The danger of Female Genital Mutilation (FGM)

Female Genital Mutilation (FGM), Female Circumcision (FC) or Female Genital Circumcision (FGC) as it is variously called refer to the cutting or alteration of the female genitalia for social rather than medical reasons (Rahman and Toubia, 2000). It has also been referred to as any practice which includes the removal or the alteration of the female genitalia (Sarkis, 2003). It also comprises all methods involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons (WHO, 2001). IAC [Nigeria] 1997:4 defined it as ‘any interference with the natural appearance of the female external genitalia using a blade, knife or any sharp instrument in order to bring about either a reduction in size of the clitoris or a complete removal of the vulva’. From the foregoing definitions, FGM can be defined as any act (deliberate or not) to partially or wholly tamper with the female external reproductive organ under the guise of culture, religion or any other belief. Several forms of FGM thrive in the world today and they vary from culture to culture and from place to place. Okonofua identified four types performed in Nigeria. These include Type I (also known as Sunna) – excision of the hooded clitoris with or without excision of the tip of the clitoris. Type II – removal of the hooded clitoris together with partial or total removal of the labia minora (inner lip). Type III (also called infibulation) – excision of part or all of the external genitalia with or without the stitching of the raw edges together/narrowing of the vaginal opening. Type IV – Angurya or Gishiri cuts incision extending from the vaginal opening anteriorly or posteriorly into surrounding tissue with damage to the urinary bladder/urethral opening or rectum and anus (listed in IAC [Nigeria] 1997).

2.1 FGM IN OTHER AFRICA COUNTRIES

The term "pharaonic circumcision" (Type III) stems from its practice in Ancient Egypt under the Pharaohs, and "fibula" (in "infibulation") refers to the Roman practice of piercing the outer labia with a fibula, or brooch (James and Stanlie, 2008). Leonard Kuber and Judith Muascher write that circumcised females have been found among Egyptian mummies, and that Herodotus (c. 484 BCE – c. 425 BCE) referred to the practice when he visited Egypt. There is reference on a Greek papyrus from 163 BCE to the procedure being conducted on girls in Memphis, the ancient Egyptian capital, and Strabo (c. 64 BCE – c. 23 CE), the Greek geographer, reported it when he visited Egypt in 25 BCE (Kouba, 1985; Muasher, 1985).

Asim Zaki Mustafa argued that the common attribution of the procedure to Islam is unfair because it is a much older phenomenon (Mustafa and Asim, 1966). While individual Muslims, Christians, and Jews practise FGM it is not a requirement of any religious observance. Judaism requires circumcision for boys, but does not allow it for girls (Werblowsky et. al., 1997). Islamic scholars have said that, while male circumcision is a sunna, or religious obligation, female circumcision is not required, and several have issued a fatwa against Type III FGM (Gruenbaum and Ellen, 2001).

Sudanese surgeon Nahid Toubia—president of RAINBO (Research, Action and Information Network for the Bodily Integrity of Women) —told the BBC in 2002 that campaigning against FGM involved trying to change women's consciousness: "By allowing their genitals to be removed [it is perceived that] they were heightened to another level of pure motherhood—a motherhood not tainted by sexuality and that is why the women gave it away to become the matron, respected by everyone. By taking on this practice, which was a woman's domain, it actually empowered them. It was much more difficult to convince the women to give it up, than to convince the men" (Shetty and Priya, 2007).  Boyle writes that the Masai of Tanzania will not call a woman "mother" when she has children if she is uncircumcised.

According to Amnesty, in certain societies women who have not had the procedure are regarded as too unclean to handle food and water, and there is a belief that a woman's genitals might continue to grow without FGM, until they dangle between her legs. Some groups see the clitoris as dangerous, capable of killing a man if his penis touches it or a baby if the head comes into contact with it during birth, though Amnesty cautions that ideas about the power of the clitoris can be found elsewhere. Gynaecologists in England and the United States would remove it during the 19th century to "cure" insanity, masturbation, and nymphomania. The first reported clitoridectomy in the West was carried out in 1822 by a surgeon in Berlin on a teenage girl regarded as an "imbecile" who was masturbating (Elchalal et. al., 1997; Black and Donald, 1872) Isaac Baker Brown (1812–1873), an English gynaecologist who was president of the Medical Society of London in 1865, believed that the "unnatural irritation" of the clitoris caused epilepsy, hysteria, and mania, and would remove it "whenever he had the opportunity of doing so," according to an obituary. Peter Lewis Allen writes that his views caused outrage—or, rather, his public expression of them did—and Brown died penniless after being expelled from the Obstetrical Society (Allen and Peter, 2000).

