Finally, Justice for Suhair al-Bata'a

In one of our first blog posts, we lamented the decision of an Egyptian court to acquit the perpetrator of the botched circumcision that lead to the death of 13-year old Suhair al-Bata'a. How could an entire judicial system overlook the death of a minor, and by so doing, uphold a tradition that it had outlawed on the basis of another minor's death? How could it fail to implement any sanctions when 700 USD had cost the life of a child? In a reversal of fortunes however, the Egyptian courts conducted a retrial of both the doctor and the father of Suhair who had been responsible for the chain of events that led to her demise. The court convicted Dr. Raslan Fadl of manslaughter and sentenced him to two years in prison for the offence and three months for performing the genital surgery. His clinic will be closed for a year. Suhair's father was handed a three-month suspended sentence. Advocates against FGM/C in Egypt and around the world are hailing this development as an important stride in the campaign against the practice, especially in a country that has a prevalence rate of 91.1%. Indeed, the earlier acquittal raised questions about the effectiveness of instituting legislation against the practice. However, national laws against FGM were not encouraged as the only intervention for curbing FGM, but as an attendant to the ongoing efforts of discouraging the practice.

Another FGM/C trial is now ongoing in the UK, where Dr Dhanuson Dharmasena has been accused of performing a reinfibulation in 2012. Reinfibulation is "the practice of re-suturing and thereby creating an infibulation following a procedure in which the infibulation has been partially or fully opened, most commonly to facilitate childbirth" (WHO 2010). In this case, Dr. Dharmasena did not leave the infibulation open as has been recommended as best practice during post delivery care for women who have undergone FGM. Reinfibulating one's patient not only constitutes an offence under the UK 2003 Female Genital Mutilation Act, but it also leads to additional physical and psychological trauma for the woman. It amounts to performing FGM/C all over again. According to Dr. Dharmasena, he was unaware that his actions counted as an offence under the law. He maintains that he was simply following the wishes of patient. While we are yet to see what the UK will conclude on this case, we can consider what this case reveals about the state of healthcare and its relationship to FGM/C.

Dr. Dhanuson Dharmasena
Image Source: mirror.co.uk

Healthcare providers need to be educated on FGM/C. In today's world, and especially in countries where a significant number of the population practice FGM/C, doctors cannot afford to remain ignorant about FGM/C. Indeed, such ignorance can only lead to substandard and insensitive care for pregnant women who are circumcised. Countries need to develop and fully implement training protocols on pre and post-delivery care for women who have undergone FGM/C. Such care should be done within an atmosphere that fosters respect for the pregnant mother, while explaining why a reinfibulation will not be performed i.e it may lead to physical, psychosexual and obstetric complications. Individuals trust their lives to doctors, and doctors should never abuse this trust, whether for financial gain or out of ignorance.

****Read our other blogpost on doctors and FGM/C.
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The Battle Over Her Body

Late last year, a group of Samburu elders met together to deliberate on insecurity in their community. While discussing interventions that they would initiate, the group declared that FGM/C remained an important cultural practice that needs to continue. One man who was later interviewed affirmed the position of the group, going on to say that any child born of an uncircumcised woman would be killed. Covered by the Kenyan media, the encounter raised serious questions about the extent of FGM/C practice in the community. Even more worrying was the silence of both male and female leaders in the area who did not immediately condemn the stance of the 3,000 men present. However, the most shocking revelation was the callous manner in which the men insisted on the killing of children born to uncircumcised women.

Samburu Elders Endorse FGM as a Critical Cultural Rite.

Source: NTV

The statement may reveal the role of FGM/C in brokering access to sex and reproduction, or perhaps ensuring that children could only be born within a marriage relationship. Nevertheless, such cultural explanations have no place today. Instead, they underscore a double standard. The Samburu do not culturally value virginity, and uncircumcised girls are encouraged to have sexual relations with the Samburu morans. Such fraternizing can only increase the likelihood of an uncircumcised girl falling pregnant. Furthermore, the statement highlights how the Samburu woman's body has become a site for exploitation; for the fulfillment of men's vision for Samburu women. It's a statement reifying one of the feminist theories that has been applied to FGM/C - FGM/C as a sign of patriarchy and control of women's sexuality. 

Indeed, FGM/C, while practiced on women by women, is supported within a societal and cultural framework that includes men. Samburu girls not only undergo FGM/C, but a number are also subjected to early marriage, especially in the marginal areas. Advocating against FGM/C is thus not only mitigating physical and psycho-sexual consequences on the female body, but it's also encouraging the community to allow girls to own their bodies and their futures. It's welcoming women into the conversation around sex and reproduction that culture often deems to be the preserve of men. It's allowing our communities to take part in global conversations on women's rights and liberties, even while maintaining the cultural aspects that we collectively esteem.

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Should Doctors Collect FGM/C Data during Antenatal Care?

