By Dr. Yodit Sileshi Zewde (MD, MPH in Reproductive Health)
Dr. Yodit is an SRH advocate, born in Ethiopia, passionate about the field of reproductive health, currently working in the obstetrics and gynecology department of a public hospital
Female genital mutilation (FGM), also known as female circumcision or female genital cutting (FGC) is “all procedures involving the partial or total removal of external genitalia or other injury to female genitalia for non-medical reasons” . as defined by the World Health Organization (WHO) in 1997. It is a deeply entrenched cultural practice, perpetuated by a complex interplay of social, cultural and economic factors. Despite efforts to eliminate it, FGM remains widespread in Ethiopia, affecting millions of women and girls. As stated in the UNICEF FGM Country Profile for Ethiopia (UNICEF, 2020), the country is “hosts 25 million girls and women who have undergone female genital mutilation/cutting (FGM), the highest absolute number in East and Southern Africa.
In various parts of the country, FGM/C is a recognized and accepted practice that is considered important for the socialization of women, curbing their sexual appetites and “preparing them for marriage”. It is considered part of a ritual initiation into womanhood that includes a period of seclusion and education about the rights and duties of a wife. In practice, as noted by Boyden et al. (2023), FGM/C “tends to be seen as a necessary precursor” to marriage, particularly by families and communities most likely to engage in child marriage. By limiting girls’ “misleading sexual behavior” and thereby shaping their behavior, FGM practices “protect their social status and marriageability.”
Data from the latest Ethiopia Demographic and Health Survey (EDHS, 2016) show that 65% of women and girls aged 15-49, 47% of girls aged 15-19 and 16% of girls under 15 are circumcised. However, FGM/C is not a homogeneous phenomenon. there are disparities between regions and settings. For example, nationally, FGC is more prevalent in rural areas (68 %) than urban areas (54 %). Among women and girls aged 15–49, Tigray and Gambela have the lowest prevalence (24% and 33% respectively), and the Somali and Afar regions have near-universal prevalence (99% and 91.2% respectively).
As a female doctor working in reproductive health in Ethiopia, I have witnessed and fought against genital mutilation, one of the most pervasive yet hidden forms of gender-based violence. Unlike many who have suffered its consequences firsthand, I am fortunate to have escaped its physical trauma. However, my daily encounters with survivors have given me a deep understanding of its devastating effect on women and girls in my community.
The first time I heard about FGM, I was about 6 or 7 years old. I watched a commercial on TV talking about how FGM was a harmful traditional practice, and my babysitter asked my mother something about her going to cut them (that’s me and my little sister). , since you’ll be too old for that soon. I remember my mother replying angrily and scolding her for asking such a question. I didn’t understand the practice at the time, but her response told me something was wrong. As I grew older, I realized that most of my cousins from out of town had undergone some form of cutting at a very young age, while I was one of the lucky ones who didn’t have to. For them, it was a rite of passage. they did not consider it any different from male circumcision until they reached childbearing age.
Years later, I entered medical school. Since the university I went to is outside the capital, I wasn’t surprised to meet many women who had undergone FGM. I was surprised to find that some of my classmates were also survivors of the same practice. Despite being born and raised in the capital Addis Ababa, attending prestigious schools and being born into educated families like mine, they were subjected to this harmful practice. To my surprise, I heard a fellow medical student say she supports the practice, although she disagrees with taking it all the way to insufflation (narrowing of the vaginal opening by creating a seal by cutting and repositioning the labia minora and/or labia majora, with or without excision of the clitoris). He believed that stage 1 and 2 of FGM were necessary for women, since a woman is supposed to be “calm, collected and not driven by the needs of the flesh”.. I was shocked to hear this from a soon to be doctor, knowing that she is likely to pass this harmful practice on to her future daughter if she had one.
One of the most exciting aspects of my profession is witnessing the physical and psychological consequences of FGM/C. Immediate complications can range from severe pain, bleeding and infection, to urinary problems, sexual dysfunction and even death. However, it’s the long-term effects that haunt me. Many survivors endure chronic pain, recurrent infections and complications during childbirth, leading to obstetric fistulas, stillbirths and neonatal deaths. The psychological scars are even deeper, manifesting as anxiety, depression, post-traumatic stress disorder and a deep sense of shame and inadequacy.
I also remember a close friend of mine who worked in one of the areas of the country where the prevalence of FGM is 97%, she told me that it was indeed rare to find a woman who had not undergone FGM. He remembered an incident. a 16-year-old girl was admitted to the emergency department in the middle of the night for acute urinary retention (one of the complications of female genital mutilation). Her genital area was stitched up, leaving only a pea-sized opening for her urine and menstruation to pass through. Over the years, the scar had worsened to the point where several cysts had developed, resulting in a complete blockage of her ureter. The family was asked for permission to have a damage reversal procedure, but they refused. He ended up being discharged with a suprapubic catheter (a urinary catheter inserted into the bladder through a small incision in the abdomen).
Ethiopia’s program to end FGM contributes to the national commitment to end child marriage and FGM by 2025 and to achieve SDG target 5.3 by 2030. The program is led by the Ministry of Women, Children and Youth as and by the National Alliance to End FGM and Child Marriage, which includes other ministries, civil society, non-governmental organizations and UN entities. Based on the country’s Constitution and strong legal framework to promote and protect the rights of girls and women, a National Cost Roadmap to End Child Marriage and Female Genital Mutilation/Mutilation (2020-2024) was developed. Overcoming most campaigns is a lack of emphasis on male engagement as well as limitations in sustaining the momentum of community engagement and empowerment efforts over time, especially in rural or remote areas where resources and attention may fluctuate . Furthermore, while efforts to change social norms are necessary, a top-down approach without sufficient consideration of cultural contexts and community involvement could face resistance or lead to eventual exclusion from society due to stigma. (Landinfo et al. 2021)
In conclusion, as a female doctor living and practicing in Ethiopia, I witness the silent cries of countless women and girls whose lives have been irrevocably changed by FGM. While I may not have personally experienced its horror, I am deeply committed to advocating for the rights to bodily autonomy and well-being of those who have experienced it. I believe in educating not only women but men as well, while raising awareness of the short and long term complications of the practice. In addition, the involvement of religious leaders in these interventions would be more effective because several communities bring religious beliefs to the practice. Unfortunately, the current legislation has not taken a firm position on the matter. If we got to a level where one can report FGM during clinical practice just as we do for suspected sexual violence, it might help combat the issue. Through education, empowerment and collective action, we can end the practice of female genital mutilation and create a future where every woman and girl can live free of violence and discrimination. I hope this blog encourages dialogue and raises awareness of the harmful physical and psychological effects of FGM in order for this to happen.
bibliographical references
Boyden, JE (February 2013). Harmful Traditional Practices and Child Protection: Contested Understandings and Practices of Marriage and Female Child Circumcision in Ethiopia.
EDHS, CS (2016). Ethiopia Demographic and Health Survey. Addis Ababa: Central Statistics Office.
Landinfo. (June 2021). Ethiopia – Female Genital Mutilation (FGM).
UNICEF. (2020). A profile of female genital mutilation in Ethiopia.
