Female genital mutilation refers to the partial or total removal of the external female genitalia for non-medical reasons. Sometimes, it is the ritual cutting of the external female genital organs for cultural reasons. The practice causes harm and injury to the women and girls on whom it is carried out. The practice is deeply rooted in the culture of many communities in Africa, Asia and the Middle East. It has a cultural significance to these communities, however, many of the community members are not aware of the health implications that the practice has on women and girls. There are many negative biological effects that come as a result of the process. The United Nation's organs, governments and other humanitarian bodies have been campaigning against the practice for a long period of time. Although these campaigns have witnessed a reduction in the occurrence of the practice, there are many people who still strongly embrace the practice. However, the ultimate aim is a complete abolition of the practice and sensitization of communities that still adhere to similar retrogressive and harmful practices.
Female genital mutilation is classified into four major types. There is Type 1: clitoridectomy which refers to the partial removal of the clitoris and in some cases, only the prepuce is removed. The clitoris is the small sensitive and erectile part of the female genitals. The prepuce is the fold of skin that surrounds the clitoris. There is excision, which is Type 2. This is the removal of the clitoris and parts of the labia minora. These parts may be wholly or partially removed. In some occasions, parts of the labia mijora can be removed also. Type 3 is often referred to as infibulation. During this process, the vaginal opening is narrowed through the creation of a covering seal. The seal is formed when the labia minora and or labia mijora is cut and repositioned through stitching. Clitoridectomy may be involved in the process. Type 4 includes all the harmful practices use in female circumcision that are done for non-medical purposes. There is piercing, pricking, incising, scarping and cauterizing the genital area. Other practices may entail hymenectomy, cutting of the vagina and the introduction of corrosive substances such as potent traditional herbs to cause bleeding, to tighten or to narrow the vagina (Odukogbe et al., 2017).
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It is important to remember that there are zero health benefits that are gained from the processes of female genital mutilation. After such processes have been conducted, there is a need for a reversal process so that the women and girls may have better health and also be able to participate in sexual intercourse and childbirth. Deinfibulation is the process whereby the sealed vagina opening is cut open to cater for the aforementioned effects. FGM generally interferes with the natural sexual and reproductive functioning of women and girls because there is the damaging of the female genital structure and health. There are a lot of risks during and after the procedure. Some of these risks are as a result of the crude instruments that are used to conduct the process. FGM is not carried out for any medical purposes; hence it is not conducted in a medical environment with specialized tools. The tools used include razor blades, unsterilized knives, scissors, sharp rocks, glass, fingernails and non-surgical scissors (Okeke, Anyaehie, & Ezenyeaku, 2012). The act of cutting can be done by older women in the communities or males who are specialized with cutting tools. The unhygienic conditions in which FGM is carried out pose serious health risks to the victims. There is the risk of getting bacteria from the environment and the contaminated tools that are used. The crude means in which the organs are cut causes further reproductive problems. Short-term effects include urination problems, genital tissue swelling, excessive bleeding and severe pain. Other problems may include shock, death, and infections such as tetanus. Long-term impacts of the process include sexual problems such as extreme pain during intercourse and childbirth; vaginal problems such as discharge bacterial vaginosis and itching; psychological problems such as post-traumatic stress disorder, depression and anxiety; urinary problems such as urinary tract infections and pain when urinating and lastly FGM creates the need for later surgeries (Costello, 2015). There is a need for corrective surgeries such as deinfibulation in the future to improve the health of the women and to facilitate childbirth and sexual intercourse.
The management of the effects of female circumcision is costly. This is because there is need to respond to the short-term effects and the long-term effects individually. The best way to manage these complications is to prevent the occurrence of FGM completely. Response to patient-specific conditions requires a multi-disciplinary approach which should consider the time relations of the complications of the specific patient. Deinfibulation follows type 3 female circumcision. Urogynaecologists may help to manage fistulae and urinary inconsistencies. Also, menstrual disorders which may arise need to be checked for their level of severity and a plastic surgeon may be needed to correct large scars or keloids that may disturb sexual function or childbirth. When it comes to reproductive health, the management and financial costs that occur as a result of female circumcision are damning. The women who have undergone the cut often experience stillbirth, prolonged stay in the hospitals, caesarian deliveries, operative vaginal surgery, infant resuscitation or neonatal death. These complications arise depending on the severity of the female circumcision process that they underwent. Statistics indicate that the women who have been circumcised are four times more likely to undergo complications during childbirth and the children are also four times as likely to have health problems as compared to other children. A high neonatal death rate is reported among circumcised mothers as compared to non-circumcised mothers. The percentage of neonatal death also varied depending on the type of female circumcision that the mothers had undergone. Type 4 victims had higher neonatal deaths as compared to type 1 victims. Those women who did not deliver in the hospital recorded even higher percentage of complications with regard to their individual health, the delivery and the baby’s health. Therefore, it is evident that the effects of female genital mutilation transcend into other generations.
