FGC: A conceptual definition

FGC as a cultural practice takes many forms, even within the same community and society. There are numerous terminologies for FGC. These are "female genital mutilation," "female genital cutting’, "female circumcision," "female genital surgery," “female genital modification,” and so on [1, 13]. The multiplicity of terminology indicates the complexity of the problems related to FGC. These different terminologies reflect the different positions or contexts in which the issue is being understood [1]. Debates around the terms and the meanings they convey are ongoing [13]. However, a related study [7] shows that the use of the term "female circumcision" received grave criticism for tending to normalize the act by comparing it with males’ circumcision that is a widely accepted practice. Since the 1970s, feminist activists have exposed the harmful consequences of this tradition and began to use the phrase "female genital mutilation" (FGM) instead of "female circumcision." On the other hand, some countries insist on using the term "female circumcision," since the term "mutilation" connotes offensive and evil intent. "Female genital cutting" is also another alternative term used in the literature.

At our research site, dhaqnaqabaa, (literally, ‘catching the body’), which connotes ‘circumcision,’ is the compound word that refers to female genital cutting. The official Ethiopian legal tools also use the term ‘circumcision’, for FGC. Our target population practices what is commonly known as clitoridectomy, that is, the removal of part of the clitoris. In Ethiopia, there are four forms of FGC, namely: clitoridectomy, excision, infibulation, and all related harmful procedures like pricking, piercing, incising, scraping, and cauterization [9]. Infibulation is more severe and common among the Somalis and the Afar peoples, while in Oromia, clitoridectomy is more common [4, 9, 14]. In this article, we use the term "female genital cutting" (FGC) to be less judgmental about this culturally-sensitive term [15]. The following section focuses on some of the common values behind FGC and the approaches/efforts that are being used to terminate it.

The cultural values of FGC

There are a variety of explanations behind the practice of female genital cutting. Some of these explanations have socio-cultural, hygienic, aesthetic, and psychosexual reasons. The practice serves as a rite of passage that turns girls into womanhood. By removing part of their genitals, the clitoris, which has the appearance of a male sex organ, FGC also serves as one way of ensuring a girl’s gender identity that results from the modification of the sex organ [16–18].

Some studies (e.g. [13, 19]) explain that patriarchy provides the cultural and institutional framework for the perpetuation of FGC. It is a reflection of the power inequality between men and women, in which men control women’s sexuality, their reproductive systems, and their health. In short, FGC persists because of patriarchy. Pertinent to this, as a study (e.g. [20]) suggests, the concept of “clitoral economy” shows the symmetry between the female body (the clitoris) and the male body (the penis). The author shows how the clitoris is vested with so much power in symbolic and semiotic constructions of the female body. Clitoris has been viewed as a threat to the hegemonic phallic economy in patriarchal societies where FGC is common.

In this regard, there is a paradox behind FGC in patriarchal societies. Women who are victims of the practice defend and promote it as part of their tradition, which marks a rite of passage as well as a cosmetic procedure with some aesthetic values [13]. In some African cultures, sexual purity presumes FGC and is taken as a precondition for marriage. In Somalia, where FGC is mandatory and any girl who has not been exposed to it will never marry, is the case in point. The second reason is to attain a feminine body by removing the erectile part and to shape it into a socially-accepted behavior as a result of the practice [21].

In traditional African culture, older women reproduce patriarchal traditions by imposing themselves on younger girls, the same way they were treated before. In this regard, women adjust themselves to be active agents within the patriarchal system to promote the system that has suppressed them [22–24]. However, some studies show how the role of women in sustaining FGC changes across socio-demographic factors. There are correlations between FGC and parental factors, particularly maternal education, age, FGC experience, and residence setting. The more mothers are young and educated and have undergone FGC, the less likely it is that their daughters will experience the same [25–27].

