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Afficio Undergraduate Journal
Female Genital Mutilation in Somalia
Winner, Upper Undergraduate Social Sciences
Author: Katherine Macdonald
Introduction
Somalia, a country located on the African continent’s easternmost extremity, maintains the highest rates of female genital mutilation (FGM) in the world, with ninety-eight percent of females enduring the procedure (Gele et al., 2013; UNICEF, 2013). Broadly defined as that which “…comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons,” the practice has been classified into four categories, varying in severity, by the World Health Organization (WHO, 2018, n.p.). Terminology employed in describing the practice ranges. Commonly, FGM is described as female genital cutting (FGC) or female circumcision (FC) within literary sources. For the purposes of this paper, the terminology of FGM will be utilized as it most accurately stresses the true nature of FGM – an inhumane practice violating basic human rights (Shetty, 2014; WHO, 2008).
Within Somalia, the procedure is largely dichotomous, with the primary forms recognized as Sunna and Pharaonic. Sunna, terminologically stemming from links to Islamic beliefs (Vestbøstad and Blystad, 2014), is generally viewed as less severe by Somalis, as indicated in Hargeisa study findings conducted by Lunde and Sagbakken (2014). This reasoning offers partial explanation for the scholarly observations of widespread gravitation towards milder forms (Gele et al., 2013). However, Sunna procedures can be as severe as those labeled Pharaonic due to a lack of regional conformity in definitions, with the sole demarcating characteristic being the number of stitches following the operation (Gele et al., 2013). In contrast, Lunde and Sagbakken (2014) maintain that Pharaonic, coinciding with WHO Type III, has fallen out of favour and is presently seen as bearing greater similarity to past beliefs. Nonetheless, continued support of this form remains (Lunde and Sagbakken, 2014).
Pharaonic or Type III FGM, also referred to as infibulation, is the most drastic form according to WHO (2008), and involves “[n]arrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation)” (p. 4). The overwhelming majority of Somali women have undergone infibulation, with UNICEF (2013) finding that sixty-three percent of females aged fifteen to forty-nine years fall under the category of “sewn closed” (p. 2). In contrast to the procedure of male circumcision, FGM cannot be historically linked to any explicit faith-related fulfillment (Ismail et al., 2016), although religion remains nonetheless cited among the most dominant reasons for it taking place (Gele et al., 2013). For this reason, and because it perpetuates damaging societal patterns resulting in immeasurable harm unnecessarily imposed upon Somali women and society at large, FGM in Somalia should be discontinued.
FGM in Practice
In Somalia, similar to other countries in which the practice is entrenched, FGM primarily takes place during childhood. Findings by UNICEF (2013) indicate that the most common age for Somali females to undergo the procedure is between five to nine years. Examining demographic records of high-risk groups is crucial in understanding the manifestation of FGM. Variables that influence the procedural outcome are environmental conditions, materials employed, the practitioner performing the operation, and the opinions of mothers as well as female elders.
Demographics of Somali FGM
According to UNICEF (2013), eighty percent of Somali women between the ages of fifteen to forty-nine years have been subjected to FGM. Regional variations in prevalence, severity, and demographics are evident, with girls in Somaliland undergoing the procedure at a mean age of seven to nine years (Ismail et al., 2016). Furthermore, Ismail et al. (2016) find that the age at which the practice is performed can vary by type, with Pharaonic infibulation commonly taking place later in childhood due to the maturity with regard to physical development necessary for the more involved procedure. From these statistical findings, it can be gathered that FGM customarily takes place within girlhood – a fact that, in and of itself, renders the procedure questionable with regard to human rights.
