GENDER AND HEALTH for health care workers and students .pptx

T his is a presentation on gender concepts and how gender relates to health. it elaborates on the on the gender disparities and how to mitigate them.

1. GENDER CONSTRUCTION Everlyne makokha

2. Differences, inequalities and the division of labor between men and women are often simply treated as consequences of ‘natural’ differences between male and female humans. Gender is socially constructed because roles are stated by society

3. Gender roles They are culturally constructed They are personal Social and behaviorally accepted

4. Gender as a social construction Gender is a process, stratification system and structure; Process = day to day interactions reinforce gender as opposites. e.g , conversations, rituals of daily life Stratification = Men as a group have more status and power than women as a group. Women are treated as “other,” and compared to men Structure = Gender divides work in the home and economic production It legitimates those in authority and organizes sexuality and emotional life

5. How does our conception of gender affect work? Products created for different tasks Expectations for different jobs. Value for the tasks done

6. Gender and Power Patriarchy is a form of social organization in which males dominate females. Matriarchy is a form of social organization in which females dominate males. No matriarchal societies are known to exist or to have existed

7. Gender issues affecting health

8. Gender equality & sexuality Human sexuality and gender relations are closely interrelated and together affect the ability of men and women to achieve and maintain sexual health and manage their reproductive lives.

9. Gender equality & sexuality Equal relationships between men and women in matters of sexual relations and reproduction, including full respect for the physical integrity of the human body, require mutual respect and willingness to accept responsibility for the consequences of sexual behaviour .

10. Concepts for gender analysis Sex: - refers to the biological characteristics that define humans as female or male (but not mutually exclusive) Gender: - refers to the socially constructed roles, rights, responsibilities, possibilities and limitations that, in a given society, are assigned to men and women.

11. Common elements in gender-based differences Men and women perform different tasks and activities, occupy different physical spaces, different social networks Men and women, boys and girls, are expected to behave differently. Appropriate dress, games, interests, skills and competencies, social mobility etc. Wide differences in access to resources and decision-making power

12. Common elements in gender-based differences Gender roles reinforced by social institutions – family, school, religious institutions, workplace etc. Gender-based inequality often written in laws and policies e.g. marriage and divorce, inheritance, guardianship of children.

13. Impact of gender differences on health Blindness – women 64%, men 36% ( Abou-Gareeb , 2001) Road traffic accidents HIV/AIDS

14. Higher prevalence of blindness among women: why? Longer life spans of women? Differential mortality among blind men/women? Between 53% and 72% of those with cataract in Asia and Africa are women About 75% of adults with trachomatis trichiasis (advanced stage of trachoma) are female

15. Higher prevalence of blindness among women: why? Women with cataract are much less likely to have surgery than men with cataract. An estimated 12.5% reduction in cataract blindness if women received surgery at the same rate as men. Gender-based elements: – cost – inability to travel – differences in the perceived value of surgery – lack of access to information and resources – fear of poor outcome

16. Differential mortality for men from road traffic accidents. Why? Exposure: More men employed as drivers; machines assumed to be “male” domain; restrictions on women’s movements/greater mobility of men. Risk-taking: Risk taking and associated aggression valued as positive masculine traits, particularly among young men. Alcohol: Alcohol abuse much more widespread among men, due to tolerance by society (gender) and/or biological predisposition (sex). Men more likely to drive and walk in public when drunk.

17. Sex and gender differences in sexual transmission of HIV/AIDS Biological (sex) - Women are more than twice as likely as men to be infected in a single act of vaginal intercourse. - An untreated STI increases risk of transmission 10 times; STIs more often asymptomatic in women Socio-cultural (gender roles) - Masculinity associated with early sexual activity, many sexual partners and experiences, virility and pleasure - Femininity associated with passivity, virginity, chastity and fidelity.

18. Sex and gender differences in sexual transmission of HIV/AIDS Violence against women puts them at greater risk of HIV infection due to biological, psychological, economic and cultural factors. HIV-positive women have experienced more sexual coercion than HIV-negative women.

