FGM and childbirth: The painful connection no one talks about

The birth of Sadia Hussein’s first daughter, Maryam, was miserable. Sadia had laboured for three days, was tired and at that moment, she hungered for death.

As Sadia lay in bed writhing in pain, on one hand, her mother was curled in a corner, her body folded in on itself as she made a fervent prayer for her health. On the other, traditional birth attendants (TBAs) laboured to save Sadia and the unborn child. They had cut her many times determined to get the baby out.

“It was a harrowing experience that nearly cost me my life,” she said. Yet, the women around her dissuaded her from seeking medical intervention in formal healthcare.

As it turned out, the effects of female genital mutilation (FGM) had stalked her to the delivery bed.

Sadia, 34, was born and brought up in the Wardei community in Tana River County. She was raised inside the walls of a community that practised FGM, a cultural practice that was outlawed in 2011 and is punishable by law.

“There are four main types of FGM, and I went through cut type three —  infibulation,” says Sadia.

“This involves excision of the exterior genitalia and the sewing shuts off the opening of the vagina,” explains Dr Hawa Abdulghafoor, Tana River County’s gender coordinator. “After marriage, one is reopened (de-infibulated) to allow intercourse and facilitate childbirth.” The 2021 data from United Nations sexual and reproductive health agency show that roughly 475,022 girls are at risk of FGM in Kenya between 2022 and 2030, and 75 per cent of girls undergo the cut between the ages of eight and 14.

According to Dr Hawa, women who have undergone infibulation are more likely to suffer from prolonged and obstructed labour, sometimes resulting in foetal death and obstetric fistula.

“Recently, we had a case of a 21-year-old who came to the facility two weeks after a traumatic home delivery. She was leaking urine and we diagnosed her with a vesicovaginal fistula. Her husband, who had accompanied her to the hospital, divorced her on the spot. FGM has zero benefits but very many repercussions,” says Dr Hawa.

Statistics (2022) from WHO, Unicef, UNFPA, the World Bank and the United Nations Population Division reveal that most of the high-FGM-prevalence countries also have high maternal mortality ratios and high numbers of maternal death. Two high-FGM-prevalence countries are among the four nations with the highest numbers of maternal death globally. Five of the high-prevalence countries have maternal mortality ratios of 550 per 100,000 live births and above.

At first, Sadia wanted it. It was the same thing that other girls in her community wanted—what her mother wanted for her. She was 10 when she underwent the cut.

“Before it was criminalised, it was a big ceremony during the school holidays. In praises, girls would be escorted to a nearby river. My time, however, I was alone,” says Sadia.

It was a painful wound that took close to two months to heal, and she felt betrayed; that no one had told her about the process. “There were no painkillers, anaesthesia, sympathy, or explanations. My father was not even aware,” her voice quivers with emotion.

Back at school, her mind kept rifling to the occurrences of that day. At one point, like many other girls, she moved on with life.

“My troubles re-emerged again when I got married because I had to go through the process of deinfibulation. I was convinced that the worst was behind me. Yet, the worst awaited me at childbirth.”

“I was feeling a lot of pain but also excited because I would finally hold my child. I could see my mother purchasing razors in preparation for the third cut, but I didn’t know why she was buying them. The TBAs would come in and announce that the baby was coming out but in the real sense, she wasn’t. Before that moment, I didn’t know that genital scar tissue does not stretch. It had become scarred and narrowed, making it difficult for the baby to pass through the birth canal.”

“As a pastoralist community, we have seen cattle giving birth, but they don’t go through the cutting that we go through,” she painfully reflects.

Moments before she delivered, the mother of three reveals that she had given up on life. “My mother even wished for a stillbirth as long as I survived. In that instant, only my life mattered,” she offers.

Through the intervention of a more experienced TBA, she delivered on the third day of labour. “The baby’s head was elongated because of the pressure, and I fainted immediately after.”

When she regained consciousness after a few hours, she couldn’t sit properly. “The wound was fresh and I had been cut many times. Assisted by my mother, I leaned on my left elbow sideways just to touch her.”

She cried when the gender was revealed to her. “I couldn’t imagine my daughter going through what I had gone through—complications follow you throughout your life. I vowed, as if whispering, to protect her and other girls from FGM,” she says. Sadia’s mother overheard her and called her a coward who couldn’t endure pain.

Sadia, who is the author of the book, “The Hidden Scars of FGM,” fights for women’s rights and the eradication of FGM and other retrogressive cultural practices through her organisation, Brighter Society Initiative. “There were many challenges when I started because the anti-FGM law was not in place, but we are now seeing a decline in the practice. Another great achievement is that none of my daughters have been mutilated,” she offers.

In 2018, she was awarded Young Achievers Award by the Anti-FGM board, and in 2019, feted as a national heroine by the state.

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