The Biggest Health Care Cost for 27 Countries? FGM

Ex-female genital mutilation (FGM) cutter Monika Cheptilak, who stopped practicing after the country set anti-FGM law in 2010, shows a homemade tool from a nail used for FGM, during the meeting of anti-FGM women group in Alakas village, bordering with Kenya, northeast Uganda on January 31, 2018. The UN estimates that over 200 million girls and women have experienced FGM which is a life-threatening procedure that involves the partial or total removal of a woman's external genitalia. February 6, 2018, marks the 6th International Day of Zero Tolerance for FGM. / AFP PHOTO / Yasuyoshi CHIBA (Photo credit should read YASUYOSHI CHIBA/AFP via Getty Images)

The Biggest Health Care Cost for 27 Countries? FGM

By Pallabi Munsi


FGM is bleeding countries' health care resources too.

By Pallabi Munsi

  • Countries with widespread female genital mutilation could save 60 percent of their health costs by ending the practice.
  • It’s the first time researchers have pinpointed the economic cost of the practice, and experts believe it helps add pressure on regimes to change laws.

When Hoda Ali underwent a genital cutting at age 7 in her hometown, Mogadishu, in Somalia, she thought it was a practice every girl in the world had to endure. Little did she realize that there would be lifelong consequences. At age 11, when she went to a doctor after falling severely ill, the medical practitioner initially thought she had a cyst they needed to remove. But after opening her up, the doctor found the prepubescent Ali wasn’t able to menstruate properly because of the cutting. The period blood was accumulating inside her body.

Women protesting during the International Day against female

Women in Madrid, Spain, protesting against female genital mutilation.

By the time she was 17, Ali had gone through three surgeries — in Somalia, one in Djibouti, and in Italy — all while shuttling from one refugee camp to another to escape her country’s civil war. Now 42 and settled in the U.K., Ali teaches about the trauma of female genital mutilation (FGM) at 15 British schools, and is campaigning to help countries where the practice is common recognize that it’s not just girls, but national economies that are bleeding.

According to a recent, first-of-its-kind WHO assessment:

27 countries with a high prevalence of female genital mutilation would save more than 60 percent of their health care costs by 2050 if they abandon the practice.

These countries — Benin, Burkina Faso, Central African Republic, Ivory Coast, Cameroon, Chad, Djibouti, Egypt, Eritrea, Ethiopia, Ghana, Guinea, Gambia, Guinea-Bissau, Iraq, Kenya, Mali, Mauritania, Niger, Nigeria, Sudan, Senegal, Sierra Leone, Somalia, Togo, Tanzania and Yemen — include many of the world’s poorest nations. Associated lifetime health care costs for women who suffer from the practice work out to $1.4 billion every year, globally, according to an FGM calculator launched by the WHO in February.

At a time when the world is battling a global pandemic, and struggling nonprofits are expected to cut back on funding in developing nations, experts are hoping this computation of the monetary loss to societies from FGM will strengthen their hands in fighting the practice.

Finally “attaching a financial cost to the ill effects of FGM” makes it easier for them to seek judicial fiats against genital cutting, says Grethe Peterson of Orchid Project, an U.K.-based nonprofit working to eradicate FGM. “It’s not just the procedure that’s problematic — along with it comes post-traumatic stress, child-bearing problems, hundreds of gynecological problems … for which cut girls need to go to doctors, and spend money, throughout their lives.” 

Ali, for instance, got married in the U.K., but was having trouble conceiving. She underwent an IVF procedure but then suffered a miscarriage. “The doctors said I cannot bear my own child because of all the abrasions in my internal organs because of the cutting,” she recalls.

FGM includes procedures that intentionally alter or cause injury to the female genital organs for nonmedical reasons. More than 200 million girls and women alive today have been cut in 30 countries in Africa, the Middle East and Asia, where FGM is concentrated. It’s less common but still practiced in another 60 countries. The 27 countries analyzed in the WHO’s assessment have the population-based data and the details of the types of FGM practiced, which the U.N. body needed for its calculations.

There are three types of FGM: type 1, where some or all of the clitoris is removed; type 2, where some or all parts of the clitoris and the inner labia are removed; and type 3, where the vaginal opening is narrowed by creating a seal, formed by cutting and repositioning the labia. The processes — often done under the garb of religion — are rooted in deep patriarchal beliefs and are aimed at ensuring that a woman doesn’t turn “promiscuous.” 

Ali underwent the most gruesome process of all — type 3.

Razor Blade Used for Circumcision

A razor blade, used in traditional female circumcision ceremonies, sits on a pile of millet flour, which is used to stop the bleeding. (Getty Images)

But as the WHO calculator shows, the costs are also mounting for societies. While the money women would save on procedures wouldn’t automatically go to national budgets, it would free up equivalent resources in hospital beds, medicines, surgical equipment and other costs that countries could then deploy to address other health care challenges. In Sudan, for instance, 87 percent of women in the 15–49 age group are cut. This means that at present, the associated health costs for the country are $276.57 million — 10 times what the country spends on vaccines, medicines, ambulances and emergency clinics on diseases that spread during Sudan’s rainy season.

Some countries are changing course. Last month, Sudan finally banned FGM, introducing a punishment of three years for anyone found engaging in the practice.

For women who’ve already been cut, “the damage caused by FGM is irreparable no matter what anyone says,” says Sujaat Vali, an India-based gynecologist who has worked with patients who have endured the procedure.

To Ali, a big part of the problem is that the people making the laws are primarily men. “And because FGM is happening to women, they don’t care much,” she says. “But if they are not cut, a lot of women would probably not even have to go to doctors, including psychiatrists, throughout their lives.”

She says the FGM calculator is encouraging activists like her reach out to counterparts and governments across the world where the practice is prevalent to “collect data so that they can understand the financial costs they are incurring.”

The math is as simple as the practice is brutal — all countries need to do to cut their health care costs is stop the genital mutilation of women.