Female genital mutilation, or FGM, is a traditional practice that is performed throughout the Horn of Africa and other parts of the continent. The procedure is often called female circumcision, and it is illegal but still common in the self-declared republic of Somaliland, where health care workers, activists and others are working to end it. Cathy Majtenyi has more for VOA.
As many as 97 percent of girls and women in Somaliland are believed to have undergone the procedure.
It involves cutting some or all of the external genitalia and commonly sewing up the genitalia, leaving a small hole for blood and urine to pass.
It is an ancient practice in Somaliland and throughout the Horn of Africa.
Halimo Elmi Wehliye manages an FGM awareness project at Care International that aims to convince communities to abandon the practice. She says that there are many reasons why people practice FGM, one being that it is believed to prepare women for marriage, "The reason why they are practicing [is they believe] if women do not circumcise, they become sexually very active - when she goes out she tries to rape even the men," says Wehliye. "In order to reduce that sensitivity, [they believe,] we have to remove this kind of organ."
Most women who have undergone FGM experience a wide range of medical problems, including acute bleeding, urinary infections, infertility, complications giving birth and even damage to the baby.
Edna Adan Ismail is the founder of a maternity hospital in Somaliland's capital Hargeisa and one of the first health-care professionals to bring the issue of FGM to the world's attention.
She describes what happened to one 12-year-old girl whose opening in her sewn-up genitalia was too small. "The abdomen was distended. There was abdominal pain. We did an ultrasound scan [to determine,] 'Is she pregnant? Why is the abdomen distending?' Of course, the diagnosis was that this young lady had been menstruating and the blood had been collecting inside the body all these months," she explained.
Ismail says a too-small opening can also spell disaster for marital relations. "They bring the bride to us on her wedding night, hemorrhaging like crazy. We suture. We stop the bleeding. We take care of it. We let her go home," she says. "She's brought back the following night with even more severe hemorrhaging, because the wound that we had sutured and the bleeding points that we had stopped were not given a chance to heal by the husband, who forced himself on this girl."
Activists say that the situation is slowly changing as people talk more and more openly about FGM and the harm it causes, with some women rejecting the practice for themselves or their daughters.
One mother described why she prevented her daughter from undergoing FGM. "I have experienced many problems myself, and my sister died because of FGM. She bled to death," the mother said. "I do not like any forms of FGM. My daughter does not wish to do a practice that goes against the Koran."
Activists say some communities are starting to challenge the practice of FGM.
Care International's Halimo Elmi Wehliye says she and her staff ask communities to describe the complications they experience from FGM and come up with possible solutions. "Most of them, they are saying, 'We have to stop [FGM],' and at the same time some of them are saying, 'We have to at least get centers.' Those who want to continue the practice said, 'We have to train qualified midwives at least who can use clean materials to prevent HIV or all blood-transmission infections.'"
But Edna Adan Ismail and others say the pace of change is slow, and that girls and women will continue to suffer needlessly until certain traditional attitudes are changed.