Dupe Onadeko wants more action against female genital mutilation

Prof. Modupe Onadeko is the National President of Inter-Africa Committee, Nigeria Chapter (IAC-Nigeria) campaigning against Harmful Traditional Practices (HTP), including Female Genital Mutilation (FGM). In this interview with IYABO LAWAL, the professor of Reproductive and Family Health, and a foundation member of IAC-Nigeria, spoke on issues affecting women and children, and particularly, FGM, as well as the activities of the organization since she came on board. Excerpts:

The role of Inter-African Committee (IAC) in the fight against Harmful Traditional practices (HTP), including Female Genital Mutilation
The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children (IAC) is an International Non-Governmental Organization created in February 1984, at a seminar in Dakar, Senegal with 28 African countries. The Nigerian Chapter was established on May 31, 1985 through the efforts of the late Dr. Irene Thomas, Dame Priscilla Kuye, SAN, Prof. Oludayisi Oduntan, late Mrs. Adewole, former Chief Nursing Officer of Lagos State, Dr. Mrs. Da-Silva, and a number of other doctors and professionals.

Harmful Traditional Practices often result in premature death of girls and women, as well as leave many physically, medically, psychologically/emotionally damaged for life.

The goals of IAC-Nigeria therefore are, to create awareness among the general public about the dangers of these harmful traditional practices and work towards eradicating them.

The aims and objectives are primarily the organization of cross-sectional campaigns against harmful traditional practices that affects the health of women and children including FGM, as well as training of various categories of health personnel, (Traditional Birth Attendants/Community Birth attendants, Community Extension Workers, Nurses and Doctors), and conducting enlightenment and economic empowerment programs for the Traditional Circumcisers.

FGM is still quite prevalent in this country, though we thank God that the new cases that are being done are reducing. The average national prevalence rate is 41 per cent. However our ultimate goal is to get it to zero level, that is, no girl or woman should ever be subjected to female genital mutilation. It used to be called female circumcision but they do more than this simple thing called circumcision, which is just the removal of the hood of the clitoris; they do much more than that. They chop off the whole clitoris (a small highly sensitive part of the female sexual organ located on the outside of the body in front, at the top of the opening of the vagina) and the circumcisers go on further to remove the small lip of the vagina, (the labia minora) as well as the big lip of the vagina, (the labia majora), and in the severest type, they scrap off everything, and then close up the whole vagina by suturing (tying) it up with a needle and raffia thread, leaving only a tiny hole for urination and menstruation in the future.

FGM may be classified into basically four types:
Type 1- is the removal of the hood of the clitoris
Type 2- is the removal of the whole clitoris as well as part of the small lip of the vagina
Type 3- is the total excision of the whole female genitalia and suturing of the vagina. This is also called Infibulation.
Type 4- anything done to the vagina that cannot be assigned to the categories above is put under this category.

An example is a practice commonly carried out on pregnant women in the Northern part of Nigeria during delivery. The genitalia usually gets engrossed with blood flow and sometimes the birth attendants see it as a pouch of something, darkish colour, ballooning in the upper part of the vagina, and they think that might obstruct the delivery of the baby. So they take a blade or scalpel and make several tiny cuts (Gishiri Cuts), in the upper part of the vagina, sometimes-inflicting injury on the cervix (the ‘neck’ of the womb).

They think they are letting out ‘bad’ blood to enable the baby come out. That is how they damage the cervix of these women that eventually have incompetent cervix, resulting in recurrent abortions.

Another example is the ‘Zurzur’ practice prevalent among some menopausal Hausa and Fulani women in the North. These women in polygamous relationship want their husbands to feel they are still menstruating. They think their husbands might abandon them once they (the men) realize that they are menopausal. They want to pretend that they are still having monthly menstruation so they go to the traditional men or women who, with a blade or scalpel will make incisions on the lower part of the vagina to let blood out and then the women will be using sanitary pads and their husband will believe they are still menstruating, so that they can continue to have sexual relation with them, and not abandon them for younger wives!

