FGC refers to the intentional removal of part or all of the external genitalia, or other damage to the female genitalia, for cultural or other non-therapeutic purposes. In simpler terms, it is the cutting of the clitoris and involves the complete removal of the external female genitalia and subsequent stitching, leaving a tiny opening for urine and menstrual flow.
Female Genital Cutting (FGC), also known as female genital mutilation (FGM) and female circumcision, is practiced in 28 countries of sub-Saharan Africa, a few countries in the Middle East and Asia, and among immigrant populations from these countries in Europe, North America and Australasia. As many as 100-140 million girls and women worldwide have undergone the practice, and at least two million girls are at risk of being cut each year, about 6,000 girls a day! The Somali community living in Kenya (and in their native Somalia) has practiced the severest form of female genital cutting (FGC), infibulations, for centuries thus making FGC a deeply rooted and widely supported cultural practice.
WHO. 1998. “Female Genital Mutilation: An Overview,” Geneva: WHO.
According to research conducted by Safe Womanhood Kenya, several closely related reasons are used to sustain the practice: religious obligation, family honor and virginity as a prerequisite for marriage and even as an aesthetic preference for infibulated genitalia by men. However, FGC plays no role as a rite of passage. Underlying these reasons is the use of infibulations to enforce the cultural value of sexual purity in females.
Yet in Kenya, the health sector is still ill equipped to serve women who have been cut, particularly infibulated pregnant women. However, this stems from an overall weakness in the availability and quality of safe motherhood services. In addition, and especially in Nairobi, health workers are increasingly being approached to perform infibulations and re-infibulations.
Given the clear strength of feeling that FGC is a critical component of Somali culture, efforts to encourage behaviour change cannot focus solely on education about health and rights alone. The underlying reasons for the practice need to be discussed and debated so that a desire for change can emanate from the community itself. Because of the Somali community’s perception that efforts to abandon FGC are driven by international interests, working with them will require credible organizations and individuals that have gained their trust and acceptance.
Types of Female Genital Cutting (FGC)
Type 1: Excision of the prepuce, with or without excision of part or the entire clitoris
Type 2: Excision of clitoris with partial or total excision of the labia minora
Type 3: Excision of part or all of the external genitalia and stitching or narrowing of the vaginal opening
Type 4: Infibulation
- Pricking, piercing or incising of the clitoris and/or labia.
- Stretching the clitoris and/or labia. Cauterization by burning of the clitoris and surrounding tissue.
- Scraping of tissue surrounding the vaginal orifice (anguriya cuts) or cutting of the vagina (gishiri cuts).
- Introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purpose of tightening or narrowing it.
- Any other procedures that fall under the above definition.
Experiences with FGC in Eastleigh – Nairobi.
8th December 2012, Safeway Medical Clinic, Eastleigh, 08.15pm.
The eerie silence that characterizes the beginning of the night atmosphere at the clinic is shattered by a sudden, poignant and loud knock at the door. It is still early, so the night guard has yet to report for duty and neither has the night nurse. Fardhosa Ali – a registered nurse, is seated in the doctor’s room pondering at the day’s happenings. It has been such a busy day for her as there has been an outbreak of diarrhea and vomiting within the area served by her clinic – mostly inhabited by refugees of Somali origin. Woken from her stupor by the heavy knock, she timidly lifts her weary self to go for the door.
In her mind, she is sure that is another case of vomiting and diarrhea. She grabs the keys and makes for the door. And like she expected, there are two patients being stretchered into the clinic by a number of panic-faced women. Her mind dashes to the emergency medical procedure for managing typhoid as she walks ahead of the following pack. She directs the women to two beds and turns to get the necessary equipment and drugs for the procedure. But her eyes are quickly met by a horrid sight of blood. She lips to consciousness and notices two young girls, their eyes peering expectantly at her. She fixes her gaze at them and quickly notices that they are in pain. These are Zuleka* and her sister Mayam* (not their real names). They are 12 and 11 respectively.
The two girls are the latest victims of Female Genital Cutting (FGC) in the area. They are a case of an operation gone sour! They had – earlier in the morning – been subjected to the cut by way of a traditional circumciser – usually an old lady. This is done in secret with the knowledge of only close family members. It is normally a closely guarded secret done in the early hours of the morning. The sisters had been taken through Type 3 FGC which had included removal of part or all of the external genitalia and stitching or narrowing of the vaginal opening. What that meant was that the virginal opening is sewn up leaving barely a small hole for passing urine and as a discharge route during the monthly menses. This prevents or leaves no possibility of premarital sex during the girl’s growing life.
But for Zuleka and Maryam, the operation had borne heavy and elongated bleeding leading to shock. By time of arrival at the Safeway Clinic the patients were so pale and passed out. But they could not be presented early for medical attention as it had still been day light and so any attempt to transport them to hospital would have given away the secret of the ‘illegal operation’.
So at the clinic, the initial emergency measure was to handle the shock before embarking on managing the entire problem of bleeding and accompanying trauma. This is a situation that recurs all too often at the clinic. And although Safeway handles and manages the ensuing complications, it is often too early to commence anything reconstructive.
For the case of the two girls, Safeway Clinic conducted dressing for over two weeks during which time the patients had healed and were thus able to move and pass urine without much pain. But that just marked the beginning of a difficult life ahead for the two young girls assumed to have been traditionally initiated to adult life. The two will stand a great chance of experiencing serious post FGC complications which range from urine retention to difficult child birth and sometimes fistula problems. But Safeway Clinic has in several occasions also done de-infibulations for newly married girls and women as well as pre-natal preparations for safe delivery.
