Humble Proposal for Effective Health Policy in Sudan Female Genital Mutilation must end!

Alaa Babiker

As a health care provider and as I was still studying, I imagined that working at hospitals in Sudan would be like Grey’s Anatomy, Bones, or even House! So organized with much resources. But! After graduation I was first hit by the lack of job opportunities, then when I finally found one I was shocked by the limited work resources and environments! I mean I know that we live in a low-income country and my expectations were not really high, but I was not expecting the reality I faced.

For the above-mentioned events, I recently got enrolled in a health mater’s program for the following reasons; first: to be able to work at an international organization and therefore be able to participate in making effective health policies. Second: help improving not just health status in Sudan, but also help raise the awareness of the community about dangerous practices that cause extreme damage in many aspects. One practice that really cause not just health problems, but has severe psychological effects on girls and women, is Girls Circumcision! Or medically known as Female Genital Mutilation (FGM).

Today I am proud to be able to publicly speak about this, and share with you one of the assignments I wrote at my master’s program. The assignment was about choosing a position and an audience, and then research and write a health policy that would be effective addressing the proposed heath problem for that audience. Below is what I have shared with my supervisor, and I am glad to share it at The Citizen for more awareness and knowledge sharing.

( Introduction:-

As a primary care physician, I would like to adopt a very important health initiative that affects the lives of many girls and women in my community. That is Girls Circumcision! Or medically known as Female Genital Mutilation (FGM).

Having the ability to speak on behalf of all the girls and women of my country, I would like to direct this initiative to the Minister of Health in Sudan.

Policy Memo: –

Girls Circumcision is considered one of the harmful procedures ever done to hurt girls and women at the time being of the procedure and in their future. The procedure is the removal of some or all the parts of the girls’ genitals, leading to one of the following catastrophes: –

1. Physical distortions.
2. Extreme pain and sometimes sever bleeding after the procedure.
3. Development of bacterial infections (especially when the tools used are not sterile).
4. Sever complications at delivery which at many cases lead to death.

The main problem is that Girls Circumcision (Female Genital Mutilation FGM) is still being practiced at almost all parts of Sudan. Despite some decisions being made by the government about punishing those who practice it, but people still believe that it is a necessary thing to do. And in fact their believes has nothing to do with the reality!

Girls really suffer from this procedure and when they grow older and reach the age when they supposed to have normal child delivery process, they face the fact that the problem is only getting bigger, and they suffer a lot before, during, and after the delivery process.

This problem is very important one to address, you see, during giving birth some girls have complications that may lead to delay the delivery process leading to having difficulties pushing the baby out, leading to lack of oxygen for the baby, ending to having results of Hypoxic Ischemic Encephalopathy (HIE) which is believed to affect up to 3 in 1,000 newborns worldwide, but considering the reality I believe that this proportion might be higher in Sudan. HIE can result in a number of disabilities, brain damage and even death. And having difficulties at delivery does not only affect the child, but can also lead to bleeding and even death for the mother as well.

Therefore, it is very important to educate the community about why Girls Circumcision is a very bad practice and has nothing to do with what they believe.

Policy of Action:-

Unfortunately Female Genital Mutilation is practiced in 30 countries in western, eastern, and north-eastern Africa, with many girls and women having medical complications before, during, and after this procedure, and especially at delivery if they have a certain type of the Circumcision.

To fully and successfully address this problem, major actions of policies are to be made and applied at various levels as follows:-

1. At Governmental Level: the government needs to take more serious actions about punishing those who practices this harmful procedure, and actually apply the law of taking away the Medical Practice License from the midwives who do it. And the government should also be strong enough to make clear and public statements about that.
2. At Locality Level: the Governor should – and with corporation with the MoH – to establish a special department of Police Forces composed of women so that the communications and the discussions are more easily with the victims of this procedure and their families.

These Women Police Forces should have regular visits to all the hospitals in the Capital and at the rural areas, searching for cases of Girls Circumcision (because some cases get sever bleeding after the procedure, or have severe bacterial infections after the procedure and they are moved to hospitals for treatment), or even looking for cases of delivery complications due to FGM.

3. At Community Level: Women’s Rights activists and health care providers should have major role in educating the parents about the harm of this procedure, and that workshops should be held regularly for awareness about this important matter. And that reports of health care centers should be raised to police and government to help them make the right decisions about what to do next.

The positive impact of this policy should work at two parallel tracks:-

First: The above mentioned policies will help us reduced the future Maternal Mortality Rates because people might get frightened of getting punished by the police and actually stop practicing this procedure. When police is present order gets in place, at least to some extent! And this will make even the midwives who actually do the FGM procedure stop doing it, especially when they know that they are putting their careers at risk.

Second: the awareness of the community is to hopefully get raised by the extensive works of workshops, seminars, and discussion groups held by the health care providers and the community’s women’s rights activists.

Finally, this policy will face great resistance from the people who truly believe in Girls Circumcision (FGM) and they will actually fight everyone who would try to convince them the opposite. An example is what happened to one of the organization’s staff, a female who was educating women at a village of one of the rural areas to have deliveries at hospitals (because women at rural areas have their child deliveries at home and many of them have complications during the process, and it gets difficult to transport the case fast enough to the nearest hospital – which is far – leading to the death of both the child and the mother), unfortunately she was followed by some of that village’s men, and she was stabbed to death. Because of this example and many other examples, the safety of the working staff is a priority as well, and here comes the importance of the involvement of police forces, especially at rural areas where people are aggressive when it comes to interfering their thoughts and believes).

At end, if you work at heath facilities in Sudan, please share your experience with us, and if possible leave some solutions to problems you have personally faced, when we combined all the solutions together we will develop an effective health policy, and with the help of health authorities in Sudan we will be able implement these policies on the ground. Stay safe and healthy everyone.