Doctors need to step up the fight against FGM/C. FGM/C impacts women during child birth, leading to obstetric complications like prolongation of second stage labour, tears and subsequently fistula or episiotomy so as to remove the obstruction. If the obstetrician is caught unaware, he or she will resort to performing a C-section on the mother. Others include perineal tears and infections, fetal distress, cerebral palsy and even still birth. Hence, doctors should record histories of women during antenatal visits. 

At the hospital, doctors are at the point of contact with possible victims of FGM/C and can easily counsel and guide them given their training on the matter rather than waiting to the point of emergency. Kenyan medics should include FGM/C questions and facts in the antenatal cards and books recording a mother’s history. Alternatively, FGM/C prone areas can have a register and questions asked while taking history. These records would not only give us information on what an area is experiencing but also give much needed data on the trend of this scourge. This will in turn make doctors aware so as to track antenatal complications in their area and subsequently see how they can improve the lives of mothers and children. 

Because FGM/C is a generational trend, doctors and clinicians should be well equipped with information and able to advice these women, thus creating more awareness on FGM/C complications. We need more ambassadors, especially medical practitioners, as the social dynamics have proven that people now go to doctors to perform FGM/C hence the term "medicalization of FGM/C." To curb this trend, the doctors should be armed with both socio-cultural and medical information counseling them against performing the cut. After all, no one would want to be caught uninformed, as their information will then lose credibility.

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Consent is no Defence

This week at a validation workshop in a hotel in Nairobi several implementing partners in advocacy against FGM/C met to validate an abridged version of the Prohibition of Female Genital Mutilation Act 2011.

One of the interpretations of the law proposed partly states that if a woman consents to undergo FGM/C, she has not committed an offence. Such an interpretation shows a gap in the existing law and presents a setback in the efforts towards abandonment of the practice. With worldwide prevalence at a high and abandonment efforts few, every loophole has to be addressed lest we run the risk of slowing down campaigns against FGM/C.

Commenting on this interpretation, ACCAF’s Dr Agnes Meroka notes: “The anti FGM law in Kenya covers both the traditional practices as well as medicalized practices. While the prohibition of FGM Act 2011 does not expressly mention medicalization as an outlawed practice this in itself does not mean that medicalization is not outlawed in Kenya. This act must be read together with articles 2(5), 2(6) 27, 28, and 29 of the constitution, which led to the conclusion that FGM, regardless of whether it is performed by a traditional practitioner or medical professional, constitutes a violation of fundamental rights and freedoms, and is a violation of the law.”

As we have noted in one of our posts, medicalized FGM/C does not mean safe FGM/C. Only last month in Egypt, Dr. Raslan Fadl was acquitted of murder charges that had been proffered against him after performing a botched FGM/C. The victim, 13-year old Suhair al-Bata’a succumbed to complications as a result of the surgery. In Kenya, medicalization is a new trend and is widely practiced by the Kisii. However, this medicalization contravenes the medical code of ethics. Allowing it to continue would give a green light to quacks in the industry to perform the act. Indeed, the mere fact that FGM/C can be performed under medical supervision does not alienate the complications a woman would suffer as a result of the operation. Hence, it is very important that the law is read and interpreted correctly to avoid such loopholes.

A lot of money, human resource, time and effort have been invested in the fight against FGM over the years. Every loophole has to be sealed, as gaps in our advocacy will thwart all the years and efforts of survivors and campaigners who want to see an end to this practice.

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Should Circumcisers Face Tougher Jail Terms?

The December holiday season in Kenya comes with a lot of activities, one of which is female genital mutilation/cutting (FGM/C). Patterns in the practice of FGM/C are now shifting from traditional hyped ceremonies to secret ceremonies performed at night, with only members of the household present. This shift makes it difficult to trace the circumcisers, who continue with the practice because they see it as a lucrative business that earns them up to Kshs. 20,000. Although laws have been put in place to discourage FGM/C, chiefs find it difficult to prosecute the perpetrators owing to the absence of consenting witnesses. Sometimes, the victims even deny that any harm was done to them.

After carrying out its own research into these changes, the Office of Director of Public Prosecutions in Kenya is proposing a set of new legal directives. An article by The Star Newspaper highlights this statement, noting that,

“to make it easier to arrest those who refuse to give up FGM, the office of Director of Public Prosecutions is proposing a raft of amendments to the Female Genital Mutilation Act to make it more punitive. The proposed amendments arise from a study report on FGM trends carried out by the DPP's office among various communities in the country. One of the key amendments is the introduction of a life imprisonment sentence for persons who perform FGM on children aged between 0 and 5 years. ‘This proposal caters for those communities that circumcise girls at their infancy as such it is difficult to detect. In communities such as the Tavetas, this has led to high infant mortality rates,’ the DPP's report says. The amendments will also introduce an offence of performing FGM on oneself and which will attract a one-year imprisonment and a fine of Sh100, 000. ‘There some communities where the girls or women cut themselves. This occurs mainly where the parents have refused to give their consent for the ceremony. This practice we found was common among the Ameru,’ the DPP's report says. Attempted FGM will attract an imprisonment of 5 years, according to the proposals by the DPP's team. The DPP is also proposing that it be an offence to use threats and intimidation is used to cover up for the commission of an offence. This offence, the proposals read, should attract a sentence of three years with no option of a fine. It will also be an offence for teachers and doctors withholding information on cases of FGM that come to their knowledge.”

