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Portrait of Pain - Julia Ruben gauges the health effects of female genital cutting on women's risk of HIV in Ethiopia - by Valerie Gregg
spacer Pain permeates life for women in rural Ethiopia.
Major milestones—love, marriage, and having babies—are fraught with unimaginable agony due to the traditional practice of female genital cutting (FGC). Deeply rooted in African countries from Senegal, eastward to Somalia, and from Egypt, south to Tanzania, FGC often leads to infection and sometimes death for women or their babies during childbirth. It also reveals a lot about the general status of women in cultures where FGC is prevalent.
     “The women often marry very young, start reproducing right away, and don’t stop until they have to,” says MPH student Julia Ruben, who spent this past summer working with Save the Children in the Liben district of southeastern Ethiopia. “Having children is basically the focus of their lives.”
     An Emory Woman’s Club scholarship, designated for a first-year RSPH student with a career interest in women’s health, is helping Ruben shed new light on FGC, which WHO calls female genital mutilation. She interviewed scores of men and women about the practice. In her master’s thesis, Ruben will attempt to gauge the effects of different types of FGC on women’s risk of HIV infection, with the help of her RSPH adviser, Kathryn Yount (See "Understanding the Roots of Domestic Violence in Egypt").
     What has emerged is a larger portrait of pain. Life is hard in this parched, rural part of southeastern Ethiopia. Families live off a little corn and the milk of cows and camels. Food is scarce, and a three-year drought shows little sign of easing.
     For women, things are especially difficult. Almost all of the women interviewed had undergone some form of FGC.
     “The practice is widespread—almost universal—but the reasons for and opinions about the practice vary considerably,” says Ruben, whose sample includes all the major ethnic groups and religions of the Liben district, including Islam, a traditional Borana religion called Wak Efata, and Christianity.
     According to the WHO, most of the women and girls who experience FGC live in 28 African countries. WHO defines the practice as the partial or total removal of the female external genitalia or other injury to the female genital organs for nontherapeutic reasons. About 2 million girls, most younger than 15, undergo the procedure worldwide every year.
     With the help of a female interviewer and a male interviewer/translator, Ruben conducted in-depth interviews of both women and men about sex and marriage, FGC methods and practice, sexual habits, and knowledge of HIV and sexually transmitted diseases.
     Physical problems from FGC depend largely on the type performed. In type I FGC, part or all of the clitoris is removed. In type II, both the clitoris and the labia minora are removed. With type III, called infibulation, the clitoris and the labia minora are removed, and the vagina is stitched closed, so that it heals as a smooth surface, leaving only a small hole for urine.
     “Type III has the worst complications,” says Ruben. “I’ve heard from them that they use spikes from plants, horse or human hair, or tire thread for the sewing. The women’s legs are then tied together for one or two weeks afterward.”
     Excessive bleeding and infection can result from all types of FGC. “When women die from such things, it is often thought of as ‘her time’ from God and not attributed to the practice,” says Ruben.
Ethiopian women
ff ff ff
spacer Through her research in Ethiopia, Julia Ruben hopes to spare women the physical and emotional pain of female genital cutting. She conducted her research with the help of an interviewer (second from right) and three traditional birth attendants. Two of the women (far left and far right) are “uncut” Guji women. The women are in the town of Hardot. spacer
spacer Complications from childbirth
Because of scarring from FGC, a woman tears instead of stretches with every birth, which usually occurs at home, with few or no supplies or medicines. “With type III, the first birth is particularly difficult, because the baby is basically stuck. One woman exclaimed, ‘How is the baby supposed to come out?’ Often they have to use a razor blade to cut open the area. I heard of a few women getting reinfibulated after birth, but most do not.”
     For many of these women, the most painful consequence of FGC is losing their virginity, most often by sheer force on their wedding night. Often, women 14 to 18 years of age (and sometimes younger) marry men chosen by their parents.
     “Women explained that they fainted, bled for several days, and came close to death,” Ruben says. “It often takes several days for a man to penetrate an infibulated girl. In more than one community, men and women both explained that how quickly he is able to teaNo woman seemed to initiate sex. Many of them had heard of this 'desire' in uncut girls and were curious about it. Others run away from sex or avoid it as much as possible says Julia Ruben.r through to devirginize the girl is a measure of his strength. Many reported not letting the tear heal and continuing sex every night afterward.”
     Education and real-life experience with health complications, particularly during childbirth, are key to improving the health of these women.
     “Type I is now much more common, particularly closer to town,” says Ruben. But the continuing practice of FGC reflects the low status of women in society.
     “Many men have no idea a woman can even have sexual pleasure, or if they do, they don’t care,” she says. “No woman seemed to initiate sex. Many of them had heard of this ‘desire’ that uncut girls have and were curious about it. Others run away from sex or avoid it as much as possible. Most seem to tolerate it as a duty, as something done to satisfy their husbands.”
     Ruben also learned that virginity is absolutely essential to all ethnic groups and religions. Women continue the practice of FGC with their daughters because the social repercussions of stopping are greater than the pain and health problems it causes.
     “One woman described her infibulated daughter’s first childbirth,” says Ruben. “The girl was in labor for three days before she got to the hospital because of obstructed labor. Her mother took her to the hospital and was asked by the health worker whether to save the mother or the baby. She watched the baby being pulled out with forceps, which also tore her daughter. The baby was dead. She exclaimed to us: ‘I killed my own daughter’s baby. It was by my own hands.’ ”
     Through her research, Ruben hopes to shed light on the
realities of FGC and transfer that powerful knowledge to these women.

Valerie Gregg is an Atlanta freelance writer and former editor of this magazine.


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