June 30, 2018
Analyzing the Determinants of Female Genital Mutilation in Somalia
by Fatuma-ayaan rinderknecht
I remember when I first read about female genital mutilation in a textbook in my Human Sexuality course in college, and I was surprised that the book mentioned that rates of FGM are particularly high in Somalia. I was startled to see this because my mother’s side of the family is Somali and I hadn’t heard about the procedure before. When I spoke to my mother she explained that discussion surrounding FGM is usually viewed as “taboo” as it concerns the cutting of a woman’s genitalia. I decided to look further into the effect that FGM has on female public health in Somalia, where 98% of women have reportedly undergone the practice.
FGM refers to a brutal procedure in which parts of a young girl’s external genitalia are cut off with a blade, and without anesthesia.1 It is most common in parts of Africa and the Middle East, and the majority of girls who undergo the procedure are between the ages of 5 and 10. Around 200 million women worldwide have been subjugated to FGM. Not only is the procedure extremely painful and traumatic, but it has several lasting side effects. 2
There are several serious side effects and complications that come with FGM. 92% of Somali women who have undergone the procedure have reported health complications that include hemorrhage, pelvic infections, kidney damage, cysts, infection, sepsis, and death.1 FGM not only affects young girls that have the procedure, but can affect their children as well; hemorrhage caused by FGM can cause chronic anemia in affected women and inhibit them from properly nourishing their children during pregnancy and breastfeeding. The stitching of the vagina during FGM can also block the fetal head from exiting, causing women to bleed out from perineal tears and greatly increasing the rate of maternal or infant mortality.1
But perhaps some of the most damaging and less discussed side effects are psychological in nature. European studies of immigrant women who had FGM showed that 33% of women reported anxiety disorders and 17.5% of women indicated PTSD resulting from enduring the genital cutting procedure.4 Even less reported is the effect that FGM has on the sexual health and satisfaction of women affected with it. Multiple studies have found that women with FGM are much more likely to report painful intercourse, reduced sexual satisfaction and desire. 3,4,5 Because FGM is often carried out in religious countries like Somalia, conversations surrounding women’s mental health or sex life are taboo. Ultimately, it is impossible to detangle the physical harm from the psychological damage caused by FGM--the procedure is pervasive in every aspect of a woman’s life.
If FGM is so damaging, then why does it continue to be so pervasive in Somalia? The social determinants underlying the issue offer an important perspective. One of the reasons why FGM is seen as a cultural tradition rather than a medical procedure-- desire to conform to Somali culture has maintained the popularity of FGM.6 The procedure is also falsely rooted in Islam, as many Muslims believe that it encourages women to be chaste and remain virgins. Conversations with Somali women reveal that Somali mothers often plan the procedures for their daughters, worrying that failure to undergo the procedure may result in ostracism and rejection from the community. Because FGM is so deeply rooted in Somali culture, religion, and tradition, it makes it particularly hard to eradicate.
Education, poverty, and urbanization are also determinants that will affect the likelihood of women undergoing circumcision and the severity of complications they may face from it. Women from urban areas, who often have higher levels of education and wealth, are more likely than rural women to disregard the practice.6 However, because Somalia is one of the poorest countries in the world and the vast majority of Somali women in Somalia are poor and under-educated. Increased health education could prove useful in decreasing the FGM prevalence as women would learn of potential complications to the practice and might become more averse to engage with it.
It is imperative that the global health community address the physical, mental, and sexual harm caused by FGM and take active steps to reduce the incidence of this procedure. The World Health Organization has recently taken a “zero tolerance policy” stance regarding FGM, and this month released a comprehensive handbook that addresses many major concerns surrounding FGM. Because FGM is deeply rooted in Somalia, initiatives to stop FGM must come from within the Somali community. Large global health organizations should work with local groups to effect change. Somali-led initiatives like the Edna Adan Hospital Foundation and the Ifrah Foundation work directly with community members in Somalia to reduce FGM and treat women affected. Improvements in poverty, education and health literacy will help in attaining this goal. It is essential that both women and men in Somalia are educated in the damage caused by FGM so that they can soon reject it as a tradition, and instead recognized it as a harmful procedure.
Fatuma-Ayaan is a graduate of Harvard College, and currently works as a clinical research specialist in the Pediatric Cardiology Department of UCSF.
1. Toubia, Nahid. "Female Circumcision as a Public Health Issue." New England Journal of Medicine 331.11 (1994): 712-16. Web.
2. "Female Genital Mutilation/Cutting in Somalia." World Bank. World Bank, 2004. Web.
3. Vloeberghs, Erick, et al. "Coping and chronic psychosocial consequences of female genital mutilation in The Netherlands." Ethnicity & health 17.6 (2012): 677-695.
4. Berg, Rigmor C., and Eva Denison. "Does female genital mutilation/cutting (FGM/C) affect women’s sexual functioning? A systematic review of the sexual consequences of FGM/C." Sexuality research and social policy 9.1 (2012): 41-56.
5. McCool, Megan Elizabeth. Epidemiology and care of female sexual dysfunction. Diss. 2017.
6. U.S. Department of State. U.S. Department of State, 2009. Web. 05 May 2017