How surgery is saving women from FGM pain during child birth

Faudhiya, not her real name, clearly remembers the day, at age 12, when her mother persuaded her to consider undergoing circumcision, a topic she had previously refused to even think about despite being exposed to extensive information about Female Genital Mutilation (FGM).

"If I could turn back time, I wouldn't have agreed to undergo the ritual. But I was afraid to refuse my mother's request because I believed she knew what was best for me as her daughter," said Faudhiya.

She recalls her mother mentioning that women who had undergone the procedure were more esteemed in their culture and considered more attractive compared to those who had not.

"As a young girl, I didn't question much because even my own mother had undergone the procedure. I assumed that since she had given birth to us after undergoing it, it couldn't be that harmful or inhumane."

However, after the procedure, her life took an unexpected turn. She began to experience intense pain in everyday activities such as using the bathroom, causing her considerable distress. She even had to endure holding her urine for extended periods. Although she eventually healed after a few weeks, she initially thought everything had returned to normal.

"After the procedure, my menstrual cycles became significantly more painful than before. Every month, I dreaded the experience and often had to stay home, though my family didn't consider it a major issue."

Years later, when she finally got married, she faced the most shocking realisation of her life. The very procedure she had been persuaded to undergo for attractiveness had serious consequences. It ultimately contributed to the end of her first marriage.

"Copulation became a source of dread for me, to the point where I avoided discussing it despite being married. My husband tried to endure it for a while, and we attempted counselling, but the pain I was experiencing didn't improve. Eventually, we mutually agreed to end the relationship," said Faudhiya.

When she raised the issue with her mother, she advised her to endure the pain, saying it was normal and that she should try to stay positive about it.

"I grew very bitter towards my mother because I felt deceived. No solution was being offered, only encouragement to endure. I questioned how long I could bear it and desperately wanted to find a way to resolve the issue," said Faudhiya.

Years later, she married again. During childbirth, she opted for a reversal procedure, a decision she says has transformed her life and that of her family.

"Never did I imagine I would find relief, but during a clinic visit, I confided in a healthcare provider who advised me that a minor procedure could reverse it. This allowed me to give birth naturally and quickly, with fewer complications."

Despite the relief she found, Faudhiya has never disclosed to any of her family members or close friends, not even her husband, that she underwent the reversal procedure, a secret she intends to keep forever.

Rubbina Machoka, a nurse at Anisaa Hospital in California Eastleigh, notes that many women who have undergone female genital mutilation (FGM) experience significant fear and anxiety during pregnancy and delivery.

"Many women often fear allowing healthcare providers to examine their reproductive organs, leading to prolonged labour before they consent. We strive to counsel and reassure them that they are in safe hands and that everything will proceed smoothly," says Machoka.

Doctors attend to patients at a Kenyan hospital in the past. (Photo: Courtesy)

She highlights that the challenges are particularly pronounced with first-time mothers who have heard negative stories about childbirth after FGM.

"In my experience, I've seen varying degrees of cuts, some more severe than others. However, the common factors are the stigma, shame, and increased pain endured by these mothers due to the interference with their reproductive organs," Machoka says.

To assist these mothers, they carefully inquire about their experiences and provide advice to prevent avoidable complications.

"We make every effort to encourage mothers to open up so we can advise their families accordingly. However, there are cases where a mother refuses to disclose her history or allow an examination until labour contractions begin," Machoka explains.

Extra precautions are taken in such cases to ensure the safety of both mother and child, aiming to prevent excessive bleeding and complications.

Machoka also says a growing number of mothers are opting for reversal procedures after delivery, which she describes as a great relief.

"We advise mothers that opting for reversal and subsequent closure surgery is crucial to avoid ongoing pain during childbirth. Many mothers accept this advice, marking a significant breakthrough."

According to the 2022 Kenya Demographic & Health Survey, the prevalence of FGM among girls and women aged 15 to 49 is 15 per cent.

Since Kenya banned FGM in 2011, the practice has shifted from public ceremonies to secretive procedures conducted in private homes and makeshift clinics.

Supporters of medicalised FGM argue that it preserves cultural traditions more safely, but UNICEF highlights its significant physical, psychological, and sexual health risks.

UNICEF reports an increasing incidence of medicalized FGM in countries like Egypt, Sudan, Guinea, and Kenya, which undermines efforts to eliminate this harmful practice.

Recognised by the WHO as a violation of human rights, FGM impacts millions worldwide and strains healthcare systems financially.

The four primary types of FGM—Type 1, Type 2, Type 3 (infibulation), and Type 4 (other harmful practices)—impose immediate risks such as intense pain, bleeding, infections, and long-term health complications, including urinary and menstrual issues, as well as psychological trauma.

More than 230 million girls and women globally have undergone female genital mutilation (FGM) in 30 countries across Africa, the Middle East, and Asia, where the practice is prevalent.

FGM is typically inflicted on young girls from infancy up to age 15. WHO recognises it as a violation of the human rights of girls and women.

The treatment of health complications stemming from FGM is estimated to cost health systems approximately US$ 1.4 billion annually, with this figure expected to rise unless urgent action is taken to eliminate the practice.

According to the United Nations Fund for Population Activities (UNFPA), despite Kenya's efforts to outlaw Female Genital Mutilation (FGM) with the 2011 Act, secrecy and deeply ingrained cultural and religious beliefs continue to fuel the practice. This ongoing challenge jeopardises the well-being of 4.4 million girls globally. Enforcing existing laws against FGM in Kenya is critical to creating a supportive environment for survivors and ending this harmful tradition effectively.

To achieve the goal of eradicating FGM by 2030, UNFPA emphasises the need to break down the stigma surrounding FGM. Establishing safe spaces where survivors can openly share their stories is crucial. These efforts are essential to keeping the conversation about FGM alive in communities nationwide, promoting understanding and collective action towards its elimination.