Source: Daily Trust
On February 6 2012, the world marked the ninth annual International Day of Zero Tolerance to Female Genital Mutilation/Cutting (FGM/C). 'Female Genital Cutting (FGC) is the partial or total removal of the external female genitalia for non-medical reasons.

The term describes a varied range of practices, including the following: slight pricking or nicking of the clitoral hood; hoodectomy (excision of the clitoral hood); clitoridectomy (excision of the clitoris); the excision of the clitoris and labia minora and majora; and infibulation (suturing) with excision of the external genitalia.'

For those of us working in promoting maternal health in Nigeria the day was marked as a moment of reflection, given the challenges the country is currently facing in achieving the Millennium Development Goals MDGs. Nigeria has one of the highest rates of VVF in the world, a disability that is linked to female genital cutting FGC. Vesico vaginal fistula (VVF) or recto vaginal fistulas (RVF) are holes resulting from the breakdown in the tissue between the vaginal wall and the bladder or rectum caused by unrelieved obstructed labour. The consequences of such damage are urinary or faecal incontinence resulting in the constant leaking of urine or faeces. Vesico vaginal fistulae (VVF) and recto vaginal fistulae (RVF) are serious reproductive health problems for women in the developing world, although they have been practically eliminated in developed countries. The large majority of sufferers are young, poor, uneducated rural women. Most of the cases are in Northern Nigeria with cases also reported in Cross River and Ebonyi states in the South East.

A study by a founder of Forward Foundation in Nigeria Dr Rahmat Mohammed and her colleague Meg Braddock said the estimates for Nigeria of 2 VVF per 1,000 births and a total of 150,000 to 200,000 cases ' is rather low because 'they are calculated from the number of women who arrive at the hospital for treatment. These are the lucky few who have heard (generally by word-of-mouth) that treatment is available and can get to the specialist VVF hospitals, of which 2 out of 3 are in the north. Many actual sufferers do not know treatment is available or cannot get to hospital, and many potential sufferers die in childbirth before the VVF is formed.

The real backlog of cases is therefore likely to be much higher.' Experts identify the 'principal direct cause of VVF is unrelieved obstructed labour. When the mother's pelvis is too small to allow free passage, the baby's head pushes against the pelvic bones. Obstructed labour is one of the principal causes of reported maternal death in Nigeria. Other causes are female genital cutting from traditional surgery done by local midwives called 'Gishiri' cuts to widen the vaginal wall during labour. The social costs of unrelieved obstructed labour and VVF are enormous, including the cost in stillborn babies, maternal mortality and social rejection of women who develop a VVF who are often abandoned by their husbands.

Government and Civil Society organisations are working together to eradicate the scourge of VVF in our communities. Forward Foundation for Women's Health is a Kano based nongovernmental organisation working in the prevention, treatment and rehabilitation of patients of vesico vaginal fistulae VVF. Last year it invited AdvocacyNigeria, a nongovernmental organisation working to reduce maternal mortality and morbidity and the Federation of Muslim Women's Associations FOMWAN which has been providing integrated maternal health services for two decades in its hospitals nationwide, to join it in implementation of its VVF project in Dambatta, Kano State.

As the world focused attention on the harmful effects of female genital cutting, government officials and civil society have added their voices to the call to end FGC. In a press statement, Hillary Rodham Clinton, the US Secretary of State traced the cultural tolerance for FGC which said include 'the faulty beliefs that FGC is "a good tradition" or a religious requirement or that it ensures "cleanliness" and prevents excessive clitoral growth. FGC is also deeply connected to marriage rituals and ideas about protecting virginity and preventing promiscuity.' The release shows that FGC is practiced openly in 28 different African countries, as well as secretly in parts of the Middle East, Europe, Australia, and the United States. Over 130 million women worldwide have been affected by some form of FGC, and three million girls are at risk every year. Most children are subjected to FGC between the ages of four and ten years; however, there has been a recent downward shift in the age of victims.

Secretary Clinton said 'Every government has an obligation to protect its citizens from such abuse. As we commemorate International Day of Zero Tolerance and remember those who have been harmed, we reaffirm our commitment to overturning deeply entrenched social norms and abolishing this practice. All women and girls, no matter where they are born or what culture they are raised in, deserve the opportunity to realize their potential. We must continue to act to end this affront to women's equality and the rights and dignity of women and girls. She said 'No religion mandates this procedure, though it occurs across cultures, religions, and continents. It is performed on girls in Africa, Asia, and the Middle East. Even in the United States we are fighting this practice. FGM/C became a federal crime in the United States in 1997, but the procedure persists in some communities.

The U.S. Government is working with practitioners in the health and legal community to educate groups about the negative consequences of FGM/C. Over the years, community advocates have found that when men come to understand the physical and psychological trauma FGM/C causes, they often become effective activists for eradication, including fathers who refuse to allow their daughters to be subject to the procedure. Communities must act collectively to abandon the practice, so that girls and their families who opt out do not become social outcasts. This approach has led around 6,000 communities across Africa to abandon the practice, usually through a public declaration. Communities working together can ensure stronger, healthier futures for girls and young women.

From Austria, the Vice Chancellor and Foreign Minister Michael Spindelegger put it very clearly: "Female genital mutilation is a severe violation of human rights and must be stopped by all available means. We must double our efforts to eradicate this archaic custom that puts the health of young women and girls at stake. A current report of the United Nations states that while the continued international efforts to eradicate female genital mutilation has brought about a slight decrease in the number of women mutilated; the cutting of women and girls is still very common in many African countries, some areas of Asia and the Middle East - despite national legal bans.

There are also disturbing reports about an increasing number of cases of mutilation of immigrants living in Europe and the USA. This shows that the efforts to effectively implement legal bans need to be intensified and that more awareness must be created. "Female genital mutilation is a particularly perfidious form of violence committed against women. Austria is going to proactively support the protection of rights of girls and women within the framework of the imminent session of the UN Commission on the Status of Women and to fight for the worldwide abolition of this discriminating practice", Spindelegger concluded.

• Nigeria