The Significance and Dangers of FGM and Its Recent Spike in Kenya

“The female circumciser, an older woman whom Tracy recognized as a member of a neighboring community of the Rendille tribe of northern Kenya, approached the space between the girl’s legs with a newly purchased razor blade in hand. Tracy watched as she made three quick cuts on her clitoris: first up the center, then down each side.”[1]

Sixteen-year-old Tracy, who was next in line, was to undergo one of the most controversial surgical procedures still performed (and, at times, enforced) on females in the 21st century.

Widely termed by Western human rights activists as female genital mutilation, FGM is a practice that “involves cutting part or all of the female genitalia for non-medical reasons and is predominantly performed on children and adolescent girls between infancy and 15 years old.”[2]

Some refer to this practice as female genital cutting (FGC) with an aim to reduce its stigma or judgement among the ‘outsiders’ or/and as a politically correct term (since the word ‘mutilation’ sounds derogatory and can complicate conversations) to appeal to communities that practice it in order to change their minds regarding the necessity of its implementation.

The image depicts 4 different types of FGM. The image of the first type, clitoridectomy, portrays the removal of clitoris, while the image of the second type, excision, depicts the removal of clitoris and labia minora. The image of the third type, infibulation, depicts the removal of clitoris, labia majora and manora as well as the stitching of vulva to leave only a small gap. Type 4 is described as "all other harmful procedures to the female genitalia for non-medical purposes."
4 Types of FGC (FGM).
Credits: UK Says No More.

There are four main types of FGC based on the severity of the procedure[3]:

  • Type 1 or Clitoridectomy encompasses “a tiny nick of the clitoral skin”[4]– that is, a total or partial removal of the clitoris and its surrounding skin.[5]
    • Most Kenyan tribes practice this type of FGC .
  • Type 2 or Excision incorporates clitoridectomy plus “the removal of the labia minora, or inner skin folds surrounding the vagina.”[6]
  • Type 3 or Infibulation involves “extensive cutting and narrowing of the vaginal opening by stitching it together to create a seal [or a small gap].”[7]
    • This is done by cutting and repositioning of the labia minora and the outer skin folds surrounding the vagina (the labia majora).[8]
  • Type 4 encompasses “all other harmful procedures like pricking, piercing, incising, scraping and cauterizing the clitoris or genital area.”[9]
The image of the statistical coverage and studies on FGM/C around the world. It marks countries in 4 colors based on their level of coverage, studies on and occurrence of FGM/C. The image also reads "FGM/C is present in at least 92 countries around the world". .
Credits: FAWCO.

While FGC has no proven medical benefits and at times can even be life threatening, the United Nations Children’s Fund (UNICEF) estimates that for a variety of different reasons “at least 200 million individuals alive today have been cut in 31 countries across the world.”[10] The U.N. forecasts that “if current trends continue, 15 million additional girls ages 15 to 19 will be subjected to the mutilation by 2030.”[11]

With the onset of COVID-19, this trend has been on the rise as pandemic-related travel restrictions have barred humanitarian workers and government officials from travelling in regions with high instances of FGC to implement reforms to end the practice, and as schools have been closed, thus allowing girls to have ample time to heal from the painful procedure without losing out on academic material.[12]

Kenya is one of many African countries dealing with the consequences of COVID-19 pandemic, which, besides many well-known problems, also include the rapid spike of FGC cases.

According to Plan International, 21% of Kenyan women admitted that they have undergone FGC before COVID-19: it was estimated that there were around 11% of circumcised women aged 15 to 19 and more than 40% of circumcised women aged 45 to 49 years in Kenya.[13] In 2014, around 4 million Kenyan women (approximately a fifth of the female population) had undergone some type of FGC.[14]

Now, with the onset of COVID-19, per UNICEF, there was “a 121 percent increase in the number of FGC cases between January and November 2020 compared to the same period in 2019 […] in that same timeframe, the number of girls rescued from FGC dropped from 1,073 in 2019 to 994 in 2020”[15] in nine Kenyan counties.

Moral Ethnicity of Clitoridectomy

The photograph of a woman's hands showing the razorblade.
This woman in Mombasa, Kenya shows the razorblade she has used on girls’ genitals.
Credits: Time.

Before trying to understand the reason behind the pandemic-related spark of FGC cases in Kenya and why it is so hard to stop the practice, it is important to understand what FGC is as well as the main reasons behind its popularity.

