The midwife on a mission to stop female genital mutilation

April 15, 2011
The Guardian
Joanna Moorhead

It feels incongruous to be sitting in a cafe in Kendal – a town they call "the gateway to the Lake District" – discussing women's rights in the Rift Valley. And yet it couldn't be more relevant: because Cath Holland, the down-to-earth Lancashire midwife I'm with, has managed almost singlehandedly, and in her spare time, on a tiny budget, to steer an entire province of northern Kenya towards eradicating a practice that surely rates as the most extreme example of male domination today.

Holland – a nurse and midwife who works on the labour ward at Furness General Hospital – first went to Kenya with VSO back in 1998. She was in her late 40s: her two sons were in their early 20s, and she felt she wanted an adventure. She was sent to be a midwifery tutor at a nursing school in the Cherangani Hills in Pokot, an area of Kenya that the Lonely Planet Guide describes as "East Africa's best-kept secret".

But when Holland arrived, she discovered Pokot had another secret – and it wasn't one travel books boasted about. The community still practised a form of female genital mutilation (FGM) that the World Health Organisation considers the most extreme – in which the entire outer genitalia, including the clitoris, are removed.

As a midwife, Holland saw the consequence: women giving birth had vaginal openings too narrow to let a baby through. "In that area, they say there are three sorrows of womanhood. The first is when a girl has her genitalia removed, usually in her teens. The second is when she gets married, and has to have her vagina opened so she can have penetrative sex, which is usually done using an animal's horn. And the third is when she gives birth, and has to be cut again so the baby can be born."

'I will never be cut': Kenyan girls fight back against genital mutilation Link to this video The practice turns healthy teenage girls into women with chronic ill-health – kidney problems, pelvic and back pain, infertility and birth difficulties are common. And they are the lucky ones: others won't survive the blood loss of the initial procedure or will contract HIV from the knives used, or die giving birth, or have stillborn or brain-damaged babies.

Holland abhorred the practice from the moment she came into contact with its effects. "At its root," says Holland, "FGM is all about patriarchy. It's about controlling women – controlling their sexuality, controlling their libido. In communities like Pokot it's regarded as a prerequisite for marriage." But her life was changed when a young girl she'd befriended in the village where she lived asked her if she'd like to attend her initiation ceremony – the event at which she would be mutilated.

"Nellie was about 14, and she often called in at my house on her way to and from school," she remembers. "One day she was a bit shy and coy, and she told me it was her initiation ceremony next week – and she wanted me to be there. As far as she was concerned, this was an important day on her life's journey. To me it was a tragedy, for her it was a rite of passage."

Holland says the event was like a village party – until they brought out the girls. "The men were all standing with their backs turned. I was with the women – and the sense of solidarity, and horror, was almost palpable," she remembers. "There were two circumcisers – they moved quickly from one girl to the next, cutting their labia." Then, says Holland, the girls were led to a wooded area, away from the men, for the more extensive cutting. "It was horrendous," she says. "And none of the girls cried out, because they'd had it drilled into them that they had to bear it without making a sound."

Afterwards, Holland couldn't forget what she'd seen. "It haunted me," she says. "I knew I couldn't just go home, go back to my old job, forget all about it. Because there were more girls like Nellie, and it was going to go on and on. I couldn't turn my back on it."

Back in Cumbria after her two years with VSO, Holland roped in her colleagues and friends to help her fundraise. In 2005, when they had collected enough money, she persuaded Miriam Lopus and Rhoda Lodio, two Kenyan midwives she knew from Pokot, to travel to Kendal and meet specialists who campaign against FGM. "I felt midwives were key," she says. "They see the effects of FGM – educating them had to be the way to start.

"They'd never had passports, and they'd never been on a plane. But they came, and I took them to meet doctors at places like Liverpool Women's Hospital, so they could learn more about FGM and its effects."

