Female Genital Mutilation Moves Into Hospitals

by Fredrick Nzwili

(WE) NAIROBI -- Activists working to end female genital mutilation in Africa find themselves in a bitter phase of the struggle. Now that some traditional practitioners have disavowed it, many doctors and nurses are taking up the illegal practice. And these are people that activists thought were their friends.

"With activists campaigning about the unhygienic conditions in which traditional circumcisers carry out their trade, some parents are taking their daughter to the modern doctors," says Efua Dorkenoo, a Ghanaian activist against FGM.

"This is actually taking people centuries back," says Millie Odhiambo, executive director of The CRADLE (also known as the Child Rights Advisory Documentation and Legal Center), a Kenyan nongovernmental organization that works for children's rights. Instead of helping to lead the fight against FGM, says Odhiambo, many doctors are now becoming the new face of the problem as they earn much higher sums. Doctors and nurses are highly paid for this work compared to traditional circumcisers.

In Kenya, activists say, doctors charge between 3,000 and 10,000 Kenya shillings, or between $37 and $125, while traditional practitioners would charge, at most, about $25.

Activists can not offer any statistics about the so-called medicalization of FGM, but they suspect is occurring in Egypt, Sudan and Kenya.

Along with parents' preference for hospital settings, they say the trend is explained by a population shift away from villages toward larger urban areas. As this happens, many parents are losing contact with traditional practitioners and looking to medical doctors to take over the work.

About 14 countries in Africa passed laws against FGM during the 1990s. But in most cases, the laws are not being enforced. "Implementing laws on FGM is difficult since it is not regarded as an important issue," says Bassille Urasi, an anti-FGM activist from Tanzania.

The passage of laws against FGM made parents more circumspect, but did not necessarily change their minds about upholding the traditional procedure. "Largely due to sensitization in the '90s, people are being discreet about circumcising daughters," says Lakshmi Anantnarayan, media campaign director of Equality Now, the women rights organization based in New York.

Anantnarayan says parents are now more concerned about the health risks of the procedure, so they are taking their daughters to hospitals, where the procedure is often performed under the pretext of illness and often takes place early in the morning or late at night to avoid possible detection, which, by law, could be up to 12 months' imprisonment or a $625 fine.

Although no physician's organization has officially addressed the problem, individual doctors are speaking against it.

One is Dr. Elijah Mbogori, a program officer of Building Eastern Africa Community Network (BEACON), a nongovernmental organization based in Nairobi. "FGM has now entered a dangerous zone," says Mbogori.

"We are asking physicians under what principle have they picked up the practice and how they can defend it."

Julie Maranya, director of Julikei International, Women and Youth, a Nairobi-based women's rights organization, says her organization has been lobbying Kenya's health ministry to reprimand doctors associated with FGM. "The war against FGM appears to be going round in circles, as physicians take it up," she says.

Nurses are also performing FGM in settings outside of hospitals, activists say. Even though they do not provide the same hygienic conditions as hospitals they have sufficient medical credentials to attract clients.

Some of the traditional FGM practitioners who have disavowed the procedure now push for the immediate arrest and prosecution of any who are caught performing it, including physicians.

"If they cannot listen, just put them in jail," says Fatoumata Daou, a Mali FGM practitioner for 25 years who gave up the work earlier this year after anti-FGM activists persuaded her that her work was dangerous to women's health.

About 130 million women around the world have undergone FGM. The practice is common in about 30 African countries, where girls traditionally underwent FGM when they reached 17 or 18 years. Because young women in are increasingly reluctant to undergo the mutilation, the age at which they are forced to undergo the procedure has been dropping to between 6 and 10.