New Vision (Kampala)

5 February 2013

Uganda: FGM - Despite the Ban, Monster Still Rears Its Ugly Head

On Wednesday (February, 6, 2013), Africa will commemorate the 10th International Day of Zero Tolerance to Female Genital Mutilation/Cutting.

According to WHO, about 100 million to 140 million girls and women worldwide have undergone genital mutilation and more than three million girls are at risk of cutting each year. Andrew Masinde writes:

Scovia Chelengat was born in Lomolyeywo cell, Bukwo district. She vividly recalls the excruciating pain she underwent as she was being 'initiated into womanhood'. She tells her story with teary eyes, as the memories are still fresh.

"We were treated like cows in a slaughterhouse. We were forced to lie down, with our heads pressed hard on the ground and our mouths gagged to prevent us from shouting. I lost a lot of blood during the cultural ritual. I would never wish that experience on my child," Chelengat says.

"I do not enjoy sex. Whenever I attempt to have sex with my husband, I feel too much pain at the scar area," she adds.

At the age of 33, Chelengat has given up on sex. She separated bedrooms with her husband to give him a chance to get another woman.

Chelengat has two children and has vowed not to have any others because during childbirth, the scar tears and she loses a lot of blood.

Like Chelengat, many Sabiny girls face a lot of problems after genital mutilation and they stay with this pain for the rest of their lives. The practice is meant to reduce a women's desire for sex and in doing so, reduce the chance of sex outside marriage.

According to the World Health Organisation (WHO), female genital mutilation (FGM) is a violation of human rights.

About 140 million girls and women worldwide are living with the consequences of the practice.

In Africa, according to WHO, about 92 million girls aged 10 and above have undergone female genital mutilation (FGM).

What does FGM entail?

The cultural ritual is practiced in eastern Uganda among three tribes; the Pokot, Sabiny and Tepeth, mainly in the districts of Kapchorwa, Kwen and Bukwo.

There are three varieties of the procedure: Sunna circumcision consists of the removal of the retractable fold of the skin and/or the tip of the clitoris.

Clitoridectomy consists of the removal of the entire clitoris and the adjacent labia.

Infibulation involves removal of all or part of the labia, which is then stitched up allowing a small hole to remain open to allow for urine and menstrual blood to flow through. In Uganda, most tribes practise clitoridectomy.

"A woman who has undergone FGM loses genital sensitivity as the clitoris (a sensitive area that serves the purpose of providing sexual pleasure) would be replaced by scar tissue.

The scar resembles cured animal hide. It is, therefore, hard for a woman to have an orgasm as the scar makes penetrative sex difficult and makes intercourse a nightmare," says Beatrice Chelengat, the director general of REACH, an NGO fighting FGM in Uganda.

Often times, rudimentary methods are practised, using unclean knives or blades. In case of complications, the victims may die.

Way forward

Tete Everline, the Woman MP for Bukwo district, says communities practising FGM have been sensitised about its dangers and some people have abandoned the practice.

The activists include the Ministry of Gender, Labour and Social Development, the media, key stakeholders like some community leaders, religious leaders, influential elderly women and victims of the mutilation.

According to Cherop, the only sure way to stop FGM is by involving the people who have snubbed the archaic practice to sensitise the community about the dangers. Some victims of FGM have come out to discourage their peers from embracing the culture, but a lot more sensitisation still needs to be done.

FGM should, therefore, be wiped out as it degrades women and denies them the right to enjoy their lives and make decisions that affect their health and wellbeing.

Complications that may arise from FGM

The immediate side-effects of female genital mutilation (FGM), according to Chelengat, include; shock, stress and excruciating pain resulting from cutting of the sensitive clitoral tissue without using an anaesthetic.

As a result of cutting of the clitoral blood vessels in the vulva, one may over-bleed. This can result in anaemia and eventually death, if not handled immediately.

Chelengat adds that FGM can lead to urinary retention due to fear of the pain one feels as she passes urine. It can also cause the genital tissue to swell, or injure the urethra, resulting in bladder and urinary tract infections.

Chelengat says many times the local surgeons do not use sterilised instruments, so given the unhygienic environment and the fact that the circumcision instruments are shared, this can cause infections such as HIV, Hepatitis B and Hepatitis C.

"An infection may also cause pelvic inflammation and blood poisoning, resulting in tetanus. If the surgeon is inexperienced, the anus, urethra and bladder can be damaged," she adds.

Long-term consequences

According to Linda Cherop, the coordinator of REACH, Bukwo district, FGM causes long-term gynaecological, obstetric and urinary tract complications. One may also suffer from repeated urinary infections and painful urination.

This is because FGM narrows the urinary outlet, preventing complete emptying of the bladder, thus causing urine retention. This can result in inflammation of the bladder.

"A person who is mutilated also gets painful menstruation due to blood retention in the uterus," Cherop explains.

The scars and keloids on the vulva can also develop abscesses (collection of pus) if not treated hygienically.

