Women's Health Problems and Solutions

International Day of Zero Tolerance for Female Genital Mutilation 2024

Women's Health

6 Feb 2024

11 mins

International Day of Zero Tolerance for Female Genital Mutilation 2024"Let us join her, hand in hand, To end FGM across the land. For in her triumph, our hope is found, As her voice echoes, the world around." On February 6th each year, the world comes together to observe the International Day of Zero Tolerance for Female Genital Mutilation (FGM), shining a spotlight on a crucial issue. Female genital mutilation, a deeply concerning practice, involves altering or harming the female genitalia for non-medical reasons. It is recognized universally as a violation of human rights. Sadly, an alarming 200 million girls and women worldwide have undergone this procedure. While there is progress in reducing this practice in many countries, the challenge persists. Compounded by high population growth rates in many regions, there is a pressing need to accelerate efforts to end FGM. Every year, this day serves as a reminder of our collective responsibility to protect the rights and dignity of girls and women everywhere, ensuring they live free from harm and discrimination. FGM DAY THEME 2024 UNFPA and UNICEF are working together to stop Female Genital Mutilation (FGM). They lead a big global plan focusing on 17 countries. This plan helps regional and worldwide efforts, too. In 2012, the UN General Assembly made February 6th an International day of zero tolerance for female genital mutilation, saying "No" to FGM. They wanted to make everyone focus on stopping this bad practice. This year, the International Day of Zero Tolerance for Female Genital Mutilation has a special theme: "Her Voice. Her Future". It Is about supporting groups led by survivors to stop FGM. WHAT IS FGM? Female genital mutilation (FGM) is when someone hurts or changes a girl's private parts on purpose for reasons that aren't medical. They might use a sharp tool, like a knife, and it Is usually done in unsafe conditions. This practice primarily targets girls from infancy to around the age of 15. It is also called female circumcision or cutting. Some people might think doing this with medical help makes it safer, but that's not accepted because it is against the rights of girls and women worldwide. Every year, over 3 million girls are at risk, and around 200 million women have already been through it. This happens a lot in parts of Africa, the Middle East, and Asia, as well as among people who move from these places. There are rules against it in many countries now, and people are trying to convince those who do it to stop. WHY IS FEMALE GENITAL MUTILATION (FGM) PRACTICED? People usually do FGM on girls when they are young, sometimes even when they are babies or when they are teenagers. Sometimes, it's done to adult women too. The reasons why they do it can be different depending on where you are. Some communities believe a girl must go through this to become an adult and get married. In many places, FGM is seen as something everyone must do because it is what society expects. People feel pressured to follow these expectations or worry about being rejected if they don't. Some do it because they think it is the right way to behave sexually. Even in countries where FGM is not common, like in parts of Europe, it is still a problem. Each year, many girls and women are at risk of going through it because of globalization and immigration. WHO CLASSIFICATION OF FGM The World Health Organization (WHO) classifies this procedure into four types. Type I (clitoridectomy): This involves either partially or completely removing the clitoris, which is a small, sensitive, and erectile region of the female genitals. In some rare cases, only the prepuce, which is the fold of skin around the clitoris, may be removed. Type II (excision): This procedure involves partially or completely removing both the clitoris and the labia minora, which are the inner folds of the vulva. It may also involve the removal of the labia majora, the outer folds, with or without excising the labia minora. Type III (infibulation): This is the most severe form, where the vaginal entrance is narrowed by forming a covering seal. This seal is created by cutting and repositioning the labia minora or majora, sometimes with stitching. In some cases, the clitoris may also be removed. Type IV: This category includes any additional harmful non-medical treatments, such as piercing, incising, or pricking of the female genitalia, that are not categorized under Types I, II, or III. CONSEQUENCES OF FGM I. SHORT-TERM CONSEQUENCES: FGM in the short term may lead to severe complications such as: * Experience immediate pain, excessive bleeding, and swelling. * Face risks of infection, urinary and vaginal issues, and menstrual complications. * Encounter sexual and psychological