Approaches to ending FGC

The UN, WHO, UNICEF, and other women’s rights advocacy organizations have used four main approaches to end FGC. These are bodily and sexual integrity, human rights, legislative, and health approaches [28]. Feminist writers who advocate a bodily and sexual integrity approach emphasize women’s sexual rights and satisfaction. This approach underlines how FGC impairs women’s right to sexual health and pleasure by shaping, mediating, and controlling women’s sexual enjoyment through social institutions [29]. In this regard, functionally, the clitoris is a site for sexual pleasure and is taken as a symbol of female sexuality by Western “second-wave feminists,” and the removal of this part of women’s genitalia obliterates their sexual enjoyment, freedom, and expression [28]. In this regard, FGC is also linked to the need to reduce promiscuity and maintain premarital virginity [14, 28, 30].

However, some challenge the bodily and sexual integrity approach because they believe that sexual enjoyment must be "normal" and ethical. As a study suggests (e.g. [28]), since sexuality is guided by societal norms and is a private issue, conservatives challenge the Western prescription to stop FGC. In conformity with this view, a study (e.g. [31]) reported that about 30% of Kenyan women are in favor of the continuation of FGC to preserve virginity.

The second is the human rights approach, which considers FGC as a basic violation of the human rights of girls and women. According to this approach, FGC harms females’ bodies for no medical reason, and it is a gendered discrimination and a fundamental violation of the human rights of women and children, including the right to freedom from discrimination, torture, and violence; the right to health, the right to education, and the right to life. This approach is prominent with the UN, the European Union, and several governments of developed countries [28]. FGC violates the rights of girls who are not able to consent to the practice and has to, therefore, end [6, 14]. This position is what is usually known as the “zero tolerance” approach of the agencies [1].

However, there are also challenges to the human rights approach, for it is biased toward the liberal democratic tradition that gives priority to individual rights instead of “community” rights [31]. For instance, Africans perceived the 1960s and 1970s European and American feminists’ campaign to eliminate FGC as an imposition from the outside and another attempt at colonial imperialism [28].

The legislative approach is the third-to-end FGC. Since the turn of the century, governmental, intergovernmental, and non-governmental organizations, as well as academia, have made FGC a hot topic. Most of the countries where FGC is common have laws that prohibit the practice [13, 32, 33]. For instance, the majority of African countries have laws that criminalize it. The African Charter on the Rights and Welfare of the Child is another effort to abolish the practice [13]. These laws have labeled FGC as a criminal act of bodily harm or injury and provided a structural framework or “enabling environment” to act against it [28].

However, the debate is whether it is possible to end FGC by criminalizing the practice or not. There is a consensus that the law alone does not serve the purpose. Despite the criminalization of the act, local practitioners continue to cut female genitals secretly. This practice has contributed to even more unsanitary and unsafe conditions during the surgery [13, 17]. There is another negative side to the legislative approach for parents who practice FGC underground, and it is less likely that they seek health care for complications resulting from the surgery for fear of prosecution [28].

The health approach is the fourth one, which emphasizes the negative health implications of FGC [13]. The WHO focused on health hazards to justify strongly the abolition of FGC. However, later, UN agencies shifted their attention from bodily injuries and therapeutic risks of FGC to the human rights violations in their efforts to end it [1]. Written sources show that the practitioners include midwives, trained circumcisers, doctors and nurses, or traditional practitioners—local specialists (circumcisers), traditional birth attendants, traditional healers, and experienced grandmothers—without any formal training. Regardless of who the practitioner is, she or he does the surgery mostly without anesthesia, antibiotics, or sterile equipment [7, 31]. Thus, the practice has short- and long-term health effects. The short-term impacts can include severe pain, shock, bleeding, tetanus or bacterial infection, urine retention, open sores in the genital region, and injury to nearby genital tissue. The long-term consequences include recurrent bladder and urinary tract infections, cysts, infertility, an increased risk of childbirth complications, and the need for later and repeated surgeries for childbirth and sexual intercourse [6].

However, this is not without controversy. Some challenge this approach, for it does not take into consideration the lived realities of women who have experienced different forms of FGC [28]. In some cases, the community has considered FGC an important surgery. For instance, the Nigerians and the Ghanaians believe that FGC cures infertility, and for some Sudanese, it prevents diseases in infancy and promotes child health [13].

