Female Genital Mutilation : The pain of many girls and women

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It is unbelievable that in the 21st century female genital mutilation (FGM) remains a common practice among some communities in Kenya and other countries in the world. This practice, recognised internationally as a violation of the human rights of girls and women, portrays a very high form of discrimination against women. ESTHER KIRAGU addresses the subject.

The World Health Organisation (WHO) defines female genital mutilation (FGM) as comprising all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. The practice is mostly carried out on young girls, sometime between infancy and age 15, and occasionally on adult women. FGM is universally regarded as a practice resulting from patriarchal societies that have attempted to subjugate women and repress their sexuality. A traditional birth attendant or an older village woman generally performs the brutal procedure.

Although decades of work by local communities, government, national and international organisations have contributed to reducing the prevalence of FGM in many countries, the practice remains widespread. According to the 2014 US-based Population Reference Bureau (PRB) data sheet, Female Genital Mutilation/Cutting: Data and Trends Update 2014, an estimated 100 million to 140 million girls and women worldwide have undergone FGM and more than three million girls are at risk of being cut each year on the African continent.

The United Nations (UN) considers FGM a human rights violation because of the physical and psychological impact the procedure as on girls and women. It is a violation of a person’s rights to health, security and physical integrity; the right to be free from torture and cruel, inhuman or degrading treatment; and the right to life when the procedure results in death.

So why is FGM practiced?

There are several reasons provided to justify the practice of FGM and they vary from one community to another. Some of the common ones include:

  • A rite of passage from girlhood to womanhood. In some communities, a circumcised woman is considered mature and aware of her role in the family and society. As such, considerable social pressure is brought to bear on families who resist conforming to this tradition of FGM.
  • It is often considered a necessary part of raising a girl properly and a way to raising her marriage prospects. Young girls who go through this rite barely in their teenage are married off immediately rather than encouraged to pursue an education. An uncircumcised girl fetches a lower bride price in communities where the practice persists. This is because bride price is deeply entrenched and a girl who refuses to be circumcised is a threat to the would-be wealth her father expects upon her marriage.
  • To reduce the sexual desire of girls and women, thereby curbing sexual activity early and ensuring fidelity within marriage.
  • To increase male sexual pleasure. Some people believe that FGM influences sexual pleasure, though this isn’t true since sexual pleasure is mainly a psychological rather than a physical issue.
  • It is a religious directive for some. However, it is important to note that the practice existed before the introduction of both Christianity and Islam religion.

Implications of FGM…

To begin with, the pain, shock and the use of physical force are a traumatic event for the victims. There is never use of anaesthesia or painkillers and the victims have to endure the pain, as this is a measure of their bravery.

Immediate complications from the procedure can include haemorrhage (bleeding) that can lead to anaemia or even death. Proper anaesthesia is rarely used during the procedure and even when used, it is not always effective. The severe bleeding may result in death or problems while urinating.

Bacterial and tetanus infection and open sores in the genital region may spread after the use of contaminated instruments because in most cases there is use of the same instruments in multiple genital mutilation operations. There is also the risk of contracting human immunodeficiency virus (HIV) due to use of the same surgical instrument without sterilization. Long-term consequences can include recurrent bladder and urinary tract infections and infertility.

Link between FGM and fistula…

A fistula is a hole that occurs between the vagina and the rectum or the bladder during childbirth. Fistula usually develops as a result of prolonged labour when a cesarean section cannot be obtained. The pressure from the unborn child against the mother’s vagina cuts off blood flow to the surrounding tissues between the vagina and the rectum and between the vagina and the bladder causing the tissues to split up.

Fistula is more common among women who have undergone FGM, especially in the severe forms where the vaginal tissues are mutilated and vaginal entrance almost fully closed up. This not only makes sex very painful but childbirth may result in severe injuries as the baby’s head tries to go through the sewn up vagina.

Fistula is preventable and can also be treated. It is estimated that globally three million women suffer from fistula, the majority of whom are in Sub Sahara Africa. In Kenya about 3000 women suffer from fistula annually. The rate is said to be particularly high in parts of Kenya where access to skilled delivery remains low such as the Nyanza region in Western Kenya with some areas having less than 30 percent of women delivering under a skilled attendant.

