Health Risks and Complications Associated with FGC

The Kuria communities in the study practice FGC type II as indicated in Chapter 2 of this study. The risks and complications associated with FGC types I, II, III, and IV are similar, however, studies by other researchers of FGC highlight that complications are more severe with the practice of type III. This section examines the health risks that female participants reported, and the aftermath complications they claimed they continue to experience because of the FGC ritual. These interviewees spoke about the long and short-term health issues they encounter undergoing the FGC ritual. In the focus group discussion, the senior women also shared their personal health experiences highlighting the health burden they identified, which women suffer from in the society because of the FGC practice.

The narratives of two health workers (– a female nurse midwife and a male gynecologist) gave medical explanations for the health problems participants shared.

The midwife was not a Kuria and therefore had not undergone FGC.

The young women had earlier talked about the short-term complications they associated with the cut, which includes violent pain, haemorrhage or excessive bleeding from the rupture of the blood vessels of the clitoris. The 18-year old told that the cut ritual is a high health risk and could place the lives of girl children in danger. She narrated that:

“Because I was cut badly and bled a lot, it took a long for me to heal.”

This young woman told that she felt dizzy and was weak for many days after the cut.

She recalled how her mother spent weeks nursing and feeding her with a nutritious diet to regain her energy and strength. She also explained how she would not walk properly for days after the cut and believed that the Ngariba could not identify the blood vessels before the cut. Another young woman told how she and her colleagues recuperated from the cut. She did not say whether all her companions had infections, neither did she tell the duration spent in the camp nor the number of days to recuperate. However, her experience was that:

“I had infections after undergoing FGC that took a long time to heal. I was too young;

this was before I turned 12 years old. I had a lot of complications and had health problems for almost two years. As a result, I dropped out of school. I got married shortly after regaining my health and had my first child before I turned 16” (28-year old young woman).

It was understood in the above narrative that females suffered ill health after the cut.

The 28-year old told that she and her initiate companions were kept in a camp under the watchful eye of an elderly woman. The young female explained that the older woman nursed and treated them with some special herbs and botanical oils until they healed and could walk properly. It emerged in her narrative that unsanitary conditions under which the operation is performed prevailed, and at times the herbs and oils applied to their wounds after the cut were not always prepared under hygienic conditions. These combinations contaminated the fresh wound of the cut and added to their infections, which prolonged the recuperation period as in the case of this 28-year old.

The Ngariba said in her interview that it takes three to four weeks for an initiate to heal completely from her wounds. She added that some of the initiates took a longer time to recuperate, depending on the gravity of the cut and infections they have. The Ngariba’s explanation confirmed the seriousness of their ordeal, but she did not accept the responsibility for poor health outcome. She said:

“I do my job as required; the initiates have to be taught not to resist during the genital cut” (56-year old Ngariba).

In their narratives, the young women highlighted the unhygienic conditions, the skill/expertise, and eyesight of the circumciser. They believe that the health risks and complications of FGC depended on the severity of the cut. This issue became a concern for me, and so brought it up during the focus group discussion of the community actors. One of the elderly women explained:

“Most of the circumcisers (Ngariba) are old women, some of them may experience poor eyesight. Coupled with the resistance of the girl child during the operation, it may cause damage to some other organs. This kind of situation prolongs the healing process” (45-year old woman).

Some of the women in the group discussions shared that some girl children faint while others have died during the cut because of the pain and the consequences of excessive bleeding. They claimed that the Ngariba performed the cutting ritual without ever giving the initiate any form of anesthesia. The Ngariba argued her standpoint in her interview that the girl child is supposed to be healthy and well nourished by her parents before the cut ritual. Moreover, if the initiates’ instructors such as their mothers or grandmothers feed their daughters properly, there should be no casualties because the girl child would be robust enough to withstand all odds.

This circumciser explained that before the cut, the girls have a stone-cold bath that should help clot the blood and prevent excessive bleeding. She added that in ancient times, the cutting ritual was performed in the early hours of the morning before the scorching sun comes out.

All of the female interviewees in the study had mentioned that after the cut, they had been afraid to pass urine because of the pain of the raw wound. As a result, they had acute urine retention for the first few days after the surgery.

The health workers explained that urinary infections also occur from the application of local dressing of cow dung and ashes. The medical expert further stressed that fever could result because of blood poisoning as the operation might well be performed in unhygienic conditions with unsterilised equipment. Moreover, the health workers said that the application of herbs and ashes to the wounds in addition to the use of instruments that have rarely been sterilised often results in tetanus and septicaemia.

When the issue of long-term risks and complications were addressed in the focus group discussions, some of the elderly women shared that they have seen fellow women in their communities suffering from fistulae. They claimed that some of these women do not even seek medical health because of the stigma attached to the disease, and therefore remain in isolation. I became concerned and inquired from the health workers whether they had seen cases of this nature in their health centres.

The nurse midwife passionately stated:

“Female genital cutting poses a threat to a woman’s health it is also a major public health problem that has long and short-term consequences. The magnitude of the health issue includes severe pain, problems with urination, excessive bleeding, menstruation problems, infections and kidney problems, which is on going in this discussion. The FGC practice is also causing complications with pregnancies and

childbirth. It contributes to a high number of maternal and infant deaths in our district” (Nurse Midwife in FGD).

