The United Nations General Assembly adopted a resolution last week that calls on member countries to pass and enforce laws banning female genital mutilation (FGM), which it deems a violation of human rights.
The World Health Organization says there are still as many as 140 million women and girls living with effects of FGM, and the group estimates that 92 million of them, aged 10 and older, live in Africa.
In Senegal, the latest African country to offer victims free reconstructive surgery, seven physicians were recently trained on a technique that repairs the physical damage of FGM and can restore sensation.
“The surgery is very effective in terms of rebuilding the anatomy," says Dr. Abdoul Aziz Kassé, a Dakar-based surgical oncologist. "It’s very effective in terms of sexuality. More than 80 percent of patients are totally satisfied. So to my point of view, [there are] no complications, [it is] very effective in terms of function and anatomy, and so really this is just great.”
But not everyone, he says, is praising the surgery.
“Sometimes, in some populations, people can think we are trying to reverse something important for women," he says, explaining that some consider genital mutilation a necessary rite of passage or social norm related to cleanliness and fidelity.
"If they think that mutilation is something good in terms of their culture, and if you try and reverse it, people can think that what we are doing is having some kind of confrontation with the culture," says Kassé.
Banned by Senegalese officials 1999, FGM entails partial or full removal of external female genitalia.
Although many people believe it has no health benefits and even causes numerous short- and long-term problems, such as chronic pain, urinary problems, and life-threatening childbirth-related complications, the practice persists in parts of Africa.
Malick Gueye, communications manager for Tostan, a Dakar-based rights group that has prompted up to 6,000 communities across Africa to abandon the practice, is concerned that free reconstructive surgery could undermine efforts to eradicate FGM.
"Reconstructive surgery has many benefits," says Gueye. "But knowing that women can repair the damage later, if needed, could be used as an argument in favor of continuing the practice on a broader scale."
But some members of Tostan and the Rome-based No Peace Without Justice (NPWJ) say this is unlikely.
Alvilda Jablonko, FGM program coordinator for NPWJ, which was a key force behind the campaign to get the U.N. General Assembly resolution against FGM, says nothing can undo all the damage of FGM.
“I think there’s a problem, certainly, that if people think by repair, we can return to the state prior to the initial mutilation," says Jablonko. "Obviously, if you cut something off, you’re not going to be able to bring it back.”
According to Khady Koita, president of La Palabre, a Dakar-based women’s rights group, reconstructive surgery is merely a tool, not the solution.
“If you say, ‘Okay, we can do [the FGM] because we can make the surgery after,’ it’s not fine," says Koita, who herself was mutilated as a girl. "It’s good to make the surgery now for the people who had FGM, but for the new people, no FGM. Not any kind, any form of FGM.”
Koita, who has not had the reconstructive operation and is not sure that she ever will, says she has heard good reviews from women who elected to do it.
In Burkina Faso, which began offering reconstructive surgery in 2006, and where women frequently decline to speak publicly about such intimate topics, gynecologist Michel Akotionga says several patients have been so happy with the results that they have named their children after him.
"The women are happy to regain feeling in their vagina, to be able to urinate properly and to have sex without pain," he says of the procedure, which re-exposes nerves and grafts new tissue.
In Senegal, where only a handful of women have received the medical procedure, surgeons say they plan to integrate counseling and sex therapy into their treatment plans to help women deal with the psychological trauma associated with FGM.
The surgery is being offered in Senegal free of charge through the end of the year, and then at a minimal cost starting in 2013.
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