How FGM is shifting from dingy, dirty shrines to sterile hospital rooms

For decades, Kenya has been at the forefront of the global fight against Female Genital Mutilation (FGM), making commendable progress in reducing prevalence rates. However, a new challenge is emerging, the secrecy shrouded in the act. Once an openly practised cultural rite, FGM has now been driven underground due to legal restrictions, making it harder to track and eradicate the vice. The changing nature of the practice is a worrying concern to the stakeholders actively involved in the fight towards zero tolerance for FGM. "FGM has persisted for generations despite global efforts to end it. What innovative strategies can we then implement to accelerate progress and to ensure the protection of every girl who is at risk?" says Anne Wang'ombe, the Principal Secretary for Gender. According to Bernadette Loloju, the Anti-FGM Board Chief Executive Officer, FGM is no longer an open celebration. It has moved into private homes, deep forests and even across borders. "When I was growing up, FGM was a norm, it was a common practice. Our mothers and grandmothers and aunties celebrated a girl going through the cut. So what has happened is that since we got the law, which is the prohibition of FGM Act 2011, we have seen more communities make FGM very secretive," says Loloju. Loloju expressed concerns that some parents are taking their daughters to neighbouring countries like Tanzania, Uganda and Ethiopia to undergo the cut to evade authorities in Kenya. The shift She states that the secrecy is not just an adaptation to the law but a new survival strategy by those determined to keep the harmful tradition alive. "Today, no young girl would really want anyone else to know that they are cut, except their peers. They would want to tell their peers that I'm cut and you're not cut. But when these girls grow up and come to university or get exposed and leave their villages, no girl really wants to say, I am cut," the CEO explains. She states that the shift makes it even harder to track and prevent cases. "Now we have changed our tactic to say, every mother should protect their daughter from FGM because it is only the mother who is the contact of the girl. FGM is becoming a hidden crime, and that's why we need stronger community movements, more involvement of survivors, and the media to expose the secret practices," says Loloju. According to the anti-FGM board, the country has made strides in reducing FGM prevalence. In 1998, the Kenya Demographic and Health Survey reported a national prevalence of 38 per cent. By 2022, this had dropped to 14.8 per cent among women aged 15-49, and 9 per cent among teenage girls aged 15-19. Despite the progress, some regions remain hot spots. "Counties in the North-Eastern region, that is, Mandera, Wajir, Garissa and Marsabit alongside Kisii, Nyamira, and Kuria, still report high cases of FGM. While some communities like the Maasai and Pokot have shown improvement, we still have a long way to go," Loloju says. The persistence of FGM is partly due to deeply entrenched cultural beliefs, economic incentives for traditional cutters, and the silence of survivors. Many women who have undergone FGM suffer in silence, fearing stigma if they speak out. The silence allows the cycle of abuse to continue. For many survivors, the scars, both physical and emotional, last a lifetime. Their testimonies reveal the devastating toll of FGM on young girls and the lifelong trauma they endure. Evangeline Mukami was only 11 years old when she was subjected to FGM. "I went through the cut. It was this one thing that still, for many years, I have been unable to deal even after the counseling, after psychological supports, but I am coping each day," says Mukami. Mukami has since turned her pain into activism, speaking out to prevent other girls from enduring the same suffering. "Being a survivor, I got to be in the space of advocacy, more so preventing and promoting because the aftermath or the outcomes of FGM, accompany the women or the girls throughout their lives. So the best way would be to prevent. Our parents did it because they didn't know any better. Now we do. We must protect the next generation," says Mukami. She emphasises the need for alternative rites of passage and community education to break the cycle. "We need to work with survivors. They know where and when FGM happens, and they can help stop it," she says. Esther Chepoisho, a survivor, recounts her experience, one she says she would never wish upon any girl. "I remember waking up that morning, and my mother told me I was going to become a woman. I didn't understand what was happening. I was excited, thinking it was some kind of celebration," she tells The Nairobian. Chepoisho had no idea of what awaited her was way far from a celebration, and a reality she struggles to live with. "They held me down. I screamed, but my cries went unheard. The pain was unimaginable. I felt betrayed. My mother was there, watching, and she didn't stop them," says Chepoisho. The aftermath, she says, was just as painful. "I suffered infections for months. I couldn't walk properly. The pain stayed with me, but the worst part was the emotional trauma. I couldn't trust anyone anymore, not even my own mother." Naserian Letoya, now 46, grew up in the Maasai community where FGM was an unavoidable rite of passage. "I was just 12 years old at the time. I had dreams of becoming a teacher, but after FGM, everything changed. I stopped going to school and I was married off," she says. Shortly after being cut, Letoya, now a single mother of seven children, was married off to a man she says was way older than her. "I never went back to school. My father said I was now a woman and had to take up my