challenges. * Struggle with pregnancy and childbirth difficulties. II. LONG-TERM CONSEQUENCES: Long-term consequences include: * Urinary problems (painful urination, urinary tract infections [https://www.mrmed.in/health-library/health-care/urinary-tract-infections]), * Vaginal problems (discharge, itching, bacterial vaginosis, and other infections), * Menstrual problems (e.g., painful menstruations, difficulty in passing menstrual blood), * Keloid formation on the scar tissue, * Sexual problems (e.g., pain during intercourse, decreased satisfaction), * Increased risk of childbirth complications (e.g., perineal tear, difficult or prolonged labor, Increased rate of cesarean section and postpartum hemorrhage, increased need for newborn resuscitation), * Rarely newborn deaths. HARSH REALITY OF FGM: THE STATISTICS Female Genital Mutilation (FGM) remains a grave violation of human rights across the globe, with societies practicing it through the ages. * In 2024, the world faces a staggering reality: over 4.4 million girls are at risk of FGM [https://www.un.org/en/observances/female-genital-mutilation-day]. This number climbs by over 12,000 every single day. * Without intensified efforts to halt this practice, projections suggest the number of at-risk girls will reach 4.6 million by 2030. * According to UNFPA, between 2015 and 2030, a shocking 68 million girls are at risk of mutilation. * In Europe alone, the European Institute of Gender Equality estimates that 180,000 women and girls face this risk each year. * The COVID-19 pandemic has further exacerbated this situation, putting an additional two million girls at risk of falling victim to this harmful tradition. Protecting these vulnerable girls demands an urgent and concerted effort to accelerate the elimination of this harmful and often deadly practice. FAQS 1Q. Is there a link between female genital mutilation and the risk of HIV infection? There isn't a clear, direct association between FGM and HIV. However, sharing instruments during the procedure or experiencing laceration of scar tissue during intercourse may increase HIV risk. 2Q. What are the psychological effects of female genital mutilation? FGM can lead to psychological issues like post-traumatic stress disorder, anxiety, depression, and physical complaints without organic cause. 3Q. Which types of FGM are most common? Types I and II are globally the most common, with Type III (infibulation) being practiced by about 10% of affected women, primarily in Somalia, Sudan, and Djibouti. 4Q. Where does the practice of FGM come from? The origins are unclear, but it has been practiced across ages and continents. Historically, various cultures, including early Romans, Arabs, and African tribes, practiced forms of female circumcision. 5Q. Where is FGM practiced? FGM is documented in 92 countries worldwide. It's prevalent in Africa, the Middle East, Asia, and even in countries like Australia, the United States, and parts of Europe. Shockingly in India, FGM is practiced among the Bohra community in Mumbai [https://www.hindustantimes.com/static/fgm-indias-dark-secret/]. 6Q. Who performs FGM? Typically, elderly community members, often women, or traditional birth attendants, carry out FGM. In some cases, health workers also perform it, leading to what's known as the "medicalization" of FGM. According to UNFPA, Over 20 million girls and women have undergone FGM at the hands of healthcare providers [https://www.unicef.org/sites/default/files/2019-02/Factsheet%20FGM-Medicalization-2018-06-15.pdf] (medicalization of FGM) with Egypt and Sundan accounting for 78% and 77% respectively. 7Q. What instruments are used for FGM? Special knives, scissors, scalpels, pieces of glass, or razor blades are commonly used. Anesthetics and antiseptics are generally not used except in medical settings. In communities practicing infibulation, girls' legs may be bound together to immobilize them during healing. THE BOTTOM LINE As mentioned above, different regions have their reasons for practicing FGM, like religion, fear of being excluded or wanting to protect virginity before marriage. International efforts have tried to stop FGM for many years. While some progress has been made, many countries still don't fully follow the laws against it. On this International day of zero tolerance for female genital mutilation 2024, we need everyone in the community to work together to end FGM. It is important to focus on human rights and ensure everyone, regardless of gender, is treated fairly. We also need to help women and girls who have been through FGM with their health needs. Women and girls play a big role in making progress against FGM. When they lead, it helps make society more equal and fairer for everyone. We must work together to create FGM awareness and prevention to ensure no girl or woman is left behind. "#Her voice matters! #End FGM!"