Despite the fact that the above approaches are all relevant to put an end to FGC, the local government at our research site uses the legislative and health approaches more vividly. The Ethiopian criminal code [11] labels FGC as a criminal act and a violation of the human rights of women and girls. There are also various government offices working against FGC and other cultural practices that are categorized as harmful. These are the Women, Children, and Youth Affairs (WCYA), Culture and Tourism, Health Office, Education, and Police offices. Despite this, FGC survived as a longstanding cultural practice. In the following sections, right after methods and materials, we will look at the cultural meanings of FGC as well as the factors that contribute to its persistence in the face of the government’s efforts to end it. Thus, the objective of the study was to discuss how FGC has survived, although there are legal instruments and institutional setups that work towards the end of the practice

Study site

The study was conducted in Dawo District, which is situated in central Ethiopia. The administrative center of the district is located approximately at 90 kilometers southwest of Addis Ababa. The total population of the district is 122,731 people [34], while the Oromo constitute 93.35 percent of the total, and Afaan Oromo (Oromo Language) is both the official and spoken language of the district. Ethiopian Orthodox Christianity is practiced by more than 90% of the population. There are followers of traditional beliefs and Protestant Christianity [35].

Research design

The study employed a qualitative approach in which both primary and secondary data were used. Data from the field were collected through key informant interviews and focus group discussions. The fieldwork was conducted from February 27 to March 20, 2020. All the participants of the research were purposively selected in consultation with the office of the WCYA of the district. Partly, convenience sampling was used to identify the participants. The selection criteria were individual knowledge and access to information about the issue under discussion. For the secondary data sources, the Ethiopian Federal Constitution, legal codes, and policy strategies were retrieved and used, and documents from the district’s WCYA and police station and closed files from the district court were used to show some government efforts to stop FGC. These secondary sources, such as the constitution, legal codes, and policy strategies, were accessed online, while others were secured at their respective places in the research site. Generally, the secondary data were used to supplement the primary data, and the former shows the normative standards while the latter is more of community practice from where our title was drawn.

Key informant interviews

We interviewed 20 key informants—13 women and seven men. The participants were three (a man and two women) from the Women, Youth, and Children Affairs Office; a focal person from the Police Office (a woman); an expert from the Culture and Tourism Office (a man); an expert from the Education Office (a woman); four women and three men from the community; and seven schoolteachers (five women and two men). Three of the five women were married and had children, while the rest were bachelors. The two men had daughters. The offices listed above were chosen because they have directly or indirectly worked on the abolition of the FGC. Elderly, male, and female key informants were purposively chosen from the community to gather data on the cultural values underlying FGC and the community’s reactions to government interventions to abolish it. The key informant interviews took between thirty minutes with community members and ninety minutes with an expert from the office of WCYA.

Focus group discussion

We also used focus group discussions (FGDs) to triangulate the data from key informant interviews. To look at the concerns of different individuals and to explore their common understanding of some issues, we organized two FGDs. In the first FGD, there were eight experts (four men and four women) from concerned offices: two from the office of WCYA, two from the Culture and Tourism office, one from the Education Office, a schoolteacher, and two from the district police. The participants of the second FGD were nine married women who had experienced FGC as recipients and mothers. This method helped to access data from individuals as members of a group rather than simply as individuals. The discussions, debates, and consensus were all important because, by bringing together different individuals who have a common background, FGD plays an essential role in building meaningful data from common societal issues and confrontations.

Data collection tools and analysis

For both key informant interviews and FGDs, we used semi-structured questions that were few in number and open-ended in nature, with the objective of eliciting views and opinions from the participants. These questions were set with the intention of guiding the informants rather than restricting them to answering what was just asked. All the interviews and FGDs were conducted in Afaan Oromo, the language, which we, the researchers, speak natively, and the principal investigator is well familiar with the research site. We transcribed the data into the original language and translated it into English. We used a thematic qualitative data analysis whereby we coded, categorized our transcript, interviews, and secondary data into themes and sub-themes, and finally interpreted them qualitatively.

