Her family pins her down, encumbering her revolting thrashes. An elderly woman forces her legs spread and, with an unsterilized shard of glass, slices into her clitoris. She slabs paste—cow dung, blistering ashes, tree bark and roots, herbs—to her wound to palliate the bleeding to little avail. Blood pools beneath her. Crying is verboten.
This is luridly familiar for more than 200 million girls and women alive today in 30 countries across Africa, the Middle East and Asia, where Female Genital Mutilation (FGM) is highly concentrated. At least another estimated three million girls are at risk annually.
FGM is the practice by which the female genitals are cut, often using unsterilized glass, scalpels, razor blades, knives or scissors. The procedure induces inexorable bleeding; acute urine retention; sexual dysfunction; the risk of blood-borne diseases such as septicaemia, Hepatitis B, HIV and AIDS; recurrent urinary tract infections; dysmenorrhoea; cysts; chronic pelvic infection; infertility; prolonged and obstructed labor; vesico-vaginal or recto-vaginal fistulae; scarring and keloid formation as well as psychosocial and emotional consequences.
Health hazards that ensue with FGM vary in extremity, as it’s classified by four types. Clitoridectomy is the partial or total removal of the clitoris or, in rare cases, the prepuce—the fold of skin surrounding the clitoris. Excision is the partial or total removal of the clitoris, as well as the labia minora—the inner folds of the vulva, with or without excision of the labia majora—the outer folds. Infibulation is the narrowing of the vaginal opening by cutting, repositioning and stitching the labia minora or majora as a seal, with or without removal of the clitoris. Of course, deinfibulation then refers to the tearing of the sealed vaginal opening to permit intercourse or facilitate childbirth. And type four includes all remaining harmful procedures to the female genitalia for non-medical purposes, (e.g. pricking, piercing, incising, scraping and cauterizing).
“As in other Countries, FGM is deeply rooted in culture and tradition. It’s considered important for the socialization of women, curbing sexual desires and preparing women for marriage,” said Dr. Taiwo Oyelade, World Health Organization (WHO) national program officer of family and reproductive health in Abuja, Nigeria. “Most circumcisers are elderly women in the community. They don’t necessarily do it on their daughters; they usually have an important position within the community or are leaders of a particular cult or ritual group. Others do it as a means of livelihood.”
FGM is typically carried out at infancy or childhood as a “rite of passage” to adulthood, or because elders expect young women to conform and thus yield to social pressures. It’s also deemed necessary in ensuring premarital virginity or marital fidelity. In some cultures, it’s performed at first pregnancy or even at death.
FGM is an indubitable violation of a child’s rights to health, security and physical integrity, her rights to be free from torture and inhumane, degrading treatment and her right to life if the procedure results in fatality—which it all-too-often does.
“The 2015 Violence Against Persons Act (VAPP) prohibited Female Genital Mutilation in Nigeria. Individual and group efforts to eliminate FGM started in the ’80s but resulted in some modest advancement in the early fight against FGM,” said Oyelade. “Additional efforts by government and civil society organizations that further galvanized action include the dissemination of findings of the National Baseline Survey on Harmful Traditional Practices in 1998, the development of a National Policy and Plan of Action on Elimination of Female Genital Mutilation in Nigeria in 2002, various anti-FGM projects including provision of alternative means of income generation for circumcisers in high-burden areas and efforts of 13 pioneer states that enacted anti-FGM legislation as of 2014. These efforts gingered stakeholders and CSOs to continue advocating for a national legislation against FGM.”
In ’97, WHO issues a joint statement against the practice of FGM in unison with the United Nations Children’s Fund (UNICEF) and the UNFPA. Revised legal frameworks and climbing political support has resulted in laws against FGM in 26 countries in Africa and the Middle East, as well as in 33 other countries with migrant populations from FGM-practicing countries thus far. WHO continues to publish global strategies and issue statements on the elimination of FGM in partnership with a gamut of international agencies.
But, nonetheless, the practice subsists across Nigeria.
“The approaches for implementation of the law is still emerging as the law was just enacted in 2015. Even the 13 pioneer states that had laws against FMG before the national law have not been able to establish mechanisms for enforcement,” Oyelade explained. “FGM is still being practiced because the awareness about the national law is still very low. The most important step now is for all states to domesticate the law and sensitize their citizens.”
Preliminary findings by the United Nations Population Fun (UNFPA) lists Osun, Ekiti, Oyo, Ebonyi, Imo and Lagos as having, on average, 61 percent of women subjected to FGM. Cutting has actually increased in the Southeast, Northwest and Northeast between 2003 and 2013, according to the National Demographic Health Survey.
Today, the average prevalence of FGM in Nigeria remains between 10 and 25 percent, as it has for close to three decades, but with significant regional variations. Prevalence in the South is higher with some states witnessing rates closer to 80 percent, and areas in the North seeing less than one percent.
These figures put Nigeria on a roster of countries where the total prevalence of cutting hovers at less than 30 percent, alongside Benin, Kenya, Tanzania, Senegal, Ghana, Cameroon, Togo, Niger and Uganda—unlike places like Djibouti (98 percent), Egypt (91 percent), Mali (89 percent) and Sudan (88 percent). While the percentage is comparatively low, the concern for Nigeria is its dense population—meaning still about 19 million women have undergone FGM.
FGM is a social practice that has been imbibed over centuries of socialization. In order to eliminate the practice in Nigeria, Oyelade recommended the implementation of longer-term strategies to promote awareness of the medical and psychosocial consequences associated. Concerted efforts in educating the policy- and decision-makers, the general public, health workers and those who carry out the practice is critical.
“This calls for the active involvement of political leaders, professionals, development workers, local communities and their leaders, and women’s group and organizations,” Oyelade said. “It is also important that governments establish mechanisms for educating the citizens on the letter of the VAPP act and punishment for offenders, and set-up support systems for enforcement of the law including capacity building of police, judiciary and civil society organizations.”