Increasing performance of female genital mutilation and cuts (FGM/C) by healthcare practioners, also referred to as medicalization of FGM/C,is slowing down efforts to eradicate FGM/C in Kenya by 2030 Non-governmental Organisations (NGOs) have warned.
The Civil society Organisation working against FGM now want healthcare regulators, healthcare professional associations and unions to keenly focus on medicalization of FGM in an effort to curb its impact on impeding progress towards abandonment on the harmful practice.
According to the NGOs, medicalization of FGM is now an emerging trend coupled with cross border cuttings. The CSO’s therefore calls for need to engage more with regulators, professional health worker associations, unions and practitioners so that the practice does not gain wider acceptance.
This was key message from a three-day convening workshop in Naivasha for Civil Society Organizations (CSO) Network working towards ending FGM, organized by the government’s Anti-FGM Board, The Girl Generation, Options Consultancy, Coalition on Violence Against Women (COVAW), among other CSO’s.
Speaking during the workshop, The Girl Generation team leader, Dr Jacinta Muteshi-Strachan said that medicalization of FGM is not safer as the popular narrative suggests and that medical professionals should not involve themselves in the practice which causes harm to women and girls.
“Medicalization of FGM/C not only provides legitimacy to the cut but continues to put many girls and women at risk from the consequences of the cut, Jacinta said adding that, “there is a need to strengthen healthcare sector and practitioners to help end FGM.”
She says that although there are anti-FGM laws in the country, implementation remains a challenge because of both social, political and cultural beliefs. With the age of cutting dropping to as low as 2 years old its consequences remain harmful in both short and long term with some girls dying due to over bleeding or sustaining lifelong consequences such as urinary and vaginal infections, sexual problems, complications giving birth, and psychological trauma.
Dr. Muteshi-Strachan called for capacity building for health care providers to respond to women exposed to FGM/C in both health care facility and community settings. In addition, she urges both county and national government to strengthen health care systems by anchoring FGM/C interventions to existing programs and socio-community structures and ensuring that communities practicing the cut are involved and part of the intervention.
FGM is illegal in Kenya. However, 15 percent of girls and women aged 15 to 49 have undergone some form of the practice, according to the United Nations Population Fund. The World Health Organization (WHO) estimates that around 200 million girls and women around the world have been genitally mutilated, with a further 3 million at risk of being subjected to the practice each year.
The World Health Organization defines the “medicalization” of FGM/C as situations in which the procedure performed by any category of health professionals, whether in a public or a private clinic, at home or elsewhere, at any point in a female’s life including reinfibulation
Population Council senior program officer Dr. Denis Matanda, says many communities are now trying to modernize FGM to counter historical campaigns against FGM/C which have over time stressed on the adverse health consequences of the practice. Previous campaigns have placed more efforts on stopping traditional FGM – which often involves the use of unsterilized instruments, no anesthesia and more severe cuts.
He explains that for a very long time anti-FGM messaging’s have centered on the negative consequences of using unsterilized tools and infections that come with it hoping that this would help to raise awareness of the health risks but in turn motivate people to abandon the practice. However, he said that it is speculated that the health approach taken in these campaigns has unintentionally encouraged the medicalization of FGM/C, at both demand and supply side.
“Even when the procedure is performed in a sterile environment by a health care provider, there is risk of health consequences immediately and later in life. Under any circumstances, FGM violates the oath that healthcare practitioners took -a promise to share knowledge, to help the ill and not cause harm,” Matanda said.
Dr. Matanda said that the prevalence of FGM is disproportionately higher in women with no access to education therefore underscoring the fact that educational opportunities for girls is not just a necessity but a pathway to breaking the cycle of harmful practices.
He revealed that Kisii and Nyamira counties are leading in the Medicalization of FGM/C in Kenya.
According to World health Organization (WHO) Female genital mutilation (FGM), also referred to as female genital cutting or female circumcision, involves altering or injuring the female external genitalia for non-medical reasons. The term encompasses a broad range of practices that are classified into four main types, based on specific anatomical descriptions.
Practiced in 30 countries in Africa, the Middle East and Asia, FGM involves the partial or total removal of the external, visible part of the clitoris or other injuries to female genitalia, usually inflicted during childhood.
WHO classifies FGM/C into 4 types, varying in severity from partial or total removal of the clitoris to extensive mutilation of the external genitalia. majority of FGM procedures consists of Types I clitoridectomy and type II excision, type III infibulation is the most severe form.
The UN agency says FGM/C is physically invasive, emotionally damaging, and is associated with complications that may seriously affect the reproductive health of women and increase the risks for the unborn child. Female genital mutilation can also result in infections and cause “horrific complications” in childbirth and during intercourse.
Condemning all forms of FGM/C, performed by either traditional or medical personnel and adding that Kenya has made commitments to end FGM Chief executive officer (CEO) Anti-FGM Board, Bernadette Loloju pointed out that emerging trends such as increased medicalization and cross border FGM pose a significant challenge to ending the harmful practice in the country.
She also observed that in Kenya, girls are mostly subjected to the cut during the school holidays since the perpetrators know that they will have a long period away from school and hence perceived to have time to heal from the procedure without scrutiny.
Kenya is a party to, and has ratified, the Convention on Elimination of All Forms of Discrimination Against Women (CEDAW), alongside international, regional treaties on the rights of women and children. Locally, the country has enacted the Prohibition of Female Genital Mutilation Act of 2011 which has provided a good environment for programmes and development of policies for 22 hotspot counties which practices FGM/C. In Kenya, 4 million girls and women have undergone FGM.
Secretary gender, state department for gender Dr Josephine Obonyo praised the anti FGM CSO network saying that united anti FGM CSO’s will create an enabling environment that promotes girls’ protection against the cut, reduce teenage pregnancies and child marriage while increasing girls’ chances of getting formal education. She said that recognizing and amplifying voices of the victims is critical in shaping policies against the practice.
Child Fund Kenya representative at the event Eunice Kilonzo said that women and girls who have undergone FGM/C have been found to experience negative physical and psychological effects that often harm their wellbeing, including their sexual functioning.
She urged the stakeholders to change on the way they have been approaching FGM by training men on effects of FGM and child marriages.
FGM rates in Kenya have gone down significantly over the past decade from 38 percent down to 21 percent in 2014. Kenya’s anti-FGM law imposes hefty fines on practitioners, and has stepped-up surveillance and enforcement but the reduction rate happens at paltry 1 percent every year calling for increased efforts to end the vice.
There is also lack of evidence and knowledge around treatment access, rehabilitative and preventative services for women who have undergone FGM/C especially those living in hot spot counties.
Chairperson, Anti-FGM Board, Sulum Ipato said that during the on going 16 days of activism observed each year, from 25 November to 10 December, the board will create awareness on ending FGM by engaging elders, youths and religious leaders and bring all anti-FGM CSO’s together to discuss and help curb the emerging trends.