Approaches to end FGC and community resistance in Dawo District

The micro-level efforts to end FGC are direct reflections of the national policies, rules, and regulations. The major macro-level approaches are the human rights approach, the legal approach, and the health risk approach. As indicated in the introduction, Ethiopia introduced a penal code banning FGC (Ethiopian Criminal Code Article 565 and 566). In addition, in 2013, a National Strategy and Action Plan on Harmful Traditional Practices against Women and Children, which was followed up by another strategy known as the Social Norm Change Communication Strategy, were made effective. The strategy to end HTP has been based on the three-pillar approaches of prevention, provision, and protection [12]. Led by the Ministry of Women, Children, and Youth (MoWCY) the country set up a national alliance to terminate child marriage and FGC. Other sectorial ministries, national associations, faith-based institutions, international and local civil society organizations have collaborated on the implementation of the national strategy. In addition, the Ethiopian government has restated its plan to stop FGC and child marriage by 2025 [10].

In January 2017, the Ministry of Health banned the medicalization of FGC in all public and private medical facilities, and any breach of this ban will be subject to legal action. The restriction goes hand-in-hand with the criminalization of FGC under the Criminal Code of 2005 [9, 10]. As an extension of the criminalization of the act, the district police office has a focal person who works to protect the human rights of women and children. The focal person is in charge of handling cases such as early marriage and/or abduction, rape, and violence against women, including FGC.

The MoWCYA at the federal level has offices at regional, zonal, and district levels to implement national policies and strategies to end FGC and to ensure gender equality (the Ethiopian federal state has regional, zonal, district, and kebele levels of administration) [10]. There is a district office for WCYA, designed to oversee and protect the rights and well-being of women and children, and FGC is one of its central focuses. The Office of Culture and Tourism is the one in charge of promoting cultural elements and fighting against "harmful traditional practices." The schools are also responsible for teaching the young generation to develop all-rounded personalities. They attempt to create awareness about the adverse effects of practices such as FGC and early marriage. These offices and institutions work in cooperation and even as a team against the FGC [36, 37].

The national FGC network that aimed at fighting FGC was established in Ethiopia in 2002 under the initiative of Norwegian Church Aid. The network was officially launched in 2010 and had 46 members from government, NGOs, faith-based and civil society organizations, and UN agencies (notably UNFPA, UNICEF, and WHO) [14]. Ethiopia also introduced a health extension package to reach villages and households through health extension workers. Among others, the health extension workers focus on creating awareness to end harmful traditional practices (HTPs), including FGC.

The persistence of FGC in Dawo District

Data from our informants [36–39] show that the community is well-informed about the criminalization, the negative health impacts, and human rights violations related to FGC. However, mere knowledge of the issue has not deterred the community from practicing FGC. The primary data from the field imply four explanations for the persistence of this practice. Primarily, the community gives precedence to the cultural values of FGC over its negative health effects and its legal implications. Secondly, the community has designed a mechanism to escape the potential legal prosecution that could result from the violation of the law that bans it. Thirdly, the community generally undermines the health effects of FGC by appealing to their lived experiences. Fourthly, the community also disregards the fines that could result from the practice. On the other hand, issues related to individual rights, bodily integrity, and sexual pleasure are not a point of attention for the community. That means individual rights has no space in this community because it is collectivistic, focusing on ’we’ consciousness, collective identity, and emotional dependence rather than the opposite. The norm does not also allow the discussion of the second issue,—sexual integrity,—in public. In the following sections, we focus on the explanation of these issues.

Cultural values vis-à-vis approaches to end FGC

The community provides multi-layered cultural reasons for practicing the FGC that are intended to challenge the government’s intervention efforts to stop it. The main cultural explanations they provide include sexual modesty (controlling women’s sexual drive), preserving premarital virginity, and developing accepted feminine behavior that ensures the marriageability of the girls. The community uses the compound term “dhaqnaqabaa” or "huuba irraa fuudhuu" to refer to both FGC and male circumcision. The term dhaqna refers to the body, and qabaa, from qabuu, means to ‘catch’. Literally, it means ‘catch the body’ (to circumcise). According to our participants [36, 40–42] and FGD [37], a woman who has not undergone FGC is clean neither physically nor ritually, for her body is not caught for cleaning and cleansing.