The cultural, religious and economic significance of female circumcision places constraints in the efforts to eradicate and eliminate the practice. In some communities, especially in African communities, female circumcision marks the change from childhood to adulthood. Women who were not circumcised were assumed unfit for marriage. One of the religious and cultural justifications of the practice in question is the reduction in promiscuity and ensuring purity before marriage. This is through the reduction of sexual drive. This is inaccurate because of the many negative consequences that come as a result of the process. FGM deprives women of sexual satisfaction and pleasure. Women who have undergone the cut have reported a significant reduction in or total loss of sexual desire, arousal, excitement and orgasm. The type of circumcision dictates the level of sexual dissatisfaction that a woman is likely to experience. Women who have undergone type 2, 3 and 4 are more likely to experience sexual dysfunction because of a distorted genital image, lower levels of sexual functioning, vaginal dryness and orgasm with increased pain. Those who have undergone type 1 have reduced orgasm, but do not undergo total elimination of sexual pleasure.
Interviews
It is evident that the culture of silence prevails. The women who have undergone the cut are usually forced to keep quiet about it or face a rejection by their communities and treated as outcasts. It is difficult to find one who shall openly speak about the injustice that is done to them. However, a few have come out and shared their experiences. They, however, wish to keep their identity in secret because of the society’s tendency to stigmatize and judge victims of unfortunate circumstances. The first interviewee was clear that female circumcision in her community was mainly conducted on children and young girls. It was rare to have a girl get to adolescence without undergoing the cut. As for her, she was circumcised at the age of six years old with her sister who was three years old. She was not aware of what was going on and it was not conducted in sanitary conditions. According to the explanation she was given later on, she was told that if she did not go through the process, she would be treated as an outcast by her family. The woman in charge of the process used one knife on all of the girls and they remained in one hut for nearly three months healing by the help of traditional herbs. Some of the girls she was with died during childbirth in the recent past. The events of that day and the deaths of her friends still haunt her. She had to undergo corrective surgery for her scars to heal completely and has had to deliver her two daughters through C-section. She promises never to take her children back home to her parents because her mother is adamant that all the girls in the household shall undergo the procedure. She is also traumatized and afraid of her children coming into contact with anyone from her native home.
The second respondent at the interviewer shared her story too. She confirmed that she underwent the process when she was very young and she did not know or understand what was going. Her father, who was the sole caretaker of her and her sister, was away at work when they took her sister. He had strictly been against the practice and, therefore, the women in the family that is his sisters who are aunties to the children, did it while he was away. She did not know that she had been mutilated until she heard the screams of her little sister. She claims it is the helplessness that she felt on that day and her inability to help her sister that haunts her everyday especially because her sister is unable to give birth. When she saw her sister’s pain, it triggered her memory and it felt like it was happening to her for the first time. The experience reminded her of what she had experienced during her mutilation. She experienced the trauma twice, for herself and for her sister. The respondent affirmed that the women in the village affirm this to be the gospel practice and one must go through it. If one escapes, the women wait until the moment when she is giving birth to a child then conduct the process. The act affected the respondent psychologically. She still has nightmares and cannot be intimate with anyone because of the traumatizing memories. Her father was unable to do anything. He tried to sue the aunties who had planed the saga, but the case was settled at a community meeting where the chief said, "What's done is done". The respondent has had to undergo several surgeries and other medical processes so as to have normal reproductive health.
Theoretical analysis
It is evident from the stories told that there is cultural significance placed in the act. One of the main reasons that have been attributed to the prevalence of FGM is that traditionalists view it as a good way to control female sexuality, which is wrong. First of all, sexuality is not terrorism for it to be controlled. The practice also leaves a lot of negative consequences on the reproductive health of the victim. Sexual chastity is insufficient to justify such a brutal practice. Marital fidelity and premarital virginity are important values in these communities, hence the members are willing to employ extreme measures so as to ensure that these values are maintained. It should be noted that the vaginal opening is sealed after the process of FGM, hence the fear of opening the seal or being found out discourages women from engaging in sexual activities. Therefore, these communities justify the practice as a fundamental part of raising a child and a good way or preparing them for marriage. The belief that the cut increases marriageability of the women in the community makes the practice more prevalent. In most communities in the sub-Saharan region, it is a cultural mark of the difference between a girl and a woman. Initiation is a rite of passage from childhood to adulthood. Female circumcision is therefore done to mark the growth of a girl into womanhood in several communities. It is considered that after the practice, the woman is fit for marriage. It also improves the economic prospects of the family. This is so because the women who have been circumcised attract more bridal wealth and in African communities, daughters have always been seen as a source of wealth. The wealth that is got from circumcised women at their married gives many communities the impetus to continue practicing the process. Being a rite of passage makes female circumcision a social norm. There is social pressure to conform to social norms, especially in areas where there is little enlightenment and education. Most of the women and girls who refuse to undergo the process are treated as outcasts. The rejection from the community and the harsh treatment that comes along with it generate the impetus for such retrogressive practices. The situation gets worse since there are many communities in which the process is unquestioned and routinely performed.