Worse still, one may develop fistula (a hole in the birth canal), resulting from a rupture of the vagina and or uterus during childbirth.

Cherop says a woman who has undergone FGM gets severe pain during sexual intercourse. This may result in psychological traumatisation.

The vaginal canal may also lose its elasticity due to the excision and the vaginal opening may be partly closed, necessitating another operation to open up the vaginal cavity.

This sometimes leads to prolonged labour, which may be fatal to both the mother and child, as it forces the head to press on the scar, leading to obstructed labour, rupture of the scar or the uterine cavity and tears on the vulva and perineum (the region between the anus and genital organs). Difficult childbirth can lead to foetal death and brain damage of the infant.

Why the cultural ritual thrives

Patricia Chepkwemoi, 25, is a resident of Lomolyeywo cell in Bukwo district. Sixteen years ago, she was forced into a cultural ritual, where her clitoris was cut off.

"On December 24, 1997, a group of women knocked at my door, early in the morning and ordered me to get out. I did not know what they wanted, but I obliged. On stepping out, I met a bigger group that had gathered in my homestead.

Immediately they saw me, they started singing that they had come to initiate me into womanhood. They asked me to follow them to the ritual grounds where my genitals were mutilated. Every time I look at the scar, I am haunted by the humiliation and excruciating pain they put me through," Chepkwemoi explains.

Chepkwemoi is one of the girls who, given the opportunity, would not undergo the cultural ritual. But because Chepkwemoi feared to become an outcast in her community, she gave in.

According to the World Health Organisation (WHO), the procedure is generally carried out on girls aged between four and 14, although it also extends to women who are about to be married and sometimes, those who have already had their first child.

In Uganda, female genital mutilation (FGM) is practiced mainly by the Kalenjin ethnic group which includes; the Sabiny in the districts of Kapchorwa, Kween and Bukwa and the Pokot in Tepeth and Budama districts of Amudat, Nakapiripirit and Moroto as well as Karamoja region.

The practice stands at 95% among the Pokot and at about 50% among the Sabiny.

The districts where FGM is practised have a large population with Kapchorwa having 114,100 people, Nakapiripirit 154,494, Mourita Sub-county in Moroto 128,311, Amudat 95,900, Bukwo 73400 and Kween 103,300.

Female genital mutilation of any type has been recognised as a harmful practice and a violation of the rights of girls and women.

However, despite the WHO's commitment to eliminate FGM within a generation, the practice is still rampant.

What is fuelling FGM?

Ill-equipped law enforcers

Wilfred Sali, the LC3 chairman of Sinedet, a sub-county in Bukwo, the local authorities have tried to sensitise the communities about the dangers of FGM, but the practice still thrives in sparsely populated areas, surrounded by mountains and thick forests.

He says local councillors face a lot of hardships as they try to identify the areas where the ritual is still being practiced. In fact, the communities in these places are aware that they are being hunted, so they are on high alert and always ready to fight anyone who disrupts the rituals.

Sometimes they carry out FGM at night when the authorities have gone back to their homes. Sali says law enforcement officers, sometimes intentionally do not pursue the people practicing FGM because they fear to be killed.

Kipiyo Cheptai, the Police Inspector of Bukwo, says the law enforcement team is small and not well equipped to patrol all the mountainous areas, where the practice thrives.

Sparse population, forests

Cheptai adds: "It is not easy for the Police to penetrate the thick forests when they are not well equipped and protected. The residents are armed with spears, pangas and guns, and since the practice is mainly done at night, one could easily be harmed," Cheptai explains.

He adds that Sabiny land is too big, yet the entire area has one resident state attorney, based in Kapchorwa, who handles all the FGM-related crimes in the three districts.

Poverty and ignorance

This has also contributed to the thriving of FGM. When a girl is initiated into adulthood, this increases her chances of marriage as well as her parents' chance to get bride price.

The rigidity of parents has also contributed to the thriving of FGM in Uganda. Following the ban in Uganda, some parents send their daughters to Kenya, where they undergo genital mutilation.

Peer pressure

Some girls are driven by peer pressure from the colleagues who have undergone the ritual. And because they fear to be labelled 'incomplete women', they succumb to the pressure.

Cultural beliefs

Steven Anguria, the chairman of Bukwo Elders Association, says culturally, it is believed that if a woman gets married without first undergoing circumcision, she is likely to suffer from various illnesses for a lifetime. Therefore, due to fear of the curse, some women accept to undergo FGM.

Some men cannot marry a girl who has not undergone the ritual. This has partly fuelled the practice as some societies scorn girl who do not get married.

Some parents reportedly give their girls incentives and traditional medicine to entice them into the cultural ritual.

Everline Tete, the Woman MP for Bukwo, says despite efforts to stop the practice, it has persisted because of the cultural attitude and failure to value education of the girl-child. In addition, the high level of illiteracy among women hinders them from resisting the practice.

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