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Friday, April 29, 2011

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."