19. Long-term effects of sexual violence include increased sexual risk taking (greater numbers of sexual partners, casual partners, transactional sex and lower condom use.) Violence or fear of violence keep women from disclosing their HIV status, from seeking VCT and obtaining HIV/AIDS care and treatment.

20. Sex and gender differences in sexual transmission of HIV/AIDS Men more likely to experience pressure to be sexually active before and outside of marriage Men more likely to be injecting drug users than women Men who have sex with other men are highly vulnerable to HIV infection

21. Men less likely than women to have access to sexual and reproductive health services (less likely to receive appropriate information) Men victims of sexual violence less likely to report it and receive appropriate care.

22. What can be done? Collect sex-disaggregated data on ill-health and on use of services Design interventions that take into consideration the needs of men and women Design research to examine reasons for gender disparities – "engendering research" Ensure gender roles are taken into account in the way in which research is conducted – male or female investigators/questionnaire administrators

23. Epidemiological synergy between STI/RTI and HIV STI/RTI primarily disrupt the integrity of the skin/mucosal barrier, enabling HIV easy access to the body The presence of genital ulcers is known to increase the risk of HIV transmission by 10 to 100 times STI/RTI that primarily cause inflammation, such as gonorrhea, trichomoniasis, and chlamydia, weaken the skin barrier to HIV. Increased viral shedding has been reported in genital fluids of patients with STI/RTI STI/RTI treatment has been demonstrated to significantly reduce HIV viral shedding

24. HIV infection affects STI/RTI through: HIV alters the response of STI/RTI pathogens to antibiotics. This has been reported for chancroid and syphilis HIV alters the clinical appearance and natural history of STI/RTI as in genital herpes and syphilis HIV-infected individuals have increased susceptibility to STI/RTI

25. Association Between HIV/AIDS and STI/RTI STI/RTI serve as a marker of increased number of sexual partners and high risk partner selection, and are associated with increased heterosexual HIV transmission Due to this epidemiological synergy, STI/RTI control is considered a key strategy in the primary prevention of HIV transmission

26. Other Cofactors for HIV Transmission Sex with insufficient lubrication leads to micro-ulcers which facilitate HIV transmission Cervical ectopy: results in weaker mucosal lining within the end cervical canal and extends outside the cervical opening towards the vaginal walls in females around puberty and in those taking combined contraceptive pills Risky sexual behaviour predisposes persons with cervical ectopy to STI infections, mainly gonorrhea and chlamydia, which put one at a higher risk of HIV

27. Other Cofactors for HIV Transmission Uncircumcised males have an independent increased risk of HIV acquisition Sex during menstruation or shortly after delivery may expose raw bleeding areas to the risk of HIV transmission

28. GENDER ANALYSIS

29. Gender analysis WHO’s Gender Policy 2000 includes as an objective ‘to ensure that its policies, programmes and projects include analysis of gender issues in their activities

30. Gender analysis Gender analysis identifies, analyses and informs action to address inequalities that arise from the different roles of women and men, or the unequal power relationships between them, and the consequences of these inequalities on their lives, their health and well-being

31. Gender analysis Social science methods to examine relational differences in women’s and men’s and girls’ and boys’ roles and identities needs and interests access to and exercise of power and the impact of these differences in their lives and health.

32. Definition “A methodology for collecting and processing information about gender It provides disaggregated data by sex, and an understanding of the social construction of gender roles, and how labor is divided and valued.” (UNDP)

33. Gender Analysis GA is a systematic way to explore:   Current and potential roles and responsibilities of women and men, Their access to and control over resources and benefits at various levels and particular positions within community, household, project…

34. Gender Analysis GA objectives To reduce gender gaps concerning meeting Gender Practical Needs (GPNs) and Gender Strategic Needs (GSNs) to lead towards : Achieving Gender Equality in participation and decision making in private and public life Widening the range of equal opportunities, choices and rights of women and men in all development and empowerment areas  Eliminating obstacles that impeded women from accessing equally to resources

