Female Genital Cutting among the Somali of Kenya and Management of its Complications

Abstract

The Somali community living in Kenya (and in their native Somalia) has practised the severest formof female genital cutting (FGC), infibulation, for centuries. To understand the context within which the practice takes place, and how its complications are managed, the Population Council’s Frontiers in Reproductive Health Program (FRONTIERS) undertook a diagnostic study in North Eastern Province (Wajir and Mandera districts) a nd in the Eastleigh area of Nairobi. The study collected data through: in-depth interviews and focus group discussions with community and religious leaders, and recently married and unmarried men and women; interviews with health providers, and an assessment of their clinics’ readiness to offer safe motherhood and FGC-related services ; and interviews with antenata l clients who had been cut. The study confirmed that FGC is a deeply rooted and widely supported cultural practice. Several closely related reasons are used to sustain the practice: religious obligation, family honour, and virginity as a prerequisite for marriage; an aesthetic preference for infibulated genitalia was alsomentioned. However, FGC plays no role as a rite of passage. Underlying these reasons are the use of infibulation to enforce the cultural value of sexual purity in females. A relevant lesson learned from FGC abandonment strategies elsewhere is the impor tance of working with inter-marrying groups, as FGC is a critical prerequisitefor marriage. If consensus can be generated that marrying uncut women is acceptable within the social group and this decision is then publicised through a form al declaration, then a “social convention shift” can happen. Thus, when developing a strategy for working with community members, it is important to determinemarriage patterns and to organize activities accordingly. The study also found that the health sector is ill equipped to serve women who have been cut, particularly infibulated pregnant women. However, this stems from an overall weakness in the availability and quality of safemotherhood services in NorthEastern Province. In addition, and especially in Nairobi, health workers are increasingly being approached to perform infibulations and re-infibulations. Specific recomm endations were made about the ways in which the health system could strengthen its handling of FGC among the Somali. Policy makers should seek to improve management of associated complications with in the framework of improving safe motherhood generally, and contribute to abandonment effort s through ensuring that staff adhere to MOH policy, and become involved in community-level discussions to create a climate for behaviour change. Given the clear strength of feeling that FGC is a critical component of Somali culture, efforts to encourage behaviour change cannot focus solely on education about health and rights alone. The underlying reasons for the practice need to be discussed and debated so that a desire for change can emanate from the community its elf. Because of the Somali community’s perception that efforts to abandon FGC are driven by international interests, working with them will require credible organisations and i ndividuals that have gained their trust and acceptance