#endcuttinggirls Campaign: Agony of FGM/C survivors – Onyinye Mbam & Opeyemi Yekini

mbamprofNote:  FGM/C is more prevalent in the southern zones than in the northern zones. States with the highest prevalence Osun (77%), Ebonyi (74%) , Ekiti (72%), Imo (68%) and Oyo (66%)
Health Organization WHO, is “any partial or total removal of the external female genitalia or any other injury to the female genital organ for non-medical reasons”.

Adeola was just two years old when what medical experts described as the type one form of female circumcision was performed on her. Clitoridectomy, which is what female circumcision is, is a partial or total removal of the clitoris, a small, sensitive and erectile part of the female genital.

Its medical and social consequences have been established. This consequence has proved true in the case of Adeola as she cannot hide her shock when others describe the pleasure they derived from sex. Adeola, even in private, can hardly speak about any pleasure from sex, she doesn’t derive any pleasure in sex and so is ignorant of any feeling of pleasure from sex.

When asked she responded, “Pleasurable sex! Do I enjoy sex? She asks rhetorically, smiling sarcastically. The only thing I know about sex is that it is my husband’s right. It is not about whether I want it or not. If he wants it, I have to give it to him.

“It has never happened that I asked him for sex. Once he wants it I have no choice. I must do as my husband wants and as soon as he is done I am also up. So, l don’t know if sex is meant to be enjoyed by the woman.”

The question of pleasure is one that most women of Oja Oba Ile-Ife local government in Osun State finds both amusing and surprising.

Like Adeola, 38 years old Mrs Bili Sule, another FGM victim, said she had had the type two FGM performed on her when she was six months into first pregnancy as her in-laws believe that the clitoris contains powers strong enough to damage a man’s penis or to kill a baby during childbirth.

Bili, who hails from Ijebu-Ode, Ogun State but is married to an Osun man, said the practice of female circumcision was not part of their culture, as such, she was not circumcised as a child until she married her husband, whose parents later insisted on performing circumcision on her during her first pregnancy.

She admitted, “I do not engage in intercourse for pleasure, only for my husband’s satisfaction. It is my husband who demands sex, you have to give him, it has never happened that I initiated sex, or even that I wanted it. I didn’t know how to initiate it, never”.

Bili, despite admitting that she never experienced pleasurable sex, stated that it is an irony that she has been in and out of the labour room five times, and currently carries her sixth pregnancy.

Iyabo Jimoh, 31, doesn’t expressly say she doesn’t enjoy sex. Her dilemma is that it comes with a lot of pain because the circumcision carried out on her was the the excision type. This type is a partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are “the lips” that surround the vagina. This was the type of excision that was performed on her when she was just a kid.

“I think I enjoy sex. But I experience a great deal of pain in my vagina during and after sex, which sometime makes me want to run away from having sex. I know it would have been different if I was not circumcised”.

Iyabo said, “During my school days, we usually share our experiences after having sex and whenever I listen to some of my friends who were not circumcised, about how they enjoy intercourse, I usually feel very sad that I can never have a pleasurable sex”.

Contrary to many cultural believes that female circumcision is a recognized and accepted practice that is considered important for the socialization of women, curbing their illicit sexual appetites and preparing them for marriage, it has been proven to be harmful to women’s sexuality and reproductive health.

In most cultures where female genital mutilation is practised, it is considered as part of a ritual initiation into womanhood that includes a period of seclusion and education about the rights and duties of a wife.

Despite its cultural importance, FGM has drawn considerable criticisms because of the potential for both short- and long-term medical complications, as well as harm to reproductive health and infringement on women’s rights.

Following global condemnation of the act, some human rights and women organisations in Nigeria have in the last seven years been sensitizing Nigerians on the negative effect of this harmful practise

Because of the prevalence of the practice in some states in Nigeria, female circumcision or more accurately the dangers of female circumcision has been included in the curriculum for nurses and doctors by the Nursing Council of Nigerian NCN, and the Medical and Dental Council of Nigeria MDCN.

The fact is, between 100 million and 140 million women and girls are thought to be living with mutilated genitals, according to the World Health Organisation, which has repeatedly argued that circumcision has no health benefits, rather is harmful to girls and women in many ways.

The National President of Inter-Africa Committee on Harmful/Violent Practices against Women and Children FGM, Professor Modupe Onadeko, observes that there isn’t a remotest evidence of benefit in the practice of female genital mutilation and cutting.