But the bigger battle, as Holland was aware, lay in convincing the community to put an end to the practice. She returned to Pokot once or twice a year and kept in touch with Nellie, now a mother of two. FGM had led Nellie, as it does for many girls, to early marriage and an end to schooling. (Improving educational opportunities for women will, says Holland, be another ambition of the anti-FGM campaign in the long term.)

Over the years, events were held to educate different sections of the community: including men – which in some ways, says Holland, wasn't too difficult. "Because the men travel more, they're aware of communities in which women aren't mutilated, and they know that women don't have to be circumcised in order to get married."

In 2009, Lopus and Lodio got more than 60 traditional birth attendants from across Pokot together to spread the word about the dangers of FGM. "The idea they came up with," says Holland, "was to put together an alternative rite-of-passage ceremony that didn't involve cutting."

Back home, Holland fundraised for a week-long girls' camp that would end in a public ceremony to initiate 100 young girls into adulthood without FGM. "We were inundated with girls who wanted to attend – and many of them had had a tough time persuading their families that it was the better thing to do than FGM," she says. "In the end we had around 175, all aged between 14 and 20." The camp – which is the subject of a Guardian film – involved workshops and classes about the dangers of FGM, as well as dancing and fun events.

Holland's plan is to hold an annual rite of passage ceremony in Pokot, and fundraise for its costs. "Once the local community is on-side, and there's an alternative way of initiating the girls into adulthood, more and more becomes possible." It's a pretty impressive result for a project whose entire budget, at about £7,000 to date, would barely register in the world of international aid spending.

But Holland, now 61, is unwilling to stop. "Pokot is only one area of one country," she says. "There are many, many others where FGM still goes on. We want to replicate this work in other parts of Kenya, and in other parts of Africa. There's a lot more to be done."

The Economic Impact of FGM: How Female Genital Mutilation Hurts Women and Society

International Museum of Women: Economica
Ola Faisal Hassan

Female Genital Mutilation (FGM) is one of the most controversial rites of passage in Sudan. Here, Sudanese student Ola Faisal Hassan gives background on FGM, shares interviews with women who have been affected by FGM, and explains how it relates to the economy.

What is FGM?

Practices of Female Genital Mutilation (FGM) differ, but the practice often involves excision or a clitoridectomy. This is called Khafd (reduction) in Arabic and is more popularly known in the Sudan by as Tahara (purification). It is the removal of the clitoris, with partial or complete removal of the external female genitalia to varying degrees. In some instances, the two sides of the vulva are stitched together with catgut, sutures or thorns, thus obstructing the vaginal opening except for a very small part--just enough to allow the exit of urine and menstrual blood.

FGM was declared illegal in Sudan in 1941, but the practice has continued with little interruption. Successive national surveys between 1979 and 1983 recorded that 96% of women have undergone FGM. In 1991, this percentage dropped to 89%, and in 2009 the UNICEF World Report on Children reported a drop to around 81%. This gradual shift in public attitudes toward FGM is due in large part to efforts to educate the Sudanese about the risks of FGM led by nongovernmental organizations coordination with many other autonomous organizations and individuals.

Why is FGM Practiced in Sudan?

 The reasons people practice or encourage female genital mutilation stem from a mix of cultural, religious and social factors within families and communities. For decades, FGM has been a social convention, and families feel social pressure to conform to what others do and perpetuate the practice. Local leaders, including religious leaders, community leaders, and even some medical personnel, can perpetuate the practice as well. The argument that it is a cultural tradition is one of the most prevalent in terms of continuing FGM.

FGM is often motivated by beliefs about what is considered proper sexual behavior, linking procedures to premarital virginity and marital fidelity. In many communities, FGM is believed to reduce a woman's libido, and thereby is further believed to help her resist "illicit" sexual acts. When a vaginal opening is covered or narrowed, the fear of pain of opening it, and the fear that this will be found out, is expected to further discourage premarital sexual intercourse among women with this type of FGM.