Dr Vijayalakshmi

Women's Health

1 Oct 2023

9 mins

Breast Cancer Awareness Month"In the sea of life's colors, October paints itself pink, A month of hope and courage, it's time to truly think. Breast cancer; our focus, as awareness takes its flight, Let's stand together, shining in the pink October light." October is like a pink canvas, and we are here to paint it with purpose. It is a month when we join hands to talk about breast cancer. Let's spread the word, create awareness, and show support because every small effort can make a big difference. SIGNIFICANCE In October, the world takes on a pink hue as breast cancer awareness month begins to focus on screening and preventing breast cancer. This month holds immense significance due to the alarming statistics: one in eight women in the United States, one in 29 women in India, and 2.3 million women globally [https://www.who.int/news-room/fact-sheets/detail/breast-cancer] are affected by breast cancer. Led by advocacy groups and retailers, it offers vital support, especially for those with metastatic breast cancer. The focus remains on education about risk factors and stressing the importance of regular screenings, often for women starting at the age of 40. Moreover, it serves as a fundraising period to eradicate the threat of breast cancer in women's lives. HISTORY The roots of breast cancer awareness month can be traced back to 1985 when it commenced as a one-week awareness campaign by the American Cancer Society in collaboration with Imperial Chemical Industries, later becoming part of AstraZeneca. Over the years, it transformed into a month-long event. Additionally, Betty Ford, the wife of former President of the United States Gerald Ford, played a significant role. Her impactful advocacy, driven by her personal experience following a mastectomy due to breast cancer, emphasized the importance of early detection and screening, making her a pivotal voice in the campaign's history. THE PINK RIBBON In 1992, the pink ribbon was used to symbolize breast cancer awareness. A breast cancer survivor, Charlotte Haley, made peach-colored ribbons to raise awareness about cancer prevention. She distributed cards urging people to wear the ribbons and raise funding for prevention. Her idea caught the attention of Alexandra Penney, editor-in-chief of Self magazine, who was working on Self magazine's 1992 National Breast Cancer Awareness Month issue. She saw the initiative to adopt Haley's idea by working with her, but Haley refused their offer because she thought it was too commercial. Later, Self magazine and other organizations chose pink ribbons to symbolize breast cancer awareness due to legal issues with Haley's peach ribbons. STATISTICAL FACTS * Breast cancer ranks second in cancer prevalence in India, affecting 221,757 individuals of both genders [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10231735/], placing it among the top five sites with the highest cancer burden by the end of 2022. * Survival rates decrease significantly in the advanced stages of cancer, with over half of Indian women diagnosed at stages 3 and 4 of breast cancer. The post-cancer survival rate for Indian women stands at 60% [https://cytecare.com/blog/breast-cancer/statistics-of-breast-cancer/], in contrast to the 80% reported in the U.S. * Breast cancer is the most common cancer among Indian women. * In India, every four minutes, a woman gets diagnosed with breast cancer. [https://www.medindia.net/news/breast-cancer-diagnosis-one-woman-every-four-minutes-213396-1.htm] DISCOVERING THE RED FLAGS: EXPLORING THE FACTORS THAT INCREASE THE RISK OF BREAST CANCER * Gender: Women in India face significant risk due to hormonal influences, with 1 in 29 women at risk during their lifetime. * Age: Around two-thirds of invasive breast cancer cases occur in women aged 55 and older. * Family History: Having a first-degree female relative diagnosed with breast cancer doubles your risk. * Genetics: Between 5% to 10% of breast cancers are inherited caused by abnormal genes from parents. * Radiation Exposure: Chest or facial radiation before 30 elevates the risk. * Race/Ethnicity: White women have a slightly higher risk, but Black women are prone to aggressive breast cancer at a younger age. * Weight: Being overweight raises initial and recurrent breast cancer risk. * Pregnancy & Breastfeeding: Delaying