When learning about tribal traditions and customs (and FGC is most commonly considered a tribal custom), it is crucial to fully understand the notion of ethnicity, or what it is and what it means to belong to a social group that has a common national or cultural tradition.

Most historical analyses of ethnicity generally solely focus on political tribalism and rarely look beyond primordialism and instrumentalism to focus on the internal dimension- moral ethnicity– which accompanies and greatly influences the external dimension of political tribalism.

For instance, former Kenyan President Jomo Kenyatta’s defense of the ritual of female circumcision in his Kikuyu tribe emphasizes upon this importance of the commonly-disregarded by Westerners element of moral ethnicity. He notes that precisely due to the disregard of the psychological and cultural background behind the practice, it has (and still is) regarded as barbaric by most of the ‘outside’ world.

The image of a book cover of Jomo Kenyatta's "Facing Mount Kenya: The Traditional Life of the Gikuyu"
The book cover of Jomo Kenyatta’s “Facing Mount Kenya: The Traditional Life of the Gikuyu”.
Credits: AbeBooks.

In his anthropological study, Facing Mount Kenya (1938), Kenyatta provides an interesting perspective on the traditional custom of clitoridectomy, or the type 1 practice of female circumcision.

His defense of this practice is deeply rooted in moral ethnicity, or the way individuals understand what it means to belong to a certain community (the internal dimension).

The importance of moral ethnicity as opposed to political tribalism, which focuses on the external dimension of collective action or on the strong ethnic identity that separates one group of people from another one, should not be overlooked.

The dichotomy rooted in political tribalism between primordialism, which is based on blood relationships and unchanging tribal traditions, and instrumentalism, which represents ethnicity as a tool of manipulation of people by colonial authorities and African politicians, gives no real weight to history.

In fact, “without both deep grievance and hope of its removal men and women do not rebel”[16] and thus moral ethnicity, which is grounded on the historical imagination and on “what people argue about between themselves in the unequal spheres of property, labour, gender and exchange, rather than how they behave in common”[17] should also be accounted for when defining ethnicity.

Kenyatta argues that the negative definition of clitoridectomy (irua) was artificially constructed by the colonial officials and missionaries due to the misinformation they acquired from Kikuyu converts taught by Christians who used their outsiders’ perspectives of irua and naturally did not account for its psychological background.

It follows that with regard to irua custom the moral ethnicity is not accounted for and, thus, the wrong perception, which views female circumcision as something barbaric, is formed by the outsiders.

The Significance of Clitoridectomy for Kenyan Tribal Communities

Most importantly, Kenyatta argues that “the abolition of the surgical element in this custom [irua] means to the Gikuyu the abolition of the whole institution”[18], since besides the external element of surgery itself, the irua custom has enormous social, cultural, educational, moral, economic and cosmetic values and reasons.

The image of psycho-sexual and social reasons for FGC. It portrays 3 main reasons for FGC: religion (since FGC is perceived as necessary for the attainment of spiritual cleanliness), hygiene and aesthetics (many believe that uncircumcised vulva is not aesthetically pleasing and even unclean) and society (most often FGC is performed for cultural reasons including the rite of passage which allows one to be accepted by her tribal society). Other reasons are also listed. They include the importance to maintain chastity/virginity before marriage, family honor, control of women's sexuality and the superstitional belief that the clitoris threatens the penis. The image also lists main enforcement mechanisms used on women in FGC-practicing communities. They include divorce or refusal to marry women who have not undergone FGM/C, using fear of punishment by God or supernatural forces, and poems, songs that celebrate FGM/C and deride girls that are not cut. ,
Reasons for and enforcement mechanisms of FGC.
Credits: Cureus.

1)One of the principal reasons behind the custom’s importance is its moral significance, since irua symbolizes the unification of the tribe, rooted in the commencement of the real age- groups (riika) of people who “act as one body in all tribal matters and have a very strong bond of brotherhood and sisterhood among themselves.”[19]

    • The moral ethnicity of clitoridectomy is thus a theory of social relations that “allows others to remain or become trusted strangers”[20] due to their ‘ethnic otherness’ that helps them to stay protected from the dangers of the ‘outside’ world.
The photograph of mothers with their children. A young mother who is holding her child is depicted on the foreground of the photograph. .
Credits: devex.

2) Age-groups also represent the custom’s social implication of transitioning from childhood to womanhood, or the “custom of rite de passage from childhood to adulthood”[21], which marks the participant’s acquirement of political rights and participation in a tribal community, as well as her parents’ promotion to a higher (seniority) status in the society.

