Sun, 23 Apr 2000

Female who are circumcised suffer throughout their lives

By Solita Sarwono

WASSENAAR, The Netherlands (JP): Fortuna's daughter did not come to the playgroup that morning. The little girl had a fever and pain when urinating. The mother, a refugee from Somalia, brought her daughter to the doctor at the refugee center in the Netherlands.

The examining doctor discovered that this four-year-old girl had an infection in her genitals as was the result of circumcision that was performed when she was a baby.

Indeed, all the women in Fortuna's family were circumcised following the tradition practiced by almost all Somali women and by millions of others living in Africa and in the Middle East.

Female circumcision is a serious problem among these women. The procedure, in which all or part of the external genital organs of women are removed, is detrimental to their physical and psychological health.

In Somalia the operation is performed as a part of the socialization process. This tradition preserves virginity and ensures marriageability. Besides religious beliefs, the motivation underlying this practice is that female chastity and family honor should be preserved.

Female circumcision is a very old custom, believed to stem from Islam, although various studies indicate that this tradition dates back as far as the time of the Pharaohs, centuries before Christ.

In the fifth century B.C., according to the Greek historian Herodotus, female circumcision was practiced by the Phoenicians, the Hittites, the Ethiopians and the Egyptians. Today it is still common practice in Africa (Sub-Saharan countries), in the southern part of the Arabian Peninsula and to a lesser degree in India, Pakistan, Malaysia and Indonesia.

Female circumcision, also known as female genital mutilation (FGM), has three forms. The less severe type is the sunna, which is the removal of the tip of the clitoris. It is this form of circumcision that is practiced by some families in Indonesia.

The second form, clitoridectomy, is more severe. It is performed by partially or totally removing the clitoris and the adjacent tissues of the labia minora.

The most drastic form is called infibulation, also called Pharaonic circumcision. When a woman is infibulated the clitoris, labia minora and parts of the labia majora are excised and the row edges stitched together, leaving only a very small opening for the passage of urine and menstrual flow.

The magnitude of female genital mutilation practice is illustrated in the State of Women in the World Atlas (Joni Seager, 1998). In Egypt, Mali, Nigeria, Kenya, the Ivory Coast, Liberia and Guinea, as many as 50 percent to 80 percent of girls and women have had either a clitoridectomy or infibulation, whereas in Sudan, Somalia, Ethiopia and Eritrea this percentage is between 80 percent to 100 percent; and the type of FGM most commonly performed is infibulation.

Other countries in Africa and in the Arabian peninsula do not have records of the number of women who have undergone genital excision or infibulation.

In Somalia, girls usually are infibulated between the ages of six and 12, clearly violating the Convention on the Rights of the Child.

In Fortuna's family this is done during infancy, or before the baby is one year old. The operation is mostly performed by traditional midwives, using a razor blade or knife, often without anesthetics and under unhygienic circumstances.

This operation not only causes severe pain but often results in death, as a result of tetanus. Female relatives attend and assist in this operation.

Afterward the girl is given a small reward, like some new clothes, money or a big portion of delicious food. This reward is much too small and insignificant for the traumatic experience and the agony the girl has gone through and for the pain and problems that will follow in her life.

According to a 1996 study by the United Nations Children's Fund, (Progress of Nations), approximately two million girls are mutilated every year.

Not only do the girls suffer from physical injuries during the operation itself, but later in life infibulated women have to endure many hardships, such as hemorrhage, cysts in the genital area, urinary incontinence and even infertility.

On her wedding night a bride experiences painful defibulation performed by the husband. If natural penetration is not possible, the husband (or a midwife) makes an incision to separate the labia minora that are stitched together.

In many ethnic groups great prestige is attached to "opening" the bride. If the groom fails, the next day he will be ridiculed and teased by his friends.

The women's agony is increased with child bearing. Infibulation prolongs the delivery process and consequently increases the mortality risks of both the mother and the baby.

In countries like Somalia, Ethiopia, Eritrea and Mali, where infibulation is common, the maternal mortality rates are higher than 1200 per 100,000 births.