full-term pregnancy increases the risk while breastfeeding for over a year reduces it. * Menstrual History: Starting menstruation before 12 or experiencing menopause after 55 heightens risk. * HRT Usage: Certain hormone replacement therapies may increase breast cancer risk. Know more about the targeted therapies for breast cancer [https://www.mrmed.in/health-library/cancer-care/targeted-therapy-hope-breast-cancer]. * Lifestyle Habits: Unhealthy lifestyle choices such as alcohol, smoking, and lack of exercise escalate the risk. Stay informed, adopt a healthy lifestyle, and consult healthcare professionals for personalized guidance. Know more about the signs and early symptoms of breast cancer [https://www.mrmed.in/health-library/cancer-care/early-symptoms-of-breast-cancer] here. DISPELLING MYTHS Myth: Underarm deodorants and underwire bras cause breast cancer. Fact: No evidence or studies indicate that using deodorants or bras, especially at night, increases the risk of breast cancer. Myth: There is usually a palpable lump when breast cancer is present. Fact: Breast cancer might not always cause a lump, especially when it first develops. Myth: I won't get it if I don't have a family history of breast cancer. Fact: Most breast cancer patients have no known family history. Myth: If you have larger breasts, you are more likely to develop breast cancer. Fact: There is no link between breast size and breast cancer risk, although examining larger breasts can sometimes be more challenging. Myth: Only women get breast cancer. Fact: Men can also develop breast cancer on occasion. Many people are unaware that males have breast tissue and that breast cancer can strike them as well. Myth: Breast injury develops as breast cancer. Fact: Trauma or injury to the breast does not lead to cancer. This myth arises from the possibility that an injury can make a developing breast cancer lump more noticeable. EARLY DETECTION SAVES LIVES: BREAST CANCER SCREENING Regular breast self-exams, yearly check-ups with your doctor, and annual mammograms are key components of early breast cancer detection. India's low breast cancer survival rates stem from limited awareness and inadequate early screening. The triple assessment, involving physical examination, imaging, and biopsy in a hospital setting, provides a comprehensive screening method. The various screening methods are as follows: * Self-examination: You can self-examine your breast [https://www.mrmed.in/health-library/cancer-care/how-to-do-self-examination-of-breast]by detecting any lumps or masses indicative of cancerous growths. Timely reporting of any findings to healthcare providers is crucial. Regular monthly self-examinations are recommended for women of all ages to monitor their breast health actively. Although self-exams are valuable, they must complement mammograms and clinical exams. * Physical examination: A clinical breast exam (CBE) is a routine medical procedure done by a healthcare provider to detect any abnormalities or signs of breast cancer. * Mammography: Mammography is the most common screening test for breast cancer. X-ray images of the breast are taken to detect tumors that are too small to be felt. * Ultrasound: Ultrasound uses sound waves to create images of breast tissue. It's often used along with mammography to further evaluate the suspicious areas in the breast. * Imaging: Magnetic resonance imaging (MRI) may be used to screen women with a high risk of breast cancer for detailed images of breast tissue. * Biopsy: A core needle biopsy (CNB) for breast cancer is typically done when a suspicious lump or abnormality is found during a mammogram, ultrasound, or physical examination. It is used to obtain a tissue sample from the lump for further analysis, confirming whether it is cancerous. THE BOTTOM LINE As Breast Cancer Awareness Month 2023 commences this October, let's embark on a journey of unity and education. Let's illuminate the path towards early detection, support, and resilience together. This month, we pledge to spread awareness, encourage screenings, and stand alongside those facing breast cancer. With our collective efforts, we can make strides in research, support, and understanding, fostering a world where breast cancer is met with courage, compassion, and unwavering hope. Empowered Together, Defeating Breast Cancer Forever!

Dr Archana Gupta