Conditions and Equipment
FGM can be dangerously unhygienic. The procedural conditions can be problematic in that environments are in large part unsanitary due to a lack of trained personnel and the setting’s informality (UNICEF Somalia, 2004). Likewise, the materials employed in the procedure are commonly unclean, with the same devices often being reused on multiple individuals with no sterilization in between (Chalmersn and Hashi, 2000). Ismail et al. (2016) indicate that instrumentation is often crude, with practitioners utilizing sharp objects unintended for use in this context. Examples can be seen in broken glass employed for cutting while thorns found locally can be substituted for sutures (Ismail et al., 2016). Infection can also result from contaminated substances being applied to wounds, such as “[p]astes containing herbs, local porridge, or ashes...rubbed on the wounds to stop bleeding...” (Chalmersn and Hashi, 2000, p. 228).
Those performing the procedure range in training and skill level. The most common individuals carrying out the surgery are informally trained traditional practitioners who vary in experience and have learned to perform the procedure through familial links, midwives, senior women within the community, and select medically-trained professionals such as doctors (Gele et al., 2013; Chalmersn and Hashi, 2000; UNICEF Somalia, 2004).
FGM: A Women’s Practice
Contrary to common belief, women constitute a large proportion of those in support of the practice. Although numerous exceptions can be found in instances of women advocating against FGM, a sizeable share of Somali women remain in favour, exemplified in an Ethiopian Somali diaspora community where ninety-one percent of women interviewed planned to have their daughters undergo FGM (Mitike and Deressa, 2009). WHO maintains that “…older women who have themselves been mutilated often become gatekeepers of the practice…” (2008, p. 7) indicating that undergoing the procedure is not always a deterrent nor necessarily a catalyst for negative opinions of FGM. Deemed a necessary formality due to cultural longevity and entrenchment (Khaja et al., 2009), women are expected to ensure that their daughters undergo the customary procedure – sometimes against a father’s wishes (Lunde and Sagbakken, 2014; Gele et al., 2013; Abubakar, 2013).
Shifting Attitudes Toward FGM in Somalia
The recent history of Somalia is exceptionally tumultuous due to its political climate. Presently, the country has been identified as “…one of the world’s least protective environments for children…” (UNICEF, 2016, p. 3). Somali youths endure the consequences of instability in terms of both health, relating to issues such as malnutrition, and security, exemplified by the prevalence of domestic violence (UNICEF, 2016). Circumstances such as these provide an atmosphere in which various harmful practices may be inflicted upon children. The present state of FGM within Somalia can be contextualized through exploring the governmental conditions prior to and following its collapse.
Pre-1991 Somalia
Somalian governmental actors recognized the problematic nature of FGM during the 1970s, proceeding to initiate various strategies aimed at combatting the procedure on a widespread scale, in accordance with international efforts, while independent grassroots approaches by local Somalis became increasingly apparent (Gele et al., 2013; Khaja et al., 2009). Ford (2001) indicates that steps towards eradication included increased investigation into health effects, with bans directed towards medicalization. Historical records indicative of national action intended to eliminate FGM provide evidence that the practice has long been recognized as harmful and counterproductive to the wellbeing of Somalis. Had the government been capable of furthering the aforementioned initiatives without hindrance, it is likely contemporary Somalia would bear greatly reduced rates of prevalence.
Somalia Post-Governmental Collapse
The promising efforts undertaken by Somalis prior to 1991 elapsed with the ousting of Somali President Siyaad Barre during conditions of ongoing domestic conflict (Ford, 2001; Mohamud and McAntony, 2006; UNICEF, 2016). Following the political upheaval, Talle (2008) states that thousands fled in the midst of increasing decline. Presently, combatting FGM has continued largely through initiatives promoted by non-governmental actors (Gele et al., 2013). Although the country has overall seen little progress in terms of mitigation, areas such as Somaliland, following its declaration of independence during the time of governmental coup, have continued their work to combat FGM (Lunde and Sagbakken, 2014). Due to governmental failure, efforts have not been effectively employed on a scale sufficient in magnitude to procure evident change in either practice or attitude.
Persistence of FGM
Despite efforts from multiple actors, the practice of FGM remains widespread, to the detriment of Somali women. The resilience of FGM can be ascribed to cultural entrenchment, religious ties, social conventions and conformity to norms, patriarchal societal structures and requirements for marriage. Additionally, factors such as rejection of alleged Western agendas, deficient combatting efforts, false pretenses regarding effects, definitional ambiguity and monetary incentives further contribute to continuation.