This fact becomes clearer by the phrase "huuba irraa fuudhuu," which means to "remove something unwanted." The term "huuba" means ‘unwanted’, or ‘smut’; irraa fuudhuu, means "to pick" or "remove something from a surface." Together, the two words mean "eliminate a chip or something malignant or unwanted." The phrase "huuba irraa fuudhuu" also implies that female genital cutting is as important as male circumcision [43]. A male person who is not circumcised is mocked at and insulted with a derogatory word ‘uncircumcised’ or ‘one whose prepuce is still intact.’ The expression shows that there is something alien and, therefore, unwanted on the genitalia, and due to this, should be removed. For the community, FGC is the surgical removal of the phallic and "unnecessary" or "unwanted" part of the genitalia, the clitoris, to make her a real woman, both sexually and physically, because the phallic is for men, and therefore, should be removed from the females.

Beyond the physical concern, the surgery entails a behavioral change that ensures femininity in terms of gender. There is an assumption that girls who have not undergone FGC are hypersexual, unclean, and indulging. As a result, our data from primary sources unanimously show that girls who have not undergone FGC are not esteemed and wanted for marriage. This is so because they still have the erectile part of their genitals (the clitoris), have not yet attained femaleness physically, and are not also properly feminine in their gender.

The community uses different sayings to ridicule women who have not yet undergone genital cutting. Referring to the physical presence of the clitoris, they say ishiin eeboo baatti, dankaraa baattee deemti, ‘she carries a spear’. Focusing on the sexual behavior and gender identity of the uncircumcised girl, the community often uses such sayings as ishiin farda,’she becomes disorderly (like a horse);’ safuu dhabdi, ‘she is unethical;’ ija re’ee nyaatti, ‘she becomes shameless;’ abbaa manaa jala hin bultu, ‘she cannot remain with one husband’; dhaabbattee hafti, ‘she will remain a bachelor’ [37, 44]. Any act deviating from this norm has social costs, including ostracization, in which girls are labeled as being ‘unclean’, ‘clumsy’, ‘unfit’ for domestic work, or ‘having uncontrolled sexuality’, and thus unmarriageable [4].

Men do not choose such girls for marriage, mainly because of the fear of hyper-sexuality and untidiness. If they get married, their marital life will not be successful. One of our participants, a woman, tried to substantiate this view by narrating the story of a certain unsuccessful marriage. She knew an uncircumcised woman who married and divorced three times. According to this informant, the divorcee did not have a stable marital life, mainly because she did not undergo genital cutting and due to this she challenged those who married her [40]. We, the researchers, have not confirmed the story and do not know the real reasons behind the frequent divorce of the woman in focus. However, this informant, who is a pro-FGC strongly, recommends FGC as the best therapy to ensure a successful marriage for a woman and that is why she made all her daughters undergo the genital cutting.

Within the prevailing patriarchal cultural framework, women, as such, mothers and grandmothers, are the prime promoters of FGC because they are given the irreplaceable role of socializing and shaping, including the sexual behavior of girls, and one of the instruments for this is FGC. If a girl behaves in a customarily wrong way, the problem is soon attributed to the way she has been brought up. To express this fact, they use the common expression isheen guddisa badde, ‘she was badly brought up.’ If the misconduct is related to sexual activities, the blame becomes more severe and goes to the mother or the grandmother who brought her up.

A mother whose daughter has not undergone FGC often receives shaming remarks from others. Sayings such as Intalli kee saafeela kan dhaabbattee hafte, ‘You are the mother of the uncircumcised, therefore, unmarried girl’. It is so shameful and dishonoring to be insulted in this way. In another saying, haadha ilaali intala fuudhi, ‘see the mother before marrying her daughter’, similar to the saying ‘all daughters grow up to be like their mothers’ [39, 44], members of the community convey the strong message to families that they have to cut the genitals of their daughters if they want them to have a successful marital life.

