Major health issues exist all over the world. Some countries, usually developing countries, have more serious health issues. But, developed countries also have some serious health implications. These may be harder to identify in a developed country because money and research can often quickly be provided in the situation of need. Oftentimes, a developed country has established a firm foundation for quickly and safely handling these public health crises and trained professionals to oversee. However, in developing countries, it can be much harder to solve these tremendous problems due to lack of money, distraction with other issues, and more. A foundation of healthcare standards and public support has not been established. This poses a large issue for developing countries, as the means to a solution are not easily accessible nor time efficient.
There are many factors that can influence major health issues. Politics, discrimination, lack of education, poverty, and endless other factors can contribute to a systematic trend of public health problems. The trends and practices of a culture and society can also directly lead to public health issues. One of these culturally influenced instances occurs in the country of Sierra Leone. This paper will assess and investigate the controversial, yet culturally widespread practice of female genital cutting.
On the coast of West Africa, resides a country by the name of Sierra Leone. Some have heard of Sierra Leone because there was a large Ebola outbreak around 2014. However, there is, and has been, a major health issue effecting many Sierra Leonean women. Female genital mutilation/cutting (FGM/C) has been an issue for many years. It was noticed during the Ebola outbreak because it was exposing more women to Ebola and infection. There was a temporary ban on the cutting, and some hoped that it would end the tradition. (28 Too Many, 2019) However, since the outbreak has been controlled, FGC continues just as it had before. This is an example of the persistent issue affecting developing countries today. The solutions required for many health issues are either not easily accessible or would require an undoing of years of cultural practice.
According to the World Health Organization, there are four types of female genital mutilation. Warning: the descriptions can be slightly gruesome. The Types become increasingly more invasive as it progresses. Type I is the partial, or total, removal of the clitoris and/or prepuce. More specifically, Type Ia is the removal of the clitoris hood or prepuce only. Type Ib is the removal of the clitoris with prepuce. Next, Type II is the partial or total removal of the clitoris with the labia minora; with or without the excision of the labia majora. To distinguish further, Type IIa is the sole removal of the labia minora. The partial or total removal of the clitoris and the labia minor is Type IIb. Partially or totally removing the clitoris, labia minora, and labia majora is Type IIc. Continually, Type III is the narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or labia majora, with or without the excision of the clitoris. Type IIIa is the removal and appositioning of the labia minora and Type IIIb is the removal and appositioning of the labia majora. The last type is Type IV: all other harmful procedures to the female genitalia for non-medical purposes. (World Health Organization, 2019)
In Sierra Leone, the prevalence of FGC is a percentage of 89.6%. (28 Too Many, 2019) Typically, Type I and Type II are the procedures completed. (Orchid Project, 2019) The Bondo, a secret society in Sierra Leone, are major encouragers when it comes to this health issue. The Bondo is an exclusive all-women group. (Bosire, 2012) Female genital mutilation is a part of a ceremony that takes place to bring young females into womanhood. There are other events that happen during this ritual as well, but many of the women are sworn to secrecy. (Bosire, 2012) It seems that female genital mutilation has a political determinant. Most politicians support the Bondo group because they hold so much support for elections. In 2002, there was a woman candidate who was chased away from a campaign because she was anti-FGM. (Bosire, 2012) Many believe FGM to be an issue of gender-based violence. However, 46.3% of men believe the practice should continue and 69.2% of women believe it should continue. (28 Too Many, 2019) Most of the support comes from women, debunking the myth. The systematic and societal trend of this practice could help explain the prevalence of support with women.
There are many health risks that come with every type of FGC, but the risk varies substantially with each type. Since Sierra Leonean women typically experience Type I and Type II, the focus will be on the risks that arise with those specific types. The World Health Organization has arranged the post-FGC health risks into three categories: short-term medical, long-term medical, and sexual, mental, and social consequences. A few short-term medical issues can include hemorrhaging, infection, shock, pain, and urinary retention. Scars, pelvic infections, infertility, menstrual cycle irregularities, and problems in pregnancy and childbirth (which could account for Sierra Leone’s first place in the maternal morality rate.) (Yoder, Abderrahim, & Zhuzhuni, 2004) Mentally, it can be hard to understand what and why it happened and what it means for that person as an individual. FGC can lessen a woman’s sex drive and can make it very uncomfortable, and even painful, to have intercourse.
There is no law to combat the tradition and ritual of female genital mutilation. (Office of the Senior Coordinator for International Women’s Issuses, 2001) There have been some that are trying to make the practice illegal and broadcast the dangers of FGM, but they are often threatened to silence because there are so many supporters of the Bondo society. Those in office and running for office declare allegiance to the Bondo society, male or female, because they will receive loyal support from that group in return. There are more people in support of female genital mutilation, in Sierra Leone, than there are people who want to end the tradition. Those against FGC, hoped the temporary ban during the Ebola outbreak would be the beginning of the end, but it picked up just as it had before.
While investigating female genital cutting, I used the interpretive theory to investigate. The interpretive theory asks of the meaning that humans associate with events and circumstances. Traditionally, females are forced to undergo the procedure when they become adolescents and hit puberty. The idea of this ritual is that it brings the girl into womanhood. (Office of the Senior Coordinator for International Women’s Issuses, 2001) The interpretive theory has two approaches. One being that people act on their beliefs and preferences. Which can allow those investigating someone’s actions to be explained. But the other approach is that we cannot know someone’s beliefs or preferences based off of a few actions. (Bevir & Rhodes, 2002) With those who have female genital cutting performed, in Sierra Leone, it can be assumed that those women value traditional practices and the ritual to be apart of the secret society.