Cultural Entrenchment
According to Gele et al. (2013) FGM “…has been practiced by the Somali people since time immemorial…” (p. 2) indicating that the tradition is inextricably linked with notions of cultural heritage. The custom is believed to predate Islam, a religion followed by many Somalis (Khaja et al., 2009) suggesting that present continuation is in large part due to the significance FGM has gained throughout history. In spite of the harmful effects, Somali people are unwilling to accept the practice’s abandonment, declaring it to be an essential element of their culture (Gele et al., 2013; Lunde and Sagbakken, 2014). The longevity of FGM presents difficulties of varying proportions in regard to discontinuation. It is likely that certain groups within Somalia will cede the custom with more severe backlash than others – a phenomenon that will present obstacles to attempts to reduce FGM’s prevalence.
Religious Ties
Although FGM, as ascertained by academics and others, is not linked to the Islamic religion, many Somalis believe the practice to be a religious requirement (Lunde and Sagbakken, 2014) – a misconception that presents further barriers towards eradication. Disastrously, Neuwirth (2018) finds that death resultant of complications from FGM is often regarded as divine intervention by the families of those who have passed away. This perception highlights the mindset of Somalis toward the tradition – even in times of preventable fatality attitudes do not waiver. Opinions such as these are furthered by the support of religious leaders (WHO, 2018) who are highly powerful in shaping community attitudes. Advocacy by these prominent figures thus leads to acceptance of the practice, in attempts to act in accordance with religious expectations.
Social Conventions and Conformity
Within Somalia, social conventions (WHO, 2018) denote that girls must go through FGM in order to remain welcome in society and avoid the widespread stigma associated with being buurya qab – a term with negative connotations used to refer to women who have not endured FGM (UNICEF, 2013; Lunde and Sagbakken, 2014). Findings by Chalmersn and Hashi (2000) indicate that “[n]ot having the procedure performed may be psychologically more disturbing in these cultures than having it performed” (p. 228), demonstrating the difficulty those without mutilated genitals may face in their communities. In a social climate such as this, it is difficult for individuals to go against norms, inarguably presenting an impediment towards change.
FGM and Marriage
According to custom, undergoing FGM renders women suitable for marriage (Shetty, 2014), with WHO (2008) finding that the majority of Somali men refuse to enter marital union with a woman whose genitalia have not been altered. One of the largest obstacles thwarting eradication of FGM is its connection to marriage, with research findings indicating that continuance of the practice is largely linked to this social ritual (UNICEF, 2014). Although these tendencies derive from patriarchal structures perpetuating unequal gender expectations (Borsand et al., 2015; WHO, 2008), women are compelled to comply as marriage is viewed as one of the few, or even only, means of prospering in society (Abubakar, 2013). Additionally, FGM is seen as a way to guarantee virginity (WHO, 2018), without which suspicions of impurity may arise.
The role FGM plays in marriage is an obstacle in itself as women in developing countries, including Somalia, often have little jurisdiction in regard to their future. This barrier is further compounded by the fact that the procedure primarily takes place with the approval of a female guardian, leaving women and girls with little sovereignty over their physical or social futures.
Western Agendas
The perception of eradication strategies as the imposition of foreign, or Western, beliefs upon Somali society (Pflanz, 2011) presents a further hindrance in ending FGM. People of all backgrounds are commonly averse to intervention by outside forces that attempt to dictate which societal customs are authorized or disallowed, especially those which have persisted throughout long periods of history. The viewpoint of Somalis is understandable as many cultures resist change related to long held traditions. Strategies that appear foreign or ill-willed, may thus stimulate a further desire by Somalis to prevent the custom from falling out of practice.
