The impact of FGM/C on mental health It is beyond the scope of this literature review to discuss the wide ranging and long lasting effects of FGM/C on health and well-being. I have therefore narrowed down this review to considering just one body of evidence that points to the adverse effects on women’s mental health. This review is necessarily selective but illustrates that consequences go beyond the physical and social.
The literature on the effects of FGM/C on mental health is sparse but indicates that any of the FGM/C procedures can increase health problems such as anxiety, depression and phobia (see for example, Elnashar & Abdelhady’s (2007) study of newly married women in Egypt). Here I give an example of a recent study that illustrates the importance of involving community members in data gathering and documents the impact of FGM/C on mental well-being.
Vloeberghs et al (2012) examined the psychosexual consequences of FGM in the Netherlands. They adopted a mixed methods approach of questionnaires and in-depth interviews of 66 women who had migrated from Somalia, Sudan, Eritrea, Ethiopia and Sierra Leone. One sixth suffered from PTSD and a third had symptoms related to depression and anxiety.
The Vloeberghs et al (2012) study is based on a culturally-validated structured questionnaire, and in-depth interviews with circumcised migrant women from different countries. To gain women’s trust, members of the community were actively involved in the process of data collection and in the interpretation and analysis of data. Representatives of communities were consulted on the preferred terminology, phrasing of questions and acceptability of research methodology.
The interviewers met to see how questions should be formulated, how answers should be noted and how special situations were dealt with (such as refusal to answer/did not understand). The authors analysed the data using grounded theory and triangulation to understand the mental, social and relational consequences of FGM/C in a migration context (see Hammersly and Atkinson, 1983). All respondents were asked about the type of FGM/C they had experienced, at what age it was performed, and how they see it now they are living in the Netherlands.
There were some interesting results by the type of procedure the women had undergone. Women who were infibulated and who clearly remembered the event, and women who had education concerning the circumcision, reported more Post-Traumatic Stress Disorder (PTSD) symptoms as well as more anxiety and depression. Women who were older at the time and with whom circumcision was discussed also reported more PTSD symptoms. The interesting finding here is that both the severity of the procedure and age at which it occurred appears to be related to the effects of mental health. Nevertheless all the women reported some adverse effects of stress such as recurrent bad memories and nightmares at all times (see Utz-Billing & Kentenich, 2008 for a similar finding).
One counter-intuitive finding from the Vloeberghs et al (2012) study is that support- seeking was associated with more mental health complaints. So those who sought support experienced more anxiety and depression than those who did not seek it. Obviously the relationship is complex here, because it may simply mean those who were suffering from more anxiety and depression were more likely and willing to seek help. A number of respondents indicated that they had not received support from people important to them (partners, mothers in law) and a number said they felt lonely and a spectacle when they sought the help of service providers in the Netherlands. The authors developed a taxonomy based on how women are adapting with different rates of success. They classified women into three types based on their questionnaire measures:
The Adapted: These women were overcoming FGM/C but continue to be troubled by problems of a physical/sexual nature although they can overcome them. They talk about what bothers them and some are in contact with family but can make decisions independently. For Muslim women, the opinion of the umma or the community is important and comfort can be found in prayer and religion.
The Disempowered: These women feel angry and defeated. They bear their grief and do not see any way out - they do not talk about what was done to them, they feel ashamed, alone and disempowered. They avoid sexual contact and are emotionally inhibited. They have a poor relationship with their husbands and feel they would not approach a service provider for help on their own accord.
The Traumatised have been infibulated and suffered a lot of pain and sadness. They are divorced/and or in a bad relationship with their husband, they have recurrent memories, sleep problems, chronic stress, they feel misunderstood by their immediate environment and health providers. The women may isolate themselves and experience a high incidence of anxiety/depression.
This study is important not only in showing the mental health consequences of FGM /C but in illustrating how important it is not to stereotype or place women in a single category. Instead, we need to look at circumcised women as individuals who may have differing emotional and social needs, and tailor support structures and interventions accordingly.