Dr Tatu Kamau: Give adult women choice of getting circumcised

In one of the landmark cases decided last year, the Kenyan Judiciary held that adult women cannot voluntarily undergo Female Genital Circumcision (FGC). The famous petition, which rattled legal circles and gender rights’ groups has since earned the moniker ‘The Tatu Kamau Case’.

This is in reference to the seasoned medical doctor, who moved to court requesting that some provisions of the Female Genital Mutilation Act (2011) be declared unconstitutional.

In a one on one interview with the Nation.Africa, the now retired doctor says her stance has not changed, if anything, she still vehemently believes that adult women should be allowed to choose to be circumcised.

What inspired Dr Kamau to file the petition?

I have been a public health specialist working with the Ministry of Health for over 30 years. In the course of my duties, I interacted with a lot of communities that practise female circumcision. Like many other people, I believed the practice was detrimental to women. But my perspective started shifting when I was posted in a refugee camp in Garissa. I was in charge of the maternity unit and used to deliver about three babies in a day.

The Somali women in the camp practised type three female circumcision (narrowing of the vaginal opening through stitching of labia). I had anticipated that there would be a lot of challenges based on what I had read and heard about FGC, but was surprised to learn that there was no difference between circumcised and uncircumcised women.

In cases where some women had delays because of a narrow birth canal, we would just conduct an episiotomy (a cut made in the tissue between the vaginal opening and the anus during childbirth). This is something that we even do to uncircumcised women and stitch them back.

So, I kept asking myself, when am I going to see this disaster? During my assignment, I had not encountered any circumcised woman who was not able to deliver because she had been circumcised. This changed my perspective completely.

When the FGM Act came into force in 2011, I thought it was reinforcing the Children’s Act that prohibits female circumcision amongst children. But then I started seeing adult women being arraigned in court with their babies and being handed long criminal sentences. I wondered ‘why is no one protesting this?’ Because at the end of the day, it is a choice that doesn’t affect anyone else. Women should be free to do whatever they want to their bodies, they have agency and autonomy over their own bodies.

What was the response to your petition?

Once the case broke out, so many circumcised women reached out to me and told me they were fed up with this circumcision fuss. They had nothing to complain about. They told me they don’t experience medical challenges. They were living their lives normally.

What about sexual satisfaction?

Well, I don’t remember anybody complaining of that or low self-esteem. In fact, what I do remember is a young woman who was not able to engage in sexual intercourse in her marriage because she had been sewn too tight. I remember her telling me that, ‘Don’t open me too wide like an old woman’.

Once the procedure was done, the young woman came back complaining that I had destroyed her life and marriage because I had opened her up like an old woman. She wept so much and told me that I had destroyed her marriage.

For me, that was also a culture shock because I didn’t even feel that I had even restored her to her natural state, and yet she was unhappy that I had made her too wide.

I realized that women in those communities value a certain level of ‘tightness’ for their spouses and themselves. This quality is not perceived to be in uncircumcised women. So, the concerns of sexual satisfaction are skewed.

But witnesses in the case testified that they experienced risks associated with women’s reproductive and sexual health such as intense pain, difficult pregnancies and prolonged labour. Are those not valid experiences of women who need to protected from harmful cultural practices?

There is a universal understanding that in any surgical procedure, there are possibilities of negative outcomes. But we never stop surgery as a whole. What we do is we learn from the bad experiences and see how we can do better.

Those women’s experiences are not the rule but the exceptions. Why do we emphasize on the few cases? Circumcised women with no negative experiences have been silenced and they cannot publicly admit that they have been circumcised. The ones who are encouraged to speak are the exceptions. This skews the data and perceptions of FGM.

You say adult women should be allowed to consent to FGC and agree that it should be prohibited in children. However, given that many circumcising communities conduct the practice on lower age-groups, wouldn’t that create a loophole that can be exploited?

We have laws that protect minors from other practices such as smoking and drinking alcohol. If we can enforce those laws to protect children, why can’t we do the same for female circumcision? We already have the Children’s Act, let’s enforce that.

FGC is not just a physical cut but holds cultural significance in most practising communities. Most women and girls are expected to marry and have children at the expense of their education.

It is true that some communities like the Massai do that. However, just because one community has a problem, doesn't mean that we should hold the whole country ransom. Why don't we go back to this community and help them change their perception of the practice? The Maasai don't live in a vacuum. We can help them see that women don't have to abandon their studies just because they have been circumcised.

One of the major propositions in the petition is for medicalisation of FGM/C. Why do you advocate for this?

Medicalisation of male circumcision has done wonders in reducing deaths associated with the practice. In communities like the Kisii, the practice is already heavily medicalized and we hardly hear of any issue from that community.

The argument has been that we are altering women’s genitals for no medical purposes, but female genital cosmetic surgery is already being practised heavily in Western countries and has become so popular in Kenya. Women from high social-economic backgrounds are allowed access to refined medical safe processes to alter their genitals for cosmetic purposes.

How would a woman’s genitals know whether they are being altered for cultural or cosmetic purposes? You have two sets of law where you are allowing one set of women the autonomy to alter their genitals and prohibiting another.

Is it a class issue then?

Yes. A high class Samburu girl can just go to cosmetic surgeon to have her genitals altered but when her counterpart goes to the local midwife, the whole administrative structure comes down on her. Women who go for cosmetic genital surgery say they are doing it to save their marriages, but these other women are getting circumcised to save their marriages as well.

What do you believe would be the impact of medicalization of FGM/C?

I see it an empowering prospect for adult women. Women should have autonomy and agency over their own bodies. There are procedures like breast and butt enlargement that are not shunned upon. Why should we put caveats on female circumcision?

It would also move the practice from younger age-groups and allow adult women decide for themselves. This would enable valid consent. The reason it is even practised amongst minors is because of these laws.

While dismissing Dr Tatu Kamau’s petition last year, the High Court of Kenya held that even though FGM/C was central to the culture of some communities, medical evidence adduced in court left no doubt about the negative short term and long term effects on women’s health. The practice remains criminalised for both minors and adult women in Kenya.

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