Deficient Efforts to Combat FGM
Although efforts to combat FGM have been present for decades, the practice remains ubiquitous. Explanation can be found partly in the ineffectiveness of government action. In Somalia, the practice is not presently prohibited by law (Neuwirth, 2018); however, governmental efforts offer promise in their renewed attitude towards eradication, coupled with increasing media attention. Lack of consistency in efforts against FGM can be attributed to corruption, failure to achieve results, and apprehension held by the government due to controversy surrounding the issue (UNICEF, 2016; O’Grady, 2018; Adebayo, 2018). These efforts have done little to discourage active participation in the process, thereby allowing FGM to flourish unrestrained. The governmental leniency perpetuates a viewpoint that normalizes the custom.
Definitional Ambiguity
Outside interventions intending to eradicate FGM have caused confusion with regard to the forms of FGM targeted, with Lunde and Sagbakken (2014) finding that, “[a]lthough there is a change in terminology, it does not necessarily reflect a change in the practice” (p. 175). Issues with properly defining the practice and utilizing incorrect terminology in eradication campaigns have led to some forms of FGM, namely Sunna, being viewed as not harmful, due to the misperception of Pharaonic as the focus of anti-FGM campaigns (Lunde and Sagbakken, 2014). Thus, if terminology lacks proper clarity, the practice is provided with additional potential for continuation because interventions are ineffective in targeting the breadth of the issue and achieving the specificity required.
Sunna and False Perceptions
Recently, it has been found that FGM in Somalia has shifted towards less severe forms, namely Sunna (Gele et al., 2013). Studies in an Ethiopian Somali diaspora community by Mitike and Deressa (2009), and research in Somaliland by Gele et al. (2013), reveal that the majority of participants plan to have their daughters undergo this form of the procedure. Furthermore, a Somali woman interviewed revealed that, “Pharaonic is going down, and people now ask for [S]unna” (UNICEF Somalia, 2004, p. 5). Opinions such as these are largely based on the notion that Sunna forms of FGM are benign in terms of the possibility of inflicting bodily harm (Gele et al., 2013); however, WHO (2008) maintains that all forms of FGM have the potential for negative effects. Therefore, it follows that all forms of the practice should be clearly defined, and false information eliminated.
Reasons to End FGM
From preceding discussion, it can be seen that the forces and movements contributing to the custom’s perpetuation have a variety of negative implications. While there are many reasons to end this damaging practice, this section focuses on FGM as a violation of human rights and autonomy as well as two principal negative implications, these being health effects and stress placed on the healthcare system.
Infringement on Human Rights
According to WHO, “FGM is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and…is nearly always carried out on minors and is a violation of the rights of children” (2018, n.p.). Despite global recognition of the problem, the proportion of Somali girls afflicted each year remains overwhelmingly high. The violation presented necessitates an end to the practice, as any activity of this nature is intolerable, to both women who have undergone the procedure, and those considering the practice a contravention of human rights. In spite of explicit acknowledgement by intergovernmental organizations (IGOs) through various publications, the practice remains pervasive throughout Somalia and some diaspora communities.
Violation of Autonomy
Soraya Mire, a survivor of FGM during adolescence, details her experiences during the procedure, stating “…I had become a tortured prisoner for trusting my own mother…my body was not my own anymore….it belonged to someone I didn’t even know” (Mire, 2011, p. 60). This heartbreaking account details the loss of autonomy many who undergo FGM face in the aftermath of excision (WHO, 2008). As described previously, the majority of FGM procedures are performed upon minors, a group unable to provide consent. This situation creates a scenario under which parents are permitted to make the life-altering decision for their children, in the absence of any medical necessity. The pressure for conformity too often leads FGM to take place under the wishes of one or both parents, leading young girls and women to incur irreversible bodily harm that will likely result in further problems throughout the remainder of their lives. The loss of autonomy incurred by this procedure is an important reason to end the custom, as girls and women should not be involuntarily made to face such violation for the sake of preserving cultural heritage.
Negative Implications
In addition to the multiple violations represented by the practice, two crucial factors which demonstrate a need for discontinuation are the myriad of health effects and consequent burden upon health care systems.
