Although illegal, and seen as an outdated practice in many African countries, female genital mutilation (FGM) is prevalent in 26 African countries. The practice has been justified by cultures and religions as a rite of passage but a published this year reaffirms the practice has serious health repercussions, particularly in relation to sexual and reproductive health.
FGM is normally carried out before a girl reaches the age of 15 and often at a very young age. The practice is linked to , sexual and reproductive health problems and may lead to later complications in pregnancy and childbirth as well as psychological impacts. If the vision of getting to zero new HIV infectionsis to be reached, the elimination of FGM and child marriage must be realised.
Jessica* from Kajiado County in Kenya says she has never recovered from the trauma she experienced ten years ago. FGM is illegal in Kenya but, at the age of 12, her aunt tricked her into leaving school one day so that elderly women in the village could carry out FGM on her.
“What hurts me most is that my mother knew the plot and was part of the women who ululated [a celebratory call] when the initiation was completed,” she says.
Jessica was later introduced to an elderly man who had already paid part of a dowry to marry her. But Jessica managed to escape being forced into marriage by running away, and is now studying at university.
“Had I not escaped and come to Nairobi to live with a relative, who took me through counselling and enrolled me in a school in the city, today I would be a fifth wife and a mother,” says Jessica. She adds that inadequate education on sexual and reproductive health for affected communities has greatly contributed to the violation of young girls. “If such communities like the Masai of Kenya were educated on better ways of ushering girls into adulthood, FGM would be a thing of the past,” she says.
Rebecca Gitau, senior counsellor at , describes FGM as an act of gender based violence (GBV). She says the facility offers counselling to help women cope with the trauma FGM brings, just as they would for any other GBV incidence. But despite the hospital offering free psychosocial services and treatment to all survivors of GBV, plus the existence of many anti-FGM campaigns, some girls still do not know where to seek help if they are threatened with FGM or undergo it.
A further complication for girls who have undergone FGM is that they are often placed in situations where they may be at greater risk of HIV. For example, FGM is often linked to early and forced marriage to an older partner and the sexual intercourse may be forced, all of which can increase their risk to HIV.
A vital service that the Nairobi Women’s Hospital offers for free is to provide girls with post-exposure prophylaxis (an intensive course of antiretroviral therapy that can stop HIV from occurring in someone who has recently had unsafe sex). But many girls affected may not know of or have access to this service.
A nurse at Meru hospital, who asked to remain anonymous, highlights a further consequence of FGM in relation to HIV. The hospital serves an area where FGM is still common, and the nurse says he has treated girls who have lost a lot of blood after the ritual has gone wrong, making transfusion necessary.
But he adds: “During an emergency, the blood offered to the patient from the bank is not guaranteed to be HIV free.”
Despite the pain, violation and major health risks girls face through FGM, there are still many people who support the practice. Gregory Mbunduki from the Masai community believes there is a big difference in terms of moral values between those who have undergone FGM and those who haven’t.
“The girls who have gone through the ritual are disciplined and make better wives than those who haven’t,” he says, adding that girls who undergo FGM are helping their families as their dowries are often used to educate male relatives.
But a schoolteacher from the same region spoke out against FGM saying that girls who undergo it are unlikely to complete their education due to pressure from parents to get married.
In Kenya, FGM attracts either a minimum a fine of 200,000 Kenyan Shillings (USD 190), or both. If a girl dies in the process of FGM, the perpetrators may face life imprisonment. But often girls are too scared to go to the police, and even if they do police are reluctant to arrest FGM suspects because many times they are released for lack of evidence. According to a police report since 2011 there have been and of those only 16 resulted in convictions.
This week, 193 governments will come together at the to adopt the new global . Goal five seeks to achieve gender equality and empower all women and girls, and one of its targets is to eliminate harmful practices, such as child, early and forced marriage and female genital mutilation.
But with an ambitious scope of 17 new goals and 169 targets in the sustainable development goals, competition is fierce to ensure these issues are put high on government agendas.
Gideon Mugira an anti-FGM activist says it is a pity not much is said on FGM and child marriages in the UNAIDS draft strategy for 2016-2021. “The need to address these issues on a bigger platform can’t be over-emphasised. It is my earnest hope that they are addressed before it is too late,” he says.
One thing is certain it will take a concerted effort all the way from grassroots activists to governments if stories such as Jessica’s are to become a thing of the past.
SHAPE * MERGEFORMAT
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