This procedure is repeated every month and all this leads to recurrent infections and many complications. We have a video that we show to educate people on the dangers of FGM.

In fact, when I went to Osun State and showed it to the Legislators, many of them covered their eyes, and they just couldn’t look at it. It really impacted on them that soon after, Osun State legislated against FGM. Oyo States and Osun States have the highest prevalence of FGM in Nigeria. In 1985 when we first carried out a research on the prevalence of FGM in Nigeria we found a prevalence rate of 97.8 per cent in Osun State, while Oyo State was 98.4 percent. There are designated family areas in Ibadan, Oyo State where FGM is still being practiced till today. They start early in the morning, around 6am because they think that when it is getting towards noon, the blood flow increases in the body and the baby may bleed beyond what they can control. We are trying to enlighten the circumcisers themselves and encourage them to engage in other income-generating ventures.

In areas where we have succeed in having FGM banned such as in Akwa-Ibom, Cross River, and Balyelsa States, we have trained the Circumcisers in various income-generating/ economic empowerment programs such as how to make ice cream, liquid soap and even block making. These ventures are generating more money for them than they get for circumcising girls and women.

What are the main reasons why they do it?
The reasons for Female Genital Mutilation can be classified into five categories, Psychosexual, sociological, hygiene and aesthetic, myths and religious reasons.

Firstly they (the perpetrators) say it is to preserve virginity so that the girl will not be promiscuous. They feel that the clitoris is such sensitive parts that when a girl gets to the age of puberty if she sees any man passing by, she will feel like having sex and lose her virginity in the process thus bring dishonor and shame to her family.

Also they believe it will keep the woman safe with her husband and ensure faithfulness in marriage. In fact, in the Northern part of Africa, particularly in Sudan and Ethiopia, after their women have delivered, they sew the vagina up again, until it is time for the woman to get pregnant again and have another child, all because they want to make sure that she will not have sex with another man. It is a very serious matter and we really need to put a stop to it.

Secondly, they believe that if the head of the baby should touch the clitoris during delivery that the baby will die or develop hydrocephalus (big head). If the delivery is conducted in a safe and hygienic way, mother and child will be alive and well. Women who have NOT been circumcised or mutilated have healthy children who are doing well, and have turned out to be lawyers, engineers, doctors, administrators and men and women in big positions.

So we need to disabuse the minds of people, and get them re-orientated because FGM is a longstanding tradition that has passed from one generation to another, so it is very difficult to eradicate. However, with education and enlightenment, particularly through the media, we hope that people who can read and hear will tell others, will discuss it in their various associations, in their churches, mosques, in the market places, and at social gatherings, so that people can be discouraged from subjecting young girls and women to a totally unnecessary and barbaric procedure called FGM. FGM is a violation of Fundamental Human Rights, a violation of Child Rights, and a violation of Women and Girls’ Body Integrity. Hence we need to stop it.

Instruments of destruction

Age at which FGM is done
In Oyo State where FGM is most prevalent, it is carried out on the girl on the 9th day of birth but in some places, it is done within three to nine months.

Among some ethnic groups, however, it is done as a ritual when the girls are transitioning from childhood to adulthood. It is accompanied by an elaborate ceremony and much merriment, with plenty of food and drinks.
The girls are then taken to a secluded place where FGM is performed on them. So this makes the girls look forward to it as they get new clothes, shoes and jewelry also. They psyche them and these girls believe that if they don’t do it, they will be ostracized. So these girls do it in order to belong, to be respected and to be honoured in their communities. Their parents also make the girls believe that if they don’t do the FGM, men would not marry them.
Complications

Physical consequences include severe pain. Some of the children die as a result of shock due to the severe pain as FGM is carried out without anaesthesia or any form of painkiller.

