The Monitor (Kampala)
ANALYSIS
October 22, 2004
Posted to the web October 22, 2004

By Muhwezi G. Bonge
Kampala

Betty Cheboi from Kapchorwa has been paralysed for 28 years due to circumcision. She was forcefully circumcised in 1976 when she was 22 years, but the operation did not go on as planned. She became bed ridden for some weeks.

When she healed, Betty discovered that she was unable to walk. The 'surgeon' had paralysed her. A few months later her husband abandoned her and since then she has been living alone with a supportive mother on her side.

Female circumcision refers to several practices that involve the cutting of female genitals. Over the past decade, the term female genital mutilation has been adopted by a wide range of women's health and human rights activists because it clearly indicates the harm caused by the practice.

Female circumcision is usually performed on girls before puberty as a way of preparing them for marriage. However in some cultures, it is practiced as early as a few days after birth. This act is a basic violation of women's rights to physical integrity regardless of the degree of cutting or of the extent of complications that may or may not ensue.

The World Health Organisation (WHO) estimates that 130 million women worldwide have undergone some form of female circumcision. Female circumcision is cultural and not a religious act but sometimes it is linked to Islam and though not mandated, it is not completely discouraged.

One tradition permits the removal but does not encourage, circumcision of women provided no harm is done. The Islamic law protects a woman's right to sexual enjoyment, as demonstrated by the fact that a woman has the right to divorce on the grounds that her husband does not provide sexual satisfaction. Muslims argue that permitting such a ritual constitutes an act of tolerance by Islamic law for pre-Islamic practices.

In Uganda female circumcision is mainly practiced by the Sabiny in Kapchorwa, Bantu in Somali by the Masai in Kenya. It is also practiced in other African countries like Senegal, Mali, Chad, Djibouti and Ethiopia.

Among these cultures, female circumcision is practiced as a prerequisite for marriage. Men tend to prefer women who are circumcised given they have a belief that they are more faithful due to reduced sensitivity during sexual intercourse. Girls who are not circumcised, are considered immoral, they make rude wives and daughters-in-law. In some communities it is drummed into the girls' head right from a tender age that no man will marry an uncircumcised girl.

In a community where most women are circumcised, family, friends and neighbours create an environment in which the practice of circumcision becomes a component of social conformity. Circumcision goes from being a perceived need to a pervasive practice that is necessary for acceptance. In such cases circumcision may not be an option.

In some parts of African, female circumcision is delayed until two months before a woman gives birth. This practice is based on the belief that the baby will die if it comes into contact with their mother's clitoris during birth.

In other cultures, it is a symbol of purification, a cultural rite of passage; girls who have not been circumcised are considered "unclean" and can be treated as harlots by other women.

Many men believe in a myth that they will die if their penis touches a clitoris.

Female circumcision can be carried out in three different ways; it may be light where the tip of the clitoris and its covering (prepuce) are removed this is known as clitoridectomy. Another type is where the entire clitoris, the prepuce and adjacent labia are removed and it is referred to as excision.

Infibulation is the extreme case in which the entire clitoris, the prepuce and adjacent labia are removed followed by stitching up of the vulva to narrow the vaginal opening. This is done with crude instruments like razor blades, scissors or knives without the use of anaesthesia. This leaves them with reduced or no sexual feeling. Orgasms are sometimes impossible to experience later in life. Many health problems result from the surgery.

Dr. Josephat Byamugisha, a gynaecologist at Mulago hospital says that the immediate complications due to female circumcision include; shock due to severe pain or haemorrhage, difficulty in passing urine, wound infection caused by unsterile cutting instrument. If bleeding is very severe and uncontrolled, it can result in death.

Long-term complications include urinary tract infections, chronic pelvic infections; these may cause irreparable damage to the reproductive organs and result in infertility. Other complications include; menstrual problems, stones in the urethra and bladder, excessive growth of scar tissue or cysts at the site of cutting. There is also pain during sexual intercourse especially in cases of infibulation. Dr. Byamugisha further says "These women also face problems during child birth. A tightly infibulated woman must be cut open (deinfubulated) during delivery.

If this is not done, labour will be obstructed and this can cause life-threatening complications for both mother and the child." Though such cases haven't been reported at Mulago hospital, he encountered them in Sweden.

About psychological effects, Dr. Byamugisha says that girls may face fear, submission or inhibition and suppressed feelings of anger bitterness or betrayal. There are also negative effects on self-esteem and self-identity.

Its not only women who find problems with female circumcision. Dr. Byamugisha says that men may also find difficulties for example in cases of infibulation, the whole vaginal area is stitched leaving a small opening that a man may find difficult to penetrate. This may cause wounds and inflammation on the penis, decreased sexual desire and enjoyment for the woman. There are also economic difficulties associated with deinfibulation at the time of delivery.

Betty Cheboi now carries the banner against female circumcision, through a programme called Reproductive Health and Community Education. She has championed the plight of women due to face the knife. This group works tirelessly for the elimination of genital mutilation in Kapchorwa.

Today less than 50 percent of the entire population in Kapchorwa practices female circumcision. And in those communities that still allow the practice, it is getting rare. Most non-governmental organisations are using collaborative methods to eliminate this it with less confrontational approach.

Due to health campaigns, female circumcision has been falling in some countries in the last decade. In Sudan, the practice dropped by 10 percent between 1981 and 1990. In Kenya, a 1991 survey found that 78 percent of teenagers had been circumcised, compared to 100 percent of women over 50.

Several governments have introduced legislation to ensure only trained doctors carry out the process in hospitals.

Countries like Senegal, Egypt and Togo have taken steps to eliminate this practice. For example in Egypt the act was banned. In Senegal and Togo, anyone found practicing it may face up to five years in jail.

Also massive campaigns by UNICEF against the act has prompted these countries to take steps in ensuring that female circumcision is eliminated.

In Kenya a legislation that prohibits female circumcision is in place, although there is little enforcement. In 1989, the Regional Committee of the WHO for Africa passed a resolution urging participating governments to adopt appropriate policies and strategies in order to eradicate female circumcision and to forbid female circumcision and to discourage health professionals from performing such surgery.