From villages to clinics: How doctors are keeping FGM alive in hospitals

Female Genital Mutilation (FGM). (Courtesy) The potency of some retrogressive cultural norms lies in the hearts and souls of its people, who act as the bearers of the same, for their future generations. While culture defines a people, its dark side is engendered by the very same, especially when part, of the whole of it, is passed by time. This was the case for Josephine Passienyi, a resident of Narok now in her 40s, who reflects on her experience with Female Genital Mutilation (FGM) with pain, regret, and resignation in the knowledge that she cannot redeem a precious part of her that she lost to an outdated practice. She vividly recalls the terrifying moment when she faced the cut, a day that she had been fearfully anticipating, yet kept pushing behind her mind as she grew up. At that time, aged between 14 and 15, FGM had already begun attracting opposition in some parts of Kenya, yet still deeply steeped in her area. Rejecting it would mean being ostracised, and abandoned by kith and kin. "I remember the unbearable pain, the excessive bleeding and the illness that followed for a whole month. I knew then that FGM was wrong, but there was no way out," she says. Today, as a survivor and an anti-FGM advocate running Mission with a Vision, a rescue center for girls, she fights to protect others from going through the same ordeal. While traditional FGM continues in rural areas, a disturbing trend has emerged: FGM is now happening in hospitals, and performed by medical professionals. What was once an underground, unregulated procedure carried out by village circumcisers has found its way into sterile hospital rooms, giving the illusion of safety while still violating the rights of girls and women. FGM remains a major global concern. According to the United Nations (UN), an estimated 230 million girls and women have undergone FGM, with the practice reported in 92 countries across all continents. In many of these regions, a new wave of medicalized FGM is taking root. FGM is particularly prevalent in 30 countries across Africa, the Middle East and Asia. Each day, approximately 12,000 girls are at risk of undergoing FGM. The World Health Organization (WHO) classifies FGM into four types, ranging from clitoral cutting to full infibulation. The practice has no health benefits and leads to severe physical and psychological complications. Medicalizing FGM does not make it safer; it only reinforces a harmful norm. Traditionally performed by community circumcisers, FGM is now being carried out by medical personnel at an alarming rate. Approximately one in four survivors, amounting to around 52 million individuals, were cut by health professionals. This trend is particularly pronounced among adolescents aged 15 to 19, with 34 per cent undergoing medicalized FGM, compared to 16 per cent of women aged 45 to 49. Egypt and Sudan have some of the highest rates of medicalized FGM, with nearly 80 per cent of girls undergoing the procedure at the hands of medical personnel. In Kenya, the situation is worsening in counties like Nyamira, where medicalized FGM has reached an alarming 65 per cent, followed by Kisii at 50 per cent. Other affected counties include Narok, Nairobi, Embu and Garissa. Ashley Nyaboke* (not her real name) never had to experience the trauma of FGM, thanks to her mother's deception. Born to a Kisii father and a Kikuyu mother, Nyaboke grew up in a community where every girl was expected to undergo the cut. But her father was strongly against it. "My dad warned my grandmother that if she ever cut us, he would disown her," Nyaboke recalls. But the grandmother was persistent. When she realised she couldn't convince her son, she turned to Nyaboke's mother, hoping they could do it in secret. "My mother, knowing what was at stake, told her that we had already been cut. She even convinced her by saying she took us to Nyeri, where another tribe practices FGM. That's when my grandmother backed off." Nyaboke, now an adult, understands the weight of what her mother did. "If she hadn't lied, my sisters and I would have suffered just like my aunts and cousins. In our community, a woman who hasn't faced the cut is called 'gesaganeke,' a name meant to sound like an insult," she says. But Nyaboke embraces the label. "I don't mind being called 'gesaganeke.' I am grateful to my mother for protecting me." She has seen firsthand what happens to girls who undergo FGM. "As far as I know, all my aunts and female cousins have faced the cut. Maybe only one managed to escape. One of my cousins painfully narrated how she was held down and forced to go through it." The justification for FGM in her community is one she finds deeply flawed. "I've heard that it's done to lower a woman's libido, to control her sex urge or to make her 'a real woman.' But all my cousins who were cut ended up having children before they turned 18. It's a myth," Nyaboke says. Kenya's Anti-FGM Board chief executive