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“I have a mark that can never be erased”: The Rise of FGM

This week Antonio Guterres posted on Twitter that around 4.3 million girls will be at risk of female genital mutilation, or FGM, in 2023. It is a startling statistic regarding a public health and human rights crisis that has been around for centuries in more than 20 counties throughout Africa, Asia, and the Middle East. The World Health Organization defines FGM as an umbrella term for procedures involving the complete removal or injury of female genitalia for cultural, religious, or other non-medical reasons not including prescribed surgeries. In other words, it is completely unnecessary but horrifyingly common in certain countries around the world. 

Somaliland, an independent region that used to be part of Northern Somalia three decades ago, is the epicenter of FGM. Plan International, a global aid organization, along with other sources report that 98% of the current female population in Somaliland has undergone FGM. FGM is usually conducted on girls between the ages of 5 and 10 but can also be done for grown women. It has no citation in religious books, including the Quran and the Bible, so the practice is solely a cultural entity. Thus any religious backlash to the abolishment of FGM is entirely unfounded. The cultural idea that FGM is based on believes that the procedure keeps girls “pure” and “sealed” for marriage. The Los Angeles Times spoke with a woman named Safia Ibrahim in Somaliland who had performed the procedure hundreds of times and she stated, “This is our Somali culture. Our great-grandmothers, grandfathers – all of them used to practice.” Ibrahim does not plan to stop performing FGM until it is illegal in Somaliland. Yes, this process is still legal.

Edna Adan Hospital in Somaliland thoroughly describes FGM on their website They state how the women in Somliland refer to two kinds of FGM: the Sunna and the Pharaonic. The Sunna correlates with what the WHO classifies as type 1 and type 2 FGM while the Pharanoic correlates with types 3 and 4. The Sunna is usually performed when the child is just a baby and the Pharaonic is performed when they are older (between 5 and 11 years of age). On the day of the procedure, the child undergoing FGM is often completely unaware until all the necessary preparations for the procedure have been made. It is usually conducted by senior female members of the community, relatives, traditional birth attendants (TBA’s) or occasionally a healthcare worker. FGM is usually performed in a house and household materials like a mat are used to soak up blood lost during the procedure. Generally, no anesthesia is used since (1)it is not available and (2)the person performing the FGM is not trained in using the anesthesia. The “operator” does not wear gloves nor wash their hands. In the place of surgical needles, regular sewing needles can be used and in many rural villages, thorns are used as well. There are countless more procedural details laying the groundwork for infection and lifelong trauma, both physical and psychological. 

The Covid-19 pandemic sparked a new rise in FGM since the economic distress that families faced led to them pulling their daughters out of school and towards marriage. And as enforced by decades of cultural oppression, unless the girl is “sealed” by FGM, she is not viable for marriage and therefore not an acknowledgeable member of society. 

With this rise of FGM comes the rise of the health complications it causes. Unfortunately, the healthcare system in Somaliland is not equipped to effectively deal with these complications. A research study done in 2020 by BMC Health Services investigated the capacity of the Somaliland healthcare system in managing FGM and treating its complications. They conducted 20 interviews with actual healthcare workers – medical doctors, nurses, midwives, and system administrators – in the Maroodi Jeex and Awdal regions of Somaliland. The study reported that although the healthcare workers were aware of the physical dangers of FGM, “they faced multiple contextual challenges in their preventative and management roles at the individual level, e.g., they lacked specific formal training on the prevention and management of FGM/C complications and its medicalization; institutional level, e.g., many facilities lacked funding and equipment for effective FGM/C management; and policy level, e.g., no national policies exist on the management of FGM/C complications and against its medicalization.” As FGM continues into the 21st century, the ability of the accompanying healthcare system to prevent, diagnose, and treat FGM is far behind. The study emphasizes the necessity of incorporating FGM care into primary healthcare services so that diagnoses can be made and treatments can be sought faster.

As is with many global disasters, there are rescue efforts in action. Edna Adan Hospital in Somaliland is actually a non-profit organization run on charitable funds. It was founded in 2002 by the former First Lady of Somalia, Edna Adan Ismail. The hospital provides various antenatal and postnatal care services as well as immunization and minor surgeries. Activists in Somaliland, like Edna Adan Ismail, have been trying to pass anti-FGM legislation for years. They had a huge victory last year when Somaliland passed the Children’s Act protecting children from all forms of abuse and neglect. FGM is still legal but this a huge step in the right direction. One hurdle in the way may be the fact that every lawmaker in Somaliland happens to be a man. Ismail remains skeptical, stating, “It is not legislation that will stop it,” she said. “Because if legislation would stop it, it would have stopped it in Sudan, and it has not. It would have stopped it in Djibouti, and it has not. Whatever women say, whatever we say, at the end of the day there’s some imam who says, ‘Oh, this is wrong.’ Those few words wipe out all the efforts that have been done.” Nevertheless, the fight goes on. February 6th marks International Day of Zero Tolerance for FGM. Many women and some young men spoke at the event about their own experiences and threat of FGM to women’s rights. The LA times reported on 23-year old nurse named Hana Ismail who shared a moving poem at the event about her own experience with FGM. She recited to the crowd, “I have a mark that can never be erased.” 

With the preponderance of FGM in subsaharan Africa and the magnitude of health risks it poses, it comes as a surprise that the mainstream media in developed nations rarely reports on FGM and those it affects. There may be many reasons as to why this is so. For one, FGM is not exactly the most comfortable thing to talk about at the dinner table. Nevertheless, the discomfort felt by those involved in a conversation about FGM is unparalleled to the immense pain and trauma felt by the millions of young girls who are forced to go under the needle every year. Another reason may be the issue of cultural interference. In other words, some may see it as inappropriate for individuals from a developed nation to come into places like Somaliland and challenge a culture that they have voluntarily accepted and executed for generations. The question then becomes –  is it inappropriate to question traditional ideologies at the risk of disrespecting a culture that is not your own or is it inappropriate to enforce ideologies that are blatant violations of human rights? It seems to me that powerful systems in our world throughout history have cited religion, culture, and other seemingly non-debatable societal pillars as a means of enforcing oppressive agendas on groups of individuals seen as inferior – one of these groups being women. By basing an oppressive agenda on such a strong pillar like religion for example, the group that is being targeted also has little means to fight back because they are made to believe that their place in a hierarchical society is not significant enough to have a voice that matters. There is a solution to this: education. The more we fight for girls’ education and encourage young women to hold jobs and become financially independent, the more we teach them to value themselves, their bodies, and their potential in life. With the many incredible people who are fighting towards this mission right now, FGM does not foresee a strong future.