Health effects. Health-related implications, both physical and mental in nature, range in severity. Individuals who have undergone FGM often experience severe mental trauma due to the crude nature of the practice, enduring psychological impacts in some cases for the remainder of their lives (UNICEF Somalia, 2004). According to UNICEF (2016), some women face depression and other feelings of unhappiness following the procedure. However, psychological effects are not limited to women because the custom affects sexual behaviour, thereby presenting relationship problems which can, in some cases, lead to the suicide of either partner (UNICEF, 2016; UNICEF Somalia, 2004).
The physical effects of the procedure form a lengthy list, occurring immediately or in a long-term context. According to UNICEF Somalia (2004), those who have undergone FGM often acquire or have a heightened susceptibility to infection, this being due to the unhygienic materials used and increased exposure through bodily wounds. The majority of complications relate directly to the genital area, such as urinary difficulties, cysts, deformity, scarring, and pain (Ismail et al., 2016; Chalmersn and Hashi, 2000; Ford, 2001). Furthermore, the process of childbirth is frequently impacted as women are at increased risk of becoming infertile, or of experiencing complications during the birthing process, oftentimes resulting in death of the mother, child, or both (Ford, 2001; WHO, 2018). Eradicating FGM would prevent, or at least reduce the prevalence of, the multitude of conditions described above.
Stress on healthcare system. Health effects resultant from the procedure have major implications for healthcare systems which treat patients who have undergone excision. UNICEF (2016) finds that FGM survivors are at increased risk for heath related tribulations, in turn resulting in added strain on care facility resources (Gele et al., 2013). Maternal mortality is elevated as a result of FGM, while many women require additional operations following the initial procedure, due to complications (Ford, 2001; Chalmersn and Hashi, 2000). The custom exerts further pressure on regional healthcare facilities which are too often already facing strain.
Somali Diaspora of FGM
The governmental collapse in early 1991 has resulted in many Somalis fleeing their country in search of a better life. Consequently, the tradition of FGM has entered nations now home to diaspora communities, despite laws prohibiting the practice in most destination countries (UNICEF, 2018; Khaja et al., 2009). The possibility of facing criminal prosecution for practicing the custom has resulted in FGM occurring largely in secret within communities abroad (Shetty, 2014). The clandestine nature of the practice poses potential risks to Somalis, with many who have undergone the procedure in their home country neglecting to seek medical care because Western practitioners lack adequate comprehension of FGM (Chalmersn and Hashi, 2000). The diaspora of Somalis should warrant recognition of FGM as a global problem.
Contemporary Somali Attitudes Toward FGM
In spite of efforts aimed at eradicating the practice, many Somalis are unwilling to leave the tradition in the past, with UNICEF (2013) finding “[a]lmost two thirds of girls and women think the practice should continue” (p. 3). UNICEF (2013) states that, within this group, the highest rates of support for continuation were from those in rural areas and generally impecunious. This shocking finding indicates that attitudes towards the practice remain rigid, and require further programs aimed at elimination. Specifically targeting communities with high levels of support for FGM would prove beneficial, as it is likely these areas and demographics may have not been reached by movements within urban centres. While women maintain the highest levels of support, this issue has been furthered by the perpetual desire, held by men, to marry women who have undergone excision (Gele et al., 2013). This preference is a likely contributor to the attitudes of women towards the practice because, as previously noted, marriage is often crucial to prosperity.
Although widespread support remains, recent research conducted in communities has found evidence of changing attitudes. A prevalent subject of discussion has been the emerging preference for less severe forms of FGM (Gele et al., 2013). This has contributed to decreased rates of invasive forms, although this should not be understood as a beneficial change, due to the perpetuation milder practices reinforce (Mohamud and McAntony, 2006). Promisingly, regional studies have found that some groups, specifically younger generations and men, oppose the practice at perceptible levels (Mitike and Deressa, 2009; Abubakar, 2013). Furthermore, Chalmersn and Hashi (2000) found that some women would be open to leaving their daughters’ genitalia unaltered, although they remain fearful of community backlash.
