From the Winter 2007/08 Child View, World Vision's magazine for child sponsors, this is an article about the tradition of female circumcision and the risks it causes:
SCARRED BY TRADITION
Three million girls undergo circumcision rituals each year. Community awareness is the key to ending this harmful practice that puts their lives at risk.
Story by Nicolette Beharie
As Tadelu Wodajo sits outside her brick schoolhouse, the 19-year-old gracefully raises her hand to shield her face from the sun. It's hard not to notice the black tattooed spots that line her jaw bone, distinctive marks of beauty and womanhood in her rural Ethiopian culture. She was a child, Wodajo has always desired to identify herself with her female peers.
"I forced my family to circumcise me," she says of the rite of passage observed by women in her community. "It was only when I was in Grade 1." Her confession is abrupt and her countenance unflinching. A brief silence, however, indicates there is more. "If I wasn't circumcised, I would be different and they would tease me and insult me."
Then 10 years old, Wodajo persuaded her mother to invite the local circumciser to their home that Easter, the time when circumcision rituals take place in their Orthodox Christian community. Wodajo was the first of several girls to undergo the procedure that day.
Female circumcision, a euphemism used to describe female genital mutilation (FGM), involves the cutting away of one or several parts of the female genitalia for cultural or non-medical reasons. Although the origin of FGM is unclear, this practice predates both Christianity and Islam and is often marked with celebrations.
Untrained traditional midwives, using no anesthetic, typically perform FGM on prepubescent girls. This causes excruciating pain and puts them at risk for infections and hemorrhaging, which can lead to shock or even death.
For those who survive the procedure, the serious health consequences become evident during childbirth. FGM is not only associated with urinary tract infections, but also prolonged and obstructed labour.
In Ethiopia, women face a one in 14 chance of dying during childbirth or from other pregnancy-related causes. Maternal mortality rates are also high across sub-Saharan Africa. UNICEF reports that one out of every 16 women will die as a result of pregnancy or childbirth, compared with one out of every 4,000 in industrialized countries.
When the United Nations presented the Millennium Development Goals in 2000 (see sidebar), this disproportion was at the heart of its fifth goal: improve maternal health. World leaders pledged to reduce by three-quarters the maternal morality ratio by 2015. But in countries where harmful practices like FGM compromise the reproductive health of girls, meeting this goal continues to be a challenge.
Despite international campaigns in recent years to eradicate FGM, it is practised in more than 28 countries in Africa and in parts of the Middle East and Asia; three million girls worldwide undergo the operation each year. In Ethiopia, where 74 per cent of women between the ages of 15 and 49 have experienced FGM, World Vision is working with communities to help reduce maternal deaths by raising awareness about practices like FGM that make women vulnerable to the risks.
Wodajo lives in a World Vision-supported area of Hidhabu Abote, a district northwest of Ethiopia's capital, Addis Ababa. In her community, the tradition is to have girls undergo FGM before they reach puberty. While Wodajo asked for this procedure, she knows her widowed mother would have eventually arranged to have it done. Refusing FGM meant Wodajo would have been ostracized, reducing her chance of marrying.
Although mothers pursue FGM for their daughters, and female midwives typically perform the procedure, men with a preference for women who have undergone FGM is one of the factors that drive the culture that demands it. In many cultures, FGM is practised to decrease a woman's libido and prevent promiscuity.
Myths and superstitions, which vary depending on the country and region, also perpetuate this practice. "I heard people say that if a girl is not circumcised, she will have problems when she gives birth," says Wodajo, who no longer holds this belief and now regrets having the procedure done.
In a recent study conducted by the World Health Organization, researchers found that women who had undergone FGM were more likely to suffer complications during childbirth than women who did not experience FGM. Women who had the procedure done were also more likely to need a Caesarean section, an episiotomy and an extended stay in hospital.
But in a country like Ethiopia, where nearly a quarter of the people lie on less than a dollar a day, many women are unable to access the health care they need for a safe delivery. Only six per cent of women in Ethiopia give birth with a skilled attendant such as a doctor or nurse present.