    • In most tribal communities, FGC, which is performed during the wedding ceremony, also becomes a prerequisite for inclusion among circumcised women in a husband’s family.[22] For a young newly married woman in Kenya it is extremely important to be included in her husband’s family’s female network, as she has to financially rely on him and his relatives for the rest of her life.

3) As for educational implications, legends of people and historical events are remembered based on the names given to people’s age-groups during irua[23]

    • For instance, if famine occurred during the initiation, that age-group would forever be remembered as ‘famine’. Naturally, without irua, a tribe that has no written record would not be able to keep track of important events of its history.
A photo of a Kenyan renowned traditional circumciser Regina holding a razorblade.
A photo of a Kenyan renowned traditional circumciser Regina.
Credits: Plan International.

4) FGC is also performed for economic reasons: the practice is mostly executed by traditional circumcisers- local women who make a living from cutting.[24]

    • Now, since the government banned FGC, many have become unemployed with no alternative sources of income as, for them, the trade of circumcision is the only one they know how to do since they have been doing it their whole lives.[25]
      • Nevertheless, even those who have abandoned the practice and tried to learn a new trade have faced huge obstacles due to COVID-19 and were thus forced to resort to their old trade by working underground.[26]
    • Also, as a prerequisite for marriage, FGC is the main step before a bride’s family receives a marriage dowry, which is more often than not essential in elevating economic hardships.[27]

5) It is also important to note that not everyone believes that human bodies are naturally beautiful, as some believe that bodies are androgynous and that both male and female bodies contain male and female parts.[28] Thus, FGC is also performed for cosmetic reasons.

    • For instance, some believe that a man’s foreskin is a female part, while the covering of the clitoris is a male part.[29] So, in order to become wholly male or female one has to undergo circumcision.
    • Also, “some men prefer the physical aesthetic of a woman who has been circumcised to one whose reproductive organs are intact and who may be viewed as unclean.”[30]
An image of a quote that reads "For men, the circumcision is done for health and hygiene, while for women, it is meant to curb sexual desire and tame them".
Credits: NDTV.

6) Another reason for continued perpetuation of the practice is a  deep-rooted tribal culture and superstitions.

    • Most tribes are patriarchal, where women and their reproductive rights are controlled by their fathers, husbands and sons.
      • Many believe that FGC helps to curb a girl’s sexuality and prevents excessive sexual desire, so that she can stay loyal to her husband.[31]
      • Parents raising a daughter reason that “if I don’t do these things, the girl will grow up horny.”[32]
      • In such communities, men would not marry uncut women, nor would they allow their daughters to opt out (and if they end up refusing and running away from home, they will be ostracized by their families).[33]
      • Likewise, it is unthinkable for most women who live in those communities to deliver a child without being circumcised.[34]
    • Superstitions also play a huge role in tribal day-to-day lives. They are passed from generation to generation and are so deeply entrenched that any interference by government officials and foreign humanitarian workers seems distant, intrusive and unnecessary.
      • For instance, some Kenyan tribes believe that “an uncut girl brings death. Her child may be born, but her husband will die. […] Better that one girl dies than to bring death on the entire community.”[35]
The photograph of a female doctor Tatu Kamau in Kenyan court fighting to decriminalize FGC in Kenya for women above 18.
A female doctor, Tatu Kamau, wants FGC to be decriminalized in Kenya. She is asking Kenya’s courts to allow women above the age of 18 to be able to practise FGC, as she believes that they have a right to choose what they do to their bodies at that age. She wants the Kenyan government to annul the Prohibition of Female Genital Mutilation Act 2011 and to disband the board set up to enforce the law. Kamau argues that FGC is an age-old Kenyan tradition and that an outright ban infringes on a woman’s right to exercise her cultural beliefs.
Credits: CNN.

Due to these aforementioned reasons, it is very hard to completely eliminate FGC practice. In fact, it has been proven that most people who practice FGC recognize its costs, however, they think that the benefits outweigh them, as one cannot get married, start a family, nor can one become an adult and a full member of a tribal community without undergoing FGC.[36]

As a deep-rooted cultural practice, FGC is an integral element of many Kenyan women’s lives, since for them “if one refused to undergo FGM, they would never find a husband and if they did, they would never be fully accepted in that homestead. They would be returned to their family, bringing shame and ridicule to their people.”[37]

Notably, in 2018, a Kenyan doctor, Tatu Kamau, publicly argued in favor of overturning the 2011 Prohibition of Female Genital Mutilation Act– Kenyan legislation that imposed harsh penalties on perpetrators of FGC or three years imprisonment- and legalizing FGC. She argued that “banning FGC penalizes women for observing their culture and ranks certain cultures and their practices superior to others.”[38]

Negative Consequences of FGC

Despite the aforementioned significance of FGC for many communities, “unlike male circumcision, which has been shown to help reduce transmission rates of HIV and other STI infections, female circumcision has no proven medical benefits.”[39]

FGC can even be life threatening.