Future of FGM in Somalia
Recent research in Somalia indicates that movement towards milder forms of FGM will continue. Meanwhile, various efforts to eradicate the practice are commencing presently, or projected to begin in the near future.
Movement Toward Milder Forms
Mitike and Deressa (2009) chronicle “…a reported shift of FGM from its severe form to milder clitoral cutting” (p. 1). This observation is paralleled widely in literature on the subject, appearing to indicate the future, predominant, form of the practice. With Gele et al. (2013) finding one participant to claim “…leaving girls untouched has no room in their culture” (p. 5) it appears unlikely that past efforts have led to tangible change in altering opinions appealing to abandonment. Studies indicate that the commonness of extreme forms is explicitly decreasing (UNICEF, 2016). However, interpreting the decision to adopt less severe practices as progress misrepresents the larger issue (Ford, 2001) – the presiding and persistent notion that the mutilation of non-consenting youth is acceptable.
Contemporary Efforts
From a review of literature regarding attempts to discontinue FGM, it is clear that valiant endeavors have been undertaken to end the process over the last several decades by both IGOs and grassroots organizations. Projects have been present within local communities since the 1970s, according to Khaja et al. (2014), with local Somalis, namely women, spearheading the call for eradication. UNICEF (2016) found that the practice has been banned across the country by separate governmental forces, however, at present no laws have formalized this alleged criminalization (Adebayo, 2018). Common methods of eradication include awareness initiatives, some of which advocate against the medicalization of FGM, wherein the procedure is performed in a formal healthcare setting (Lunde and Sagbakken, 2014; Mohamud and McAntony, 2006).
Although there has yet to be an international decree, encouraging efforts have recently been displayed in the nation’s first ever trial against FGM, due to the death of a ten-year-old Somali girl in early September 2018 (Adebayo, 2018). This development points towards a hopeful future in which prosecution of FGM will become commonplace.
Possible Solutions
Thorough review of related literature provides numerous possible solutions to this seemingly intractable issue. The most promising suggestions involve furthering legislation, with prosecution occurring under laws specific to the practice, as well as eradication programs aimed at education involving both IGOs and grassroots assemblages that encourage participatory efforts, discussion, feminist methodologies, and community-wide decisions (WHO, 2008; Mohamud and McAntony, 2006; Gele et al., 2013; Shetty, 2014; Levin, 2011). These educational strategies should primarily focus on issues of health and religion, with the latter involving introduction to groups who follow Islam but do not practice FGM (Shetty, 2014; Pflanz, 2011; Vestbøstad and Blystad, 2014).
Further initiatives that could bring about tangible change relate to the inclusion of influential figures such as elders, men, religious and community leaders, and practitioners of FGM, including health care workers (Mohamud and McAntony, 2006; Mitike and Deressa, 2009; Pflanz, 2011). The medicalization of FGM must be actively rejected in order to dismiss false impressions of permissibility, while the employment of appropriate language is necessitated due to the ambiguity surrounding terminology used in previous approaches (Mohamud and McAntony, 2006; Lunde and Sagbakken, 2014).
Conclusion
This paper has aimed to explore the practice of FGM in Somalia and describe the seemingly innumerable negative implications that have impacted and continue to affect Somali society. The future of FGM eradication appears promising based on recent developments, namely the groundbreaking prosecution conducted as of late. However, there remains great need for increased efforts on the part of both IGOs and local governing forces within Somalia. The custom of FGM has, without question, continued for far too long, undoubtedly facilitated in part by the present governmental situation afflicting the Somalian state.
It is imperative to further ongoing efforts as, hopefully with increasing advocacy and awareness, palpable change will be reached, in turn liberating Somali women and girls from the burden imposed by FGM. Optimally, efforts must remain aware of the cultural significance of the practice. Ideal strategies will permit change to occur under the acknowledgement of negative effects of FGM by Somalis themselves, rather than solely via unshared views imposed by way of external intervention.
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