In Ekiti State, Nigeria, late payment of healthcare workers has meant many are looking elsewhere for income. Families have been reaching out to nurses and other healthcare workers, believing medicalised FGM would pose little or no harm to their daughters. The International Center for Advocacy on the Right to Health (ICARH) has been working with the community to help end FGM and to demystify common misconceptions about medicalised FGM.
"Many health workers deny that they practice female genital mutilation (FGM). That is a lie. In Ekiti State, some parents offer about N 2000 to a nurse who has gone without a salary for months. How many nurses will be able to turn down such an offer when that amount can cater for some rice and beans that the family survive on for some time?" says Hope Akerele* one of the healthcare workers that went through training on FGM courtesy of the International Center for Advocacy on the Right to Health (ICARH).
According to United Nations Population Fund (UNFPA), Ekiti and Imo States are regarded as two of the six high burden FGM States in Nigeria. The other four being Ebonyi, Lagos, Osun, and Oyo. It is estimated that 72% of girls and women in Ekiti State have gone through the cut. Whilst there have been significant efforts to make FGM unlawful in Nigeria (such as the implementation of the Violence Against Persons Prohibition Act), many states are still struggling to end FGM. The experience of Akerele shows that the practice is still rife and some parents believe that they can safely have their daughters undergo FGM by going directly to a healthcare worker. It is a source of livelihood for some of the healthcare workers living in Ekiti, which is one of the reasons why the prevalence rates in this state remains high.
Whether or not FGM is medicalised, the risks for women and girls remain: there is no way of safely performing FGM.
What is medicalised FGM? Medicalised FGM is when a medical professional performs FGM. Proponents of medicalised FGM argue that by improving the sanitary conditions under which FGM is performed, and by the practice being performed by a healthcare worker, there will be reduced harm to girls. However, this frames FGM as solely a health issue. Whilst also being a severe threat to short-term and long-term health, FGM is a violation of women’s and girls' human rights. In 2017, Population Council looked at data from women 15-49 in 25 countries and found that 26% of women that have undergone FGM report having been cut by a medical professional. Medicalised FGM has increased in many countries, including Egypt, Indonesia, Kenya, Malaysia, Nigeria, Northern Sudan, and Yemen. In Nigeria, over 13% of girls and women who have had FGM have been cut by a medical professional. Medicalised FGM is a serious form of violence against women and girls and poses a serious threat to their well-being and health, it is a risky procedure with severe long-term consequences. Whether or not FGM is medicalised, the risks for women and girls remain: there is no way of safely performing FGM.
The story of healthcare workers performing FGM is not exclusive to Ekiti State. Emuvoke Adebayo* from Osun State, observes that:
"We need to work harder to create awareness in the community. I met a woman who recently underwent FGM which was conducted by one of the nurses. This was not done in the hospital, rather, the nurse requested her to go to her home where she performed the act. We need to put more effort in reaching out to nurses and healthcare workers."
Through discussions with different community members in Ekiti state, ICARH found that any action to end FGM must involve healthcare workers, and also community leaders who have great influence on how things work at the grassroots level. ICARH held training sessions for healthcare workers, many of whom later stated that they were not aware of the many adverse effects of FGM and they committed to sharing this information with their peers.
Promoting medicalised FGM dampens the international efforts to end all forms of FGM. It is therefore especially important to recruit doctors to support anti-FGM measures. In Egypt for example, an initiative of Doctors Against FGM has started to address the medical sanctioning of the practice in the country. In order to tackle FGM, healthcare workers must be included in the discussion and actively engaged in the end FGM movement. They must be made aware of the harmful impacts of medicalised FGM so they can become champions in their own communities.
The Girl Generation’s End FGM Grassroots Fund supports local grassroots organisations in some of the countries most affected by FGM. We believe that their local connections, insight and influence mean they are best placed to spark the social changes required for FGM to end. Find out more about what the fund has been able to achieve.
*Names have been changed to protect the privacy of the individuals