Human Rights during COVID-19 pandemic. The issue of Female Genital Mutilations

Bellizzi, S.; Nivoli, A.; Lorettu, L.; Ronzoni, A. R.

Abstract While SARS-CoV-2 has infected millions and claimed more than 250,000 lives, experts are warning that the impact of other diseases neglected due to the pandemic may be just as significant in the months and years to come. Specifically, when health systems are overwhelmed, and people refrain from visiting health facilities due to movement restrictions or fears about illness exposure, both direct mortality and indirect mortality from preventable and treatable conditions increase.1-3 Female genital mutilation (FGM), also named female genital cutting, is acknowledged as a violation of human rights of women.4 The United Nations Sustainable Development Goals called for the elimination of the practice by 2030.5 FGM is referred to as any procedure involving the alteration or excision of external female genitalia without medical indication,6 and 3 million women in the world are estimated to be at risk of undergoing this procedure annually.6 It is a major public health problem in several countries in Africa and Middle East,6,7 being almost universal in seven African countries (prevalence >85%).6 A report from UNICEF highlighted how this practice is still being widely carried out in 29 countries in Africa and in Middle East, despite the fact that at least 24 of these countries have legislation or some form of decrees against FGM.8 However, some evident progress is ongoing: under the new FGM amendment to the criminal law in Sudan that was approved very recently (22 April 2020), anyone who performs FGM either inside a medical establishment or elsewhere faces three years' imprisonment and fine. 9 Studies conducted in different settings have clearly showed an adverse effect of FGM on psychological, sexual and reproductive health unfavourable outcomes. 10 This includes posttraumatic stress disorder,11 dyspareunia and genitourinary complications. Adverse obstetric outcomes, such as increased risk for caesarean delivery, episiotomy and postpartum haemorrhage, are also more frequent.12 Scar tissue, especially in women with FGM type III (infibulation) can result in obstructed labour or obstetric trauma.13 It is known that in situations of conflicts and disaster, gender inequality, gender-based violence and violation of human rights are likely to increase, as protection and health system are disrupted, leaving acts of violence unpunished and condoned by the societies. This applies to health emergencies as well, including the current COVID-19 pandemic. FGM, early marriage and violence against women and girls are life-threatening, health and human rights challenge, due to the inequal relations, and patriarchal rules.14 Survivors are left no choice or right of determination over their bodies, physical, and sexual and reproductive health. Estimates provided by Avenir Health, Johns Hopkins University (USA) and Victoria University (Australia) predict that significant levels of lockdown-related disruption over 6 months may cause significant delays in programmes to end female genital mutilation, potentially leading to around 2 million more cases of FGM over the next decade than would otherwise have occurred.15 These striking figures become even more daunting when compounded with the expected additional 31 million cases of gender-based violence and the 13 million more child marriages over the next 10 years.15 Support to continued access to reproductive health care services and protection of the rights and dignity of all women and girls remains even more critical in contexts such as the current pandemic. To do so, preparedness and response plans must incorporate and integrate Female Genital Mutilation in Gender-Based Violence, and Sexual and Reproductive Health Programmes, including in community awareness initiatives and activities, thus ensuring risk mitigation as well as remote and mobile case management.