2.2 FGM IN NIGERIA

Some studies conducted in the past in Nigeria had shown that FGM was widespread in the country. It was estimated that more than 50 percent of Nigerian girls/women had been circumcised while a substantial number faced the torture yearly (Inter–African Committee [IAC] {Nigeria} 1997). Some of these studies include those of Owunmi (1993) and Myers et. al., (1985) among the Urhobos of Delta State; Myers et. al., (1985) among Ishan and Bini of Edo State; Adeneye (1995) in Abeokuta of Ogun State; Olafimihan (1993) in Ibadan of Oyo State and Ilorin of Kwara State; Akpabio (1995) in Oyi in Anambra State and Ibibio in Akwa Ibom State; Ofikwu-Abba (1993) among the Idoma speaking people of Benue State and various studies by IAC (Nigeria) at different times in Adamawa, Borno, Jigawa, Kaduna, Lagos, Plateau and Rivers states among others. Findings of these varied studies had continued to expose the unflinching attitude of the practitioners. While many reasons are advanced for this deeply entrenched cultural practice, the basic intention is to diminish female sexual pleasure in order to achieve virginity before marriage and fidelity after marriage. There is no proof that showed that circumcised women are less promiscuous. In as much as promiscuity should not be encouraged, FGM practice has been found to have physical, psychological, psychosexual and health implications on the victims. In addition, the practice is sustained because of the supposed pleasure that the husband will derive at the expense of the woman. Despite these implications and the efforts being made by the world body, to eradicate this health threatening practice, many countries in 3 Africa (Nigeria inclusive) and elsewhere have continued to subject their womenfolk to the practice. Most girls/women in Nigeria still face the ritual annually irrespective of their religious inclinations (Myers, 1985).

The most recent survey is a 1999 Demographic and Health Survey of 8,205 women nationally. This survey estimates that 25.1 percent of the women of Nigeria have undergone one of these procedures (DHS, 1999).

According to a 1997 World Health Organization (WHO) study, an estimated 30,625 million women and girls, or about 60 percent of the nation’s total female population, have undergone one of these forms. A 1996 United Nations Development Systems study reported a similar number of 32.7 million Nigerian women affected. According to a Nigerian Non-Governmental Organization (NGO) Coalition study, 33 percent of all households practice one of these forms (WHO, 1997).

However, according to some Nigerian experts in the field, the actual incidence may be much higher than these figures. Leaders of the Nigerian National Committee (also the Inter-African Committee of Nigeria on Harmful Traditional Practices Affecting the Health of Women and Children [IAC]) have been conducting a state by state study of the practice.

This 1997 study by the Center for Gender and Social Policy Studies of Obafemi Awolowo University in Ile-Ife, was contracted in 1996 by a number of organizations including WHO, the United Nations Children’s Fund (UNICEF), the United Nations Development Program (UNDP), the United Nations Population Fund (UNFPA), the Nigerian Federal Ministry of Women’s Affairs and the Nigerian Federal Health Ministry. The study covered 148,000 women and girls from 31 community samples nationwide.

The results from fragmented data, according to IAC/Nigeria, show the following prevalence and type in the following states in Nigeria. Abia (no study); Adamawa (60-70 percent, Type IV); Akwa Ibom (65-75 percent, Type II); Anambra (40-60 percent, Type II); Bauchi (50-60 percent, Type IV); Benue (90-100 percent, Type II); Borno (10-90 percent, Types I, III and IV); Cross River (no study); Delta (80-90 percent, Type II); Edo (30-40 percent, Type II); Enugu (no study); Imo (40-50 percent, Type II); Jigawa (60-70 percent, Type IV); Kaduna (50-70 percent, Type IV); Katsina (no study); Kano (no study); Kebbi (90-100 percent, Type IV); Kogi (one percent, Type IV); Kwara (60-70 percent, Types I and II); Lagos (20-30 percent, Type I); Niger (no study); Ogun (35-45 percent, Types I and II); Ondo (90-98 percent, Type II); Osun (80-90 percent, Type I); Oyo (60-70 percent, Type I); Plateau (30-90 percent, Types I and IV); Rivers (60-70 percent, Types I and II); Sokoto (no study); Taraba (no study); Yobe (0-1 percent, Type IV); Fct Abuja (no study).