Somalia ranks the third highest in the world, with 1,600 maternal deaths per 100,000 while Indonesia's rate is 650 per 100,000 births.

The infant death rate in Somalia is 125 per 1,000 live births and the mortality rate of children under five years is 211 per 1,000 infants.

In Indonesia the corresponding figures are 47 and 71, respectively, according to a 1999 report, Profiles for Family Planning and Reproductive Health Programs in 116 Countries.

In Somalia and some other countries it is a custom to close the labia minora again after childbirth. This means, the woman has to go through the same agonizing experience again and again.

Despite the pain, the number of children per women is very high -- seven to nine children -- in those countries.

Contraceptives are not used, as people believe that Islam forbids them. Also, men often use their wives' objections to having many children, meaning less frequent sex, as an excuse to marry other women.

More than half the married male population in those countries has more than one wife. Take Fortuna, the Somali refugee in the Netherlands.

She has nine children, with the first child being only seven years old, with two pairs of twins and a birth interval of 12 to 15 months.

Still young at 27, Fortuna would be expected to bear many more children had she not been separated by the war from her husband and most of her children.

She came to the Netherlands with two little girls when she was pregnant. She did not complain about having so many children as she saw it as the only way to keep her husband from getting a second wife.

She just considers it as her luck to be born as a woman in a Muslim society and she does not even think of changing her situation. It is miraculous how Fortuna has been able to endure all the hardships during the frequent childbearing.

Her youngest child, born in the Netherlands, is also a girl. Although female circumcision is forbidden by Dutch law, Fortuna can find someone among the Somali community in the Netherlands who will illegally help her to perform the ritual on this little baby girl.

Although FGM severely undermines women's health, abolishing the practice is extremely difficult. Female circumcision is a vital element in those cultures. It determines the position of women in society.

Women who have not been infibulated are considered to be unclean and an "unbeliever". They will not be able to find a husband.

It is the fear of failing to get a husband that drives women to sacrifice their daughters, granddaughters or nieces to go under the knife. A number of highly educated people and women's organization have attempted to discourage the practice.


Campaigns on the eradication of FGM have started and this issue has been discussed at national and international forums. Governments in a number of African countries have developed a policy to eradicate FGM.

In Egypt, for example, a woman has been assigned to a top position in religious affairs and been given the task of thoroughly studying Islamic holy books to confirm the absence of rules requiring FGM and then to convince male religious leaders about this matter.

Notwithstanding these efforts, the practice still persists. Realizing the difficulties in abolishing the practice, governments in some countries have tried to make FGM "more humane". The operation is performed by trained midwives or nurses under more hygienic conditions and uses anesthetics, anti-tetanus injections and antibiotics.

Also by allowing the operation to be performed at very young age, the girl will be spared from psychological trauma. Continuous health education and campaigns are conducted, aimed particularly at women.

Female circumcision is a lifetime's abuse, denying a woman's basic rights and degrading her dignity. It makes a woman suffer for her reproductive role.

In the above Progress of Nations report, Peter Adamson gives an accurate description of the condition of many women.

As a child, she endures genital mutilation to protect her virginity and marriageability. As a menstruating girl, she may be set aside as unclean and made to feel dirty and ashamed.

As a teenager, she is married to someone she does not know and made pregnant before her own body is fully developed.

As a woman unable to bear children, she will be abused and abandoned, although it may be the husband who is infertile. As a pregnant woman, she is denied the basic needs, food, rest and antenatal care, to which she is entitled.

As a woman in labor, she runs the risk of dying from the lack of obstetric care, and of sustaining injuries and disabilities for which she will not receive treatment.

As a woman enduring a prolonged childbirth, she may be left to die alone and in agony, the baby inside her. As a woman suffering from a childbirth injury, she may die because her husband will not allow her to be examined by a male doctor.

As a wife, she may be forced to submit to sex within a few days after giving birth, or be subjected to violence if she refuses. As a new mother, she may be expected to become pregnant again before her body has recovered.

And finally, if she sustains an injury or infection, she may not be allowed to go into hospital, as there will be nobody to cook the meals.

The writer is a psychologist, public health consultant, educator and gender specialist residing in The Netherlands.