35. In Utero Pre - Puberty Puberty Early Adolescence Late Adolescence Young Adulthood Adulthood Near Old (55-64 yrs) Young Old (65-74 yrs) Oldest Old >75yrs technical advances family influences School influences peer influence peer pressure Socio cultural influence Cultural and societal pressure Community approval & Support Family support Family & Community From WOMB To TOMB The Life Cycle In RH

36. Gender Principles :   Gender Equality Gender Equality means an equal number or an equal % of women and men at given position, place, space… This number/ %, doesn’t imply necessarily that women and men are identical but that they have the same human value and therefore should enjoy the same human rights: Equal rights and equal opportunities

37. Long-term goal Absence of discrimination based on sex Equality between men and women exists when both sexes are able to share equally in the distribution of power and influence Gender Equality

38. Gender equity Gender equity: Equality is not always equitable Building responses on an understanding of gender-related expectations, needs, and rights and may need to challenge adverse norms It is important to recognize that different groups have different needs (biological differences; individual capacities and competencies (e.g. claim holders), social and economic status and means, and Health situations, conditions and /or problems

39. Gender equity is the process of being fair to women and men To ensure fairness, strategies and measures must often be available to compensate for women’s historical and social disadvantages that prevent women and men from otherwise operating on a level playing field Equity leads to equality GENDER EQUITY

40. equal treatment before the law equal access to social provisions Equal access to education Quota for female representatives GENDER EQUALITY GENDER EQUITY Gender equity leads to gender equality Women’s empowerment & girls’ leadership is a critical aspect of promoting gender equality Engaging men and boys

41. Contd …. Where gender inequality exists, it is generally women who are excluded or disadvantaged in relation to decision-making and access to economic and social resources Therefore a critical aspect of promoting gender equality is the empowerment of women, with a focus on identifying and redressing power imbalances and giving women more autonomy to manage their own lives.

42. WOMEN EMPOWERNMENT Equal opportunities and rights for women and men require that both were equal at the starting point…. When women and men have an unequal status within a community and unequal access to resources, women need preferential treatment and affirmative action before their starting point could be considered as equal This is positive discrimination

43. 50% of policies include guidelines and actions to promote gender and ethnic equality. Advances for Women’s Equality

44. Level of analysis Women Men Household Community

45. Category of analysis Labour Time Resources Culture

46. Domains To understand gender relations more concretely, gender analysis approaches (and tools) often choose to focus on specific “aspects” of social and cultural relations in a given context. The specific “aspects” of social and cultural relations chosen for focus in an analysis are referred to as “domains.”

47. Domains frequently analyzed in reproductive health programming include practices, roles, and participation; knowledge, beliefs, and perceptions (many of which are normative—that is, provide norms for what is appropriate behavior for women and men); access to assets; rights and status; and (related to all of these) power.

48. Gender constraints and opportunities need to be investigated in specific contexts, as they vary over time and across … Social Relationships Partnerships Households Communities Civil society and governmental organizations/institutions Sociocultural Contexts Ethnicity Class Race Residence Age

49. What different constraints and opportunities do women and men face How do gender relations (in different domains of activity) affect the achievement of sustainable results How will proposed results affect the relative status of men and women (in different domains of activity)

50. That is, how do gender relations in each of these domains present a potential opportunity or constraint to achieving project results, and how might a project’s planned activities and results affect these identified gender opportunities or constraints (and ultimately, the relative equality of women and men)?

51. Different Domains of Gender Analysis Legal rights and status Knowledge, beliefs and perceptions Access to assets Practices, roles and participation

52. To understand gender relations … Different domains of gender relations Practices, Roles, and Participation Knowledge, Beliefs, and Perceptions Access to Resources Rights and Status POWER POWER

53. Gender domains The 4 domains that structure the gender analysis in this framework are Practices, Roles, and Participation Knowledge, Beliefs, and Perceptions (some of which are norms) Access to Assets Legal Rights and Status

54. Gender domains……. Taken together, these different relations in these domains shape the different levels of power to which women and girls and men and boys may have access in a given context Power is thus in many ways a cross-cutting domain, but we also list it separately to ensure that it is considered concretely as well

