Female Genital Excision (FGM)
Female genital excision is commonly practised in many parts of the world and can often be the cause of HIV infection, through the use of shared cutting instruments. The practice can cause great long-term physical as well as psychological harm. However, it is often perpetuated by older women or by girls themselves, with pressure from their peers, so moves to stop its practice are highly complex and need to be led by women and girls themselves, rather than by outsiders. The following article, about Margaret Wambete's experiences in Kenya, has been sent to us by her to share with you. Margaret now works voluntarily for a pioneering programme which preserves the positive rituals associated with moving from girlhood to womanhood, but which has eliminated the harmful physical aspects of the ceremony. If you have personal experiences of this also which you would like others to hear about, we would be glad to hear from you. If you would prefer to remain anonymous, just let us know and we can make sure that we keep your name off what you write.
Positive Voices: Margaret Wambete's Healing Scars
Originally published in Global Health Council’s magazine Global AIDSLink Issue 83
Contributed by: Jennifer Hyman, Editor
A girlhood spent fiercely guarding her bodily integrity couldn't prevent Margaret Wambete from contracting HIV at age 25 as a result of female genital mutilation (FGM), but it has empowered her to remain a role model for other young girls.
It is a practice too painful for most people to even think about, yet FGM is the bare-boned reality for an estimated 100 to 140 million women alive today. Prevalent in varying degrees throughout 28 countries (mostly in Africa, some in the Middle East and Asia), FGM involves cutting off all or part of a girl's clitoris and external genitalia. In the most extreme cases, infibulation follows when, after excising the genitalia, the remains are sewn together with thread or thorns.
FGM is typically carried out in Kenya on pre-pubescent girls as an initiation ritual into womanhood and in preparation for early marriage. As a youth, Margaret evaded FGM by running away from home and attending a missionary school; however, during an entirely different rite of passage — when she was 25 years old and in active labor with her son — she was forcibly subjected to a clitoridectomy.
Margaret describes the horrific realization of being subjected to FGM as a feeling of utter betrayal, as she assumed the birthing assistants would try to alleviate, rather than add to, her pain.
"It was my first child, and so I had no experience about how bad the labor pains were supposed to be," Margaret explained. It was the persistent blood and agonizing pain after delivery that prompted her to look and see that her clitoris had been excised.
While Kenya's overall FGM prevalence stands at 50 percent, in some parts of the country, such as the pastoral communities at Mount Elgon near the Ugandan border where Margaret hails from, virtually every girl is circumcised. When they realized her genitalia were intact — the mark of an immature, unmarriageable girl, Margaret's birthing assistants cut her on the spot, without consultation.
As Margaret tested negative for the HIV virus prior to delivery, she is certain that the dirty communal cutting instruments that were used are responsible for her infection. Although it's difficult to estimate how many women have contracted HIV through FGM, it is well-known that these dirty cutting instruments — running the gamut from rusty knives to glass — are reused to perform numerous circumcisions, easily transmitting infections, including sexually-transmitted diseases.
It is not surprising that FGM's standing in Kenya and elsewhere on the continent has waxed and waned, in light of the long-standing tug-of-war between proponents claiming strong cultural relevance and critics decrying it as a fundamental violation of human rights. Although former Kenyan President Daniel Arap Moi issued motions to ban FGM in 1983 and 1996, and formally outlawed its practice on girls under 18 in 2001, the ritual circumcision of young Kenyan girls continues largely unabated.
In the years following her circumcision, as the roots of HIV took hold of her system, Margaret says she was increasingly succumbing to a range of opportunistic infections. Eventually, near death, she was hospitalized. Margaret recalled, "I was so sick that my CD4 cell count was down to only two, I couldn't walk and I had developed a stomach tumor that was causing boils to burst through my skin."
With the help of a sympathetic doctor and a successful personal loan, Margaret was able to purchase the antiretroviral (ARV) therapy that saved her life. She says, "I can feel my body healing now, and my CD4 count has shot back up to 417."
Margaret is among the less than one percent of Africans with access to ARVs, and, even for her, maintaining a steady supply for the past two years has become an onerous challenge. The cost of her ARVs and treating ongoing opportunistic infections mean that her debt is only mounting. Even though Margaret understands ARVs should be taken regularly for efficacy, some months she simply can't afford them.
Feeling healthier has prompted Margaret to become an advocate for the rights of infected people, as well as an activist against ritual circumcision. She volunteers with World Vision Kenya and a group called YES+, counseling people living with AIDS and delivering home-based care. Additionally, along with five other victims of FGM in her group, Margaret actively works to decry the practice.
