Emerging trends in FGM: Cross-border cutting and medicalisation

Cross-border cutting and medicalisation of female genital mutilation have been listed as some of the emerging trends of FGM in Kenya.

During the first annual FGM conference held in February this year, anti-FGM stakeholders said that the two issues have been a major challenge in the fight against FGM.

According to the World Health Organisation, medicalisation is when a health-care provider performs FGM whether in a public or private clinic, at home or elsewhere, while cross-border cutting is when girls are taken out of their home country to undergo FGM in another country.

For 19-year-old Salma*, the cross-border FGM process started when her aunt came to visit her family in Gorgoresa, Marsabit County, and asked her parents for an assistant to help her take care of her twins in Ethiopia.

Salma was only nine, but her parents took her out of school and sent her off to Ethiopia with her aunt.

After settling down, her aunt informed her that she would join her three cousins for circumcision. A circumciser was invited home to cut the girls.

“I was cut first. It was a clitoridectomy. It was very painful, but I had been warned that if I didn’t get cut, I would become a laughing stock back home and nobody would marry me. And even if I got lucky and got married, the man would divorce me as soon as he realised I hadn’t been cut,” she recalls.

When Salma returned home the next year, she felt too old to go back to Standard Three and dropped out of school.

For 19-year-old Fatma*, it was a case of medicalised FGM. The procedure happened seven years ago.

Her mother invited a nurse to their home. She used anaesthesia and gave her antibiotics and painkillers afterwards.

CULTURE

Some communities have turned to medicalising FGM, instead of completely doing away with it, to give it some credence, claiming that FGM is their culture and they can’t abandon it.

“My sisters were cut by a traditional cutter. My father is a doctor. He didn’t want me to undergo the tradition cutting, but he still wanted to maintain our culture,” explains Fatma, adding that she later came to learn that women who had undergone FGM often faced various complications later in life.

Leila* was also cut by a ‘nurse’ at the age of 10, in Nairobi’s Huruma Estate, alongside her cousins. Her mother took her on a visit to her aunt, where she was subjected to FGM.

“This old lady came home and injected us first before cutting us. I don’t know if she was a nurse or not. At first I refused, but my aunt insisted that I had to be cut.

 “I was told that FGM is a religious requirement according to Islam. Had I gotten a chance to escape, I would have run away. The injection was really painful, but after that I didn’t feel anything. My greatest fear was the pain, but even though I didn’t feel pain, I cannot subject my daughter to female circumcision,” she says, recalling that back in school they laughed at students from communities that didn’t practise FGM.

 “We used to wonder how such big girls had not been circumcised. Now we live with regret because the only ‘benefit’ we got is marriageability and community acceptance, and for that we are riddled with all these risks from FGM.”

During the three-day national FGM conference in February, the Office of the Director of Public Prosecution and the Nursing Council of Kenya acknowledged that it has been difficult to prosecute nurses and other health workers who perform FGM, due to lack of evidence.

A 2016 study by Unicef and the Africa Coordinating Centre for the Abandonment of FGM/C (ACCAF) on the medicalisation of FGM, found that FGM is increasingly being performed by medical practitioners in Kenya, Ethiopia, Somalia, Guinea, Sudan and Egypt. 

Egypt had the highest rate of health workers performing FGM (75 per cent), followed by Sudan at 50 per cent and Kenya in the third position at 40 per cent.