BY SARAH ECKINGER.
Photography by Anthony MacMillan.
When examining the history of health in Nigeria, many of the diseases and illnesses that have plagued the country are of natural origin, sprouting from bacteria or parasites that thrive in warm countries, or growing from viruses that jumped from animals to humans. Others are chronic and affect people as they live and age. But in certain situations, people have been subjected to “man-made illnesses,” as in the case of Female Genital Cutting, or FGC. Every year, more than 3 million girls undergo FGC in Africa alone, many of whom have had negative health repercussions. Nigeria is one of fourteen countries in Africa where the majority of families practice FGC. Doctors, health professionals, and activists view FGC as a disease, and a commonly practiced tradition that needs to be changed. Beginning in the 1960s, international, federal and local organizations focused on ending FGC practices in Nigeria. By examining the attempted eradication of FGC in the 20th century, future activists may be able to learn from the successes and failures of the past.
It is difficult to determine the exact number of Nigerian women and girls who have received FGC. According to the World Health Organization, approximately 40% of Nigerian females have undergone FGC, while another study reported even higher percentages of 60-90%. The discrepancy can be attributed to several problems in FGC data collection. In Nigeria, FGC varies drastically from town to town and family to family. Three major ethnic groups: the Hausa, Ibo, and Yoruba, practice FGC at much higher rates than any other groups in the country. Researchers have a difficult time conducting studies because of unreliable case reporting, and disagreement over what “constitutes” FGC. The latter issue is a problem because there are several different types of FGC. WHO defines four different types of FGC, which range from the removal of the clitoral hood and/or part of the clitoris, to removal of some or all of the labia, to the sewing together of the labia to narrow the vaginal opening.
Immediately after the cutting takes place, hemorrhage, shock and severe pain are the three most commonly reported problems, all of which can lead to death. In the long term, FGC can cause pelvic inflammatory disease, which leads to about 25% of infertility in Nigeria. The retention of menstrual blood and urine caused by the decreased size of the vaginal opening can cause abdominal swelling and infection. Studies have also linked FGC and obstetric morbidity. Many women report extreme pain during menstruation and with the ripping of stitches that occurs when they first have sex. Additionally, FGC is known to cause psychological problems in women, including depression and neuroses.
Though FGC is dangerous, its practice has continued into the 21st century because of its traditional role as a rite of passage. In Nigeria, many young girls see it as a rite of passage that every one of their friends, around the age of twelve, goes through to become a woman. Societal implications of “beauty” and “cleanliness” are also tied into FGC. Gerry Mackie, in his ethnographic study of Nigerian women, found that “many believe that the only people who do not do FGC are unfaithful women or indecent people.” Some of this stems from these historical womanhood ceremonies, but much of it comes from the importance of remaining a virgin until marriage. Women often undergo FGC when they are children so that their husbands can determine whether or not they have been sexually active. Because certain types of FGC decrease the size of the vaginal opening, women on their wedding nights are expected to “rip open,” and if there is evidence that this has already been done then a husband is often suspicious.
Though female genital cutting is ingrained in some Nigerian cultures, different groups throughout history have opposed it. Activism dates back to the early 1900s, when colonial doctors and missionaries, shocked by the practices they witnessed, appealed to their governments to outlaw the practice. Any attempts to destroy the tradition were fought off by Nigerians (since most colonial attempts to “improve” the health of the Nigerian population had ulterior motives), and colonizers generally retreated. In the 1960s, Western doctors practicing in Nigeria renewed the conversation when several published articles in medical journals depicting the horrible health problems that FGC was causing. This began the modern fight to end FGC by the western world.
In the 20th century, much of the effort to end FGC in Nigeria began with broad statements from international organizations. In the 1970s, the World Health Organization responded to these articles by promising to “promote an end to harmful traditional practices,” such as FGC. In the 1980s, they pledged to create international legislature banning such traditions, and planned research studies throughout Africa, including in Nigeria. The results were published in 1998 in Female Genital Mutilation: An Overview, which continues to serve as an important text for FGC eradication activism. Other organizations, such as the United Nations, issued more general statements that grouped FGC in a “catch-all net” of dangerous practices. In 1993, the UN stated that, “No one shall be subjected to torture or cruel, inhuman, or degrading treatment.” The Action of the Fourth World Conference on Women in Beijing 1995 declared that, “Violence against women both violates, impairs, and nullifies the enjoyment of their human rights.”
International statements indicated that the world wanted to show support and an earnest concern for the welfare of girls and women affected by FGC. And although Nigeria, was bound as a member state of the UN and WHO to adhere to their declarations, these generalized statements were often hard to realize, or more simply not enforced. A more practical route for implementing these practices would be to create a national legislature in Nigeria, supported by Nigerians themselves instead of as pressure from the West. A few attempts were made in the 1990s to create such laws. In 1996, legislation known as “The Children’s Decree,” which would put the declaration of the Fourth World Conference on Women into Nigerian law, was proposed. That same year, the Federal Ministry of Health wrote a national policy for the eradication of FGC, vowing to increase the number of doctors who were trained to prevent and treat FGC, raise public awareness of dangers, and increase education. But by 1999, the same year that Mrs. Stella Obasanjo, Nigeria’s first lady, made her declaration for zero tolerance for FGC, only one of Nigeria’s 36 states had adopted the policy into law.