As a teacher of mathematics, physical education and Swahili, Margaret tries to influence her young female students to stay in school and avoid getting involved with boys too early, and she proudly dons a shirt emblazoned with the lettering, 'Say No to FGM and Early Marriage!' Now, Margaret is desperately seeking donor support to set up a rescue center for affected girls that would ensure education remains a viable option for them.
One study by Partners for Applied Technology in Health and the Family Planning Association of Kenya bears out Margaret's assertion that education plays a positive role in preventing FGM — 62 percent of the Kenyan girls interviewed with a secondary education were circumcised, compared to 96 percent of those with no education.
"The only way to stop FGM, and the physical and emotional scars that result, is to convince parents to keep their daughters in school," Margaret insists. While defended as a coming of age ceremony by many, Margaret believes it subjects young children to adult experiences before they are ready. Carefree thoughts of playing and studying become too quickly replaced by notions of marriage, sex, babies and, often, sexually transmitted infections.
FEMALE GENITAL MUTILATION (F.G.M)
Definition:
It refers to the traditional ritual of cutting and removing parts of the female sexual organ for cultural of non-medical reasons. It can be performed during infancy, childhood or adolescence
Meaning of Mutilation
The intent of the practice may be circumcision but the outcome is mutilation.
Various names by different communities:
Meru – Ntano cia aari
Kissi – Okwaroka kwa abaisike
Masaai – Amurat intoiye
Kikuyu – Irua ria anduanja
Kalenjin – yatitaet
Somalia – Gudniin
FGM Practice:
Types:
1. Sunna – (excision of the prepuce, clitoris, cliteridectomy). This type is used by Kisii, Meru and Kikuyu
2. Excision – This is the excision of the clitoris together with all or part of the labia minora (inner vagina)
3. Infibulation or Pharaonic circumcision – Excision of part or all the external genital (clitoris, labia, minora and labia majora and stitching or narrowing of the vaginal opening, leaving small hole for urine and menstrual flow)
- Mainly practiced by Mali, Ethiopia, Egypt and Pokots in Kenya.
- In order to close the vulva, thorns, herbal paste or cut gum are used
- The girls legs are then tied together for 2 to 3 weeks until the 2 sides of the vulva have healed together.
4. Unclassified – All other operations on the FGM including:
- Pricking
- Piercing or incision of the clitoris or labia, stretching the clitoris or labia
- Introduction of corrosive substances or herbs into the vagina
- Stretching of the clitoris by the Ugandans
Complications of FGM
Immediate
- Infection due to unhygienic conditions and use of unsterilized or crude tools
- Hemorrhage which could result into death
- Shock due to bleeding and severe pain and anguish
- The procedure can also cause tetanus which causes death in most cases
- Contraction of HIV/ AIDS
Problems caused by bad traditions
- Death
- Dropping out of school
- Increase of immorality
- Early marriages
- Street families/ Children
- HIV and AIDS
Positive Voices: Margaret Wambete's Healing Scars
Originally published in Global Health Council’s magazine Global AIDSLink Issue 83
Contributed by: Jennifer Hyman, Editor
A girlhood spent fiercely guarding her bodily integrity couldn't prevent Margaret Wambete from contracting HIV at age 25 as a result of female genital mutilation (FGM), but it has empowered her to remain a role model for other young girls.
It is a practice too painful for most people to even think about, yet FGM is the bare-boned reality for an estimated 100 to 140 million women alive today. Prevalent in varying degrees throughout 28 countries (mostly in Africa, some in the Middle East and Asia), FGM involves cutting off all or part of a girl's clitoris and external genitalia. In the most extreme cases, infibulation follows when, after excising the genitalia, the remains are sewn together with thread or thorns.
FGM is typically carried out in Kenya on pre-pubescent girls as an initiation ritual into womanhood and in preparation for early marriage. As a youth, Margaret evaded FGM by running away from home and attending a missionary school; however, during an entirely different rite of passage — when she was 25 years old and in active labor with her son — she was forcibly subjected to a clitoridectomy.
Margaret describes the horrific realization of being subjected to FGM as a feeling of utter betrayal, as she assumed the birthing assistants would try to alleviate, rather than add to, her pain.
"It was my first child, and so I had no experience about how bad the labor pains were supposed to be," Margaret explained. It was the persistent blood and agonizing pain after delivery that prompted her to look and see that her clitoris had been excised.
While Kenya's overall FGM prevalence stands at 50 percent, in some parts of the country, such as the pastoral communities at Mount Elgon near the Ugandan border where Margaret hails from, virtually every girl is circumcised. When they realized her genitalia were intact — the mark of an immature, unmarriageable girl, Margaret's birthing assistants cut her on the spot, without consultation.
