February 11, 2005

Ending Female Genital Mutilation?

Rights, medicalization, and the state of ongoing struggles to eliminate the FGM in Kenya

by Gemma Richardson

The Dominion - http://www.dominionpaper.ca

NAIROBI, KENYA -- Being a deep-rooted cultural practice for many communities in Kenya, no one assumed it would be an easy task to eradicate Female Genital Mutilation (FGM). For the first time in 1998, the Kenya Health and Demographic Survey included questions on FGM and found that 38 per cent of women had undergone the procedure. In 2003, the survey found that 34 per cent of women had undergone FGM, however in communities where FGM was almost universally practiced there was very little change. The slow rate of progress is discouraging to organizations that have been working on this issue for many years. Realizing just how much of a sustained and tailored effort FGM eradication campaigns require, international organizations and NGOs are trying to collaborate on research and intervention efforts to make greater inroads into eliminating this practice. At a conference held in Nairobi in December, UNICEF, Population Council and several other NGOs presented their latest research findings on FGM, with a particular focus on the Somali community in Kenya.

"How much longer?" said Abdi Abdullahi of National Focal Point at the conference. "There has been 80 years of campaigns and yet there's been little impact."

The papers presented at the conference showed many FGM intervention campaigns have had little to no impact, and some may have even contributed to further entrenching the practice.

FGM, female genital cutting or female circumcision, are the terms used to describe several types of mutilating operations performed to the external genitalia of girls and women. The types of procedures can be broadly classified into four groups, ranging from the removal of a small part of the clitoris, all the way to infibulation, where the clitoris and labia minora are completely excised, the wound sewn shut, and just a small opening is left for urine and menstrual flow. According to No Peace Without Justice, an Italian NGO working to eliminate FGM, there are now between 120 million to 130 million women worldwide who have undergone FGM. Another two million girls and women are subjected to the practice every year, which takes place in 28 African and Arab countries, as well as by immigrant communities from these regions.

The Somali ethnic group in Kenya has the highest prevalence of FGM - 97 per cent of Somali women have undergone the procedure, and almost all are infibulations. As in many other communities, pre-marital virginity is very important for the Somali, and FGM is considered essential in preserving virginity and family honour. Many Somali also believe that FGM is an Islamic requirement, although some Sheikhs, community elders and Muslim women's groups have clarified that infibulation is in violation of the Koran. This has led to a shift from infibulation to a less-severe form of FGM, and it is a complex issue for groups working to eradicate the practice to encourage its abandonment instead of the adoption a less-severe form.

There are many negative health consequences associated with FGM, including hemorrhage, cervical infections, urethral damage, urinary tract infections, dermatoid cysts, chronic pelvic infections, difficult and often dangerous childbirth, and a variety of other complications that can lead to death. While the health implications of FGM are very serious and form a key component of any campaign, many say that focusing almost entirely on the health aspects has not addressed the violation of rights or contributed to the elimination of the practice. Instead, a strong focus on health implications appears to have contributed to the adoption of less severe forms of FGM or having medical professionals carry out the procedure in a more sanitary manner. A Population Council study in 2001 found that 70 per cent of circumcised Abagusii girls in Western Kenya reported having been cut by a nurse or doctor, whereas virtually all of their mothers had been cut by a traditional circumciser. There are also reports that the amount of tissue cut in FGM procedures for girls in the Kisii area of Western Kenya is reducing in response to the sustained FGM campaigns that focus on adverse health outcomes.

"This is a logical reaction," explains Ian Askew, senior program associate of Population Council in Nairobi. "People want to keep practicing and they want to do so safely."

Medical staff undertake the procedure mainly for the financial incentive, while to parents they provide a relatively safe and hygienic service. The preference for medical staff to carry out FGM has significantly increased in the past decade, although trained health providers performing these services are contravening medical ethics, disregarding the Ministry of Health policy, and violating the 2001 Children's Act. According to some activists, the trend of medicalization is a major impediment to the abandonment of FGM because it only decreases the risks involved, rather than eradicating the practice altogether.

In 1999, the Ministry of Health developed a National Plan of Action for the Elimination of FGM in Kenya to eliminate the practice by 2019, and in 2001, the Children's Act made FGM illegal for girls under 17. However, the Children's Act is not well-known or understood by many communities, and there is little support for enforcement of the law. The threat of imprisonment for those caught performing the procedure has driven the practice underground in some communities, and politicians representing regions where FGM is prevalent speak cautiously on the issue in fear they will not return to parliament if they openly condemn the practice. While laws banning FGM are seen as important, there is a general consensus that a grassroots, community-level approach is best, as top-down legal policies have shown to be ineffective in changing people's attitudes.

The idea that FGM is a violation of girl's and women' rights is not accepted in many communities. Population Council found that in Somali refugee camps in Northern Kenya, most people considered FGM beneficial because of the social acceptability it brings. Women who abandon the practice have a lot to loose; their position in the community is affected, they have a harder time finding a partner for marriage, and often their dowry is affected because they are not considered virginal. While a girl's mother and grandmother make most of the decisions about circumcision, many argue that the father still holds the most influence. If men continue to alienate uncut women and encourage their daughters to be cut, it seems the practice will never be abandoned. However, recent studies have shown that men appear to be more open to the idea of abandonment than women, which presents an opportunity for FGM campaigns.

Girls are now being circumcised at earlier ages, most frequently between seven to 12 years old, compared to 15 before. It is believed young girls are better able to survive the painful experience and they are easier to convince. Circumcising girls at a younger age presents a major problem to campaigns aimed at empowering women to refuse FGM. A girl at the age of eight has considerable difficulty asserting her rights when no one is asking for her consent, and support is not available within her community. The alternative rite of passage, developed to replace FGM as a transition into womanhood without any cutting, also has little impact when girls are cut at earlier ages, because by the time girls reach the age where the ceremony would be relevant, their families may have already had the procedure done.

Education of girls is the key to the long term elimination of FGM, as women with higher levels of education are more likely to refuse that their daughters undergo the procedure. School curriculums should also teach the rights of the child and awareness on sexuality issues, which would provide awareness on what FGM entails. Some have urged NGOs working within communities where FGM is prevalent to offer support, and even temporary protection when necessary, to those who publicly declare themselves against the practice.

While FGM is a deep-rooted cultural tradition which is continued through taboos and myths, culture is not static and some changes are inevitable.

"This is a gradual process of social change that we need to accelerate on, and it's already started in some communities" says Askew.

Programs for FGM eradication must be sustainable, collaborative, and multi-faceted if they are to achieve any significant change in attitude and practice, and must be tailored to meet the needs of each specific community. This requires massive resources, time and commitment, and until the international community and governments are willing to provide this, FGM will continue virtually unabated.