Severe haemorrhage. Some children also bleed excessively and die as a result of heamorrhagic shock.

Severe infections. The Circumcisers use unsterilized instruments, which lead to infections. Many children have died from tetanus, Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and Hepatitis among others. Talking about HIV / AIDS, there is a classical case I witnessed while on a one year sabbatical at Eleta Hospital, in Ibadan.

A lady had a baby girl, and on the third day after delivery, the baby developed jaundice and was brought to the hospital so we could do what is called exchange blood transfusion because otherwise, the jaundice would damage her brain and she would be mentally retarded and handicapped for the rest of her life. In the process of preparing the child for the exchange blood transfusion, a series of tests were carried out on the baby including tests for HIV/AIDS. When the results came, she was found to be HIV positive.

The mother was tested and found to be HIV positive, and actually passed it on to the baby during pregnancy. If the child had not been bought to the hospital because of jaundice and had been taken for female circumcision (FC), all those babies who were circumcised along with her would have been infected. These are some of the realities we need to face concerning FC/FGM, and we need to be well informed and be very careful, well-guarded and avoid unnecessary procedures that will jeopardize the health of our women and children.

Long-term complications can be gynaecological such as keloid formation, implantation dermatoid cysts, acute and chronic pelvic infection, infertility, haematocolpos and dyspareunia.

There is also the danger of genito urinary problems, which include recurrent urinary tract infection and may subsequently result in hypertension and renal failure.

Other long-term complications are recurring urinary tract infections. Infection may affect the bladder and kidneys due to the damage caused to the lower urinary tract or because if subsequent complications leading to painful and difficult urination.

Chronic pelvic infection
Infection may involve a hardening of scars, thus forming keloid. Keloids may cause problem at the time of first intercourse, during vaginal examination and delivery.

Dermatoid cysts
Cysts are a kind of swelling or pockets of skin and products secreted by skin including fats, hair and cells. Some may grow to the size of an egg or an orange and would require surgical removal.
Neurinomas

This is a situation where the dorsal nerve of the clitoris is cut, the whole genital area becomes permanently painful.
Menstrual problems

Difficulty in menstruation could occur when the vaginal opening is narrowed. This may result in painful menstruation or in acute cases, in heamatocolpos, which is the accumulation of menstrual blood in the uterus. This could cause distension of the abdomen and may lead to prompt suspicion of pregnancy.

Damage of other organs
There is also the problem of damage to adjourning tissue, which may affect other organs of the body. Infection can also affect the urinary tract. Due to the pain, the girls tend to withhold urine and when such happens, it leads to stasis and infection. This may affect the kidneys later in life and subsequently lead to death as result of renal failure. Infection can also affect the reproductive organs particularly the tubes that may result in infertility.
Other gynaecological and obstetric problems

When the vagina heals, it becomes narrow and left with a lot of non elastic fibrous tissue that cannot stretch. Due to the narrowness of the vagina, menstrual flow is often impeded, blood that should flow freely during menstruation tend to accumulate in the pelvis and this also leads to infection which may damage the reproductive organs, leading to infertility. If she manages to get through all that gets married and gets pregnant, she will have problems during delivery, because of the narrow and tight vaginal orifice. She will end up with obstructed labour. If emergency Caesarian Section is not carried out in time, she may rupture her uterus resulting in the death of the mother and the child. If she is lucky to be alive, she may have vesico-vaginal fistula (VVF) and/or recto-vaginal fistula (RVF), with urine and faecal material leaking uncontrollably through the vagina.

With regards to family planning, the insertion of an Inter-Uterine device through the vagina would be very difficult, if not impossible.

Psychosocial problems
There is also the psychosocial aspect, which people don’t often talk about. There are serious psychological complications of FGM. Quite a number of victims, particularly those with VVF and RVF have high tendency to commit suicide, and many have indeed committed suicide.