As Margaret tested negative for the HIV virus prior to delivery, she is certain that the dirty communal cutting instruments that were used are responsible for her infection. Although it's difficult to estimate how many women have contracted HIV through FGM, it is well-known that these dirty cutting instruments — running the gamut from rusty knives to glass — are reused to perform numerous circumcisions, easily transmitting infections, including sexually-transmitted diseases.
It is not surprising that FGM's standing in Kenya and elsewhere on the continent has waxed and waned, in light of the long-standing tug-of-war between proponents claiming strong cultural relevance and critics decrying it as a fundamental violation of human rights. Although former Kenyan President Daniel Arap Moi issued motions to ban FGM in 1983 and 1996, and formally outlawed its practice on girls under 18 in 2001, the ritual circumcision of young Kenyan girls continues largely unabated.
In the years following her circumcision, as the roots of HIV took hold of her system, Margaret says she was increasingly succumbing to a range of opportunistic infections. Eventually, near death, she was hospitalized. Margaret recalled, "I was so sick that my CD4 cell count was down to only two, I couldn't walk and I had developed a stomach tumor that was causing boils to burst through my skin."
With the help of a sympathetic doctor and a successful personal loan, Margaret was able to purchase the antiretroviral (ARV) therapy that saved her life. She says, "I can feel my body healing now, and my CD4 count has shot back up to 417."
Margaret is among the less than one percent of Africans with access to ARVs, and, even for her, maintaining a steady supply for the past two years has become an onerous challenge. The cost of her ARVs and treating ongoing opportunistic infections mean that her debt is only mounting. Even though Margaret understands ARVs should be taken regularly for efficacy, some months she simply can't afford them.
Feeling healthier has prompted Margaret to become an advocate for the rights of infected people, as well as an activist against ritual circumcision. She volunteers with World Vision Kenya and a group called YES+, counseling people living with AIDS and delivering home-based care. Additionally, along with five other victims of FGM in her group, Margaret actively works to decry the practice.
As a teacher of mathematics, physical education and Swahili, Margaret tries to influence her young female students to stay in school and avoid getting involved with boys too early, and she proudly dons a shirt emblazoned with the lettering, 'Say No to FGM and Early Marriage!' Now, Margaret is desperately seeking donor support to set up a rescue center for affected girls that would ensure education remains a viable option for them.
One study by Partners for Applied Technology in Health and the Family Planning Association of Kenya bears out Margaret's assertion that education plays a positive role in preventing FGM — 62 percent of the Kenyan girls interviewed with a secondary education were circumcised, compared to 96 percent of those with no education.
"The only way to stop FGM, and the physical and emotional scars that result, is to convince parents to keep their daughters in school," Margaret insists. While defended as a coming of age ceremony by many, Margaret believes it subjects young children to adult experiences before they are ready. Carefree thoughts of playing and studying become too quickly replaced by notions of marriage, sex, babies and, often, sexually transmitted infections.
FEMALE GENITAL MUTILATION (F.G.M)
Definition:
It refers to the traditional ritual of cutting and removing parts of the female sexual organ for cultural of non-medical reasons. It can be performed during infancy, childhood or adolescence
Meaning of Mutilation
The intent of the practice may be circumcision but the outcome is mutilation.
Various names by different communities:
Meru – Ntano cia aari
Kissi – Okwaroka kwa abaisike
Masaai – Amurat intoiye
Kikuyu – Irua ria anduanja
Kalenjin – yatitaet
Somalia – Gudniin
FGM Practice:
Types:
1. Sunna – (excision of the prepuce, clitoris, cliteridectomy). This type is used by Kisii, Meru and Kikuyu
2. Excision – This is the excision of the clitoris together with all or part of the labia minora (inner vagina)
3. Infibulation or Pharaonic circumcision – Excision of part or all the external genital (clitoris, labia, minora and labia majora and stitching or narrowing of the vaginal opening, leaving small hole for urine and menstrual flow)
- Mainly practiced by Mali, Ethiopia, Egypt and Pokots in Kenya.
- In order to close the vulva, thorns, herbal paste or cut gum are used
- The girls legs are then tied together for 2 to 3 weeks until the 2 sides of the vulva have healed together.
4. Unclassified – All other operations on the FGM including:
- Pricking
- Piercing or incision of the clitoris or labia, stretching the clitoris or labia
- Introduction of corrosive substances or herbs into the vagina
- Stretching of the clitoris by the Ugandans
Complications of FGM
Immediate
- Infection due to unhygienic conditions and use of unsterilized or crude tools
- Hemorrhage which could result into death
- Shock due to bleeding and severe pain and anguish
- The procedure can also cause tetanus which causes death in most cases
- Contraction of HIV/ AIDS
Problems caused by bad traditions
- Death
- Dropping out of school
- Increase of immorality
- Early marriages
- Street families/ Children
- HIV and AIDS