional lives. The first kindof problem is recognized, but rarely quantified, while little is known about the second. Two public health issues arise from FGM: preventing the practice in communities at risk andcaring for affected women. The national FGM and disability survey (ExH) has collected new data on the consequences of FGM and has developed a knowledge base which will improvecare management for victims.
Female genital mutilation is carried out on girls in many countries of sub-Saharan Africa. Some of the migrant women and their daughters living in France are victims of this practice.
Specific health problems
As indicated by WHO surveys administered in countries where the practice is common, FGM exposes women to specific health problems and complications during childbirth. Difficulties of daily living, particularly in sexual life, are rarely considered in these surveys, although they may have many consequences, sometimes even serious ones. The issue has come to the attention of public authorities due to the risks for women associated with this practice. Nonetheless, the extent and nature of these women’s needs in the context of the French healthcare system are yet to be evaluate.
Pain and functional disorders
In the ExH survey, FGM was found to cause a range of health problems such as urinary and gynaecological infections or tearing during childbirth. Women with FGM also report feelings of sadness and discouragement more frequently than the control group (after taking account of social characteristics). These women report more severe pain, which more frequently disrupts their daily life. For instance, one in ten women with FGM suffer from discomfort when urinating, walking or when wearing certain clothes.
Difficulties in sexual lives
It is regarding sexuality that the most striking findings are obtained. Women with FGM have recurrent difficulties in their sexual lives, and more often report experience which is unsatisfying or even systematically painful. Many of these women see a direct link between their mutilation and difficulties they face in their sexual lives. The survey indicates that the victims of this practice would like to receive support and information on these issues, even though speaking of their sexuality and sexual problems is often difficult (especially for women from societies where these subjects are rarely discussed).
Demand for reconstructive surgery
The development of reconstructive surgery ( the cost of the operation has been covered by the French social security since 2003. It is available in around 15 hospitals and clinics, mainly in the Paris region but also in the provinces) offers victims the possibility of «repairing» the damage. A majority of the surveyed women knew of the existence of this type of surgery, mainly through the media, healthcare professionals or a person in their social circle. Among the survey respondents, 5% had undergone this procedure or were preparing to undergo it and 20% were interested in the possibility, mostly to improve their sexual lives, to regain their female integrity or for their health. Women who were not interested in the surgery reported having «accepted their fate» and «not feeling the need». This procedure is all the more appealing for young women (below 35 years) who have grown up in France. Reconstructive surgery is still marginal however, and the procedure is unlikely to become systematic.
The risk of FGM among young girl
Some 11% of daughters of women with FGM are themselves subjected to the procedure. However, this proportion is much smaller among those who were born in France (3%) where the practice is illegal. Moreover, FGM has been dying out in recent generations, not only among immigrant communities but also in the countries of origin. Some young girls who were uncircumcised at the time of the survey, especially those younger than 15 years old, may still be at risk. The level of risk can be ascertained by questioning mothers about their own intentions and those of the father or the family in the home country. In 7 out of 10 cases, there is no reported intention to circumcise the girl on the part of the parents or family members. In 3 out of 10 cases there is still a risk for the girl, either upon her return to her country of origin (with the parents’ knowledge), or because one or other parent directly or indirectly expresses this intention. A survey of this kind requires a lot of time, a team of professionals who are conscious of the ethical implications, and a political and institutional will to improve expertise on the subject (Thanks to the support of the Direction générale de la santé, the
survey was national in scope. Health professionals played a crucial role in data collection ). However, the survey owes its success primarily to all the women who agreed to take part. The study has shed light on the issue of female genital mutilation. Even though the French healthcare system prevents most of the complications encountered in the country of origin, a good quality of life - including sexual life - for the victims of this practice is nonetheless as important as eliminating the health risks.