55. Different Domains of Gender Analysis Legal rights and status Knowledge, beliefs and perceptions Access to assets Practices, roles and participation POWER

56. Gender and Sexuality Influence One Another Gender Sexuality

57. Gender and sexuality It is important to recognize that norms related to gender and sexuality—and the resulting hierarchies—are closely related and reinforce one another

58. Practices, Roles, and Participation Gender structures peoples’ behaviors and actions —what they do ( Practices ), the way they carry out what they do ( Roles ), and how and where they spend their time ( Participation ) Participation Activities Meetings Political processes Services Training courses

59. Practices, Roles, and Participation Gender structures peoples’ behaviors and actions—what they do and the way they engage in reproductive health (and the particular program areas of training, such as safe motherhood) activities

60. Practices, Roles, and Participation This domain refers to peoples’ behaviors and actions in life—what they actually do—and how these vary by gender It encompasses current patterns of action, including patterns of actions related to sexuality (such as men and women’s sexual behaviors ) It also encompasses the way that people engage in development activities It includes attending meetings, training courses, accepting or seeking out services, and other development activities

61. Practices, Roles, and Participation Participation can be both active and passive Passive participants may be present in a room where a meeting is taking place and therefore may be aware of information transmitted, but do not voice their opinions or play a leadership role Active participation involves voicing opinions and playing an active role in the group process

62. Knowledge, Beliefs, and Perceptions Knowledge that men and women are privy to — who knows what Beliefs (ideology) about how men and women and boys and girls should conduct their daily lives Perceptions that guide how people interpret aspects of their lives differently depending on their gender identity

63. Access to Assets The capacity to access resources necessary to be a fully active and productive participant in society (socially, economically, and politically). Assets Natural and productive resources Information Education Social capital Income Services Employment Benefits

64. Access Access refers to being able to use the assets necessary to be a fully active and productive participant (socially, economically, and politically) in society Includes access to resources, income, services, employment, information, and benefits Differential access to assets is often shaped by a person’s social status; in turn, differential access to assets can reinforce differences in social status Related to sexuality, how one conforms to or transgresses norms of ‘proper’ sexuality shapes a person’s social status and access to assets

65. Legal Rights and Status Refers to how gender affects the way people are regarded and treated by both customary law and the formal legal code and judicial system . Rights Inheritance Legal documents Identity cards Property titles Voter registration Reproductive choice Representation

66. Gender and sexual norms and inequalities exist in legal rights and status, including differences in rights accorded to men, women, and transgender people in formal and customary legal systems, differences in how the judicial (or other law and customary systems) actually enforce or apply the law, and

67. differences in recognition that certain rights even exist (at either the individual level—where women, men, and transgender people may not recognize the existence of certain rights—or at the institutional level within written or applied laws, where certain rights are not recognized as “rights” in the first place).

68. Power Gender relations influence people’s ability to freely decide, influence, control, enforce, and engage in collective actions. Decisions about … One’s body Children Affairs of household, community, municipality, and state Use of individual economic resources and income Choice of employment Voting, running for office, and legislating Entering into legal contracts Moving about and associating with others 2005 Kevin McNulty, Courtesy of Photoshare

69. Power Taken together, these four domains ultimately affect the ability of people to decide, influence, control, and enforce a decision—that is, the ability of people to have the power to make decisions freely and to exercise power over their body, sexuality, and within their individual households, communities, municipalities, and the state.

70. Power This includes the capacity of adults to decide about the use of household and individual economic resources, income, and their choice of employment. It also encompasses the right to engage in collective action, including the determination of rights to and control over community and municipal resources. Finally, it includes the capacity to exercise one’s vote, run for office, be an active legislator, and enter into legal contracts .