She made the observation when the Advocacy Unit, Child Rights Information Bureau CRIB, of the Federal Ministry of Information, in collaboration with the United Children’s Fund UNICEF, marked the World Zero Tolerance to Female Genital Mutilation/Cutting in Osogbo, Osun State, at a two-day media dialogue on the vexed subject of female circumcision.

According to her, it has now become a punishable offence for any medical practitioner, be he or she a nurse or doctor to be involved in the practice of female genital mutilation/cutting. The act is now seen as violent and harmful practice against women and children and attracts severe legal action against any medical personnel found culpable.

In her presentation on: “The Practice and Experience of FGM/C in Nigeria” she said the practice of FGM/C is widely common in parts of the South-west, South-south, South-east and areas located around Chad and Niger Republic extending to some areas in North-east like Kano, Abuja, Nassarawa among others, where certain cultural practices have infiltrated.

She said though the prevalence of cutting is more in the South-west and South-south, some tribes are practicing the unclassified types including one which is often referred to as medical circumcision.

According to her, “Here a medical practitioner helps to carry out the procedure in a facility to eliminate infections. Whichever form or method of mutilation or injury done on the female child, this is unacceptable and it is a harmful practice that must be stopped forthwith.

“It is estimated that between 100 million to 140 million girls and women alive today have experienced FGM. If current trends continue, 15 million additional girls will be subjected to it by 2030.

“Some communities believe the practice is religiously required. Others believe that FGM will deter pre-marital sex or promiscuity. It’s these entrenched believes that the United Nations Population Fund, UNFPA and other UN agencies like UNICEF are working to change.

“An estimated 19.9 million Nigerian women have undergone FGM/C meaning that approximately 16 percent of the 125 million FGM/C survivors worldwide are Nigerians NPoPC 2014. The overall prevalence of FGM/C among girls and women aged 15-49 years in Nigeria (27%) is lower than in many countries NDHS 2013”, she stated.

Prof Onadeko, who is also Community Health Physician and Consultant Reproductive/Family Health University College Hospital, Ibadan, also adduced that FGM/C affects women and young girls in various ways such as: Infections (genital abscesses), problems having sex. They also experience pain, suffer depression and anxiety, have painful menstrual periods, urinary problems, suffer Vesico Vaginal Fistula VVF, or Recto Vaginal Fistula RVF. Problems in childbirth (need to cut the vagina to allow delivery and the trauma that results, often compounded by re-stitching), are common.

She expressed profound reservation on the common allegation that women who were not circumcised are more prone to promiscuity than the circumcised ones, noting that about 99.9 per cent of commercial sex workers had had female genital circumcision performed on them.

Despite its cultural importance, FGM has drawn considerable criticism because of the potential for both short- and long-term medical complications, as well as harm to reproductive health and infringement on women’s rights (Toubia, 1995).

– National Demographic Health Survey (NDHS) 2013

FGM is the “any partial or total removal of the external female genitalia or any other injury to the female genital organ for nonmedical reasons.” The World Health Organization (WHO) 1997.

Type I

Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).

Type II – Excision:

partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are “the lips” that surround the vagina

Type III

Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris

Type IV

Unclassified: includes

All other harmful procedures to the female genitalia for non-medical purposes: pricking, piercing or incising of the clitoris and/or labia.

Stretching of the clitoris and/or labia cauterization by burning of the clitoris and surrounding tissue.

Scraping of tissue surrounding the vaginal orifice or cutting of the vagina. Introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purposes of tightening or narrowing it and any other procedure which falls under the definition of female genital mutilation given above

An estimated 19.9 million Nigerian women have undergone FGM/C meaning that approximately 16% of the 125 million FGM/C survivors worldwide are Nigerians (NPoPC 2014)

The overall prevalence of FGM/C among girls and women aged 15-49 years in Nigeria (27%) is lower than in many countries (NDHS 2013).

However, due to its large population, Nigeria has the third highest absolute number of women and girls (19.9 million) who have undergone FGM/C worldwide (after Egypt and Ethiopia)

Situation of FGM/C in Nigeria (NDHS 2013)

The 2013 NDHS collected information about FGM/C in Nigeria from all women age 15-49yrs. The topics covered included knowledge and prevalence of FGM/C, type of circumcision, age at circumcision, and attitudes toward the practice of circumcision.