What do you think about this proposal from the DPP's office?

Source: DPP proposes tougher jail term for FGM offenders

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700 USD for your life?

Late last week, news broke out that an Egyptian doctor prosecuted for performing FGM had been acquitted. This particular doctor, Dr. Raslan Fadl, circumcised Suhair al-Bata’a in a botched operation that resulted in Suhair’s death. Suhair’s parents had paid Dr. Fadl 700 USD for his services, only taking him to court after their daughter’s death. This case has gained international prominence because it represents the first time that Egypt has prosecuted anyone who has performed the procedure. It represents the first time that Egypt’s law prohibiting FGM has been used, albeit in a fashion that leaves much to be desired. (Tragically, the law itself came about following the death of another girl, 12-year old Badour Shaker)

FGM is widely practiced in Egypt, where over 90% of women and girls aged between 15 and 49 have been circumcised (UNFPA). Today, the prevalence varies based on residency (rural/urban) and wealth status, with urban and well-off women and girls reporting lower rates FGM prevalence. Apart from this high prevalence rate, Egypt also grapples with the difficult task of combating medicalization of FGM/C through advocacy efforts. Medicalization involves the use of health care providers typically in a health facility to conduct FGM. This medicalization of FGM is the phenomenon that led to Suhair’s demise. Reports indicate that Suhair suffered a significant drop in blood pressure and a severe allergic reaction to penicillin, a drug that would have been unnecessary had she been allowed to forgo the tradition.

13-year old Suhair al Bata'a died in June 2013 due to complications following FGM 

While Suhair’s case lets on plenty about the state of FGM advocacy in Egypt, it also complexifies the question of prosecuting FGM cases. For one, prosecuting FGM is only a recent development that has come up following the institution of national laws that outlaw the practice. Prosecution may involve proving intent of the parents or woman/girl to undergo circumcision, a task that may prove difficult if all actors collude to evade the law – as seems to have been the case in Egypt. Even more difficult is the question of imprisonment, where parents – who may be a family’s primary breadwinners – may face jail time leading to double traumatic experiences for the child in question.

Regardless of this difficulty, the Egyptian judicial system has failed Suhair. The 700 USD paid to keep her within tradition only resulted in her death. What’s more, the Egyptian  law criminalizing FGM allows plaintiff and defendant to settle their case out of court. This loophole permits a family to collect compensation for their daughter’s death; actions that neither consider the violation of Suhair’s rights nor bring the dead back to life. That Suhair had refused to undergo the procedure only shows the extent to which her death calls for a more prudent judicial system that recognizes how FGM affects the livelihoods of women and girls. Such a judicial system must consider the cultural and socio-economic contexts within which FGM is practiced, but at no time should it esteem culture over life. Suhair and Badour are two girls too many. 

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THE FACES OF FGM

Last week, local Kenyan and international print and online media were filled with photos showing Pokot girls undergoing FGM. The photos, taken by Reuters photojournalist Siegfried Modola, document how four Pokot girls underwent the practice, including the practitioners, the actual cutting, and the ceremonies that accompany the tradition.

These photos indicate that we have much that still needs to be done.

First, the photos show us that FGM continues to be practiced, even as we engage in advocacy against it. We still need to research and inform communities about the risks associated with the practice. We need to allow them to come into conversation with us; allow the communities to take active roles in addressing the practice in their communities. We need to recognize the cultural place of FGM in order to become effective advocates against the practice.

Second, displaying the photos in international media may inform people about the practices, but the comments of outrage that usually follow these photos do not bring an end to the practice. In fact, they might do more harm than good. International media reporting on African issues often reduce the complexity within the continent in order to reach a wider lay-person audience. What’s more, Africa is often “a country” rather than a continent of 54 countries, each with its diversity of peoples and cultures. FGM in Africa is one such issue, and media often describes it as a barbaric, outdated practice, rather than identifying the context of such cultural practices. Uninformed readers will think FGM is practiced in all African countries, and that all African women are suffering under this ordeal. Indeed, they would fail to know that FGM is nonexistent in much of Southern Africa.

ACCAF aims to address the aforementioned concerns by researching and documenting the best interventions that might be used, while recognizing the cultural contexts in which these communities are embedded. Our work must go beyond sharing photos and reports with the world, to recognizing that the individuals who practice FGM are human, and our engagement with them must keep their humanity at the centre. And if we are to bring FGM to an end within one generation, we must continue to engage all stakeholders, including the women and men in these communities. We must understand the faces and phases of FGM, the women who undergo the practice, the types of the cut, and the trajectory of advocacy against FGM.