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From: Women's health – Footsteps 24

A discussion of women's health issues and concerns

by Dr Halimatou Bourdanne.

Excision is a common ritual practice in certain African countries, especially the Ivory Coast where I live. It is carried out by certain ethnic groups. It consists of removing a greater or lesser part of the lips (the fleshy folds of skin around the vagina) and clitoris of women and young girls. The clitoris corresponds to the man’s penis.

There are four kinds of excision:

First degree – removing the top of the clitoris (this is similar to male circumcision).

Second degree – total removal of the clitoris, and part of the small lips.

Third degree – total removal of the clitoris, the small and the large lips.

Fourth degree or infibulation – this consists of sewing together the two edges of the vulva after removing the clitoris, the small and large lips. A small hole is left to allow menstruation.

From the second degree onwards, one is talking of mutilation. Huge health problems can result from excision – especially during childbirth.

The age of excision varies depending on the ethnic group. It can be as early as seven days old or as late as when giving birth for the first time. Generally, older women take responsibility for this ritual. They use sharp objects such as knives, razor blades or certain plants.

The reasons for excision

There are many reasons given. However the essential aim is to keep the woman in submission to the man. Excision prevents women from enjoying sex to the full, so women have a sexual life of complete resignation. They are more docile because they feel less pleasure. Some people say that non-excised women cannot conceive.

In the case of infibulation, it is to guarantee the woman’s faithfulness. In fact, each time the husband goes on a journey he carries out infibulation, and on his return he ‘tears apart’ the stitches.

The complications



Risks during childbirth

With excised women, we are often forced to make large cuts (episiotomies) during childbirth because the opening of the vagina is so reduced in size. We then risk damaging the rectum or the urethra.

One particularly tragic case affected me during my work. One day a young woman arrived, 18 years old and in the first stage of labour. It was her first pregnancy. On examining her, we found that she had a second degree excision. We felt that normal birth should be possible since the baby was small in size. However, when the labour took much longer than normal we realised there was a problem. Since there was no progress, we decided there was a need for a caesarean section. Unfortunately, while waiting for the operating equipment (which has to be paid for) the baby died.

Excision had made the skin so narrow and rigid that childbirth was impossible. In removing the dead baby, the mother’s vagina was completely ruined and we had to sew her up. In the days following childbirth, the mother had losses of urine that made us fear the later appearance of a fistula.

Our response

How should we react when faced with this practice? Excision is an important problem and a much deeper one than is believed. Anyone attacking this problem is confronted with several obstacles – the silence of the women concerned being the major one.

Excision represents a taboo subject, like anything related to sexuality. It is very rare for a woman to consult a doctor about a problem linked to her excision. It is the intellectual Moslem women who have begun to lift the veil on this practice.

Another problem we find is that uneducated women do not always agree that excision should be banned. In fact, they often want their daughters to be excised. They are convinced that this act is beneficial, in spite of the dangers they risk.

A third problem is our own ignorance about the ethnic groups concerned. Any effective action must be carried out with great sensitivity. This means long and difficult work in understanding their beliefs.

As Christians, we can make our sisters aware of the effects and health risks linked to this practice. We know that sexuality for the Christian couple is a gift of God for their delight. With our non-believing sisters, we can only raise these issues later when we have gained their confidence.

If the number of educated women increases, it is certain that this practice will go into decline.

The struggle to be waged against excision is certainly a long-term one, but it is worth it. It is only then that certain women will know the happiness of married intimacy and be free of the risks to their own and their babies’ health.

Notes for discussion…

Dr Halimatou Bourdanne is a medical doctor. Her address is 22 BP, Abidjan 22, Ivory Coast, W Africa.

Notes for discussion

Howa’s difficult decision

In West Africa there is an ethnic group that has always excised nearly 100% of its girls. This ethnic group practises a type of excision that removes the clitoris as well as the two small lips. This practice continues in spite of government measures to eradicate it. Today it is the influence of the local church that is beginning to challenge this practice.

What follows is the true story of a young woman who has dared to resist this practice. To prevent adding to her troubles, not only have we changed her name, but we have also not used the name of her country or the name of her friend who wrote this article.

A few years ago Howa returned from a neighbouring country to her home region. At that time she was of an age to be excised but was not yet engaged to be married. According to tradition, a girl must be excised before the arrival of her first baby, otherwise the child’s health will be at risk if the clitoris touches the baby during the birth.

Normally it is the girl who decides and asks to be excised. She goes to her father or her husband who must then arrange this with the old women who are responsible for carrying out excisions. Some years ago members of this ethnic group became Christians. The question of excision was discussed and, like the government, the church has taken up a position against it. In recent years young Christian girls have tried to resist excision but one after another they finally failed. Social pressure is too strong.

Howa is the only one until now who has held out. What she has suffered because of her decision is difficult to imagine for those of us who are used to our ‘human rights’.

But back to the story... When her mother’s relatives understood that Howa had no intention of being excised, her uncle gave her in a forced marriage to a non-Christian man. He thought that once married, Howa’s excision would be more certain because her husband would have power to influence her. However, Howa had her own ideas about marriage. She also saw the trap and ran away to hide in the home of Christians who protected her.

All this led to quite a lot of persecution. She was beaten more than once. Finally she found help and protection from the government. With the help of the local authorities, she was free to return to her village but she preferred to stay closer to the Christians.

One year later she married a young man from the church. Eight months later Howa received a visit from her mother. Howa was now pregnant. Her mother could not believe that Howa had married a Christian and was ready to have a baby without first being excised. That had never been done in the past and the mother did not want her daughter to be the first to spoil a tradition! All the maternal family would be ashamed.

Howa resisted her mother in all her attempts to trick her to go to her parents’ village. She now feared for her own safety (from beatings) as well as the very strong pressure of her parents – insults, curses etc. During the weeks before the birth the pressure grew. Her mother took the problem to the chief for him to judge. Howa and her husband were called to a meeting with the chief, the mother, and many of the old people. Howa’s husband was accused of stealing his wife because he had not received permission or blessing from the mother’s family. Howa’s mother begged and cried before the chief, asking him to help her force Howa to be excised. The chief could do nothing for the mother, however, because of the law of the land which he knew very well. He advised the mother not to force her daughter but, if necessary, to curse her (and, in fact, to disinherit her). The mother followed his advice and in front of the other people, she told Howa that she regretted the day she had brought her into the world.

Later, Howa gave birth to a beautiful, healthy boy. All the Christian community rejoiced. However word went round that the people who were against the young couple had asked the fetishes (special objects believed to have magical powers) for the life of either Howa, her husband or her baby.

Howa’s maternal relatives now contacted her husband’s extended family. Both of these two large family groups acted together against the young couple. It was very difficult for them to live normally. They were often threatened and insulted. More than once the parents came to kidnap Howa but they failed. The neighbouring Christians supported Howa and her husband, and the police and local government came to give protection when asked.

The officials saw their task as bringing peace between the two groups. As Howa’s marriage was official, and recognised by the state, in principle the government was on the side of the young couple. The maternal relatives insisted that the marriage was no longer valid and demanded a divorce and the return of their daughter.

And then, while all this was going on, Howa’s baby died after an illness lasting two days!

The story still continues today. For the moment, Howa has returned to her father’s home to show that she was not stolen but that she decided to marry the young Christian. She has still not been excised. But one of her Christian friends has just been excised three days ago…

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