Findings showed that 27 percent of women age 15-49 has been circumcised. Another 82 percent of women in Nigeria undergo FGM before age 5.

FGM is more prevalent in the southern zones than in the northern zones. States with the highest prevalence Osun (77%), Ebonyi (74%) , Ekiti (72%), Imo (68%) and Oyo (66%)

Knowledge of FGM is higher among Yoruba women than among women in any other ethnic group in Nigeria. FGM is most prevalent among Yoruba women (55%), followed by Igbo women (45%)

Infibulation is more prevalent in Nasarawa (22%), Kaduna (21%), and Bayelsa (20%) than in other states.

Proportion of FGM among girls age 0-14 is higher among those whose mothers have also been circumcised. The higher a mother’s level of education, the less likely her daughter has been circumcised.

26% of girls age 0-14 whose mothers were infibulated were also circumcised and had their genital area sewn closed.

Studies show that 87 percent of girls age 0-14 and 80 percent of women age 15-49 were cut by a traditional agent (Circumciser, TBA, & others). Additionally, 12 percent of girls and 13 percent of women were cut by a medical professional (Doctor, Nurse/Midwife and others).

Also 68 percent of women and 57 percent of men who have heard of FGM believe that the practice is not required by their religion.

It was established that 64 percent of women and 62 percent of men think that the practice of FGM should not continue.

Why is FGM performed in Nigeria

Sexuality: preservation of virginity until marriage.

Marriageability: undergoing FGM improves chances of marriage in some societies.

Economics: FGM is an income‐generating activity for the women who perform it, and their profession brings them high status within their communities.

Tradition: preserving and continuing a set of values and rituals in a community.

Rite of passage from girlhood into womanhood

Religion: (though no religion includes FGM as a requirement).

Cultural aesthetic reasons: in some communities, normal female genitals are considered ugly, unclean and unattractive unless they are subjected to FGM.

Myths and beliefs: some communities believe that the clitoris contains powers strong enough to damage a man’s penis or to kill a baby during childbirth.

Cultural aesthetic reasons: in some communities, normal female genitals are considered ugly, unclean and unattractive unless they are subjected to FGM.

Myths and beliefs: some communities believe that the clitoris contains powers strong enough to damage a man’s penis or to kill a baby during childbirth.

How does FGM/C affect a girl’s or woman’s health immediately after the cutting?

The type of FGM/C done determines the severity.

  • Severe pain
  • Serious bleeding
  • Infection of the wound
  • Trauma
  • Problems urinating
  • Tetanus and other infectious diseases, such as HIV, from unsterilized cutting tools
  • Death

How does FGM/C affect a girl’s or woman’s health in the long term?

  • Infections (eg genital abscesses)
  • Problems having sex.(e.g. pain).
  • Depression and anxiety
  • Painful menstrual periods
  • Urinary problems
  • Vesico Vaginal Fistula (VVF) or Recto Vaginal Fistula (RVF)

Problems in childbirth (need to cut the vagina to allow delivery and the trauma that results, often compounded by re-stitching)

UNFPA/UNICEF with FMOH and FMWASD undertook a study on FGM in 6 States (Ebonyi, Ekiti, Imo, Osun, Oyo and Lagos) to :-

  • To understand the nature, types of social norms and their effect on the social expectation and motivation of families and communities on FGM
  • Undertake an in-depth analysis of community social networks influencing patterns and collective behavior around the practice of FGM

Key findings from the study:-

  • Majority of girls are cut before age 1 and between 5 and 18 years as rite of passage to womanhood in some communities with type 1 & 2 as the most commonly practiced.
  • In nearly all communities traditional practitioners (Circumcisers) perform FGM
  • Repeatedly cited motive for the practice of FGM across the states is to curb promiscuity and in conformity with culture

“…It is not about socio-economic status; both the rich and the poor practice it. It is also not about education. Family belief is really the strongest reason for the practice of FGM/C. It is all that matters. Most times, they don’t tell them the real reason for cutting it (protecti against promiscuity), but try to scare people with taboos and serious consequences that will befall whoever doesn’t practice it.” Source: Research Survey 2015

Drivers of the practice are mainly grandmothers and mother-in-laws

Although majority of men and women prefer the practice of FGM to be discontinued, it remains a major problem within

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