responsibilities as a wife. FGM stole my dreams. I don't want other girls to suffer like I did," says Letoya. Letoya says that being a child and naive, her husband treated her as a property. "I was just a child. I didn't know how to be a wife. But in our community, once you are cut, you belong to a man, and you have to obey him," she says. Medicalised FGM FGM is not just a rural problem. It is increasingly being medicalised. Diana Kerubo, now 32, was subjected to FGM in a private hospital in Kisii. "My mother told me we were going for a check-up. When we got there, a nurse took me to a small room. Before I knew it, I was injected, and the procedure was done." Kerubo later learned that her mother had arranged for the procedure to be performed by a health professional to reduce complications. "Even though it was done in a hospital, the pain was just as bad. I don't find it to be different from the one done by the traditional cutters. We both have the emotional scars that are still there," says Kerubo. Urban areas According to a study by the Population Council, medicalised FGM is increasing in urban areas as families seek to keep the practice secret. The study sought to understand the shifts in FGM including medicalisation among the Kisii, Kuria, and Somali communities in Garissa, Kisii, Migori, and Nairobi counties. Traditionally, FGM was performed by traditional birth attendants (TBAs) and circumcisers, but there is a notable shift towards health care providers conducting the practice in hospitals, homes, and other secret locations. The study notes that medicalised FGM is most prevalent among the Abagusii and Somali communities, especially in urban areas. It further notes that Kuria community remains resistant, maintaining traditional cutting due to strong cultural influence from elders. But why is medicalisation increasing? According to the study, there are a number of contributing factors which includes the perception that it is safer due to sterile conditions and trained professionals, believed to shorten the recovery period, and that it helps evade legal consequences by keeping the practice hidden. The study also, lists reasons why health care providers perform FGM. They include reducing health complications, fear of community backlash if they refuse and financial incentives. Breaking the cycle The Anti-FGM Board is championing the Dear Daughter Campaign, an initiative that encourages mothers who have undergone FGM to pledge never to allow their daughters to be cut. Nyerere Kutwa, Programmes Director at the Board, says research indicates that a mother who has been cut is highly likely to force her daughter to go through it. "Through the Dear Daughter Campaign, we are actively engaging survivors, educating them on the legal and health impacts of FGM, and encouraging them to commit to protecting their daughters," says Kutwa. He adds: "The moment they understand that, then are able to protect their daughters. We are also looking a situation whereby the mother writes a letter to their daughters, even if they cannot write, they ask someone to help them in writing, committing to their daughters that 'my dear daughter I went through FGM but will not take you through FGM', so it is more of that conversation between the mother and daughter." Kutwa says they had one such FGM awareness forum in Kisiii, where survivors were mobilised to bring their daughters, or if they don't have daughters, to bring a neighbour's child. "Survivors tell their stories directly to young girls, and the impact is profound. Many girls are shocked to learn what their mothers went through," says Kutwa. Loloju says that ending FGM requires not only legal prohibitions but also shift in societal norms. The CEO is urging the fathers, brothers, and uncles to stand up and say 'no' to FGM. She is also calling on the religious institutions to use their platforms to influence change by advocating against harmful traditions. "We are pushing for it to be a sexual offense because someone's touching your genitals is already a sexual offense. And so as we walk towards celebrating the milestones that we have made. We also look at the challenges that we are facing because so many girls are still at risk of going through female genital mutilation," says Loloju. Men play a crucial role in ending FGM, especially in communities where uncut girls are considered unclean and unsuitable for marriage. "We need to change the mindset that FGM makes a girl more valuable. It doesn't. Rather, it subjects the girls to untold suffering," said Salome Cheruto, an anti-FGM champion in West Pokot. Community elders Cheruto says FGM is not just a cultural practice, it is a human rights violation. "Every girl deserves a future free from pain, free from trauma, and full of opportunities. With sustained efforts, secrecy will no longer be a shield for this harmful practice. We owe it to the next generation to end FGM once and for all," says Cheruto. Elders and religious leaders are being engaged to bless uncut girls as a sign of approval, replacing traditional FGM rituals. "This is a major breakthrough. When elders and spiritual leaders declare that FGM is unnecessary, communities listen," says Kutwa. Further, ending FGM demands coordinated action across all sectors, especially in tackling the cross-border FGM which remains a major challenge. "Kenya continues to collaborate with neighbouring countries so as to address this cross-border FGM and ensure that policies and enforcement mechanisms are harmonized. This regional approach is essential in eliminating FGM in border communities where the practice still exists," says PS Wang'ombe.

How FGM is shifting from dingy, dirty shrines to sterile hospital rooms

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