Medicalization delays end of FGM
There is a mythical story among the Igembe people of Kenya, that female genital mutilation/ cutting (FGM/C) originated thousands of years ago when Igembe men went to war and returned to their village to find that all of their females were pregnant. They punished the women by cutting their genitals in order to reduce their sexual desires, and placed a curse on Igembe females thereafter, that unless they continue the tradition of FGM/C there will be a curse on their land and families.
This myth of how FGM/C originated in the Igembe culture underlines the fundamental fact that FGM/C is not only rooted in deep seated cultural beliefs and practices, but also that it is nothing less than a means by which men control women and girls by culturalized and ritualized violence. Through FGM/C practices, males and the patriarchal societies where FGM/C is practiced, control the sexuality, chastity and virginity of women. FGM/C infringes upon the rights of girls and women to have the highest health standards, to freedom from harm, freedom from cruel, inhuman and degrading practices, and freedom of self-determination.
FGM/C ranks among other abusive practices that violate the rights of women and children, including polygamy, child trafficking, child marriage, and “breast ironing,” a practice occurring particularly in Cameroon, in which the breasts of pubertal girls are repeatedly beaten with a heated stone or other object in order to prevent breast development and supposedly stop the girls from being sexually exploited by men.
Kenya has made huge strides in combatting FGM/C, beginning with the 2001 Children’s Bill, which forbade FGM/C in girls under fifteen. Nevertheless, the practice is still a problem, particularly in the north-east, on the Somalian and Ethiopian borders, and in some areas in south-west Kenya.
FGM/C continues to be a worldwide problem, occurring in numerous countries in Africa, Asia and the Middle East, but also has spread to other areas of the world, including the USA, Europe and Australia, in migrant communities from countries where FGM/C is traditionally practiced, continue the tradition. There are, according to the World Health Organization, about 125 million women and girls who have been subjected to FGM/C and several million girls are at risk of having the procedure done every year.
There is ample evidence for the harmful effects of FGM/C, and zero evidence for any therapeutic or medical benefits. FGM/C causes severe pain both during the procedure and chronically. Not infrequently, young girls are held down by force and suffer terrifying pain. It is associated with bleeding that can be so profuse that the victim bleeds to death, and such cases have been documented in many countries, including Kenya. Traditional practitioners (“circumcisers”) frequently use non-sterile tools, including razors and knives, without anesthesia, to carry out the genital mutilation, increasing the risk of infection and other complications.
FGM/C causes problems with urination, infections, sometimes horrifying scarring of the genitals, prolonged labour, infertility, and increased infant and maternal deaths. In one study, FGM/C caused the deaths of one or two newborn babies out of every 100 live births. FGM/C can cause psychological problems, and traumatic memories can last a lifetime. Men are also more likely to be violent towards a wife who has had FGM/C.
A major concern globally is that doctors and surgeons are increasingly performing FGM/C procedures. This “medicalization” of FGM/C is very disturbing, and is a direct contradiction of ethical principles that should be the basis for proper physician practices. The Hippocratic Oath, first and foremost, dictates that doctors should “Do No Harm.” Obstetricians have even been known to reverse FGM/C during childbirth, only to repeat the FGM/C procedure afterwards. Some doctors argue that by carrying out FGM/C using proper sterile procedures, they are preventing inappropriate and risky surgeries from being done by traditional circumcisers. However, FGM/C carried out by qualified surgeons is harmful and abusive to girls and women, and medicalization of FGM/C might well institutionalize and give some legitimacy to FGM/C, with a consequent delay in eliminating the practice. Doctors might also see FGM/C as a way of making extra income.
Medically qualified professionals generally are poorly informed about FGM/C. A study of obstetricians and midwives in London, UK, found that only 4% of midwives and obstetricians could properly identify the different types of FGM/C, indicating the need for better education of health care professionals about FGM/C and its complications.
Some societies consider FGM/C to be a religious duty, but the practice of FGM/C goes back thousands of years and well predates Christianity and Islam. There are no parts of the Bible, Qu’ran, or other religious texts that dictate that FGM/C is a fundamental religious tenet. The Qu’ran actually forbids harming a woman’s body. According to some scholars, FGM/C originated in the erroneous idea that a woman’s clitoris was the “male” part of her body, so that cutting it out would enhance her femininity.
Eradication of FGM/C will require action at all levels. Healthcare professionals need to be given guidelines concerning appropriate medical management of FGM/C, counseling patients about the health hazards of FGM/C, and reporting cases of FGM/C, and doctors who perform FGM/C should be disciplined by their licensing bodies. Traditional circumcisers need to be educated that they are harming women and children. Both women and men both need to be involved in their communities to improve communication between males and females and educate and encourage reduction of FGM/C practices, in collaboration with community elders and religious leaders, to change cultural and religious perceptions and stereotypes about FGM/C.
The role of men cannot be underestimated: Several studies suggest that many men themselves are physically or psychologically traumatized by the consequences of FGM/C on their wives, for example by having painful intercourse, unfulfilling sexual desire, and concern for the physical and psychological suffering of their wives. On the other hand, many men feel they have sexual control over their wives and consider circumcised women to be “pure” or “marriageable.” Encouraging dialogue between men and women, educating men who support FGM/C and encouraging men who oppose it, will likely encourage better attitudes toward eliminating FGM/C.
Celebrities should get involved. A good example of this is the Masai Warriors cricketers, who are campaigning for elimination of FGM/C in Kenya. Education of children, both boys and girls, through school programmes and media. Collaborations between community, government and international organizations working together to produce campaigns, pledges, policies, laws and to empower women and girls, are making a difference and need to be strengthened. Alternative cultural means of giving girls a safe “passage to adulthood,” such as the “Cutting (Circumcision) through Words” programme, which has helped some communities replace FGM/C with non-harmful practices, have been successful in some communities.
Just over a century ago, the harmful Chinese practice of binding girls’ feet to enhance their beauty was eliminated by campaigns and programmes similar to those that are being used to eradicate FGM/C today. That achievement in China serves as a precedent for FGM/C and provides optimism and hope that FGM/C will, through concerted efforts, become a repugnant practice of the past.
Dr Frank Ashall, B.A.(Oxon), M.D., D.Phil.
Associate Professor of Biochemistry
Addis Ababa University Medical School
Addis Ababa, Ethiopia