Dec,1 2012
Tonte Ikoluba was 13 years old when her
grandmother came to her family home to circumcise her. She remembers it
as if it were yesterday. Her grandmother coaxed her and told her not to
worry. It was important she go through the rite, she was told, in order
to become a respectable woman and increase her chances of getting
married some day.
"I closed my eyes tight and tried to gather my courage," she said.
She wanted to wait a little bit, but her grandmother and another woman
held her down.
Tonte does not like talking about that day. The memory is too
painful. She was scared. Her sister had the procedure done before her,
and she bled so much that she had to have a blood transfusion in the
Malian hospital.
Female circumcision -- otherwise known as female genital mutilation
or cutting (FGM/C) -- is defined by the World Health Organization as
"all procedures that involve partial or total removal of the external
female genitalia. It also involves any other injury to the female
genital organs for non-medical reasons."
FGM/C is a millennia-long custom that practicing communities believe
is an essential part of raising a girl properly. About 140 million girls
and women worldwide are currently living with the consequences of
FGM/C, according to the World Health Organization. Some 92 million girls
10 years old and above who have undergone the practice are in Africa,
the agency adds.
Health consequences
The practice has several immediate and long-term health consequences,
says Marci Bowers, a gynaecologist in San Mateo, California. Many women
like Tonte suffer for years after being circumcised because of scarring
and frequent infections. The pain is constant, says Tonte. She is 35
years old and is still single, she says, because she cannot bear to have
anyone touch her "down there." Not even a doctor.
Dr. Bowers told Africa Renewal that pain is a major problem for her
patients. The majority have undergone the most severe kind of cutting,
called infibulation, in which the clitoris is removed and the labia are
stitched together to form a cover over the vagina. Only a small hole is
left for urine, menstrual blood, childbirth and intercourse.
Dr. Bowers is a surgeon who performs "reversal surgery" on her
patients to repair the vagina and clitoris so that these women can have
more normal lives. "The scar tissue that forms around the clitoris and
encases it is uncomfortable. But in the cases where women have been
infibulated, by dividing that infibulation, for the first time since the
incision they are able to pass urine normally, they are able to pass
menses normally. And they are able to have sex or childbirth without a
constricting band that prevents those things."
She says the surgery is 100 per cent effective in alleviating pain
for patients. "The relief that overwhelms these women has been one of
the reasons women are glad they went through this surgery."
Advances in surgery
Reconstructive surgery for patients who have gone through FGM/C has
been around for a long time. But the technique of clitoral repair
surgery was only developed in 2004 by a French urologist, Dr. Pierre
Foldès. It entails opening the scar tissue, exposing the nerves buried
underneath and grafting on fresh tissue. The procedure reduces the
chronic pain associated with FGM/C, allows women to regain clitoral
sensitivity and even permits some to attain orgasm.
In Burkina Faso, where Dr. Foldès has trained several surgeons, the
procedure has been offered since 2006. Previously, in 2001, the
government sponsored and introduced a more general genital repair
surgery, reports the National Commission Against Excision. Meanwhile, in
an effort to make the clitoral repair surgery readily available in
Africa, seven surgeons in Dakar, Senegal, recently received
certification after training under Dr. Foldès and Senegalese oncologist
Dr. Abdoul Aziz Kassé.
Dr. Bowers was also Dr. Foldès' pupil and has now volunteered to do
similar work. She will be operating on Tonte Ikoluba for free, and has
pledged to match every donation to the cause with her own money.
Together with the Campaign Against Female Genital Mutilation (CAGeM), an
international network devoted to countering FGM, she will help make the
surgery available in Africa too. The organization was established in
1998 by a group of women doctors in Africa, in response to the high rate
of infant and maternal deaths in communities that practice FGM/C. It is
also working in New York: the practice is becoming more common in the
US because of a growing population of immigrants from such communities.
CAGeM is building a hospital in Port Harcourt, in southern Nigeria.
To be called Restoration Hospital, it will provide the surgery for free
and be open to any patient from West Africa. Dr. Aberie Ikinko, director
of the organization's US branch, explains: "We have already 400 women
on the waiting list. We are also training the local doctors so that when
we leave, they can continue to perform the surgeries for free."
Most women in Africa cannot afford the surgery, nor are they able to
travel far. Dr. Ikinko told Africa Renewal that funds are being raised
in New York to send supplies in preparation for the hospital's opening.
CAGeM hopes Restoration Hospital will also be able to offer other free
medical treatments for women, including operations for fistula, a hole
that can develop over many days of obstructed labour, which is often
caused by FGM/C.
Campaign for change
A high-level event at the UN General Assembly in September 2012
called for increased commitment and concerted action from governments to
end the practice of FGM/C. A UN resolution aimed at intensifying global
efforts to end FGM/C was approved for the first time on 26 November.
Chantal Compaoré, the first lady of Burkina Faso who championed the
resolution, hopes that African countries will sign it and take ownership
of the ban.
After two decades of global efforts to end this practice, many
communities are also now embracing change. Close to two thousand
communities across Africa abandoned the practice in 2011 alone,
according to a report by the Joint Programme for the Acceleration of the
Abandonment of FGM/C. Set up in 2008 by the UN Children's Fund and the
UN Population Fund, the programme seeks to spur change through a
culturally sensitive, human rights-based approach that promotes
collective abandonment of the practice.
Some previous strategies that regarded the rite as "barbaric" and
"backward" met with resentment and backlash from local communities.
Rather than ending FGM/C, such campaigns pushed supporters to simply
hide the practice and scared them from seeking medical care, thereby
placing young girls' lives at continued risk. Recently, educational
efforts have been playing a more central role in campaigns to end the
practice, with many activists choosing to present FGM/C as a public
health issue and concentrating on the harmful and sometimes deadly
effects it has on young girls and women.
Although there is renewed hope for a global ban on the practice, so
far there has been little focus on solutions for the many girls and
women who have already undergone cutting. The possibility of
reconstructive surgery is therefore a godsend to young women like Tonte.
"They took away part of my womanhood," she says. "I just feel very
deprived. I want to be whole again."
