Fatime Hassan, 22, looks back on her teenage years with a blend of emotions. 

At 14, her parents invited a professional doctor to their home in Gwange Zawiya, a community in Borno, northeastern Nigeria, to conduct a procedure on her. This procedure marked her passage into adulthood in the Shuwa Arab culture. It was her ‘circumcision.’ 

Fatime describes her experience with a sense of acceptance and normalcy. Her parents had emphasised the importance of this tradition, she says, explaining that it would bring her dignity and honour in her future married life.

“So you see, I had to accept it,” she told HumAngle.

In 2022, UNICEF warned that Female genital mutilation (FGM) is extensive in Nigeria, with an estimated 19.9 million survivors, making the country account for the third highest number of women and girls who have undergone FGM worldwide. The estimate further reveals that “86 per cent of females were cut before the age of 5, while 8 per cent were cut between ages 5 and 14.”

Fatime considers herself fortunate because unlike many of her peers who underwent ‘circumcision’ at the hands of traditional barbers, who are mostly older women locally known as ‘Wanzamiya’, she was cut by a professional doctor at home. This medical process, she believes, spared her the severe pain and complications that others have encountered.

“I think the practice only comes with a challenge if it is done roughly by untrained people, mostly elderly women. Some of my age mates who were circumcised by a traditional Wanzamiya struggled with pain. There were no painkillers to help them during the process or afterwards.”

In an interview with Dr Maryam Bukar, a gynaecologist at the University of Maiduguri Teaching Hospital, she explained that FGM is a procedure that involves the partial or total removal of the female genitalia.

“There are no medical reasons whatsoever attached to female genital mutilation. It is also worthy to note that FGM is a violation of the human rights of the individual, and the procedure has no health benefit but jeopardises the health status of an individual,” she said. 

Dr Maryam further explained that FGM is classified into four types. Type 1 is the removal of the crus with or without the partial or total removal of the clitoris. Type 2 is the removal of the corpus. 

“The corpus is like a hood that covers the clitoris, which is the erectile organ, so the removal of the corpus is similar to male circumcision,”  she explained.

The third form of FGM includes the removal of the labia minora and then stitching it up to close the opening.

“Type 4 is unclassified. It includes any other form of FGM such as splitting, pricking, piercing, or any other form of cutting,” she said. 

Dr Maryam pointed out that some of the immediate health risks associated with FGM include pain.

“The victim experiences severe pain as the procedure is being carried out without anaesthesia,” she explained. She also said that the victim might bleed and come down with complications such as anaemia.

“The victim might even die depending on the severity and duration of the bleeding.” 

She also said that other health risks could include infection, especially if the process is not carried out in a hygienic environment. “In cases where the instruments are not sterilised, victims may get tetanus and are at risk of being transmitted with sexually transmitted infections,” she said. She also explained that some victims might deal with other complications like the inability to pass urine.

FGM as a tool for repressing female pleasure

Speaking of the long-term complications that may arise after FGM, Dr Maryam spoke of sexual dysfunction and urinary complications

“Some of the sexual dysfunctions include painful intercourse as a result of the narrowing of the vaginal opening. The victim might also have a loss of libido, which will eventually lead to low self-esteem and marital disharmony,” she said. 

However, this loss of libido appears to be one of the aims of FGM, according to those who practice it. For example, Hauwa Adamu, a 53-year-old mother residing in Gwange Zawiya, speaks passionately about the tradition of female circumcision in her community, as something that ensures the “dignity and honour” of women. Though she and her sisters were all cut growing up, her daughters remain uncircumcised due to her husband’s differing cultural background as a Kanuri man. 

“My husband is Kanuri, so he prohibited me from circumcising my girls, and I had to abide because he is the head of the family,” Hauwa explained.

She strongly believes that female circumcision prevents promiscuity among women, saying that in the past, Shuwa Arab men, who were herders and traders, often left home for extended periods, sometimes for up to seven years.

“These men leave their circumcised young wives at home, then come back and find them with their dignity and honour,” she stated, implying that circumcision prevented the women from getting aroused or engaging in sexual acts that might lead to unwanted pregnancies during their husbands’ absence.

Data from the World Health Organization shows that more than 200 million girls and women alive today have undergone female genital mutilation in 30 countries in Africa, the Middle East, and Asia where FGM is practised, and this practice is mainly carried out on young girls between infancy and age 15. 

HumAngle spoke to Saleh Ali Saleh, the National Youth Leader of the Al-Hayah Association in Borno State, who is also a resident of the Gwange Zawiya area where female circumcision prevails. Saleh’s stance is similar to Hauwa’s; he believes that FGM has a long-standing significance to the value of women in his community. 

“The Shuwa Arab culture has been known for this practice for a very long time,” Saleh stated, emphasising the deep-rooted nature of circumcision in their tradition.

He explained that the practice reduces a woman’s sexual urge during her husband’s absence and helps in fostering patience. 

“My wife and female children were circumcised traditionally and I will continue this practice if I have more female children,” Saleh revealed.

Aishatu Kabu, activist and founder of the Zenith of the Girl Child Initiative and Women Support in Borno explained that female genital mutilation among communities such as the Shuwa Arab will sadly continue to be an issue because it is a part of their culture. 

