I found it almost impossible to find information on this crisis in the university library, which is an indication that these are a forgotten people. This paper will venture into a world forgotten by mainstream western media, governmental interventions, and global concern for these women is void. These women struggle daily with the systematic violation of their bodies and constant fear for their lives; the purpose of this paper is to bring context to the global phenomenon of violence against women. Highlighting the fact, that violence takes many forms some of which are not visible in Western culture but is paramount in the daily lives of women in the South, and to explore violence against women as a problem rooted in structural, cultural, and traditional conditioning. FGM and Fistula are traditionally constructed and affects millions of women globally, under the pretext of cultural and religious beliefs, fathers, brothers, uncles, and male cousins seek to control women and their sexuality in both the public and private sphere.
The World Health Organization (WHO 2008) defines female genital mutilation (FGM), also known as female circumcision or female genital cutting as, "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons".
The procedure is traditionally carried out by an older woman, with no medical training anesthetics and antiseptic treatment are not generally used and the practice is usually carried out using basic tools such as knives, scissors, scalpels, pieces of glass and razor blades. Often iodine or a mixture of herbs is placed on the wound to tighten the vagina and stop the bleeding.
The age at which the practice is carried out varies, from shortly after birth to the labour of the first child, depending on the community or individual family. The most common age is between four and ten, although it appears to be falling. This suggests that circumcision is becoming less strongly linked to puberty rites and initiation into adulthood.
A historical perspective
Although the origin of FGM is uncertain, there is evidence from Egyptian mummies
That female circumcision was routine practice 5000 years ago (Elchalal et al., 1997).
In ancient Rome slaves had metal rings passed through the labia minora (the labia minora are the folds of skin found within the inner portion of the vulva) to prevent Procreation and women in medieval England wore chastity belts. These practices are not specially associated with any particular religious faith, as they have been observed in Muslims, Jews, Christians and animists alike (Morris, 1999), and actually predate these religions.
Bantock, 1866 suggested the clitoris had a rudimentary role, with clear functional and anatomical differences between it and the penis. The virtues of the procedure as a cure for the 'vice' of masturbation asserting that, "surgery comes to the rescue and cures what morals should have prevented" Although such radical methods were aimed at male control over female chastity.
Many explanations have been put forward to explain the practice of FGM, varying
with individual culture. These include maintaining marital fidelity, controlling the female sex drive, preventing lesbianism, ensuring paternity, calming the female personality, and to prevent the clitoris growing long like the penis (Eke & Nkanginieme, 1999). Other reasons cited are to improve hygiene, aesthetics, and community belonging and to enhance fertility-these explanations are arguably partly driven by 'sexist' views of women as subservient to men and second-class citizens of society.
Rising Daughters Aware, 1999) argues that in some societies a woman's honor is dependent on her being circumcised. For instance, in a village where all the women have
been circumcised, not to be circumcised is to become a social pariah, and lose all chance of having a husband. It is therefore understandable that pressure would be brought to bear by relatives and the community on women to undergo such procedures. In societies where a woman's position is low on the social echelon, an important rite of passage is an opportunity to be honored, even celebrated, and is therefore likely to be an event that is romanticized and clung on to. The complexity of this cultural interplay was noted in a study that found over 60% of 282 female student nurses in Egypt favored circumcising their own daughters and considered it beneficial (Dandash et al., 2001).
Female genital mutilation (FGM) is practiced in at least 34 countries and in diverse cultures affiliated with different religions, including Islam, Christianity, and animistic belief systems (Sarkis, 2003). Conservative estimates suggest that 100 to 140 million girls and women worldwide have undergone FGM, with some reports estimating up to 300 million girls at risk (World Health Organization, 2008a). Depending on local custom, the procedure is performed any time between infancy and adulthood but usually when the girl is between 4 and 10 years old (Toubia, 1994). FGM is generally performed by laypersons, including family members, often with nonsterile instruments and without anesthesia, analgesics, or antibiotics (Nour, 2004).
The World Health Organization (WHO) describes four types of FGM (WHO, 2008b). Type I also called Sunna circumcision is the removal of the prepuce with or without removal of the clitoris; Type II involves clitoridectomy and cutting of the labia minora; Type III, also called Pharaonic circumcision, involves partial excision of the labia majora, with subsequent sewing of the remaining tissues to seal the vagina, leaving a hole for evacuation of urine and menstrual blood. Type IV refers to "harmful" and "nonmedical" practices that do not fit into these categories and includes burning, pricking, stretching, scraping, and piercing. The WHO recognizes that Type IV FGM is broad and includes practices that may not constitute "mutilation", such as labial lengthening in Rwanda (Mwenda, 2006) and genital piercing or postpartum vaginoplasty in the United States.
