Health Framework Research Paper
Health Framework Research Paper
Health Framework Research Paper
Athena Guzman
Dr. Rosati
December 3, 2023
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Women’s health can be a fascinating topic when you look at everything that is included in
that topic. This paper is to discuss women’s health surrounding genital mutilation in the Latin
America. This is a topic not often spoken about but still very much active in different parts of the
world. Genital mutilation is “all procedures involving partial or total removal of the external
I will be following the Health Impact Pyramid to discuss this topic further. The Health
Impact Pyramid or HIP is used to represent the tires that influence public health interventions.
The HIP consists of 5 levels with the bottommost level being Socioeconomic Factors, next level
is Changing the Context to Make Individuals’ Default Decision Healthy, next is Long-Lasting
Protective Interventions, followed by Clinical Interventions and lastly Counseling and Education.
The closer you get to the top of the pyramid the more effort an individual must put out. The
further down the pyramid you go, the more of an impact it has on the population.
According to the Economic Commission for Latin America and the Caribbean, “At least
4,473 women were victims of femicide in Latin America and the Caribbean in 2021” (United
Nations, 2022). FGM procedures can result in shock that can occur immediately, hemorrhage,
deadly infections, and can ultimately lead to infertility or complications during childbirth. 4.6
cases out of 100,000 women were found to have had been a victim of FGM in Honduras which
was the highest, 2.7 cases of 100,000 women in the Dominican Republic, 2.4 cases in El
Salvador, 1.8 cases in Bolivia, and 1.7 cases of women in Brazil. The Emberá are the only group
currently known to practice FGM in Latin America. There are approximately 250,000 Emberá
that live in Colombia, and as many as two out of three girls are subjected to this procedure. “The
secrecy surrounding the practice, which was soon revealed to be long-standing and wide-spread,
had been so profound that most Emberá men said that they were entirely unaware it occurred,
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and even women who had suffered FGM themselves reported that they did not know they had
been cut- until the birth of their first daughter” (UNFPA, 2016).
FGM begins in girls as young as 14 with the range being between 15 and 29. “More than
4% of all these crimes are committed against girls under the age of 14” (United Nations, 2021).
These women having to deal with FGM also called femicide by some, shows the inequality, and
discrimination that they face. This terrible practice is said to be tradition in these Colombian
countries and many women who are for it are doing so to not embarrass the child. In many ways
these young girls believe that if they have a child who is a girl, they will continue with the
tradition so that the child would not grow up to be embarrassed. Many speak of the “clitoris” as a
body part that would be able to turn the female genitalia into a “penis.” This is also where they
believe the term “hermaphrodite” comes from. To many people in those communities keeping
the female genitalia leaves room for the “clitoris” to enlarge which would cause it to continue
forming into the male genitalia. Removing that female body part, is said to remove the masculine
side of girls. FGM in Colombia does not have much statistic and because of that they do not
know the full extent of this issue. If girls die from the FGM, they bury the girls and do not speak
of it to anyone.
After research, The Health Belief Model was my choice to use in discussing ways to help
improve health behaviors. In this model one’s behavior surrounding their health depended on
their likelihood of getting the illness, the severity of the illness if they get it, the benefits of
engaging in behavior that will prevent illness; and the barriers to engaging in preventive
behavior. Self-efficacy which is whether a person believes that they could carry out the
appropriate behavior if they tried to. This is also part of what the health behavior model consists
of. Using this model as it relates to FGM would be how well a mother would believe that FGM
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would cause infections or even death in the newborn girl, how serious she believes it to be, to
extent to which not doing FGM would keep the baby infection free, and how easy it would be to
just not do the procedure. The young mother would also have to believe that she could handle not
Education would be one of the main ways to help bring awareness to the women and
young girls of the community. Many of these females are going along with the tradition because
that is all they know, and with that are not very educated on the true consequences from that
procedure. There are also women who turn away those who come to educate them on the
importance of preventing infection. “Trained Emberá nurses started teaching women about
general anatomy, explaining what is inside the head and the thorax. When the nurses started
talking about genitals, the women got angry, kicked them out, and warned 23 other communities
not to allow the nurses to speak to the women” (The Guardian, 2015).
The goal is to try and completely eradicate FGM. This will require a lot as many people
still believe it is for the good of the cause. This is what they grow up to know, and some of them
having been victims of it themselves see no harm in it as they are still living and were able to
reproduce without any consequences. One will have to begin in each community to spread the
awareness of the dangers involved in FGM. Expressing to families who preach that they want
their daughters to grow up to be healthy and be able to have kids would need to understand how
FGM could cause issues with that. There is no evidence that shows or proves that a female
keeping her clitoris will cause it to turn into a penis. With that being the main reason why they do
the FGM, they need to be made aware that there is nothing showing that would would if they did
“The UNFPA-sponsored intervention among the Emberá aims both to educate midwives
and other indigenous health workers and to inform communities about FGM’s extreme medical
risks and complete lack of medical benefit. It has been successfully carried out in two Emberá
communities” (UNFPA, 2016). In 2012, Emberá leaders came up with an agreement that would
officially ban the procedure. Women have since been more informed of their rights and become
empowered to stand up for themselves and other issues they find to be a problem.
Nurses can play a big role in helping facilitate change in these communities and stop the
problems. It will not happen overnight, but these women need someone to advocate for them.
“Nursing education, practice, leadership, policy, and research need to integrate SDOH to reduce
health disparities and foster health equity” (USDHHS-NACNEP, 2020). Nurses have the right to
advocate for, and protect the rights, health, and safety of the patient. In the code of ethics nurses
have a duty to integrate the principles of social justice into nursing and health policies. Nurses
are able to research the issues going on in these communities and help come up with solutions to
One of the biggest issues is the lack of knowledge. These women in Latin America will
not know the true disadvantage they put their daughters in having them go through that
procedure. Not only does it cause immense pain and discomfort, but they are also at an extreme
risk of infection at such an early age. Even though as time goes on the midwifes have become
more familiar with the ways to minimize infections when doing a “sterile” procedure, it does do
away with the ability to be able to contract a disease/infection and possibly die due to that.
This can be combated by promoting awareness of how FGM can cause poor health in
these population groups. Models can be designed to practice how to address potential SDOH and
the impact it has on population health. One can also strengthen the community support by
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showing them there are doctors here willing to help you care for your baby girl and make sure
In conclusion, with the help from transcultural nurses, much can be accomplished.
Transcultural nurses have years of knowledge and skills used to work with diversity, advocacy
and respect for the different ways people live. FGM is a serious problem that is now on the
downward spiral now that it is been made aware of the medical issues that come from in.
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References
Skolnik. R. Global Health 101. Fourth Edition. Jones & Bartlett Learning.
Brodzinsky. S. For Columbia’s Emberá, telling outsiders about FGM is worse than cutting girls.
https://www.theguardian.com/global-development/2015/nov/19/colombia-embera-
female-genital-mutilation-mystery-myth-misgiving
Press Release. ECLAC: At Least 4,473 Women Were Victims of Femicide in Latin America and
https://www.cepal.org/en/pressreleases/eclac-least-4473-women-were-victims-femicide-
latin-america-and-caribbean-2021
UNFPA. A silent epidemic: The fight to end female genital mutilation in Colombia. 09 February
2016. https://www.unfpa.org/news/silent-epidemic-fight-end-female-genita....0are%20the
%20only,perpetuate%20this%20human%20rights%20violation
TCNS. Integration of population health, social determinants and social justice in Transcultural