The image of words denoting the most common immediate side effects after FGC which include pain, death, panic, terror, screaming, shock, septicaemia, bleeding, inflamation, vomit and trauma .
Credits: Women in Balance.

Immediate complications of FGC, per the World Health Organization (WHO), can include fever, infections, urinary problems, excessive bleeding, swelling and even death.[40]

  • The risks of immediate complications greatly increase after the practice is performed the second (or even third and fourth) time in case if a girl has some flesh remaining after her first cut.[41]
The image of the long-term health consequences of FGM. It highlights 5 main issues: 1) no health benefits, only harm; 2) urinary tract infections; 3) infertility; 4) childbirth complications; 5) newborn deaths.
Credits: Twitter.

Long-term complications can encompass psychological issues, sexual challenges, menstrual problems, childbirth difficulties, including newborn death.[42]

  • This practice also affects men, as many suffer the emotional pain seeing their mothers, sisters and daughters dealing with the health consequences of FGC.[43]
  • Moreover, for many married couples sexual intercourse becomes an endurance test and many describe their first sexual experience after FGC as “traumatizing.”[44] Thus, more often than not, instead of reducing females’ alleged promiscuity, FGC only reduces the love between the spouses.[45]

    The image of the WHO calculation of total healthcare costs of treating FGC's side effects. The image reads "treating health complications caused by FGM costs 1.4 billion USD/year".
    Credits: World Health Organization.

Multiple international bodies including the United Nations have declared FGC a violation against the rights of women and girls and set a target to eradicate the practice in the following ten years.[46]

Besides the health risks and complications, FGC greatly strains  government healthcare systems: “a 2020 WHO study found that the total costs of treating all medical needs resulting from FGC amount to USD $1.4 billion globally per year”[47], which for some countries can comprise up to 30% of their annual average healthcare spending.[48]

Moreover, it was calculated that if FGC was abandoned, the associated savings in health costs could account to be more than 60% by 2050.[49]

On the other hand, if no action is taken to eradicate the practice, healthcare costs by 2050 will increase by 50%  due to the population increase.[50]

Best Approaches to Eradicate FGC

The image that reads "#End FGM".
Credits: The Global Goals.

When learning about tribal communities, we need to understand that, unlike the Western societies which promote autonomy and individualism, tribal communities live in a collective which was created and continues to prosper due to strict obedience and respect to customs, which, in the first place, “signify a belonging and duty to the group.”[51]

With this in mind, it becomes clear what a powerful role social pressures play in those communities. In fact, social pressures in societies that practice FGC are so strong that no female can opt out, since “everybody would come down on her.”[52]

For instance, if a woman does not want to circumcise her daughter, it is not up to her to decide, since she would have to answer to her husband, her father and mother-in-law, her friends and her family’s friends, as well as the whole community.

Therefore, even if someone goes and tells an individual mother what the health risks of FGC are and she believes them, it does not mean that she would be able to have the power to make a decision regarding whether or not her daughter should undergo the practice.[53]

Therefore, anti-FGC programs that only target individual mothers will most likely be ineffective.

Men living in those communities usually make the situation worse by shunning uncircumcised girls and rejecting those men who decide to marry uncircumcised ones.[54] Within a family, men- conventionally the decision-makers- usually have more influence to decide whether or not to circumcise their children.[55]

However, despite the common Western belief that the practice is forced on women by men, it has been proven that “elderly women often do the most to perpetuate the custom.”[56]Also, statistically across Africa, the support for FGC is the strongest among women.[57]

The photograph of the anti-FGM workshop where men are taught about the physical impact of the practice. At the foreground of the photograph two men are showing a poster with depictions of a female reproductive system to the class filled with male students.
At the anti-FGM workshops, like this one, men are taught about the physical impact of the practice.
Credits: BBC News.

To successfully eradicate the practice there is a need to create educative programs that target extended families with the main focus upon the figures of authority within those households as well as people in the community who influence them- that is, both male and female elders.