Interpreting the meaning of why women would still go through this ritual, even with all of the possible outcomes, is not easy. Those who have not experienced the culture will have a hard time understanding. The cultural determinant makes it a normality for many women. It is not always something they are forced to do; it is something they willingly, and sometimes joyfully, do. The risk of health issues, to them, does not outweigh the status and acceptance a woman can experience after the ritual. This satisfaction and even desire for the procedure can perhaps be attributed to the long-standing inclusion the country provides for the practice. When considering it a tradition, it can be easier to understand the support these women freely give for the harmful procedures despite the risks.
There is a lot of controversy when discussing female genital cutting. There are those who think the entire procedure should be illegal all together. Many argue that it is dangerous and can cause many future health issues. Opposingly, some believe that it is a religious freedom based on personal beliefs and values. The battle is between protecting public health standards and impeding on the rights to believe and practice what each individual prefers.
As some people think it should be made illegal permanently, there is another perspective. Some think that it is tradition, so you can not take it away from these people. There have been rare proposals of the ritual taking place in a sterile and safe environment. If done in a medical facility, the risk of infection would decrease dramatically. There would be a medical professional available to perform the procedure as well as monitor the healing process for the wounds afterwards. Antibiotics could be prescribed if needed. There is a flaw, however. Most of the people in Sierra Leone live in rural communities and do not have proper access to health care. Many of the women are living in poverty and cannot afford the health care they need. Again, the problem quickly diverts back to the structural issues of the healthcare system in developing countries. Providing this procedure in a safe, medically monitored is often not a reality for many of the countries that practice this tradition, including Sierra Leone.
Participating in the FGC ritual allows women to have protection and be a functioning member of society. There are women who refuse and are fearful for their life or fearful of being kidnapped and forced to undergo the procedure. “I am not safe in this house. I’m not safe in this community,” she said. “I am afraid, when I lie down to sleep, that one day they will grab me, tie me up and take me to that place.” (O’Carroll, 2015) That is a direct quote from a 16-year-old woman in Sierra Leone. She, allegedly, has run away to escape the cutting ritual and plans on doing so again. (O’Carroll, 2015) This case isn’t common. Usually, females are taught that it is normal and expected, which it is for many families in Sierra Leone. This teaching leads to a larger chance of acceptance with the women undergoing the procedure.
To someone not living in that culture, it would be extremely easy to be appalled after hearing about the ritual of female genital cutting. It is hard to understand why it is so important to many Sierra Leonean women. Being a part of the Bondo society means a lot for these women. It most likely means a husband, which would mean a decent, secure life. It can also mean inclusion to a community of support and love. It is up to them to choose what is the most important thing in their life. As the same way it may be appalling for someone in America to imagine going through that ritual, it may be just as appalling for a Sierra Leonean woman to imagine herself or someone else not experiencing the tradition.
Despite the acceptance from many of the women and putting aside cultural differences and objections, basic health problems still persist in this procedure. Female genital mutilation/cutting is a major health issue in Sierra Leone, its prevalence reaching almost 90% of women. The entrance to the Bondo society can only be achieved through this ritual. Yet, acceptance to this society is not the only factor. This procedure can offer great gain for politicians if they offer their support. Another determinant includes the traditional aspect of the procedure, and the staple practice it has become over a long period of time. All of these things give ample opportunity for FGM to persist. However, cultural and political gains do not diminish the risk of infection and other potential complications. The practice is often done in unsanitary environments by non-medically trained members of the culture. There is a lot of controversy surrounding FGC; debate on if it should be illegal because of people’s right to exercise their beliefs. it. Culturally, it is not a rare occurrence and has become normally expected. A solution needs to be reached to ensure safer health practices in the future as well as protection for the minority that wish to reject the procedure.
28 Too Many. (2019, August 14). Sierra Leone. Retrieved from 28 Too Many: https://www.28toomany.org/country/sierra-leone/
Bevir, M., & Rhodes, R. (2002). Interpretive Theory. UC Berkeley Previously Published Works.
Bosire, O. T. (2012). The Bondo secret society: female circumcision and the Sierra Leonean state. University of Glasgrow.
O’Carroll, L. (2015, August 24). Sierra Leone’s secret FGM societies spread silent fears and sleepless nights. The Guardian.
Office of the Senior Coordinator for International Women’s Issuses. (2001). Sierra Leone: Report on Female Genital Mutilation (FGM) or Female Genital Cutting (FGC). United States Department of State.
Orchid Project. (2019, August 14). Sierra Leone. Retrieved from Orchid Project: Working Together to End Female Genital Cutting: https://www.orchidproject.org/about-fgc/where-does-fgc-happen/sierra-leone/
World Health Organization. (2019, August 13). Classification of female genital mutilation. Retrieved from World Health Organizaion : https://www.who.int/reproductivehealth/topics/fgm/overview/en/
Yoder, P. S., Abderrahim, N., & Zhuzhuni, A. (2004). Female Genital Cutting in the Demographic and Health Surveys: A Critical and Comparative Analysis . Calverton, Maryland: ORC Macro.