In substantiating this view, a father-informant whose wife organized a genital-cutting ceremony for their daughters without his consent, narrated the following story of his family. Our informant has two young daughters and claims that he is aware of the negative impacts of FGC because he completed grade ten, while his wife, who has no formal education, is a proponent of the practice and believes that it is mandatory and necessary for the cleanliness of women and cultural conformity. According to this informant, his wife believes that it is her responsibility to raise her daughters and mold them into ideal female behavior. If her daughters remain uncut, she would be responsible for the disgraceful state of the girls. Thus, she organized a secret genital-cutting session for her young daughters without the knowledge of the husband. She assigned her sister-in-law as a jaala (sponsor, to seat behind and cover the girls’ eyes during the surgery) to keep the case confidential [45].

The father recognized lately that his daughters had undergone FGC. He noticed the girls receiving treatment while returning home from his daily farming activities. He strongly indicates that for a mother, letting her daughter remain with the clitoris is an incurable and lifelong psychological and moral failure. He says that rakkoon dubartoota bira jira. Ani kanan dhaqna qabadhe maalan ta’e jedhu. Ani qofti mucaa koo dhaqna qabsiisuu dhiisee maalifan kan kolfaa ta’a; mucaa kootti kofalchiisa jedhu. ‘The problem is with the mothers. They say, though I had my genital cut, what has happened to me? Why do I make my daughter and myself mocked at by others leaving her uncut?’ [45].

We were able to talk to the mother, who organized a secret session to cut her daughters’ genitals. She proudly explained how she was successful and admitted that the report from her husband is true [46]. In relation to this, there is a nexus between parental education and values for FGC in Africa. Particularly, maternal education matters, and the more educated they are, the less they practice FGC on their daughters, and vice versa [26]. This is confirmed by the participating school teachers who have daughters but not performed FGC on them. Three female teachers reported that they have not exposed their daughters to FGC, and promised not do so in the future [42, 47, 48]. The remaining two female teachers said that, although they are against the practice; they are not sure about what may happen when they will have daughters as the issue of FGC entails the interventions of several stakeholders [49, 50]. One of the male school teachers admitted that his elder daughter had already undergone FGC under the pressure of his mother, while the junior ones have not as he and his wife strongly resisted the urge [51]. The second male teacher, who has a young daughter of two years, said that he would not perform any FGC [52].

Coupled with this, the prevailing cultural norms put pressure on girls to have their genitals cut. Our data indicated that peer groups and friends harass, tease, and laugh at girls who have not undergone genital cutting [47, 48, 53, 54]. One of our participants, who claims that he is aware of the negative consequences of FGC, narrated to us how he finally submitted to the firm demand of his only daughter to have her genital cut. The father says that when she was eleven years old, she strongly demanded to undergo genital cutting; otherwise, she would stop going to school and escape somewhere. The father says that he was helpless to reject this demand from his daughter, for the denial might lead to a worst-case scenario, i.e., the disappearance of their daughter. In the meantime, he also believed that there was a hidden hand of his wife behind the pressure that their daughter was exerting. His wife did not openly oppose his position but agreed with her daughter and designed the way to achieve the final goal of cutting the genitalia [53].

Withstanding the criminalization of FGC

Despite the campaign against the FGC by the government, the practice is still widespread, and the legal actions against it by the judiciary are close to nil. This is mainly because the community withstands the potential legal actions either by paying the imposed fine or by hiding the practice from legal or concerned bodies to escape being prosecuted [38, 44, 48, 52]. According to our participants, several factors contribute to this effect. Primarily, the law that forbids FGC lacks any deterrent effect. The law was enacted some years ago, and given the fast devaluation of the Ethiopian currency, a fine of five hundred Birr (as stated in Article 565 of the Ethiopian Criminal Code) has no preventive effect. One of our participants expressed the amount of the fine, saying, dhibbi shan gatii indaanqoo tokkooti; eenyu illee adabbii qarshii dhibba shaniif jedhee dhaqnagabaa hindhiisu. ’Five hundred Birr is just the price of a rooster; this penalty never deters anyone from practicing FGC’ [45]. Regardless of its deterrent effect, our data indicate that the police, in cooperation with the Office of WCYA, brought a few cases of FGC before the district court and penalized the actors, including parents, sponsors, and circumcisers, as per the Ethiopian Criminal Code Article 565. Yet, parents always prefer to cover the fine instead of refraining from the practice because the payment is so meager that it can easily be afforded [38, 42, 44, 53, 55].