Traditional and local terms for FGM
Country
Term used for FGM
Language
Meaning
EGYPT
Thara
Arabic
Deriving from the Arabic word 'tahar' meaning to clean / purify
Khitan
Arabic
Circumcision - used for both FGM and male circumcision
Khifad
Arabic
Deriving from the Arabic word 'khafad' meaning to lower (rarely used in everyday language)
ETHIOPIA
Megrez
Amharic
Circumcision / cutting
Absum
Harrari
Name giving ritual
ERITREA
Mekhnishab
Tigregna
Circumcision / cutting
KENYA
Kutairi
Swahili
Circumcision - used for both FGM and male circumcision
Kutairi was ichana
Swahili
Circumcision of girls
NIGERIA
Ibi / Ugwu
Igbo
The act of cutting - used for both FGM and male circumcision
Sunna
Mandingo
Religious tradition / obligation - for Muslims
SIERRA LEONE
Sunna
Soussou
Religious tradition/ obligation - for Muslims
Bondo / Sonde
Mendee
Integral part of an initiation rite into adulthood - for non Muslims
Bondo
Mandingo
Integral part of an initiation rite into adulthood - for non Muslims
Bondo
Limba
Integral part of an initiation rite into adulthood - for non Muslims
SOMALIA
Gudiniin
Somali
Circumcision used for both FGM and male circumcision
Halalays
Somali
Deriving from the Arabic word 'halal' ie. 'sanctioned' - implies purity. Used by Northern & Arabic speaking Somalis.
Qodiin
Somali
Stitching / tightening / sewing refers to infibulation
SUDAN
Khifad
Arabic
Deriving from the Arabic word 'khafad' meaning to lower (rarely used in everyday language)
Tahoor
Arabic
Deriving from the Arabic word 'tahar' meaning to purify
FGM has been reported to put women at increased chronic risk for urinary tract infections, HIV infection, abscesses, epidermal inclusion cysts, neuromas, dysmenorrhea, poor urinary flow, hematocolpos, urinary incontinence, dyspareunia, vaginismus, primary infertility, and disfiguring scar formation (Adams, Gardiner, & Assefi, 2004; Almroth et al., 2005). Obstetric complications include increased rates of non-elective caesarean delivery, increased requirement for episiotomy, postpartum hemorrhage, extended maternal hospital stay, increased need for resuscitation of the infant, and prenatal mortality of both mother and baby (Banks et al., 2006; Rushwan, 2000).
The World Health Organization (WHO, 1997) estimates that over 130 million
girls and women have undergone some form of circumcision, and that are up
to 6000 new cases every day. In a number of African countries national rates range
from 5% to 98%. In Somalia, for instance, over 90% of women undergo an extensive form of circumcision and 1% of women giving birth die because of complications resulting from circumcision (WHO, 1993). The main causes of high short-term mortality and morbidity are hemorrhage and infection (Barstow, 1999). Other long-term medical complications include infertility, urinary retention and infection, haematocolpos {a medical condition in which the vagina fills with menstrual blood. It is often caused by the combination of menstruation with an imperforate hymen}, and the formation of fistulae (Barstow, 1999; Morris, 1999), as well as an increased risk of contracting HIV (Brady, 1999).
Fistulas are a kind of damage that is seldom seen in the developed world. Many obstetricians have encountered the condition only in their medical texts, as a rare complication associated with difficult or abnormal childbirths: a rupture of the walls that separate the vagina and bladder or rectum. Where health care is poor, particularly where trained doctors or midwives are not available, fistulas are more of a risk. They are a major health concern in many parts of Africa.
During pregnancy, many further complications may occur as a direct result of the FGM. Labour may become obstructed and if early medical intervention is not provided this may lead to the death of both baby and mother. WHO estimates that many women giving birth die in the process, simply because of FGM 19. If the mother and baby survive there is the risk of damage to the vagina leading to the formation of fistulas into the bladder or bowel, which cause constant incontinence as a result of a vessico-vaginal fistula or recto-vaginal fistula. Women in this condition are often rejected by their family and become social outcasts (http://www.ednahospital.org/hospital-mission/female-genital-mutilation/).