71. In short, Gender Analysis reveals … = gender relations (in different domains) that facilitate men’s or women’s access to resources or opportunities of any type. = gender relations (in different domains) that inhibit men’s or women’s access to resources or opportunities of any type. Gender-based Opportunities Gender-based Constraints

72. Gender Mainstreaming Gender Mainstreaming is a process to ensure that both men and women have equal access to and control over resources, decision-making, and benefits at all stages of the development process and projects. 2

73. Gender mainstreaming Gender mainstreaming in health focuses on: changing harmful organizational structures, behaviour , attitudes and practices transforming the public health agenda that includes the participation of women and men in defining and implementing public health priorities and activities programmes and processes Progressive results over the long-term

74. A Strategy for Gender Mainstreaming Clear Policy Assessment of past Performance Action Plan Effective Partnerships 4

75. “Promote Gender Equality and Empower Women” the ratio of girls to boys in primary, secondary and tertiary education the ratio of literate women to men in the 15-to 24-year-old age group the share of women in wage employment in the non-agricultural sector the proportion of seats held by women in national parliaments THE TARGET “Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than 2015” THE MILLENIUM DEVELOPMENT GOAL 3 An overview The indicators

76. Gender and the MDGs 70% of the poorest population is female 70% of the illiterate world is female - Boys are favoured over girls in health care - High Infant Mortality Rate - education/income levels of mother Women’s inability to make health-related decisions: cause of maternal mortality 61% of people living with HIV are women “ “Gender equality is more than a goal in itself. It is a precondition for meeting the challenge of reducing poverty, promoting sustainable development and building good governance.” ” - Kofi Annan - X X

77. Affirmative Action for Equality of Outcome Example: Instead of just asking: How many women or girls can apply, or can Participate, or are represented? We ask: How many women or girls have actually participated? At what level? And why [not]? And How can we make sure that more women actually participate, have equal power and benefit at all levels?

78. Debate Women are a weaker sex Referral Stigma Discrimination Myths and misconception Primary prevention Secondary prevention MARPS

79. WOMEN EMPOWERMENT

80. Of the 1.3 billion people who live in absolute poverty around the globe, 70 percent are women.

81. WOMEN’S EMPOWERMENT is the sum total of changes needed for a woman to realize her full human rights – the interplay of changes in:

82. Women and Poverty Women represent a disproportionate share of the poor. Women in the poorest compared to the wealthiest households have much higher fertility rates and far fewer safe deliveries. Women in poorest compared to wealthiest households have gaps greater in skilled delivery than other services.

83. Women’s Status Affects Access to Health Services • Lack of mobility, decision-making power, and income constrain women’s health service use. • Prohibitions against women seeking care from male providers are also a serious constraint.

84. Fourth World Conference on Women Beijing, China - September 1995 Action for Equality, Development and Peace

85. The Cairo and Beijing Revolutions • Coercive approaches were officially banned • Family planning became the free choice of individual couples • Women became equal partners in every decision concerning the family; • Women formally took their destiny in their own hands

86. Women’s Health as a Human Right Recent conventions and treaties recognize women’s right to: • Reproductive choice • Pregnancy-related care • Freedom from violence

87. Risks Due to Biological Factors • Pregnancy-related complications • Higher risk per exposure of contracting STDs, including HIV/AIDs • Special nutritional requirements, e.g. iron • Gynecological cancers Women have higher death and disability from depression, domestic violence, and sexual abuse

88. Role of health professional in women empowerment • Bridge gap between health facility and household; • Address social and cultural factors affecting women’s use of health services; • Promote essential interventions for behavior change and positive health practices; • Work to eliminate harmful practices.

89. GENDER BASED VIOLENCE

90. Definition Gender-based violence (GBV) is a violation of human rights and a form of discrimination . It is defined as violence that is directed against a person on the basis of gender. Gender-based violence reflects and reinforces inequalities between men and women.  Gender-based violence both reflects and reinforces inequities between men and women and compromises the health, dignity, security and autonomy of its victims.

91. Definition Public or private act of gender-based violence that results, or likely to result in physical, sexual or psychological harm to women; derived from unequal power relationships; includes: acts of physical aggression and harm emotional, psychological abuse & controlling behaviours coerced sex, sexual harassment, rape

92. Epidemiology (KDHS 2008-09) 83% of women and girls in Kenya report one or more episodes of physical abuse in childhood. 75% of Kenyan women report having suffered from gender-based domestic violence in the homestead. The majority of Kenyan women believe it is acceptable for men to beat their spouses.  46% report at least one incident of sexual abuse as a child. 36% of rural women report having experienced FGM. 25% report losing their virginity by force.