While all three forms occur throughout the country, Type III, the most severe form, has a higher incidence in the northern states. Type II and Type I are more predominant in the south. Of the six largest ethnic groups, the Yoruba, Hausa, Fulani, Ibo, Ijaw and Kanuri, only the Fulani do not practice any form. The Yoruba practice mainly Type II and Type I. The Hausa and Kanuri practice Type III. The Ibo and Ijaw, depending upon the local community, practice any one of the three forms (Gibbs, 1965).

In several communities, FGM is celebrated as a rite of passage to puberty. In some Urhobo communities of Delta State, the mutilated girl was decorated with beads and camwood (ohwa) and accompanied to the market place by her peers amidst singing and dancing to show off her beauty and supposed chastity and to announce her preparedness for womanhood / marriage (Gibbs, 1965). Throughout the healing period, she is treated to special meals to demonstrate the honour of having become respectable by subjecting herself to circumcision (Oyavwe) (Gibbs, 1965). It is the pride of every parent to ensure that this act is inflicted on every daughter (Gibbs, 1965). Any daughter who refuses to cooperate is held down usually by hefty men while the circumcisor cuts away. The decoy of the supposed honour and dignity as well as the fear of rejection, stigmatization and violence makes many girls and women surrender their rights to bodily integrity.

The age at which FGM is performed differs from one community to the other (Gibbs, 1965). Amongst the Urhobos, it is mostly done at puberty. It is assumed that at this stage, the victim would not have had a chance to have sex and so has not experienced orgasm (Gibbs, 1965). The idea is to permanently destroy any potential to enjoy sexual intercourse. That way, she is likely to remain a virgin before marriage and a faithful wife in marriage. If a woman however gets pregnant before she is mutilated, she is promptly rushed to the circumcisor before delivery to ensure that the head of the baby does not touch the clitoris during birth. In some parts of Nigeria, it is done 7-8 days after birth or just before marriage. It has also been reported that if an un-circumcised woman dies in certain communities, the clitoris is cut off before she is buried (Gibbs, 1965).

Accurate figures are difficult to come by but it is estimated that 2million women and girls are mutilated annually. This corresponds to over 6,000 girls per day and one in every 15 seconds. It is practiced in 28 countries worldwide including Nigeria (Gibbs, 1965).

The National Demographic Health Survey conducted by the National Population Commission in 1999 revealed 25.1% prevalence in the study group of 8,205 married women aged 15-49. Reports from other sources – WHO, the media and the academia estimate the prevalence of FGM at 36-60%. A state-by-state study of FGM conducted by the Nigerian Centre for Gender, Health and Human Rights (NCGHHR) between 2001 and 2002 reveals that one form or the other is carried out in nearly all states in Nigeria. This ranges from 5-7% in Taraba and Abuja, 20-60% in Yobe (20%), Sokoto (32%), Plateau (58%), Ogun (35%), Niger (40%), Lagos (30%), Kwara (60%), Kogi (25%), Imo (40-50%), Enugu (45%), Edo (40%), Cross River (60%), Bauchi (55%), Anambra (60%), and as high as 70-100% in Abia (70%), Adamawa (72%), Benue (95%), Borno (87%), Delta (90%), Jigawa (69-70%; Type IV), Kaduna (50-70%; Type IV), Kebbi (100%), Katsina (95%), Kano (80%), Osun (80-90%), Rivers (70%) (NCGHHR, Dec 2002).

2.3 CASES OF FGM IN DELTA STATE

According to Nigerian Centre for Gender, Health and Human Rights (NCGHHR) between 2001 and 2002 reveals that one form or the other is carried out in nearly all states in Nigeria with Delta state having about 90% cases of FGM. Apart from the work of According to Nigerian Centre for Gender, Health and Human Rights (NCGHHR), there are no other documented cases of FGM cases in Delta state.

