TRIUMPH?

How Ebola Could Eradicate Female Genital Mutilation In West Africa

With Ebola still raging in Sierra Leone, a small sliver of hope has emerged: female genital mutilation has halted. Could this be the beginning of the end for the dangerous procedure?

01.20.15 10:45 AM ET

The government of Sierra Leone, in effort to stop the continued spread of Ebola, has placed a ban on female genital mutilation (FGM). As silver linings go, it’s an unsettling triumph.

While more than 21,000 people have been infected with Ebola in West Africa, more than 3.5 million women and girls in Sierra Leone have undergone FGM. It’s an excruciatingly painful practice, one that involves the partial or total removal of the clitoris—and, in many cases, a host of lifelong health problems. Sierra Leone, which has one of the highest rates of FGM in the world, has zero legislation on it.

So while the decision to ban it is a positive byproduct of Ebola, it’s also not a solution. This motion is a temporary one, motivated not by the need to protect the 88 percent of the women subject to FGM in Sierra Leone, but the country itself.

Enter UNICEF. Long a warrior against FGM worldwide, the organization is hoping to use this as the first step on a path to total eradication. Doing so will take convincing not only the government, but the women and men across the region that it is wrong. With Ebola cases beginning to slow down in Sierra Leone, the window of opportunity has already begun to close. 

Dhuwarakha Sriram, a child protection specialist for UNICEF and mother of twin girls, is at the forefront of the battle. She has been watching public perception of the practice evolve since 2011, when she arrived in Sierra Leone. The country has shifted its view, but not enough. “In 2008-09, you [could not] even open or discuss this issue,” she tells me.  “It’s so strongly entrenched in the society, even in the educated society…quite literally, most of the women are being cut.”

The ceremony’s importance is tied to the “Bundu,” a secret female society that uses it as an initiation ceremony. “Soweis,” the older women who perform the ceremony, hold considerable power in this region, making it a “vote winner” for politicians who will pay to “sponsor” FGMs in order to get votes. 

These factors mean FGM isn’t merely present in Sierra Leone—it’s ubiquitous. UNICEF estimates that 3.5 million women and girls in this region have been circumcised (another term for FGM), which is more than half the country’s entire population. An estimated 88 percent of women are subject to cutting, one of the highest rates in the world. UNICEF, too, offers sobering statistics on the practice, which takes place in 30 countries across Africa and the Middle East. Of those, 24 have adopted legislation protecting girls against FGM—Sierra Leone is not one of them.

“Initially it was kind of a grooming process—they are taken to the bush and they are taught how to look after the men, etc.,” Sriram explains to me. “But nowadays it’s just about the cutting itself.” The cutting is, more or less then, a badge of honor—one that grants women a place in society.

Attempts to educate women there about the dangers of FGM have largely been unsuccessful. In Sierra Leone, more than 70 percent still fully support the ceremonies. “They hold a kind of spiritual power over the community…so they are very scared,” says Sriram. “When you ask the number of deaths related to FGM, no one ever talks about it. If someone dies, it means they were bad or wrong.”

Deeply interconnected to gender norms in the society, refusing to be “cut,” is like banishing yourself from the community. “It’s a cultural practice that is essentially linked them belonging to society, if you’re not cut they will ostracize you,” says Sriram. Once initiated into the Bundu, a girl is believed to be a real “woman,” ready for a husband and her own family.

Before the Ebola epidemic struck, Sriram watched pieces of legislation continually fail to make it through the government. Now, she says, change may be underway. “It takes a long time but I think we have made progress,” she tells me. “The main chief has said they will not have any cutting in the communities.”

While Sriram is unable to verify whether or not the ban is working, she says there is anecdotal evidence from on the ground that FGM has drastically reduced. “How can we utilize that momentum to change the behavior that is happening and try to build on that?” Sriram says. “If they have stopped, if they are not cutting at the moment, how we can use them as positive agents of change?”

Few reports on the phenomenon specifically occurring in Sierra Leone have been published. The first is a book by Nigerian doctor Olayinka Koso-Thomas titled The Circumcision of Women: A Strategy for Eradication. In it, Koso-Thomas lays out a plan for how to eradicate a practice that she says “cripples” women for life.

Published in 1987, Koso-Thomas’ text was met with great condemnation and opposition in Sierra Leone, where she works as a gynecologist. She spoke out in defense of her text to IRIN news in 2005. "People got me wrong at first. When I was going to the communities and sensitizing them, they thought I was against their society," she told IRIN. "But it is as a doctor that I started campaigning and sensitizing people about the health hazards, because I saw all the complications."

"The real meaning of the Bundu society is very good," she said. "It is where they train young girls to become women: they teach them how to sing, dance, and cook ... girls who don't go to school learn how to use herbs and treat illnesses; they are taught to respect others."

A more recent study, published by the National Institute of Health, set out to study the health effects of the practice. The authors examined a cross-section of 258 women and girls in the northern region in Sierra Leone. The results paint a gruesome picture of FGM’s consequences. Eighty-four percent of the individuals, 218 in all, reported one or more health complications—ranging from chronic pain to complications in childbirth. Excessive bleeding was the most commonly reported byproduct, followed by incomplete healing and tenderness. Those who underwent the procedure before the age of 10 were more likely to experience fever, and suffer worse long-term consequences.

While Ebola epidemic continues to rage on in West Africa, infecting more than 21,00 and killing at least 8,500, Sriram hopes that it will shed new light on these existing issues. “As important as it is to focus on Ebola, it’s important to focus on the issues that precede [it], because they are one of the contributing factors to this disease,” she says. “In terms of key change, its not just about Ebola, or not cutting. It's about looking at how all of this exists together.”