Several organisations are doing something about this gloomy state of affairs to help reverse the trends of FGM. The Freedom From Fistula Foundation in Kenya funds a fistula programme at Kenyatta National Hospital (KNH) and holds camps that help treat women across the country. They also donate equipment to various hospitals to help in the management of fistula. In 2010, the foundation partnered with KNH and African Medical Research Foundation (AMREF) to renovate an old family planning clinic at KNH into a fistula unit. The fistula national training centre is based here. The centre trains Kenyan surgeons and nurses in fistula care and also offers weekly fistula clinics.

OGRA foundation, a Kenyan NGO, funds fistula repairs at Kisumu’s Jaramogi Oginga Odinga Teaching and Referral Hospital (formerly Nyanza Provincial General Hospital). It also organises weekly fistula repair camps at the hospital, alongside routine repairs.

The United Nations Population Fund (UNFPA), an international development agency that promotes the rights of every woman, man and child to enjoy a life of health and equal opportunity, has been running a campaign aimed at ending fistula.  The agency advocates and raises awareness targeted at a variety of audiences in both developed as well as developing countries, including policy makers, health professionals, media, and the public in general. UNFPA also contributes to resource mobilization for fistula programmes within the regions they operate in.

Intervention measures…

In Kenya various approaches have been used with varying degree of success to encourage communities to abandon FGM. Some of these include health risk/harmful practice approaches, educating and providing alternative sources of income to circumcisers, providing alternative rites of passage, addressing FGM through religion, legal and human rights, and the promotion of girls’ education and empowerment programmes.

Kenya, as a party to the Protocol of the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa, has ratified the Convention on the elimination of all forms of discrimination against women (CEDAW) and the Convention on the rights of the child (CRC). Both CEDAW and CRC have called for an end to FGM and child marriage.

In Kenya’s national legal framework, FGM is prohibited under the Prohibition of Female Genital Mutilation Act 2011 and both FGM and child marriages are prohibited under the Children’s Act 2001. In addition, Kenya’s constitution contains provisions against both FGM and child marriage.

Despite frequent reports about cases of FGM and child marriage and girls escaping to avoid these practices, the practice still prevails in many parts of the country. Between November and December 2013, Equality Now, an organization that advocates for the human rights of women and girls around the world, supported their Kenyan partner Women Rights Institute for Peace, in providing shelter to 45 runaway girls at the Sandai Rescue Centre in Baringo County. While the girls were reported to be safe and some even returned back to school, such girls in risk communities will remain in danger until protective measures are put in place.

In response to advocacy, the Kenyan government took a positive step by creating an Anti-Female Genital Mutilation Board and appointed Linah Jebii Kilimo as chairperson in December 2013. Kilimo was instrumental in passing Kenya’s Anti-FGM Bill in 2011 and has been actively working with the government and NGOs to eradicate FGM.

Recently, the director of public prosecutions, Keriako Tobiko, in a letter addressed to the inspector general of police David Kimaiyo sought the support of the National Police Service in confirming FGM related statistics. He expressed his dissatisfaction that despite the existence of the FGM Act 2011, the vice is still practiced culturally in secrecy thus undermining efforts to combat the crime. The DPP directed to receive updated statistics on FGM cases that have been prosecuted and concluded either in conviction, acquittal, withdrawal or settlement alongside matters currently pending in court.

It is clear that there is need for strict enforcement as well as the need to conduct awareness and sensitisation campaigns in order to put an end to FGM. With these new efforts by the DPP, one can only hope that this vice will finally be curbed.

Breaking News!!

Teenage girl dies after FGM

A teenage girl died in Narok County while undergoing FGM, according to news reported in all media mid last month. The girl was among several other girls undergoing FGM and died from excessive bleeding. Two people were arrested in connection with the death and arraigned in court. They included the parents of the girl and an elder. Police have launched a manhunt for an old woman said to be the circumciser and who has since gone underground.

In yet another incident reported last month, two primary school teenage girls from Narok County were admitted in hospital with serious injuries sustained during circumcision. Ironically, their father, a local chief in Osupuko division, Narok South sub-county and who should be at the forefront in helping the government fight FGM, was responsible for taking his daughters to be circumcised.

Published on May 2014

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