FGM ‘medicalisation’ complicating efforts to end vice

President Uhuru Kenyatta has promised to end female genital mutilation (FGM) by 2022. However, some people say the target date is unrealistic due to the high prevalence rate in some parts of the country.

The United Nations says that one in five girls between the ages of 15 and 49 have undergone FGM – a worrying trend. Despite Kenya outlawing the practice nine years ago, it continues as some communities deem it necessary for social acceptance and that it raises marriage prospects.

Some families are now turning to hospitals to cut their girls as a way of sanitising the act, complicating government’s efforts to end the vice whose multiple damages are long-term.

Although government data indicates a decline in FGM rates in Kenya, the percentage of medics aiding in keeping the number of victims high, is among the leading in Africa.

Highest number

By 2014, FGM rates were 21 per cent according to 2014 Kenya Demographic and Health Survey (2014 KDHS).This is a drop by 17 points in 16 years. It was 38 per cent in 1998.

Nevertheless, Kenya is in the pack of five countries with highest number of medical professionals cutting the girls, a 2017 study Population Council shows.

Sudan tops with 67 per cent followed by Egypt at 38 per cent. In third position, are Kenya and Guinea at 15 per cent. Nigeria is at 13per cent.

This act of medical professionals cutting the girls is referred to as ‘medicalisation’ of FGM.

Alternatives in hospitals

World Health Organization (WHO) defines it as situation in which FGM is practiced by any category of health-care provider, whether in a public or private clinic, at home or elsewhere.

Ms Agnes Leina, anti-FGM board member says communities must be advised against finding an alternative in hospitals.

“The next solution for communities is turning to hospitals due to the notion that is it hygienic,” she said when she spoke to the writer on phone.

“When you go telling the community how unhygienic it (FGM) is, definitely they will start looking for the next solution,” she said.

But this option is neither legalised.

“Medicalisation of FGM is illegal in Kenya and is usually undertaken secretly to avoid prosecution,” says Ms Judy Gitau, a human rights lawyer.

Section 19 of  Prohibition of Female Genital Mutilation Act states that “A person, including a person undergoing a course of training while under supervision by a medical practitioner or midwife with a view to becoming a medical practitioner or midwife, who performs female genital mutilation on another person commits an offence.”

Committing offence

It further clarifies on abetting the offence in Section 20: “A person who aids, abets, counsels or procures, commits an offence.”

Ms Angelina Cikanda, program development manager at Centre for Rights Education and Awareness (CREAW), a national organisation running anti-FGM advocacy says fear of being caught due community surveillance is driving families into the hands of medics.

“Due to community awareness (FGM illegality), the community is vigilant…families are opting for hospitals to avoid community surveillance,” she says.

“We have had instances of families taking their girls to hospital for the cut. When you ask the parents they would tell you they were just in hospital. But when you do further interrogation with the girls, they would tell you, they were actually cut,” she says.

She warns medics of punitive consequences as provided in the law, noting that what they are doing is interfering with the wellbeing of girls.

Dr Shiphrah Kuria, an obstetrician-gynAecologist emphasises the significance of demystifying emerging ideas about FGM.

Medical doctor

“There has been dissemination of information on ills and damages of FGM,” says Dr Kuria, also corporate technical manager for reproductive, maternal, newborn, child and adolescent health (RMNCAH) at Amref Health Africa.

“It has medical complications like bleeding and infection. So, they think that by a medical doctor doing it then that can be avoided,” she observes.

She says ending FGM must not be interpreted parallel to ending maternal deaths where women are urged to deliver in hospitals.

She says medics should be made to “understand that they are not doing any girl or woman a favour… problem of FGM is beyond physical harm…it is about violating the rights of women and girls and interfering with her sexual health.”

Ms Gitau, a human rights lawyer says “medical fraternity needs to be capacitated to understand the gravity of FGM and thus enabling them to vehemently decline any covert arrangement.”