According to the United Nation Population Fund (UNFPA) Poverty, malnutrition, poor health services, early marriage, and gender discrimination are interlinked root causes of obstetric fistula. Poverty is the main social risk factor because it is associated with early marriage and malnutrition and because poverty reduces a woman's chances of getting timely obstetric care. Because of their low status in many communities, women often lack the power to choose when to start bearing children or where to give birth. Childbearing before the pelvis is fully developed, as well as malnutrition, small stature and general poor health, are contributing physiological factors to obstructed labour. Older women who have delivered many children are at risk as well(http://www.unfpa.org/public/).
Why do so few people know about fistula?
Fistula is a relatively hidden problem, largely because it affects the most marginalized members of society: young, poor, illiterate women in remote areas. Many never present themselves for treatment. Because they often suffer alone, their terrible injuries may be ignored or misunderstood. The Campaign to End Fistula is working to break the silence around this condition and the stigma attached to it.
Is there a connection between female genital cutting (FGC) and fistula?
Female genital cutting is condemned by most governments because of its devastating consequences on women's reproductive health, UNFPA is actively working to end the practice. Nevertheless, the practice persists in many areas where obstetric fistula is prevalent as well. Although FGC can increase the risk of hemorrhage and infection during childbirth, it is not clear whether it is typically a causal factor in the formation of fistulas. However, two fairly radical forms of FGC, the Gishiri cut, which is practiced in northern Nigeria, and infibulation, the stitching up of the vagina, can contribute directly to fistulas.
What are the medical consequences of fistula?
Left untreated, fistula can lead to frequent ulcerations and infections, kidney disease and even death. Some women drink as little as possible to avoid leakage and become dehydrated. Damage to the nerves in the legs leaves some women with fistula unable to walk, and after treatment, they may need extensive physical rehabilitation. These medical consequences, coupled with social and economic problems, often contribute to a general decline in health and well-being that result in early death. Some commit suicide. However, many women with fistula are strong - as demonstrated by their having survived prolonged, traumatic labour - and they can live a long time. Some women have lived with the condition for 40 years or more (http://futurechoices.net/articles/obfist/faq_obf.htm#anch3).
According to Desiree Zwanck, a gender adviser to Heal Africa Women has suffered fistulas from rapes with knives, guns, and penises.
Conclusion
This paper was a challenge for me to research but it gave me great insights into the plight of some women in developing countries. Misogyny (hatred of women) exists in most male-dominated societies and is a magnified and very intense version of thoughtlessness. I am in total agreement it Caroline Sweetman when she states that cultural diversity is not the deciding factor in whether or not women experience violence and it cannot be used to justify non-intervention. Culture also does not define whether or not violence against women is acceptable or unacceptable, just as cultures does not determine whether or not economic exploitations leads to absolute poverty, or high infant mortality should be accepted. All violence must be seen as unacceptable (p. 14).
She suggests that actions against violence against women should include effective legal measures, penal sanctions, civil remedies, and compensatory provisions to protect all women against all kinds of violence, including violence in the family, sexual assault, and sexual harassment in the workplace as well as preventative education programs to change attitudes concerning the roles and status of men and women. In a conversation with a Somalian co-worker, she confided in me that she was a victim of FGM, something that has caused her immeasurable pain and medical trauma. She also confided that because of the culture in which she was raised she given no choice as to whether she would have the procedure done; she vows that her daughter would never be subjected to such torment. Her decision cost her dearly as her family has been ostracized because of her refusal to continue the tradition. She also informed me that the cultural practice is prevalent in Canada and mothers who have to access to have it done in Canada would travel many miles to have it done. Women she is familiar with have claimed refugee status in Canada in order to escape male dominated persecution. When asked if her community was aware of the illegality of the act she responded that the level of secrecy in her community would not allow that traditional secret to be made public.
In May 1997, the federal government amended the Criminal Code and included the performance of FGM as aggravated assault under section 268(3).[31] Under the Criminal Code, any person who commits an aggravated assault is guilty of an indictable offence and is liable to imprisonment for a term not exceeding 14 years.[32] A parent who performs FGM on their child may be charged with aggravated assault. Where the parent does not commit the act but agrees to have it performed by another party, the parent can be convicted as a party to the offence under section 21(1) of the Criminal Code.[33]
Any physician who becomes aware of a procedure of this nature being performed by another physician should, in accordance with the Code of Ethics, bring this information to the attention of the College at the earliest opportunity. Since the performance of circumcision, excision and/or infibulation on any female child by any person may constitute child abuse, the Children's Aid Society and appropriate police agencies must be notified.[41] (http://www.ohrc.on.ca/en/policy-female-genital-mutilation-fgm/4-fgm-canada)
