The Author, Mark Hayford Dwira

Ghana has pledged to provide universal health care to all of its residents by 2030. The country’s fight towards this goal began in the late 1970s and early 1980s, with the introduction of the Health for All movement and the Ghana Primary Health Care Strategy.

The District Health System and the National Health Insurance Scheme (NHIS) were established in the 1990s and, more recently (in 2003), to provide Ghanaians with equitable access to and financial coverage for essential healthcare services.

Furthermore, community-based health planning and services (CHPS) have been implemented to deliver essential community-based health services. Based on these efforts, Ghana might be deemed to be on the right track toward realising the notion of Universal Health Coverage (UHC).

However, there have been limits to how far Ghana’s efforts can go in terms of increased service provision and improvement of the current services available, necessitating reliance solely on evidence-based research and innovative ideas to realise them in order to influence policy decisions.

This influenced Mark’s choice to study a PhD in specialised FGM/C-Related Care Services for survivors in the UK, as it is currently less recognised within Ghana’s Health Service provisions. He chose the United Kingdom as his study setting because it is one of the few developed countries that has commissioned specialised FGM/C-related care services for migrant FGM/C survivors. The country provides medical (obstetrics, gynaecology, and maternity) and non-medical (counselling/therapy, psychiatric, psychosexual, mental health, and sexual health) services. 

All of this is provided by qualified healthcare professionals (HCPs) in accordance with culturally sensitive care principles. Nonetheless, although these care services are widely available in the UK, they are underutilized. As a result, Mark sought to explore this topic to develop a theory explaining how men’s roles could assist migrants FGM/C survivors to access the care services available in the UK. 

Paradoxically, the provision of FGM/C care services for survivors in the two nations remains inverted, which means that, unlike the UK, services in Ghana, where FGM/C is prevalent, are limited to obstetrics and maternity.

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As a result, Mark believes that by gaining the needed knowledge in this area, he could support those who have migrated to other countries in seeking and accepting care and inform service provision in Ghana with the help of Ghana Health Services (GHS) and the Ministry of Health (MOH).

This Ghana Scholarship Secretariat (GSS) funded study is exploring whether male migrants could help FGM/C survivors access all specialised care services. The rationale for investigating men’s perspectives is to determine if the involvement that has dramatically enhanced women’s uptake of services in sexual and reproductive health, family planning, and HIV/AIDS could be applied to FGM/C.

More importantly, men’s influential decision-making power over the nuclear families that extends to them actively participating in women’s care-seeking decisions. The findings of this study will be crucial to the body of knowledge in the FGM/C care sector, given that there is currently very little literature on the subject.

More importantly, it is the first-ever study to be completed, which means it might be utilised as a baseline study for future enquiries, with Ghana serving as a pilot site with assistance from the GSS, GHS, and MOH.

Currently, FGM/C care is being taught as a topic in Ghana’s various health-training institutions as part of the Gynaecological Conditions module of the curriculum designed to train nursing students.

Even with this, however, students are rarely trained on the management of FGM/C practices and the associated referral procedure services survivors can seek within healthcare facilities when needed. As a result of their limited knowledge and information gained while in school, students who graduate from our schools may find it challenging to provide holistic care for survivors.

As a result, Mark anticipates that using the knowledge gained from this study, he will collaborate with GHS and MOH to create a comprehensive curriculum for students to be trained in providing holistic treatment to survivors that follows sensitive cultural principles.

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Ghana considers FGM/C to be a harmful practice that mainly affects women and girls. To combat it, the country had ratified and signed important international and regional accords forbidding harmful traditional practices such as FGM/C.

The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and the Maputo Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa were two among them.Aside from these, FGM/C has been illegal in Ghana since the 1960s, according to the Criminal and Other Offences Act (COA) 1960 and the Domestic Violence Act 2007. These sanction perpetrators of the practice with a second-degree felony and a misdemeanour, and not less to three years in prison.

Despite these laws, the World Health Organisation prohibits the medicalisation of FGM/C (i.e.,where healthcare professionals (HCPs) perform FGM/C on girls in healthcare settings). However, according to the United Nations International Children’s Emergency Fund (UNICEF), an estimated 9% of girls aged 0-14 who survived FGM/C in Ghana were circumcised by HCPs. This has been linked to the country’s weaker enforcement of legislation, notably when it comes to regulating the operations of HCPs within health care facilities. As a result, Mark’s doctoral research will propose policy and program reconsiderations based on the UK’s mandatory reporting and recording strategy model.

This usesthe HCPs working at various healthcare facilities as agents to enforce the laws to prevent those at risk of FGM/C and recording all cases of FGM/C while providing care to survivors. This will also help the country obtain reliable data on the prevalence of FGM/C to inform the adoption of more solid policies and programs to reduce the practice and care for survivors.

FGM/C is defined as a “traditional practice that consists of partial or complete removal of the external female genitalia or other damage to the female genital organs for cultural and non-medical reasons” by the World Health Organization (WHO). It is classified into four types: Types I, II, III, and IV include clitoridectomy, excision, infibulation, and other genital injuries such as piercing, cauterising, pricking, bleeding, and incising, respectively. Around 90% of FGM/C cases recorded in healthcare centres worldwide areclitoridectomy and excision, while the remaining 10% including infibulation.

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FGM/C has no recognised health benefits, but any of the types can have both short and long-term consequences. Short-term consequences of types I, II, and IV include bleeding, shock, septicaemia, and tetanus. Furthermore, the long-term effects are primarily associated with type III; traumatic sexual intercourse, obstetric, gynaecological, psychological, and mental well-being.

Despite these severe health implications, an estimated 200 million women and girls living in 30 countries today have undergone FGM/C throughout Africa, Asia, and the Middle East. Globally, an estimated 3.9 million girls aged 0-14 years are mutilated each year, with a projected increase of 4.6 million by 2030 if governments do not scale up abandonment efforts given the high population growth rate in practising nations. Africa had 144 million survivors out of the 200 million global prevalence.

According to the 2016 UNICEF Prevalence Index, an estimated 3.8% of the worldwide population of Ghanaian women and girls aged 15-49 live in the Upper East (27.8 %) and Upper West (41.1%), with all other regions falling below 5%.

Aside from the fact that FGM/C has long-term health consequences for women and girls, its prevalence continues to rise despite all attempts to reduce it. As a result, Mark’s Doctoral research could provide some realistic and evidence-based solutions to the issue of FGM/C care for survivors, as Ghana’s present focus on the procedure follows the global trend of a preventative approach.

Acknowledgment

This study is being funded by the Ghana Scholarship Secretariat.

By Mark Hayford Dwira (BSc, MPH, PhD Student of the University of Nottingham)Contact:mark.dwira@nottingham.ac.uk. Twittter: @MarkDwira1; LinkedIn: https://www.linkedin.com/in/mark-dwira-90124292/

AMA GHANA is not responsible for the reportage or opinions of contributors published on the website.

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