officer, Bernadette Loluju acknowledges the country's progress in the fight against FGM but highlights the persistent challenges. "Our greatest challenge is that most of the counties where FGM is practiced have been traditionally marginalized. Education has taken years to reach these communities, and as a result, many mothers are illiterate," he explains. Research shows that an educated woman is less likely to subject her daughter to FGM. "A mother in North Horr, Laisamis or at the Kenya-Ethiopia border, who has never gone beyond her small village, how is she supposed to make a decision against FGM when it is the norm in her community?" Loloju asks. For many girls, undergoing FGM is tied to marriageability. "They are told that if they don't get cut, they won't get married. And in these communities, marriage is crucial. So, a girl is forced to decide between remaining uncut and never having a family, or getting cut to secure her future," he adds. Despite laws prohibiting the practice, FGM has adapted to new environments. "We are not seeing as many girls being cut by traditional circumcisers anymore," Loloju says. "Instead, medicalized FGM is rising, with professionals performing the procedure in clinics and hospitals. Nationally, we are at 17 per cent, but counties like Nyamira have reached an alarming 65 per cent, followed by Kisii at 50 per cent, with high numbers in Narok, Nairobi, Embu and Garissa." This shift is driven by fear of medical complications. "Communities have heard about the dangers including excessive bleeding, infections, even death. So they believe that if a girl is cut by a doctor, in a clean environment with antibiotics and painkillers, the risks are minimized. But what they don't realize is that the long-term consequences, psychological trauma, childbirth complications and loss of sexual function, remain the same," Loloju explains. Passienyi echoes this sentiment: "FGM is FGM, whether done in a hut or a hospital. A doctor's involvement doesn't make it right or safe. It only gives the practice legitimacy, making it harder to eliminate." In some countries, survivors are speaking out. An article published by The Sun UK Edition, titled 'HORRIFIC ACT: I'm an FGM survivor - barbaric abuse on a family holiday aged 7 nearly killed me, I've had death threats for speaking up,' sheds light on Nimco Ali, an FGM survivor from Djibouti. Nimco was cut at the age of seven while on a family holiday to visit relatives. She later suffered health complications and now campaigns globally against FGM. Another survival story, published by The Irish Sun and titled 'VILE ACT: I was dragged into a bush & had my genitals butchered in an FGM ritual aged 6 - I realized when I looked at a biology textbook,' shares Amani Abby's experience. Abby, from Sudan, only realized the extent of what had been done to her when she moved to the UK and studied biology. She had no idea she was about to be dragged into a bush, held down, and forced to lie with her legs open as part of a horrifying ordeal that changed her life forever. Their testimonies highlight how deeply FGM impacts lives, even when performed in medical settings. Some try to equate FGM to male circumcision, but the two are vastly different. Male circumcision is often performed with consent and has documented health benefits, such as reducing the risk of urinary infections and sexually transmitted diseases. In contrast, FGM is about control, has no health benefits, and causes lasting harm. Kenya has made significant progress in reducing FGM prevalence. In 1998, the Kenya Demographic and Health Survey (KDHS) reported a national average of 38 per cent among women aged 15-49. By 2022, this had dropped to 14.8 per cent, with the rate for girls aged 15-19 at 9 per cent. However, Loloju warns that to achieve zero FGM globally, efforts need to increase "27 times the current rate." For Passienyi, the fight against FGM is personal. "I was cut because my grandmother and mother believed it was the right thing to do. But today, I know better. My daughters, and the thousands of girls we've rescued, will not go through the same pain," she says firmly. The battle against FGM continues, and while Kenya has made remarkable strides, the rise of medicalized FGM presents a new challenge. "We need more resources, more grassroots involvement and stronger enforcement of laws," Loloju says. "If we are to truly end FGM, we must push harder than ever before." For Ashley, the lesson is clear. "FGM thrives on ignorance and fear. The more we educate our communities, the more we can break this cycle. No girl should have to be saved by a lie." The fight is far from over but with stories like Passienyi's and Nyaboke's, the movement against FGM gains strength. The goal remains unchanged: no girl should ever have to endure what generations before her have suffered. And with education, advocacy and legal enforcement, there is hope that one day, FGM will be a thing of the past.

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