The midwife also told about a frightening delivery she had witnessed as a young trainee a few years ago that:

“A woman in labour was brought to the clinic one night when I was on night duty.

Her relatives had told that she had been in labour for almost three days. She bled so much and was weak, but the baby’s head was already coming out, so we encouraged her to push. When she managed to deliver, she had a tear from the vagina to her pelvic bone. I later discovered she had undergone FGC” (Nurse Midwife in FGD).

The strain of pushing too hard could affect the mother and result in fistula according to the midwife’s narratives above. I asked the health workers if they could have done anything to help women in circumstances of such a difficult delivery. The gynecologist explained that when the midwife realised her patient had the clitoris removed she should have used tactical means and then applied her expertise:

“The midwife had to make sure that she gives an episiotomy to open the lumen of the birth canal where the child would pass; this would have avoided the tear that could cause fistula. This is because no matter the kind of FGC ritual performed that removed the clitoris, it damages the elasticity of the vagina. The vagina’s elastic muscular canal is soft, and has a flexible lining that provides lubrication and it can harden and form a scar. Therefore, because the cut area is hardened it cannot expand for the cut woman to have a normal birth easily” (Gynecologist in FGD).

The gynecologist explained further that in such a situation, it is necessary for the midwife to give an episiotomy. He stressed that failure to apply such knowledge could result in a nasty tear that can extend even to the rectum, as was the case witnessed by the nurse midwife in the study. Incident such as this could lead to fistula as a long-term health problem.

A narrative of the 18-year old young woman acknowledged the health workers’

explanations when she shared:

“I had such a difficult and prolonged delivery, and the midwife told me it was because I have undergone FGC, I am afraid to have any more babies.”

The health workers in the study attest that prolonged delivery could happen to any woman in obstructed labour if she is not attended to in time. However, they claim cut women are more likely to experience obstructed labour than uncut women are.

The 18-year old woman’s narrative did not say she had a fistula. However, she shared that she was not quite 12 years old when she underwent the cut. She explained that

she never had her menstruation before the ritual. She went back to complete her primary school education that year and was married shortly after. She attests that she became pregnant without experiencing her menses.

Another disturbing health problem disclosed by the young women was the lack of sexuality education and sexual desire. An example of such experience shared was:

“I do not have sexual desire, and this has caused me many problems in my marital life. I went to the hospital looking for medical help, but I was disappointed because I did not get any medical help” (35-year old woman).

The 35-year old disclosed that it was when her husband married another wife that she began questioning herself as to whether there was something wrong with her sexuality. The woman revealed: “I went to seek medical advice on how to have sexual pleasure.

However, I was disappointed the doctor could not help me.” A few of the female interviewees in the group discussion too shared similar stories of not having sexual pleasure. One of the participants passionately stressed how FGC as a practice is a sexual oppression:

“I have no sexual desire, thus my husband kept teasing me what kind of a woman I am. At times, he beat me up out of desperation when he could not arouse me sexually.

There was much tension in my married life that at a stage, I thought my marriage was breaking up. We both tried hard to make it work, but it was not easy. He has since then married four other women after me. I now understand his frustration. If my parents were to be alive, I would ask the government to convict them to life incarceration” (53-year old woman).

Like the 35-year old, this elderly woman also could not get medical help when she went seeking for the medical solution to her problems. In a casual conversation outside of the discussion group, some of the male participants shared how they had to develop a way of having sex with their wives. These elderly male research participants told how they too get frustrated when they cannot arouse their wives.

They said they would appreciate medical help for their wives. So many questions run through my thoughts after the conversation with them. For example, “Do the men not see cessation of FGC as a possible solution? Do they even understand female sexuality and the place of the clitoris in sexual arousal? These questions need research for better understanding.

There was a common concern among all of the interviewees that the practice of FGC ritual could transmit blood-borne diseases among the peers undergoing the ritual at the same time. There can also be many long-term implications such as the risk of HIV infection, and non-sterile instruments could transmit hepatitis B,

especially when genital cutting on many girls in one group is done simultaneously.

One of the interviewees highlights the dangers of HIV transmission:

“The Ngariba uses one razor blade to circumcise about 10–20 girls. When I underwent FGC almost 17 years ago, each one of us was told to bring our razor blade.

Even though we all had our razor blades, the Ngariba did not wash the blood off her hands after each operation but went straight to operate on the next girl. She could easily transfer diseases from one girl to another. My fear shifted from the pain to the fact that I might contract the HIV in case any of my colleagues is infected with the virus” (28-year old young woman).

It was obvious that women in the Kuria community were concerned and worried about their health. They also identified the harm done to their bodies because of FGC practices. The nurse midwife in the group discussion argued that FGC practice damages the sexual organs. Additionally, those cut women who were severely cut could have their vagina vulva almost sealed, could also suffer further damages because they had to be reopened after marriage. Both events increase the chance of infection, which can increase the risk of infection by HIV. In today’s world, most parents are afraid for their daughters contracting HIV/AIDS through FGC.

The women’s testimonies assist in understanding the gravity of the health burden and a clear picture of what female genital cutting entails. Considering the impact of the health risks and complications shared, I questioned the young women whether there were socio-cultural values they attached to the practice of FGC in their point of view.