Bulletin of the World Health Organization

Fighting genital mutilation in Sierra Leone

Activists in West Africa say mass literacy campaigns and education are the best way to stop the harmful traditional practice of female genital mutilation in Sierra Leone.

Rugiatu Turay still remembers the pain she felt the day she and four of her sisters were sent to Freetown, Sierra Leone’s capital, on the pretext of visiting their aunt.

“They used a crude penknife, it was so painful. I bled excessively for two days and fainted when I wanted to walk,” Turay said, describing how at the age of 11 she was subjected to female genital mutilation.

Afterwards the scar itched and got infected. As a result she developed severe menstrual pains, blood clots and a cyst, she said.

When Turay heard her younger sisters were due to undergo genital mutilation too she tried, in vain, to intervene. The death of a cousin, who bled to death after being subjected to the practice, triggered her activism.

Today Turay leads the Amazonian Initiative Movement (AIM), one of several nongovernmental organizations that campaign in West Africa against the harmful traditional practice of female genital mutilation. She formed the group in 2002 with other women she met in refugee camps in Guinea during Sierra Leone’s 1991–2001 civil war.

Turay is one of an estimated 100–140 million girls and women worldwide who have undergone female genital mutilation — the removal of all or part of the female external genitalia as part of traditional initiation rituals or marriage preparation customs. According to WHO, every year two million girls are at risk of being subjected to the practice which is sometimes referred to as female genital cutting or female circumcision.

Sierra Leone is one of 28 African countries where female genital mutilation is practised. It is also a custom in parts of the Middle East and Asia.

The procedure is usually performed by an elderly woman of the village who has been specially designated this task, by a village barber or by a traditional birth attendant. But in some countries more affluent families seek the services of medical personnel to avoid the dangers of unskilled operations in unsanitary conditions. WHO has consistently condemned this medicalization of the harmful traditional practice as “wilful damage to healthy organs for non-therapeutic reasons.”

In the past, studies have suggested that the practice of female genital mutilation can result in infertility, pregnancy and childbirth complications, and psychological problems through inability to experience sexual pleasure.

But in a study published in August this year in the Lancet, researchers made the strongest link yet between extreme forms of female genital mutilation and female infertility. Their findings provide the most compelling evidence to date that girls who have undergone genital mutilation in childhood could be at risk of infertility later in life.

The new findings have given activists like Turay a much-needed credibility boost.

“We want people to drop their knives; we want parents and girls to become more open about the practice; we want the victims to talk about the practice and to be ready to say ‘no’, so that the government knows women are ready for a change!” Turay said.

In Sierra Leone, female genital mutilation usually takes the form of a crudely performed operation to remove the clitoris — sometimes with razor blades, penknives and even with broken glass — as a key part of the initiation ceremonies that prepare girls for marriage and motherhood. UNICEF estimates that some 90% of Sierra Leonean women are subjected to genital mutilation.

Turay and her fellow campaigners in Sierra Leone believe the best way to raise public awareness about the risks of female genital mutilation is to teach the women designated to perform the procedure to read and write — in Sierra Leone these are often illiterate older women — and provide them with an alternative source of income.

But convincing people that this ingrained tradition is wrong is an uphill struggle in a country emerging from a decade of civil war, where people long to return to traditional values and where 66% of the population is illiterate, she said.

Since AIM was founded in 2002, four activists have left after receiving death threats. Turay said that despite a powerful pro-genital mutilation lobby in Sierra Leone, the campaign is making progress.

“Educating people is empowering them. It is only through their minds that you can change the attitude of people,” Turay said.

Turay and other AIM activists visit villages and talk to the women who earn a living from genital cutting to try to persuade them to give it up. “We have been able to get about 700 practitioners from 111 villages to drop the practice,” she said.

AIM has received funding from donors in the United States to provide 40 of 700 women who perform genital mutilation with alternative employment, but Turay said she did not know how her group would help the remaining 660.

AIM would like to set up a skills training centre to teach the former genital mutilators and girls intent on escaping the practice to read and write, operate computers and make money from agriculture or tie-dying cloth.

Turay said there were other positive developments in Sierra Leone and that religious leaders there had started to oppose the harmful practice. “Two imams have made a public declaration to say that their daughters will never be initiated and other imams and pastors have started preaching about the practice in their prayer meetings,” she said.

Liliane Bitong, Freetown.

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“We want people to drop their knives; we want parents and girls to become more open about the practice; we want the victims to talk about the practice and to be ready to say 'no', so that the government knows women are ready for a change!”
Rugiatu Turay, campaigner from Sierra Leone

“Educating people is empowering them. It is only through their minds that you can change the attitude of people,”
Rugiatu Turay, campaigner from Sierra Leone