Why, by the end of the 20th century, had Africa’s most populous country, with such high rates of FGC, passed no federal laws banning the practice? The answer lies in one of global health’s biggest problems: advocating the end of a cultural tradition for the sake of improved health. Many of Nigeria’s tribes practiced FGC as a cultural or religious ceremony. Ending the practice equaled conceding to Western doctors and legislatures who believed they knew best for the Nigerian people, even though the former had little understanding of their culture. Emmanuel Baba, in his discussion of women’s rights, stated, “This Western concern over genital mutilation offers a case study in how the well-intentioned efforts of Americans to improve the lot of oppressed people…can have precisely the opposite effect.”
Indeed, the Nigerian government may not have passed anti-FGC laws because of the lack of ethnocultural empathy from Western-run international organizations. The best efforts to eliminate the practice instead came from within Nigerian communities. Community leaders were best equipped to handle this job, as they had both the understanding of the traditions and the desire to keep their neighbors healthy. Schoolteachers and local public health officials headed the education efforts in their towns. The health dangers of FGC were taught as part of middle school curricula, and communities provided practitioners with alternative jobs.
Adult men and women who had grown up with these traditional practices were the most difficult group to convince of the harms of FGC. Local non-governmental organizations, or NGOs, played a large role in teaching Nigerian communities about the positive attributes of eliminating a harmful traditional practice. One of these, the National Association of Nigerian Nurses and Midwives’sCampaign for Eradication of FGM was active in Nigeria in the late 1980s. It focused on empowering individuals to teach their friends and family about the health implications of FGC. It also incorporated FGC education into family planning and family health contexts. Women’s Issues Communication Services Agency is another NGO that created a travelling museum group active in Nigeria in the 1990s. It displayed paintings and sculptures inspired by FGC, promoting eradication dialogue in the communities it visited.
Local campaigns were more successful than their federal or international counterparts because they dealt with the issues of cultural traditions. Communities used a horizontal approach by working directly with people to integrate new, healthier practices in a traditional society, while broader efforts utilized vertical methods by focusing just on fixing the issue at hand and not on understanding what caused it. Though the fight against Female Genital Cutting is far from over, 20th century efforts have pointed modern activists in a positive direction: support community activism and the desire to end FGC.
 The term FGC will be used in this essay instead of Female Genital Mutilation or Female Castration because of its less “charged” connotation.
 Charlotte Feldman-Jacobs. “Commemorating International Day of Zero Tolerance to Female Genital Mutilation.”
 Elizabeth Heger Boyle. Female Genital Cutting: Cultural Conflict in the Global Community. (Baltimore: Johns Hopkins University Press, 2002), 83.
 World Health Organization. Female Genital Mutilation: An Overview. (Geneva: WHO, 1998), 11.
 Oka Obono, ed. A Tapestry of Human Sexuality in Africa. (Auckland: Action Health Incorporated, 2010), 141.
 WHO, Female Genital Mutilation, 17.
 Family Health Department, Federal Ministry of Health. “Elimination of Female Genital Circumcision in Nigeria.” (Abuja: World Health Organization, 2007), 1.
 WHO, Female Genital Mutilation, 26.
 Bernard E. Owumi, ed. Primary Health Care in Nigera: Female Circumcision. (Ibadan: University of Ibadan, 1997), 11.
 Tracy Slanger. “Female Genital Cutting in Edo State, Southwest Nigera: Its Prevalence, Social Correlates, and Association with Obstetric Morbidity.” AFRASLib African & Asian Health Series, vol 3 (2004).
 Family Health Department.“Elimination of Female Genital Circumcision in Nigeria,” 5.
 Owumi, Primary Health Care in Nigera: Female Circumcision,12.
 Frances A. Althaus. “Female Circumcision: Rite of Passage or Violation of Rights?” International Family Planning Perspectives, vol 23, no 3 (1997).
 Charles L Geshekter. “The Recurring Debate Over Female Circumcision.” (Chico: California State University, 1985), 4.
 Bettina Shell-Duncan. Female “Circumcision” in Africa. (Boulder: Lynne Rienner Publishers Inc., 2000), 254.
 Ibid, 2.
 Anika Rahman. Female Genital Mutilation: A Practical Guide to Worldwide Laws & Policies. (London: Center for Reproductive Law, 2000), 10.
 Ibid, 12.
 Sami A. Aldeeb Abu-Sahlieh. Male and Female Circumcision Among Jews Christians and Muslims. (Warren Center: Shangri-La Publications, 2001), 59.
 Ibid, 60.
 Kingsley Ufuoma Omoyibo. Adolescent Females’ Reproductive Health in Nigera. (Berlin: Peter Lang, 2002), 38.
 Ibid, 40.
 Anika Rahman. Female Genital Mutilation: A Practical Guide to Worldwide Laws & Policies, 201.
 Charlotte Feldman-Jacobs. “Commemorating International Day of Zero Tolerance to Female Genital Mutilation.”
 Babatunde, Emmanuel. Women’s Rights versus Women’s Rites: A Study of Circumcision Among the Ketu Yoruba of South Western Nigeria. (Trenton: Africa World Press Inc., 1998), 179.
 Ibid, 45.
Obioma Nnaemeka, ed. Female Circumcision and the Politics of Knowledge: African Women in Imperialist Discourses. (London: Praeger, 2005), 41.
 Ibid, 42.