The practice of female genital cutting (FGC) continues in certain parts of the globe. Despite a decline in Kenya’s overall FGC, a high prevalence in Marsabit County, Kenya persists. Specific risk factors for FGC include low education and literacy levels, poverty, living in rural areas, and the cultural influence of marriage and marriageability. FGC occurs in different proportions, ranging from minor to major alterations of female genitalia, with variation depending on culture and location.
FGC can result in several harmful physical and psychological outcomes, such as pain, bleeding, infection, anxiety, posttraumatic stress disorder, and obstetrical problems, including postpartum hemorrhage, a major contributor to maternal mortality. Some of its positive consequences include embracing a female gender and ethnic identity and promoting marriageability.
It is pivotal to involve local women, men, and community members while developing and implementing programs to reduce the practice of FGC in order to respect women and culture and to promote human rights within community-led cultural change. This approach creates a more sustainable platform for success and paves the way for women’s empowerment and self-sufficiency.
FGC negatively impacts communities such as Marsabit County in several ways. By promoting community abandonment of FGC based on human rights, health risks, and community empowerment, programs can effectively reduce both global rates and negative outcomes of the practice. Not only can this increase women’s self-sufficiency and community health, it can also reduce obstetrical complications, maternal mortality, and other physical and psychological concerns.
Female genital cutting (FGC) is a global public health problem affecting women and communities in Africa, the Middle East, and some parts of Asia and South America, along with immigrants around the world.
While working at a Maternal and Child Health organization in Philadelphia, the author (KW) collaborated with Dahabo Abagaro, a Borana nurse-midwife and Mandela Scholar from the Sololo District of Marsabit County. Her work inspired the author to learn more about FGC in Marsabit County and about successful programs to reduce the practice in similar communities.
Marsabit County sits in the Eastern province of Kenya on the northern border, alongside Ethiopia, and stretches south towards the middle of the country. Various ethnic groups, like the Rendille, Gabra, Borana, Samburu, and Turkana, reside here.
When considering specific risk factors, females in Marsabit County fall into many high-risk categories. For example, girl child enrollment in school in the county is only 30%, and the overall ability to read and write within the community is 26.2%.
FGC occurs in different proportions and varies depending on culture and location: (i) Type I- clitoridectomy involves the partial or total removal of the clitoris and/or the prepuce; (ii) Type II- excision involves the partial or total removal of the clitoris, the labia minora, and potentially the labia majora; (iii) Type III- infibulation involves removal of the labia minora and the potential removal of the labia majora and the clitoris, and may also include stitching the labia together, leaving only a small opening for urine and menstrual blood to pass through; and (iv) Type IV involves all other forms of procedure harmful to female genitalia.
The practice of FGC harms women in myriad ways. In the short term, FGC is extremely painful and can cause excessive bleeding, infection, shock, and death. Women often suffer long-term from chronic pain, infections, scars, anemia, anxiety, post-traumatic stress disorder, and other emotional and psychological experiences that negatively impact their lives.
FGC may also have some positive social consequences. Many societies that practice FGC believe that removing the clitoris removes the masculine part of a female, showing an affirmation of her femininity and of matriarchal power.
Marriageability may easily be considered a positive consequence and the main driver behind FGC. Sometimes the practice occurs earlier in life, sometimes as part of the traditional marriage ceremony itself, and sometimes after a marriage takes place.
Some of the overall declines in Kenya’s FGC rates may be attributable to recent laws. Part two of the Children’s Act of 2001 prohibits FGC, alongside early marriage, under the protection from harmful cultural rites section.
With the successes that Kenya has realized because of the passing of these laws, there are also unexpected consequences. Legislation may result in people hiding acts of FGC to maneuver around the law,
Programs working to reduce harmful FGC practices currently exist around the world. The following programs exhibited the greatest long-term successes and were implemented in communities similar to Marsabit County and are therefore more applicable to the context.
One of the most effective and well-known programs is Tostan, based in Senegal and stretching through parts of West Africa. Tostan began with the intention of introducing problem-solving skills to women in rural areas whose husbands worked outside of the village much of the time.
