Female Genital Mutilation - World Health Organization

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74 FEMALE GENITAL MUTILATION STUDENT MANUAL Session objectives Introduction Session 7: Use of family planning in the presence of FGM By the end of this session students should be able to: 1. Identify the type of FGM the girl or woman has experienced. 2. Identify the type of family planning method appropriate for a given situation. Family planning is as appropriate for girls and women with FGM as it is for any other client. As with other clients, the medical eligibility criteria set by WHO in 1996 should be used to determine the most suitable contraceptive methods for these women. Women who have been infibulated may have difficulties in using a method which has to be inserted vaginally, or an intrauterine device (IUD). Since women with FGM of any type are prone to infections of the genital tract, IUDs should only be used after careful consideration. When advising a client with FGM on family planning, make sure history taking is carried out with sensitivity, and reassure the woman that you are comfortable with her condition and that there will to be a family planning method that will suit her needs. It is important to carry out a genital examination to identify type of FGM and to check that there are no problems that need attention, especially infection. Constraints The following problems may be encountered by women with FGM seeking family planning: ● it may be difficult for the family planning adviser to perform a vaginal examination ● it may be difficult to use a family planning method that has to be inserted vaginally ● a client with FGM may encounter discrimination; she may be denied choice in family planning methods ● women with FGM may hesitate to seek advice on family planning due to embarrassment about the appearance of the vulva. The table on page 75 indicates which types of family planning method are suitable for use with the different types of FGM, as well as those which are not suitable.
Table 2: Family Planning Method and Type of FGM Contraceptive Method Oral pills Injectable (DMPA) Intra - Uterine Devices (IUDs): Cu and LNG - 20 Barrier methods: - <strong>Female</strong> condom - Spermicides (tablets and foam) - Diaphragm - Cervical cap Norplant Implants (NOR) Natural methods - Symptothermal method - The basal body temperature method - The calendar method - Cervical mucus method (Billings Ovulation Method) - Lactational amenorrhoea method (LAM) Type I FGM can use, follow WHO, Medical Eligibility Criteria can use, follow WHO, Medical Eligibility Criteria can use, follow WHO Medical Eligibility Criteria, but clients commonly suffer from infection, so it is important to exclude infections can use, follow WHO, Medical Eligibility Criteria can use, follow WHO, Medical Eligibility Criteria can use with training Can use with training can use with training can use with training, but exclude infection can use with training, follow WHO, Medical Eligibility Criteria Type II FGM can use, follow WHO, Medical Eligibility Criteria can use, follow WHO, Medical Eligibility Criteria can use after assessment of the introitus as too much scaring can prevent easy introduction of IUD. Also check infections. Follow WHO, Medical Eligibility Criteria can use, follow WHO, Medical Eligibility Criteria can use, follow WHO, Medical Eligibility Criteria can use with training Can use with training can use with training can use with training, but exclude infection can use with training, follow WHO, Medical Eligibility Criteria Type III FGM (Infibulation) can use, follow, WHO, Medical Eligibility Criteria can use, follow WHO, Medical Eligibility Criteria cannot use, as the introitus is very tight. If this is the only option, advise opening up of infibulation It may be very difficult to use as the introitus is very small and in most cases does not allow even a fingertip. But if this is the only option, advise opening up of infibulation can use, follow WHO, Medical Eligibility Criteria can use with training can use with training can use with training cannot use because it is difficult to test the cervical mucus as in most cases the secretions are trapped by the infibulation can use with training, follow WHO, Medical Eligibility Criteria FEMALE GENITAL MUTILATION STUDENT MANUAL Type IV FGM 75 can use, follow WHO, Medical Eligibility Criteria can use, follow WHO, Medical Eligibility Criteria can use, follow WHO, Medical Eligibility Criteria. During introduction care should be taken of the elongated labia minora and/or clitoris. Risk of infection. can use, follow WHO, Medical Eligibility Criteria can use, follow WHO, Medical Eligibility Criteria can use with training Can use with training can use with training can use with training, but exclude infections can use with training, follow WHO, Medical Eligibility Criteria
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WHO/FCH/GWH/01.4 WHO/RHR/01.17 Dist
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ACKNOWLEDGMENTS . . . . . . . . . .
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An estimated 100 to 140 million gir
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ideas given by students after a gro
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This module is intended to equip st
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Key reference ● Dorkenoo, E. Trad
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But there was one very old woman in
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Summary interpretation of the story
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STRUCTURE FUNCTION Skene’s and Ba
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FEMALE GENITAL MUTILATION STUDENT M
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Figure 1.7: It is performed on babi
Page 23 and 24: The origins of female genital mutil
Page 25 and 26: FEMALE GENITAL MUTILATION STUDENT M
Page 27 and 28: FEMALE GENITAL MUTILATION STUDENT M
Page 29 and 30: threatening complication of female
Page 31 and 32: of feelings. The experience is a vi
Page 33 and 34: Legal implications of FGM ● The e
Page 35 and 36: ased on the idea of the inferiority
Page 37 and 38: This module is intended to prepare
Page 39 and 40: Session objectives Learning activit
Page 41 and 42: Value clarification Value clarifica
Page 43 and 44: _____ Teaching community about the
Page 45 and 46: ● After they have shared their vi
Page 47 and 48: Student guideline for the community
Page 49 and 50: Because of the personal and cultura
Page 51 and 52: Introduction The involvement of pol
Page 53 and 54: partnership is to educate relevant
Page 55 and 56: This module is intended to prepare
Page 57 and 58: Session objectives Key references
Page 59 and 60: - Expose the necessary area for ins
Page 61 and 62: - If injury is very extensive refer
Page 63 and 64: e due to obstruction of the urine i
Page 65 and 66: Session objectives Introduction Cou
Page 67 and 68: Role Play Students should practice
Page 69 and 70: menstrual patterns and sexual relat
Page 71 and 72: ● If symptoms are severe, refer c
Page 73: expect and what to do at the referr
Page 77 and 78: ● Counsel the client on the proce
Page 79 and 80: Figure 4.6: Sutured sides of the op
Page 81 and 82: Module 4 is also an intervention mo
Page 83 and 84: eassure them that you are comfortab
Page 85 and 86: ● Follow the procedure for openin
Page 87 and 88: perineum as a result of scarring of
Page 89 and 90: Assessment of the introitus during
Page 91 and 92: Key references ● A Systematic Rev
Page 93 and 94: ● Assure client that you are avai
Page 95 and 96: CASE 1 Adela is a 27 years old woma
Page 97 and 98: also was mutilated when she was a c
Page 99 and 100: Films and videos APPENDIX 2: LEARNI
Page 101 and 102: NOTES FEMALE GENITAL MUTILATION STU
Page 103 and 104: NOTES FEMALE GENITAL MUTILATION STU
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Female Genital Mutilation - World Health Organization

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