Rural women who live far from a health facility or can't afford hospital fees often give birth at home with the help of a traditional birthing attendant (TBA), such as 64-year-old Gezu Dese. She's delivered dozens of babies over the past 34 years. Like many TBAs, Dese was taught by her mother to perform FGM.
"When a girl is circumcised, she is considered to be grown-up," explains Dese, who lives near Wodajo's community. "Now she is ready. She can marry at any time." Closely tied to FGM, early marriage - a union in which one or both partners are under the age of 18 - is also a harmful traditional practice that is widespread in parts of Ethiopia.
Most of Wodajo's friends who encouraged her to undergo FGM are now married. "They quit school in Grade 3," she remembers. Premature pregnancy and motherhood are inevitable consequences of early marriage, according to UNICEF, and girls under 15 are five times more likely to die during pregnancy and childbirth than women in their 20s."Thus a circumcised adolescent girl is doubly disadvantaged," concludes a World Vision report on FGM, based on research conducted in Ethiopia, Kenya and Ghana.
In 2005, World Vision launched its Safe Motherhood project, which aims to increase awareness about harmful practices that affect maternal health, in Ethiopia's Hidhabu Abote and Jeju districts. Through the project, Dese learned about the risks of FGM and how to be a more effective TBA.
Unlike some of her community members, Dese decided to stop practising FGM. She admits, however, that she began having doubts about the procedure a few years before World Vision launched the Safe Motherhood project. What she learned through the training confirmed her suspicions.
"I used to have a lot of problems with the circumcised girls and I started to think it was not good." Dese says of her years as a TBA. .But despite her observations, she continued to practise FGM. "It is not our decision," she says of her former views.
In 2004, Ethiopia's government enacted a law criminalizing FGM, joining at least 16 other African countries in the legal fight against the practice. Today, forcing a woman or child to undergo FGM in Ethiopia can result in fines and imprisonment.
While laws that penalize FGM are strong deterrents, they don't hold the promise that the practice will stop as a result. Husen Feko, a 67-year-old Muslim elder in Jeju district, southeast of Addis Ababa, is still adamant that FGM should continue. A father of 10, whose youngest daughter is four years old, Feko is not convinced that he's alone in his belief.
That's why Lydia Mesfin, World Vision's advocacy coordinator in Ethiopia, is convinced that education is the key to eradicating FGM. "We have to work on the attitudes of people," she says.
In Kenya, World Vision works with communities to establish alternative rites of passage ceremonies that are not harmful to children. In some cases, girls mark the transition into womanhood by learning about the role of women in their society. At the end of the training, the girls participate in a special ceremony to celebrate their new status.
When the Safe Motherhood project rolled out in Dese's community two years ago, World Vision staff members held education sessions targeting community leaders. Building on previous HIV-awareness campaigns, they emphasized that unsterilized blades used for FGM can also spread the virus. This, plus information about the reproductive health risks, was enough to persuade the leaders to seriously consider these issues.
With the signs of tolerance slowly dawning in her community, Dese eventually found the courage to be open about her views concerning FGM. "I told them I didn't want to do it anymore," asserts Dese. Although some opposed her new convictions, she adds that others in the village recently changed their views.
"As a woman, it's a practice that we have to work very hard on," Mesfin says of FGM. "It may take time, but people change." In both Hidhabu Abote and Jeju districts, FGM - a subject that was once taboo to even discuss - is now being discouraged by some religious leaders, is open to debate in classrooms and is the focus of student-led drama presentations.
Wodajo participates in some of these drama skits and is now promoting awareness to her peers. "I know what happened to me and I also know these are false beliefs," says Wodajo. "So I decided I have to teach others."
Although many of her peers have already experienced FGM and married young, Wodajo has hope for the next generation of girls. "I want to get married and have children," she says, but "only after I finish school and reach where I want t be."
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