Young girls who have been subjected to FGM were found often to be very bitter against their mothers. They asked why such mothers could not rescue or save them from being subjected to FGM, and they find it very difficult to forgive their mothers; but what could such mothers have done if the mothers-in-law insisted that FGM is always done in their families.

Furthermore, the victims often lose their self-esteem, so they need a lot of psychological support and encouragement. Then when they get married, they are often frigid, they cannot respond well during sexual intercourse with their husbands. In fact this may be the reason many husbands get frustrated and seek solace and sexual satisfaction elsewhere outside their homes. So also the woman, because she never experienced orgasm, she may desire to try some other man/men.

In some instances, the vagina is so narrow; the man gets bruised during sexual inter-course and begins to use the anus. In the process the woman’s anus becomes slack, and this may lead to faecal incontinence and serious psychological problems.

Activities of IAC-Nigeria
We go to marketplaces to educate market women in particular, but we also solicit the support of the men in banning all harmful traditional practices including FGM. We try to get the men and women to understand that there is no basis whatsoever for doing FGM. It is not in the Quran.

We have brought Clerics to talk about it and they said only male circumcision is allowed by God and such must be done in a sterile way and not in unhygienic conditions. Also in the Bible, there is nothing like female circumcision or mutilation because there is no basis for it. To my knowledge and experience, and I have been in this for 25 years, there is no good thing that can be gained from mutilating girls and women.

We have examined prostitutes and found that 99.9 percent of them are circumcised or mutilated. So FC/FGM does not stop a girl from being promiscuous. We believe that proper home training, good environment and family upbringing are the key factors. If we all teach our children in the way of the Lord, in the fear of God, and we parents too show good examples through holy and righteous living, then our children would grow up as healthy, good, loyal and God-fearing citizens.

We also give talks to various Health Institutions, and general public and we have also been invited by various Non-Governmental Organizations so that we can all be positive change agents and help to expand the campaign against FGM and other HTPs. Similarly, we have targeted, and we shall continue to target men that if they come out to say that they will not marry any girl who is circumcised or mutilated, it will help to stop the practice.

We have also targeted motor parks, taxi and other commercial drivers. We are now going to the media, using the radio and television stations and the print media, so that the more we talk about it, the more people will be awakened to the problems that emanate from such unhealthy practices.

I must not fail to acknowledge and appreciate on behalf of IAC-Nigeria, Oyo State First Lady, and Her Excellency Mrs. Florence Ajimobi the wife of the Executive Governor of Oyo State, Senator Abiola Ajimobi. She has been wonderful. She is worthy of emulation for her love and concern for Women and Children. February 6of every year has been designated as FGM Zero Tolerance Day by the World Health Organization and the United Nations, and her Excellency went on air last year to talk about the dangers of FGM so that people in Oyo State and other parts of the country will be enlightened about the health and social problems involved and hopefully try to stop it.

It is very gratifying to note that the former President, Dr. Goodluck Jonathan in the very last hours of his tenure on the 29th May 2015, at long last signed the Bill banning FGM in Nigeria. Glory be to God! Halleluyah!! However, we still need to muster all efforts to enforce the implementation of the Bill. I plead that our First Lady in this nation, Mrs. Aisha Buhari, all our Governors wives, and all concerned citizens should please join hands with us and other Organizations working against FC/FGM to ensure that FGM is stopped and the lives of our women and children preserved, in order to enhance the social and economic development of our nation.

Challenges of IAC-Nigeria
The major challenge we are facing right now is the lack of FUNDS to sustain our campaign activities and to monitor the implementation of legislative directives. We are therefore using this forum to appeal to the Government at the National, State and the Local Government levels to come to our aid. We also solicit for the assistance of philanthropists and well-meaning people nationally and internationally to enable us achieve our goals.

We also need more media involvement to enhance our public enlighten programs. I am sure that by God’s grace, with all ‘hands on deck’, we shall achieve our goals, and FGM and other harmful traditional practices will soon become issues of the past.