In Our Own Words

 I conducted several peer investigations among women in Sudan who were subjected to FGM, as well as uncircumcised women. Here are some excerpts from my conversations with them.

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Mona is a middle aged housewife. She was circumcised as a young girl and is now the mother of an uncircumcised girl.

"I've made the vital decision not to subject my daughter to the horrific FGM I've gone through. I have suffered the physiological and psychological effects of the FGM both before my marriage and during the delivery of my daughter. My abnormal delivery incurred a lot of costs because I had to hire a specialist and then, during delivery, check into a private clinic to avoid any health consequences.

The worst result was that during delivery, because of the circumcision of my genitals the doctor had to pull my daughter very hard. My newborn daughter's right hand was almost paralyzed because of how hard she had to be pulled during deliver. This has resulted in extremely high financial expenses in the years after her birth in trying to cure her feeble right hand. We have tried physical therapy, and we even had to travel abroad to seek a cure for her hand, which represented an added cost for our family. Her handicap has even caused her a lot of psychological problems, especially during her primary study, which I'm afraid negatively affects her education and ultimately her future."

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Nada is a new university graduate working as an accountant in a bank. She was recently married. She was (mostly) fortunate not to experience the horrific FGM process. She attributed not being circumcised to the fact that her parents are highly educated.

"Because the majority of females in our community were circumcised at the age of seven I have felt like a freak among them, and sometimes I was persecuted. However, when I became a teenager I was totally content and resolved with the ‘odd' situation I thought I was in. I had a normal menstruation, without any of the pain or infections that circumcised girls are susceptible to.

This normal feminine physiological life proved to be an asset for me when I started my career. My female colleagues at work had to take sick leave for several days each month during their menstruation. This reflected negatively on their attendance, and therefore they were not often promoted and in fact were sometimes demoted or lost their jobs altogether."

The Economic Impacts

 I believe that FGM is a burden on women, but also places an additional burden on a society's economy. Women who are FGM victims usually need more health care to deal with complications, which is a burden on the health service system run by the state. Women with FGM use a considerable share of the funds allocated for government hospitals in treating side effects caused by FGM.

Women and girls are also the backbone of the economy, especially when it comes to labor in the traditional agricultural industry that is so prevalent in rural societies in Sudan. Yet many women who have FGM experience longterm side effects, chronic infections, and pain that prevents them from participating in the economy or workforce. Therefore the side effects of the FGM and the health deterioration that follows in most case impedes economic growth in these areas. This is true for both rural settings, as well as for urban jobs as Nada described. When women are not able to participate fully in the workforce due to debilitating FGM-related health problems, it hurts the economy as a whole.

Kenya: MPs Back Bill to Prohibit Female Genital Mutilation

April 13, 2011
Nairobi Star- allAfrica.com
Francis Mureithi

MPs yesterday commended debate on a Bill that seeks to punish those found practicing Female Genital Mutilation. The motion which was moved by Mt Elgon MP Fred Kapondi received the backing of all legislators who stood to contribute saying it was time the country effected laws to curb FGM.

Kapondi told the House that FGM was interfering with women sexuality. He said the act has been a major factor undermining development noting that it had inhibited the education of the girl child in many parts of the country.

MPs Ekwe Ethuro (Turkana Central), John Mututho (Naivasha), Aden Duale (Dujis) said Prohibition of Female Genital Mutilation Bill 2010 will go along way in protecting the girl child. "FGM affects the child birth for women, FGM affects infertility and cause trauma," said Duale while supporting the motion.

The Bill provides that any one found practicing FGM and convicted will be sent to jail for seven years or fined Sh500,000. Anyone who causes death in the process of carrying out FGM will be liable to life imprisonment.

Those convicted of aiding, abetting or carrying out FGM will be liable to imprisonment for a term between three and seven years or a fine of between Sh100,000 and Sh500,000.