Thursday, July 9, 2009
Posted on June 29, 2009 AMREF News Over the past 10 years, hundreds of little girls have passed through the heavily veined hands of Asiya Harbu. Her fingers are long and slender, the nails short, but while a woman’s hands are often gentle and reassuring, a channel of love and nurture, hers have brought unspeakable pain and gross disfigurement to her fragile charges. Asiya Harbu, 45 a traditional circumciser from Sabwe Kebele ward in Awash, AfarAsiya, 45, is a traditional circumciser. She lives in Sabwe Kebele (ward) in Awash, a district in Ethiopia’s vast Afar Region. Asiya doubles up as a traditional birth attendant, and if the baby is a girl, she is the one who will circumcise her. As early as two weeks after the birth, the girl’s mother invites her to perform the operation, holding down the screaming infant to enable Asiya to do her work. There is no anaesthesia. Female genital cutting (FGC) is widespread in Ethiopia, with 73 per cent of women having been through it. But the figure is much higher in Afar, which records a 91 per cent practice rate. Efforts by various organisations to get communities to abandon it have borne little fruit. “There are deep social and cultural reasons for endurance of the practice,” says Samuel Hailu, AMREF's Programme Officer for Reproductive Health in Ethiopia. “Some people believe that it will protect girls against rape, and prevent them from becoming promiscuous by reducing their sexual urges. Others do it for health and aesthetic reasons. They say that the genital area looks better and is cleaner after the operation.” He adds: “There is also a strong belief that FGC is an Islamic religious requirement, although there is a disagreement between religious leaders over this. Some see the campaign against FGC as the western world’s attempt to dilute their way of life, and others say it should be stopped because it has no basis in Islam. Yet even those who speak out against it still have their daughters circumcised. Pressure from society in general ensures that FGC thrives. An uncircumcised girl and her family are stigmatised by the community, and no man will marry her.” Hailu has written a paper on why female genital cutting persists in the Afar Region despite all interventions. “There are strong forces of demand and supply,” he observes. “Mothers and grandmothers decide when the girl is to go through it – between infancy and adolescence – and then force her to go. On the other hand, it is a source of livelihood for the circumcisers, who are paid either in cash or kind. When they are asked to stop doing it, they demand compensation.” One circumciser who was offered goats to rear as an alternative source of income asked: “Why should I bother keeping animals when I can earn a living by cutting girls?” The World Health Organisation defines female genital mutilation, alternatively known as female genital cutting or female circumcision, as “all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons”. It has no health benefits but instead interferes with the natural function of girls' and women's bodies. In Ethiopia, the age-old custom is carried out in varying forms. Infibulation, the severest kind involving excision of the external genitalia and sealing of the vaginal opening, is the practice in Awash, where Asiya lives. Clitoridectomy involves removal of the clitoris and labia minora without the stitching. The mildest version is sunna – chopping off of the tip of the clitoris and its protective covering. All methods put the girl in grave danger. Immediate consequences include severe pain, shock, excessive bleeding, difficulty in passing urine, infection, psychological trauma and even death. In the long term, the victims suffer decreased sexual enjoyment, chronic pain, recurrent bladder and urinary tract infections, cysts, scarring, and infertility. Women who have undergone genital mutilation are more likely to have complications at childbirth, leading to caesarean section deliveries and heavy loss of blood. The fact that most women deliver outside the hospital means there are many deaths of both mothers and their babies. Dr Teshome Kassaye, a gynaecologist employed by AMREF at the Awash Health Centre, first has to cut through the scar tissue of the stitched labia of the women who come to the centre for delivery. “If she gives birth at home, which is the case for many women, the traditional birth attendant cuts her open with a jillie, a large, curved hunting knife owned by the woman’s husband. Sometimes the baby spontaneously tears the lips open,” says Teshome. Despite the pain and injury, despite the deaths and disability, female genital mutilation persists in Afar. It persists despite a law prohibiting the practice in Ethiopia, and despite activities by numerous non-governmental organisations to discourage it. AMREF has been working with the government in Afar since 2007 to improve reproductive health by reducing female genital mutilation, HIV, sexually transmitted diseases, unwanted pregnancies, and the deaths of mothers and children. Joint workshops for community health workers and female circumcisers where candid discussions are held are beginning to bear fruit, albeit very small fruit. Asiya has attended a few of these sessions, and knows quite well the consequences of female genital cutting. “I have been told what the dangers are to the girls. I know that when she is growing up, sex is a problem because she gets hurt and bleeds. Giving birth is also difficult and could result in a fistula, making her unable to control how her urine flows. Many girls have died because of complications. I was doing it because it is our culture, and it gives the girls respect in the society. But now things are changing. I want to concentrate on being a traditional birth attendant.” Other circumcisers say they too would like to stop, but people continue to bring their daughters to them. Fear of prosecution has forced some of them to ply their trade in secret, but poor law enforcement mechanisms and lack of awareness make the law largely ineffective. A police officer in Afar said he had heard that FGC had been criminalised in the Ethiopian law, but did not know what to do about it. “We don’t have a copy of the document and we are not sure on what legal grounds we can take measures against those who practise it.” AMREF’s strategy to speed up progress in the campaign includes pushing for enforcement of relevant laws, and developing alternative ways for circumcisers to earn income. Furthermore, AMREF is also involving the community in designing relevant and effective activities to deter the practice and coordinating activities of all NGOs working in this field in Afar.