Men have to be educated on this issue as well, since in patriarchal African societies “they have the platforms, they have the audience, they have the influence.”[58]

Undeniably, there is also a need for a respectful dialogue, which includes a full understanding of all the intricacies and specifics of customs of specific communities (as well as their significance) in order to find together a possible alternative way to commemorate tradition without harmful health consequences for women.

Conclusion

When learning about FGC, there is a need to account for the internal dimension of the practice, or its moral ethnicity, which concentrates on the psychological, social and historical importance of the practice for those distinct people, instead of just solely focusing on  political tribalism and the external negative surgical intricacies and consequences of the practice.

The consideration of moral ethnicity of FGC is crucial since for many Kenyan tribes the abolition of female circumcision “will destroy the tribal symbol which identifies the age-groups, and prevent [tribes] from perpetuating that spirit of collectivism and national solidarity which they have been able to maintain from time immemorial.”[59]

In other words, the abolition of irua would render the existence of those tribes impossible.

With this in mind, I believe that it is very important to come up with alternative ways to commemorate the tradition at no expense to women’s health.

 

 

Bibliography:

 

Notes: 

[1] Neha Wadekar and Will Swanson , “Female Genital Cutting Is on the Rise During COVID in Kenya,” Pulitzer Center, January 29, 2021, https://pulitzercenter.org/stories/female-genital-cutting-rise-during-covid-kenya.

[2] Ibid.

[3] Ibid.

[4] Ibid.

[5] Esther Ogola, “Kenyan Men Join Battle to End FGM,” BBC News, September 5, 2021, https://www.bbc.com/news/world-africa-58200718.

[6] Ibid.

[7] Wadekar, Ibid.

[8] Ogola, Ibid.

[9] Ibid.

[10] Wadekar, Ibid.

[11] Tonny Onyulo, “’This Practice Should Be Stopped’: Teen Girls Decry Painful Illegal ‘Circumcision’,” USA Today, January 18, 2018, https://www.usatoday.com/story/news/world/2018/01/18/kenya-female-genital-mutilation/1041960001/.

[12] Wadekar, Ibid.

[13] Onyulo, Ibid.

[14] Ogola, Ibid.

[15] Wadekar, Ibid.

[16] John Lonsdale, “Moral Ethnicity, Ethnic Nationalism and Political Tribalism: the Case of the Kikuyu,” in Staat Und Gesellschaft in Afrika: Erosions Und Reformprozesse, ed. Peter Meyns (LIT VERLAG, 1996), p. 93-106, 96.

[17] Lonsdale, Ibid, 97.

[18] Jomo Kenyatta , Facing Mount Kenya (Vintage, 1962), 128.

[19] Kenyatta, Ibid, 4.

[20] Lonsdale, Ibid, 99.

[21] Kenyatta, Ibid, 129.

[22] Olga Khazan, “Why Some Women Choose to Get Circumcised,” The Atlantic, April 8, 2015, https://www.theatlantic.com/international/archive/2015/04/female-genital-mutilation-cutting-anthropologist/389640/.

[23] Kenyatta, Ibid, 129.

[24] Wadekar, Ibid.

[25] Ibid.

[26] Ibid.

[27] Ibid.

[28] Khazan, Ibid.

[29] Ibid.

[30] Wadekar, Ibid.

[31] Ibid.

[32] Chris Bodenner, “The Complexity of Female Circumcision: Your Thoughts,” The Atlantic, May 1, 2015, https://www.theatlantic.com/international/archive/2015/05/complexity-of-female-circumcision-your-thoughts/391841/.

[33] Wadekar, Ibid.

[34] Khazan, Ibid.

[35] Wadekar, Ibid.

[36] Khazan, Ibid.

[37] Ogola, Ibid.

[38] Wadekar, Ibid.

[39] Ibid.

[40] Ibid.

[41] Ibid.

[42] Ibid.

[43] Ogola, Ibid.

[44] Ibid.

[45] Ibid.

[46] Wadekar, Ibid.

[47] Ibid.

[48] Ibid.

[49] Ibid.

[50] Ibid.

[51] Bodenner, Ibid.

[52] Khazan, Ibid.

[53] Ibid.

[54] Onyulo, Ibid.

[55] Ogola, Ibid.

[56] Khazan, Ibid.

[57] Ibid.

[58] Ogola, Ibid.

[59] Kenyatta, Ibid, 130.

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