FGM is also associated with some cultural ideals of femininity and modesty. The clitoris and the labia reconsidered unclean, unfeminine and male in some communities. These communities, therefore, seek the removal of these parts so as to make their women and girls more feminine. After undergoing the cut, the woman is considered clean and beautiful. There are various characters in the society who contribute towards the upholding of the practice. Even though there is no religious significance in the practice, religious leaders have often contributed towards the conduction of the practice. Other people such as traditional elders and leaders, circumcisers and medical personnel have often been seen supporting the practice.
The reasons mentioned above have presented the biggest obstacles to the eradication of the behavior. The argument that female circumcision is an important cultural aspect has been used to justify the unfair practice over the years. The argument is given without consideration of the implications of the practice on the health of the women and girls who are involved. It should be noted and emphasized that the process of female circumcision is a violation of women’s and children’s rights. It denies women right to proper reproductive health. The victims are denied the right to life. Lives are lost when female circumcision is carried out. The campaigns and activism against the practice have not been without resistance since many people view the practice as a vital part of their culture. Inconsistencies in the law and the failure of the prevention practices to be backed by research and education have been a major let down in the fight against female genital mutilation (Dustin, 2010).
There have been various organizations set up on a local and international basis to fight against the practice of FGM. Since 1997, a lot of progress has been made to ensure that there is the abolition of FGM at all levels. This has been through community outreach programs, changes in public policy, criminalization of all practices, including FGM and FGM itself and also through education and research. Several countries in the sub-Saharan regions have criminalized FGM and also set stringent laws on the perpetrators of the practice. Other countries have also signed and ratified the Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa that was adopted by the African Union in 2003 (Mpinga et al., 2016). There has also been the ratification of the Convention on the Elimination of All Forms of Discrimination against Women. All these acts of law and policy condemn the practice of Female genital mutilation. Several bodies of the United Nations such as the World Health Organization, United Nations Children’s Fund and the United Nations Population Fund have been on a joint mission to end the practice alongside other retrogressive practices in many communities. Notably, it is not only FGM that poses a potential risk to the reproductive health of women and girls. There are several retrogressive and backward practices such as breast ironing, virginity testing and early marriage that are retrogressive and should be abolished by all means. Concern is also rising since these practices are not only present in the sub-Saharan region, but also in first world countries such as the UK. To categorize FGM as a third world problem is an erroneous view since the practice is widespread. FGM is a universal problem and should, therefore, be dealt with as such.
The prevalence of FGM has reduced in many countries owing to the number of men and women who are desisting from and condemning the practice. The criminalization of FGM has had a tremendous effect in achieving this result. However, a lot still needs to be done since criminalization of the practice alone is not enough. The people desist from the practice for fear because of the legal implications that are attached to FGM. The communities that practice FGM should be made aware of the impacts and the dangerous effects that come with female circumcision. It should be a decision made by the people on a knowledgeable basis to stop FGM and not an act conducted in secrecy for fear of the long arm of the law. The people should be educated and sensitized to reject and stop the practice. Supposing the law is altered, there would be no restriction that would prevent these communities from progressing with the dangerous practice. Education acts as a permanent solution to ending FGM.
In conclusion, FGM is a retrogressive and retrogressive practice that should not be heard of in the 21 st century. The impacts of the practice are gruesome and costly to the economic and reproductive health of the victims. Efforts to end the practice should be doubled and accompanied with education and research for there to be more effective outcomes. All men and women should take part to end the practice and secure the futures of the children who are at risk of going through the practice.
Reference
Costello, S. (2015). Female genital mutilation/cutting: risk management and strategies for social workers and healthcare professionals. Risk Management and Health Care Policy , 8 : 225-233. doi: 10.2147/RMHP.S62091
Dustin, M. (2010). Female Genital Mutilation/Cutting in the UK: Challenging the Inconsistencies. European Journal on Women’ s Studies , 17 (1), 7-23.
Mpinga et al. (2016). Female genital mutilation: a systematic review of research on its economic and social impacts across four decades. Global Health Action , 9. Doi: 10.3402/gha.v9.31489
Odukogbe et al. (2017). Female genital mutilation/cutting in Africa. Translation Andrology and Urology, 6 (2), 138-148. doi: 10.21037/tau.2016.12.01
Okeke, T.C., Anyaehie, U.S.B., & Ezenyeaku, C.C.K. (2012). An Overview of Female Genital Mutilation in Nigeria. Annals of Medical & Health Sciences Research , 2 (1), 70-73.
