Introduction
Australia is among those countries which harbor large numbers of refugees from the Middle East and Africa, regions where Female Genital Mutilation (FGM) is highly practiced. When these women move into Australia they still look forward to continuing with this practice as it is considered as a link with their culture. Sudanese refugee women usually undergo the worst scenarios before becoming refugees in Australia. They are victims of civil war, assault, and rape. The Commonwealth (Commonwealth of Australia 2007) has reported that the department‘s settlement database (SDB) statistics, since the 1996-97 financial year, indicate that at least 20,000 settlers have migrated to Australia from Sudan.
As a cultural ritual that predates major religions in the world, Sudanese women are subjected to FGM. Policymakers deplore this practice due to the associated negative health effects. On the other hand, it has been adamant among the Sudanese as a form of cultural identity. Consequently, FGM has become a debatable issue between culture and wellbeing in Australia. This study aims of understanding FGM among the Sudanese refugee women in Australia and its impact on the health of the women.
Methodology
This is a qualitative study that employed a meta-analysis of different studies to carefully examine all available information. Consequently, the most relevant information was selected to complete the paper. Information used to complete this paper was obtained from secondary sources like journals, books, and relevant websites. Information was collected on FGM among Sudanese refugee women in Australia.
Literature Review
Australia is strongly committed to defending children from harm. Female genital mutilation is a cultural practice among Sudanese refugees settling in Australia. However, according to Australian law, it is prohibited as it constitutes child abuse. The law, alongside other kinds of interventions, has left FGM practice unabated among the Sudanese women in Australia. This is because, Australia is a multicultural region and therefore, cultural values and beliefs should be respected. It is evident that the prevalence rates of FGM have declined over the past years but there is still a small percentage, of individuals that still practice it. It is performed on young girls below the age of ten years (WHO/UNICEF 2003, 537-539; Commonwealth of Australia 2007, 4-7).
Australia has used the help and support of the Commonwealth Department of Health to reinforce the activities of the National Education Program on FGM (1996-2000) which works under a ‘holistic’ social model of health (Ian 2001, 15). The program operates at the state level where it has come up with strategies to address the problem of FGM among the refugees who perpetuate it. The community is empowered through education on healthy living and the negative effects of FGM.
Health professionals also receive training with regard to providing health services to Sudanese women. These approaches are used to supplement the legal and welfare programs that are already in place. However, better training in a multicultural aspect is required to enable health professionals to handle Sudanese women adeptly in case they seek FGM services (Momoh 2004, 291-293; Rouzi, Sindi, Facharzt and Ba’aqeel 2001).
Socio-cultural, religious and health reasons have been used to justify the process of FGM in Sudan. Maintenance of cleanliness, protection of a girl’s virginity, increasing the chances of a girl to get married and discouraging female promiscuity are the main reasons why FGM continues to be practiced in most countries including Sudan (Ian 2001, 17-20). FGM is considered to affect a woman’s health positively by improving her fertility and preventing stillbirths. The clitoris was perceived to be dangerous to a child such that if the head of the child touched the clitoris, then this child would definitely die. Therefore, FGM was performed to ensure the safe delivery of a child during birth. However, this is just a perception as there are no facts to defend it (Abdel 2002; Gray, et al 2009).
Discussion
Sudan has been ranked among the top African countries in relation to FGM and its high prevalence rate. According to a study carried out by Bedri in 2008 (7), 94% of Sudanese women had been circumcised. All of them had been circumcised while they were still below nine years of age. 93% knew of the associated health consequences of FGM. 51% of the women had been subjected to FGM type III while the rest, 39%, had undergone FGM type I.
Consequential effects of FGM are obstetric, psychological and physical complications. Physical complications can be instant for instance shock, retention of urine, haemorrhage, pain, infection or even death. Long-term effects prevail as difficulty in menstrual bleeding, development of dermoid inclusion abscesses and cysts, sexual dysfunction, intermittent period of urinary tract infection and urinary incontinence (Essen & Wilken-Jensen 2003).Obstetric complications that have been witnessed include: postpartum haemorrhage that is more frequent, the second stage of labor becomes more prolonged, there are higher rates of episiotomy and women have been seen to shy away from antenatal care (Mandara 2004).
Psychological complications are numerous and have been depicted. 25 African women that had been infibulated (based on a study to examine the clinical effects of FGM) were reported to have depression, suppressed femininity, dyspareunia, neurosis, post-traumatic stress disorder and frigidity. An observational study by Knight et al (cited in Ogunsiji, Wilkes, and Jackson 2007, 22-30) on 51 immigrant women showed that 85% of the women suffered from dyspareunia, UTI and apareunia.
Sudanese women in Australia are an example of refugee women who are fleeing away from their home countries, having undergone FGM. It is a traumatic process that is carried out in the most ruthless manner and under unhygienic conditions hence, the resultant recurrent vaginal infections (Aroian 2002, 211-213). The recent Sudan National Household Survey that took place in 2006 in Sudan revealed that there was a reduction in the prevalence rate of FGM.