Classes use traditional African methods, such as theater and dance, to encourage dialogue about societal issues, often leading to discussions surrounding positive change. Classes also incorporate skill-building, such as literacy and project management. Community Management Committees comprise 17 people from the area, including at least nine women, and are responsible for implementing projects designed by the community.
S.A.F.E., another program successfully reducing rates of FGC, works in Maasai communities of Loita Hills in Southwest Kenya. Through in-depth conversations with the community, it recognized that the most appropriate method in reducing the practice of FGC would involve an alternative rite of passage to publicly recognize and celebrate the necessary change from a girl to a woman.
The S.A.F.E. outreach team has collected detailed information from families through individual-level communication (Reding N, Personal communication, 8 November 2017). Since the program began, the Maasai of Loita Hills have seen a 30% reduction in FGC incidence, and only 10% of the girls in the community received FGC of any other than type I. Before program implementation, 99% of the girls experienced type II or III.
Marsabit County, Kenya, would benefit from the development and implementation of programs such as the above. At first glance, a program intended to reduce FGC seems to have little to no ethical risks. But indeed alternative views and understandings must be considered when creating and designing any program. Upon closer examination, there are important ethical considerations that cannot be ignored. From an international human rights perspective, FGC violates children and discriminates against women. Yet in many cultures, as a rite of passage, FGC provides the chance for a girl to become a fully actualized woman, to step into her rightful place in society as a wife and a mother, and is embraced and celebrated by women.
In addition, the international stance condemning FGC is not equal across continents. For example, the famous female cosmetic genital surgeries (FCGS), even among teenagers, in Europe and the United States are very similar to what is considered mutilation in Africa (e.g., clitoral unhooding, labial trimming, or vaginal tightening). As these procedures alter female genitalia without a medically necessary reason, they would likely fall under the WHO definition of FGC,
We must also take care not to ignore women by negating their thoughts about FGC or to minimize African voices because international agendas overwhelm the conversation.
Emphasizing the idea that women in other cultures need help and protection from outside sources may also turn them into helpless victims in our minds, unable to make their own decisions. Yet, women are not powerless, and coercive attempts to curb FGC may increase the practice underground.
Balancing physical health and cultural risk, alongside cultural freedom, proves difficult when considering FGC and its consequences. Programs intended to reduce the incidence of FGC should involve local women through all phases of development and implementation and should intentionally avoid disrespecting women and culture and instead reinforce the beauty and strength within both. Working alongside grassroots organizations within the community can provide insight into the acceptability of ideas and increase accountability to the local culture. Indeed, culture is not static. It swings and shifts through time, and peering through the lens of different cultures presents new ideas and possibilities for positive change.
Future research is needed to gain a more in-depth understanding of the current context of FGC and what will encourage the reduction of the practice. Using a gender-transformative perspective, the thoughts, opinions, and ideas of women, girls, birth attendants, and female leaders in communities with high FGC rates can provide clarity about this issue while also instigating ideas that will reduce FGC and improve other aspects in the community, as Tostan and S.A.F.E. have shown. Male voices can also add to a critical cultural understanding by providing more ideas about creating gender-transformative programs that will reach entire communities.
In addition, research is needed to pick apart the varied ethical considerations related to FGC. Specifically, an exploration of differences between what has been deemed acceptable Western practices and unacceptable foreign practices (i.e., FGC vs. FCGS and FGC vs. male circumcision) can provide an evidence base for programmatic equity and scope.
The practice of FGC heavily affects women and communities in Marsabit County, Kenya. Programs focusing on human rights, community engagement, and women’s empowerment and self-sufficiency can encourage a shift in cultural norms surrounding FGC and ultimately reduce the practice. Programs can move toward community-wide voluntary abandonment of FGC by promoting cultural movement through mobilizing the community to critically engage with previous experiences, communicate as a group, and work together to find their best approach to respecting and celebrating the lives of all community members.
Such interventions can significantly impact the lives of girls, women, and all community members in Marsabit County by influencing the immediate issues surrounding human rights and women’s health, long-term reproductive outcomes, and overall community wellness and sustainability. By shifting community norms surrounding the desirability and acceptability of FGC, girls will discover greater opportunities for achievement through fewer health risks and increased equality.