93. Epidemiology (KDHS 2014) Women in Western, Nyanza, and Nairobi regions reported higher levels of physical and sexual violence committed by a spouse/ partner. North-eastern lowest (12%) Physical violence: 38% female, 9% male Sexual violence: 14% female, 4% male

94. More than half (57 %) of women in Nyanza province have experienced physical violence, followed by those in Western province (45 %). Women in Nairobi are the least likely to report having experienced physical violence (29 %) ( KDHS, 2008-09 ). Forced sex among 12% women of reproductive age

95. Types of violence Domestic violence, sexual harassment, rape, sexual violence harmful customary or traditional practices such as FGM, forced marriages and honour crimes Trafficking in women, forced prostitution and violations of human rights in armed conflict (in particular murder, systematic rape, sexual slavery and forced pregnancy) Forced sterilisation , forced abortion, coercive use of contraceptives, female infanticide and prenatal sex selection.

96. Types of violence Domestic Sexual Cultural practices Forced –sterilization, abortion, prostitution

97. Different forms of GBV Sexual, physical, or emotional violence by an intimate partner (intimate partner violence (IPV) & non partners Child sexual abuse & child maltreatment Sexual violence in conflict situations Sexual harassment & abuse by authority figures ( e.g teachers, police officers or employers etc), Forced prostitution and sexual trafficking Child marriage Violence perpetrated or condoned by the state.

98. Effects of GBV Unwanted pregnancies and restricted access to family planning information and contraceptives Unsafe abortion or injuries sustained during a legal abortion after an unwanted pregnancy Complications from frequent, high-risk pregnancies and lack of follow-up care Sexually transmitted infections, including HIV Persistent gynaecological problems Psychological problems

99. Violence at home Most domestic violence involves male anger directed against their women partners. This gender difference appears to be rooted in the way boys and men are socialized -- biological factors do not seem to account for the dramatic differences in behaviour in this regard between men and women. Pregnant women are particularly vulnerable to gender-based violence. Cross-cultural studies of wife abuse have found that nearly a fifth of peasant and small-scale societies are essentially free of family violence .

100. Prevention of GBV Prevention programmes should increase focus on : transforming harmful gender norms and attitudes, addressing childhood abuse, reducing harmful drinking. improving access to education for girls and boys

101. Improving health sector response Developing policies & protocols for treatment of survivors Training health staff Ensuring privacy & confidentiality Strengthening referral networks with other GBV services Providing emergency supplies Providing educational materials on GBV Monitoring & evaluating GBV services

102. International legislation for violence against women The 1948 Universal Declaration of Human Rights states: “everyone is entitled to all the rights and freedoms” mentioned in the Declaration “without distinction of any kind, such as race, colour , sex, language, (…).” In 1979 the UN General Assembly adopted The Convention on the Elimination of All Forms of Discrimination against Women that set up an agenda to end such discrimination. By accepting the convention, states committed themselves to incorporate the principle of equality of men and women in their legal system.

103. International legislation for violence against women The 1993 Declaration on the Elimination of Violence Against Women linked discrimination with violence against women and mentioned “historically unequal power relations between men and women, which have led to domination over and discrimination against women by men and to the prevention of the full advancement of women (…).” In 1999 the UN designated November 25 as the International Day for the Elimination of Violence against Women in order to raise public awareness of the problem. The 2003 UN declaration on the elimination of violence against women added economic exploitation as a type of violence against women (the others being physical, sexual and psychological violence).

104. Summary Violence against women: is widespread has serious health consequences for women has intergenerational consequences – affects children & families poses considerable economic costs

105. RITES OF PASSAGE

106. A rite of passage, which marks a time when a person reaches a new and significant change in his/her life, is something that nearly all societies recognize and often hold ceremonies for. Most rites of passage fall into three main phases: separation, transition, and incorporation.