As opposed to the year 1999 when the average prevalence rate of FGM was at 89%, the average prevalence rate of FGM in 2006 was 68.5%. This decline was attributed to increased awareness. Efforts are still underway in a bid to put an end to FGM in Sudan (Bedri 2008, 6-9).
There are emerging concerns on the issue of health care providers who provide health care to Sudanese women who have undergone FGM, the very same exercise they are up and against. It becomes very difficult for health care providers to witness the brutality of culture with regard to FGM. Despite the fact that FGM is greatly forbidden, some women continue to exercise it and even seek the assistance of health care professionals. However, since FGM is greatly forbidden in Western countries, women seeking health attention with regard to FGM may eventually die. This is because; health care providers are not culturally competent on how to go about issues relating to FGM (Baron and Denmark 2006, 349-351).
According to obtained research findings and documented researches, it is obvious that FGM is not a friendly practice among women. It is associated with so many negative consequences which affect the health status of a woman in various ways as discussed earlier on. Despite the fact that various conceptions are attributed to the carrying out of the FGM, the practice remains unjustified and unjust among the women. Despite the fact that there are held perceptions on the positive health effects of FGM, there is no evidence to support this.
Conclusion
FGM is a cultural practice that is not associated with factual positive health outcomes. The paper set out to understand cultural perspectives on health with reference to FGM amongst Sudanese refugee women. The effects of FGM have been realized in Sudanese women who flee to Australia having undergone this cultural procedure. All in all, it still continues to be practised among the immigrants due to its cultural worth. However, on another note, FGM is considered a menace to human welfare and a violation against the rights of children. Until then, there is no articulate way that could be employed to demise this perceived cultural ritual among the Sudanese women in Australia.
FGM is linked to negative physical, psychological and obstetric implications based on medical professionals. However, culture opposes this as it considers FGM as a healthy practice in promoting moral behavior, hygiene and safe delivery. Therefore, the controversy still lingers on. Appropriate interventions are necessary so as to completely fight off this demeanour.
Recommendations
Sudanese women need attention and medical assistance. Health care providers should be given more comprehensive training to enhance their cultural competence in dealing with FGM situations. This should be used as a weapon to get close to a patient and counsel her on the importance of doing away with FGM despite its cultural value. Denying health care assistance to women in need of FGM due to the fact that it is prohibited by law will only lead to death of the women because of inadequate provision of health care (Papadopoulos 2006, 207-215).
Appropriate laws and policies should be put in place so as to help immigrant women coping with the issue of FGM. The laws and policies should be formulated and implemented within the multicultural context of Australia. Health promotion should continue through health education and increasing access to quality health care (Ziguras, Klimidis, Lewis, and Stuart 2003; Rahman and Toubia 2000).
References
Abdel, M., 2002. Overview and Assessment of Anti-FGM Efforts in Sudan. UNICEF, Khartoum.
Aroian, K., 2002. Immigrant Women and their Health. Annual Review of Nursing, 19, 179–226.
Baron, E., & Denmark, F., 2006. An Exploration of Female Genital Mutilation. Annals of the New York Academy of Sciences, 1087, 339–355.
Bedri, N., 2008. Volunteerism and Community Mobilization for the Abolition of FGM: Lesson Learnt from the UNV Pilot Project in Sudan. Web.
Commonwealth of Australia, 2007. Sudanese Community Profile. Web.
Essen, B. & Wilken-Jensen, C., 2003. How to deal with female circumcision as a health issue in the Nordic countries. Acta Obstetricia et Gynecologica Scandinavica 82, 683–686.
Gray, S., Vasiljevic, D., Bozinovski, G., deVille, M., & Buchanan, H., 2009. African Refugee Women and Young Refugee Women’s Health Project. NSW Health.
Ian, P., 2001. Responding to Female Genital Mutilation: The Australian Experience in Context. Australian Journal of Social Sciences, 15-33.
Mandara, M., 2004. Female Genital Mutilation in Nigeria. International Journal of Gynecology and Obstetrics, 84, 291–298.
Momoh, C., 2004 Attitudes to Female Genital Mutilation. British Journal of Midwifery 12, 631–635.
Ogunsiji, O., Wilkes, L., & Jackson, D., 2007. Female Genital Mutilation: Origins, beliefs, prevalence and implications for health care workers caring for immigrant women in Australia. Contemporary Nurse, 25, 22-30.
Papadopoulos, I., ed. 2006. Transcultural Health and Social Care: Development of Culturally Competent Practitioners. Elsevier, London.
Rahman, A., & Toubia, N., 2000. Female genital mutilation: a guide to views and policies worldwide. ZED, London.
Rouzi, A., Sindi, O., Facharzt, B., & Ba’aqeel, H., 2001. Epidermal Clitoral Inclusion Cyst after type 1 Female Genital Mutilation. American Journal of Obstetrics & Gynecology 185, 569–571.
World Health Organization (WHO)/United Nations Children’s Fund (UNICEF), 2003. Ethnic Matching of Clients and Clinicians and use of Mental Health Services by ethnic minority clients. Psychiatric Services, 54, 535-541.
Ziguras, S., Klimidis, S., Lewis, J., & Stuart, G., 2003. Antenatal care in developing countries: promises, achievements and missed opportunities. WHO, Geneva.