“These people believe that it is a part of their culture and that you don’t have the right to tell them to stop but one thing that is very interesting is that the VAPP Act domesticated in Borno is strongly against it even though I don’t know the level of the enforcement,” she said.

Aside from preserving their cultural heritage, Aishatu pointed out that there is a form of attachment to the circumcised women in the Shuwa Arab community which serves as a factor in perpetuating the FGM practice because these women want to get the approval of suitors.

“The mothers believe the practice is favouring their daughters so they keep circumcising them,” she said. 

Aishatu lamented that creating awareness on such a sensitive issue is met with certain disregard by the locals who believe that their culture can not be changed. However, she’s impressed by the interventions over the years. 

“I think that organisations shouldn’t give up. Advocacy  should be a continuous process because it’s not something that can be achieved overnight. I’m very sure that if you compare the level of female genital mutilation from years ago to what is currently on ground, there’s a level of decrease.” she emphasised. 

Aishatu calls on organizations and agencies to consider changing their approach by educating locals on the consequences associated with FGM rather than asking them to stop. 

Advanced practice

According to Hauwa, the method of circumcision has evolved in the Gwange-Zawiya community. 

She explained that previously, the wanzamiyas performed the procedure without any medical supplies. Now, these traditional practitioners use antiseptics like Dettol, iodine, cotton, and warm water to ensure the process is hygienic to reduce complications. 

Despite the ‘improvements’ by the wanzamiyas, Hauwa pointed out that there is a decline in parental diligence regarding the care of circumcised girls in her community.

Even though there are laws that say the practice is a violation of human rights and can lead to severe health complications, Hauwa dismisses these concerns, suggesting that those who oppose the practice are ignorant of its cultural significance. 

Dr Maryam explained that FGM has an impact on reproductive health.

“FGM leads to genital infection and this infection can result in infertility. It can also result in menstrual disorders and also due to the narrowing of the vaginal opening, during delivery, there may be delays in the second stage of labour,” she explained.

She further said that there’s a tendency to develop vulva and vaginal tears and these tears result in excessive bleeding which may lead to the death of the victim.

“In cases where the victim undergoes a third stage of FGM where the labia minora is stitched up, they have to be discombobulated before going into labor and this increases the risk of cesarean and the babies delivered may  suffer and will have difficulty initiating spontaneous breathing which may lead to perinatal death.”

Dr Maryam added that some victims might come down with a prolonged fistula in cases where the labor is prolonged.

Prohibited

The Violence Against Persons Prohibition (VAPP) Act, 2015, criminalises female genital mutilation in Nigeria. According to section 6 (1) of the VAPP Act, the circumcision or genital mutilation of a girl child or woman is prohibited. 

Section 6 (2) of the Act states that “A person who performs female circumcision or genital mutilation or engages another to carry out such circumcision or mutilation commits an offence and is liable on conviction to a term of imprisonment not exceeding 4 years or to a fine not exceeding N200,000 or both.”  According to 6 (3), “A person who attempts to commit the offence provided for in subsection (2) of this section commits an offence and is liable on conviction to a term of imprisonment not exceeding 2 years or to a fine not exceeding N100,000 or both.”

Section 6 (4) of the VAPP Act further states that “A person who incites, aids, abets, or counsels another person to commit the offence provided for in subsection (2) of this section commits an offence and is liable on conviction to a term of imprisonment not exceeding 2 years or to a fine not exceeding NI00,000 or both.”

 “There should be an adaptation of clear national policies for the abolishment of FGM. It is also important to establish a national commission that will follow up to see the activities of the bodies involved,” Dr Maryam cried out. 

She spoke on the need to intensify education programs for traditional birth attendants, midwives, and other practitioners of traditional medicine to demonstrate the dangers of FGM.

In cases where complications arise, Dr Maryam said that healthcare providers must treat victims of FGM with sympathy and in a non-judgmental way.

“They should not be forced but rather counselled to take appropriate care. Also, it is important that before pregnancy, complications of FGM should be inquired about and managed, especially those concerning sexual problems. Deinfibulation must be performed anytime on the patient’s request after consent has been obtained when she marries,” she said. 

She also explained that during pregnancy, it is essential for FGM survivors to be examined in communities where the ritual is common.  

“This will help to ascertain the FGM status since victims might deny undergoing it due to shyness or embarrassment. The knowledge of the victim’s FGM status and type will enable health workers to assess the likelihood of obstetric complications.”

She also stressed that the fear and anxiety that the patient might have concerning what may occur in labour must be carefully addressed. Dr Mayam also emphasised that the fear and anxiety that the victims might have concerning what may occur in labour must be carefully tackled. 

The uncircumcised

Hauwa disclosed that there is a significant cultural stigma attached to uncircumcised women in the Shuwa Arab community. 

“In this Shuwa Arab community, we see women who do not undergo circumcision as people who are not women enough,” she claimed, reflecting the deep-seated beliefs that perpetuate the practice.

Even though FGM is tagged as a violation of the human rights of girls and women, leading to severe health complications, Saleh, along with many others in his community, struggles to understand this perspective. 

“We are still not clear on why human rights fight this practice. We have seen its importance and I don’t think people like me will stand up and discourage others from doing it,” he professed.