107. In the separation phase , the participant is taken away from his/her familiar environment and former role and enters a very different and sometimes foreign routine that they are forced to adjust to and become familiar with. The transition phase is the time that the participant learns the appropriate behavior for the new stage they are entering.

108. Incorporation phase, takes place when the participant is formally admitted into the new role. The process varies across the cultures ranging from song, dance, tattooing etc

109. Examples Scarification Birth and naming ceremonies Baptism Marriage Male circumcision

110. Ethiopia - Hamar cow jumping- some grooms-to-be have their own “bachelor party” of sorts- a rite of passage they must complete prior to being able to marry. Participants must successfully jump over a castrated, male cow four times while naked, symbolizing the childhood they are leaving behind them.

111. Examples - scary Mentawai Girls File Their Teeth into Points Boys of the Fulani Tribe Whip the Crap Out of Each Other Maasai Boys Hunt Lions House arrest at female puberty Read more: http://www.cracked.com/article_20075_the-5-most-terrifying-rites-passage-from-around-world.html#ixzz2cxOXzsuj

112. Female Genital Mutilation FGM

113. What is FGM ? Female Genital Cutting are all procedures involving partial or total removal of the external female genitalia, or other injury to the female genital organs, whether for cultural or other non therapeutic reasons Female genital mutilation (FGM) includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons.

114. Facts FGM is a violation of the human rights of girls and women. The procedure has no health benefits for girls and women. Procedures can cause gynaecologic as well as complications in childbirth leading to increased risk of newborn deaths. About 140 million girls and women worldwide are currently living with the consequences of FGM. FGM is mostly carried out on young girls sometime between infancy and age 15. In Africa an estimated 101 million girls 10 years old and above have undergone FGM.

115. KDHS 2014 96% have heard of FGM 21% ever circumcised North Eastern region (98%) Nyanza (32%) Rift Valley (27%) Eastern regions (26%). Western region 1%

116. Types of female genital mutilation as defined by the WHO Type 1 Excision of the prepuce, with or without total or partial excision of the clitoris. Type 2 Excision of the clitoris with partial or total excision of the labia minora . Type 3 Total or partial excision of the external genitalia and stitching or narrowing of the vaginal opening ( infibulation ).

117. Types of female genital mutilation as defined by the WHO Type 4 Unclassified, which includes pricking, piercing or incising the clitoris and/or labia; stretching the clitoris and/or labia; cauterizating the clitoris and surrounding tissue; scraping the tissue surrounding the opening of the vagina ( angurya cuts) or cutting the vagina ( gishiri cuts); introducing corrosive substances or herbs into the vagina to cause bleeding or to tighten or narrow it; and any other procedure that can be included in the definition of FGM noted above.

118. Why does FGM occur? A traditional rite of passage/ part of initiation into adulthood. power inequalities and the passive nature of women to dictates of their communities.

119. Justifications for FGM are: A custom and tradition religious; it is a religious requirement preservation of virginity social acceptance for marriage Hygienic and a cleanliness practice increases sexual pleasure for the male family honour a sense of belonging to the social group enhances fertility

120. Consequences of FGM Can have short-term and long-term health implications

121. Short term health implications include: severe pain and shock infection urine retention injury to adjacent tissues immediate fatal hemorrhaging

122. What are some of the consequences of FGM? infection tetanus bleeding tearing during child delivery keloid formation risk of HIV infection

123. Long-term implications Extensive damage of the external reproductive system Uterus, vaginal and pelvic infections Cysts and neuromas Increased risk of VVF Complications in pregnancy and child birth Psychological damage Sexual dysfunction Difficulties in menstruation

124. WHO efforts to eliminate female genital mutilation focus on: Strengthening the health sector response : guidelines, training and policy to ensure that health professionals can provide medical care and counselling to girls and women living with FGM; Building evidence : generating knowledge about the causes and consequences of the practice, how to eliminate it, and how to care for those who have experienced FGM; Increasing advocacy : developing publications and advocacy tools for international, regional and local efforts to end FGM within a generation.

125. Conclusion In Kenya, estimated prevalence rate of FGM is 21% (KDHS 2014), and the prevalent forms are clitoridectomy and excision