Hence, this leads me to determination of the knowledge, attitude and practice of female genital mutilation in Delta state.

2.4 REASONS FOR CONTINUED PRACTICE OF FGM

The continued practice of FGM appears to be largely grounded in a desire to terminate or reduce feelings of sexual arousal in women so as not to engage in pre-marital sex or adultery (Modupe-Thomas, 1995). As the clitoris holds a massive number of nerve endings, and generates feelings of sexual arousal when stimulated, leaving it untouched will lead to promiscuity. Secondly, uncircumcised women in countries where it is largely practiced may have difficulty getting a marriage partner as most men in such countries prefer circumcised women since they are considered more likely to be faithful than non-circumcised women. Other claims in support of FGM include:

• The clitoris is dangerous and must be removed for health reasons. While some believe it could make a man sick or die, others think it could make him impotent. Others still believe it will affect a child if its head touches it and others feel the milk of the mother will become poisonous if her clitoris touches the baby.

• The presence of the clitoris and labia minora emits bad genital odour and so cutting it off is healthy and necessary.

• FGM prevents vaginal cancer

• An unmodified clitoris can lead to masturbation or lesbianism.

• FGM prevents nervousness from developing in girls and women.

• FGM prevents the face from turning yellow.

• FGM makes a woman’s face more beautiful

• If FGM is not done, older men may not be able to match their wives’ sex drive and may have to resort to illegal stimulating drugs.

• An intact clitoris generates sexual arousal in women, which can cause neuroses if repressed (religioustolerance.org). And the list is endless.

Other reasons identified by (Modupe-Thomas, 1995) in her discussions with those determined to continue the practice are: aesthetic reasons, to curb promiscuity, as a rite of passage and to prevent infertility and as a cure for infertility.

The reasons enumerated above, we know, are unfounded but they seem to be quite convincing to most practitioners. Or better still, they feel that tradition and custom must be preserved for continuity sake.

This position is buttressed by the NDHS (1999) data. As many as 85 percent support the continuation of the practice on grounds of custom and tradition which by implication need not be challenged whether good or bad. This could be the only reason that can lay credence to its continued existence. To this end, the next section looks at the health implications facing women as this practice continues unabated.

2.5 THE HEALTH IMPLICATIONS OF FGM PRACTICE

Several health implications have been advanced for victims of FGM. These implications had been found to be similar in almost all societies where it is practiced (Modupe-Thomas, 1995). However, the immediate and long-term health consequences of FGM vary according to the type and severity of the procedure performed. The immediate health consequences as identified by WHO (2000) include: severe pain, shock, hemorrhage, urine retention, ulceration of the genital region and injury to adjacent tissue. Hemorrhage and infection can also cause death. More recently, concern has also arisen about possible transmission of the Human Immuno-deficiency Virus (HIV) – the virus that causes Acquired Immune Deficiency Syndrome (AIDS) – due to the use of the same instrument in multiple operations – though this has not been subjected to further research (Modupe-Thomas, 1995). The long-term consequences include cysts and abscesses, keloid scar formation, damage to the urethra resulting in urinary incontinence, dyspareunia (painful sexual intercourse) and sexual dysfunction and difficulties with childbirth. On psychosexual and psychological health, FGM may leave a lasting mark on the life and mind of the women that has gone through it. On the long run, women may suffer feelings of incompleteness, anxiety and depression. (Modupe-Thomas, 1995) identified urinary tract infection, Haematocoipos, obstructed labour, dermoid cyst and inability to consummate the marriage as some of the complications faced by infibulated victims. With these health implications made known to both practitioners and custodians of culture and tradition, the practice goes on unabated. Even the supposedly victims are willing to face the excruciating pains rather than face shame, humiliation and antagonism in their various societies. Also where the victims do not believe in the reasons enunciated for the practice they still find themselves complying with the customs and traditions. What could be responsible for this unquestionable compromise? This is what the next section hopes to unfold as it looks at the theoretical justification for its practice (Modupe-Thomas, 1995).