Experiences of Girls Who Underwent Female Genital Mutilation/Cutting

Abstract

Objective

To describe the experiences of girls who have undergone FGM/C, so that efforts toward ending this practice can be scaled up using evidence-based interventions. Method: A qualitative descriptive design with in-depth interviews conducted with 16 genitally mutilated girls, aged between 12 and 19 years. Results: Four themes and 10 sub-themes were identified. The themes were: it is the right thing to do; the cold circumcision morning; life after FGM/C; FGM/C is ongoing. They experienced fear, uncertainty, pain, and helplessness due to the practice. Conclusion: The FGM/C experiences of these girls could serve as evidence to scale up efforts toward ending FGM/C.

Introduction

Female Genital Mutilation (FGM), also referred to as Female Genital Cutting (FGC) or Female Circumcision (FC), has drawn considerable attention from many organizations and researchers worldwide (Obiora et al., 2020). This is a harmful practice, with both short and long-term complications, but continues among many ethnic groups, especially in Africa, as it is based on complex reasons which include cultural and sometimes religious myths passed from generation to generation (Graamans et al., 2019; Obiora et al., 2020; Onuoha, 2018; UNICEF & UNFPA, 2018). It is an ancient practice, originating from communities who wanted to control female sexual behavior and ensure women’s virginity by reducing their sexual desire (Berg & Denison, 2013; Rafferty, 2013; World Health Organization (WHO), 2017). FGM/C is widely recognized as a violation of human rights (Obiora et al., 2020; WHO, 2018, 2020).

According to the World Health Organization (WHO) (2018), FGM/C includes all procedures that involve the partial or total removal of the external female genitalia and/or injury to the female genital organs, for cultural or non-therapeutic reasons. From a health perspective, FGM/C can lead to immediate physical complications, such as hemorrhage, genital tissue swelling, shock, infection and death, as well as some severe long-term effects such as increased risk of childbirth complications, scar tissue and keloid formation, and a need for de-infibulation (Bogale et al., 2014; Ekenze et al., 2007; Kaplan et al., 2013; Obiora et al., 2020; WHO, 2018; World Health Organization (WHO), 2017). Psychosexually, FGM/C could lead to dyspareunia (Anis et al., 2012), which can lead to crises among couples. In addition, FGM/C could have a detrimental influence on the economic and social development of females and prevent them from realizing their full personal potential (Getachew, 2006; WHO, 2020). This is because the moment a girl is circumcised, it indicates she has transited from being a girl to a woman and is now marriageable, which may predispose her to early marriage with the attendant consequences of dropping out of school (Njogu, 2018) and adolescent pregnancy.

According to UNICEF (2015), eight African countries have an FGM/C incidence of more than 80%; Somalia has the highest incidence of 98%, followed by Guinea, Djibouti and Egypt with an incidence of more than 90%, and Eritrea, Mali, Sierra Leone and Sudan with more than 80%. FGM/C is widely practiced in Nigeria, where an estimated 21.6 million women of childbearing age have undergone the procedure (UNFPA & UNICEF Nigeria, 2016); this accounts for 24.5% of the practice globally (National Population Commission [NPC, Nigeria] & ICF International, 2014). According to 28 Too Many (2018), 50% of the 55 million girls (aged 0–14) who have experienced or are at risk of FGM/C in Africa live in three countries, namely Egypt, Ethiopia and Nigeria. However, since Nigeria is the most populous of these countries (NPC [Nigeria] & ICF International, 2014) it may add the greatest share to the 50%. Several studies on FGM/C showed the age of cutting in Nigeria is mainly between 0 and 5 years, and that the four classifications of FGM/C, according to the WHO, are practiced in various Nigerian communities (NPC [Nigeria] & ICF International, 2014; Obijiofor et al., 2020; Obiora et al., 2020; WHO, 2020).

In 2008, a global UNFPA/UNICEF joint programme on the abandonment of FGM/C was launched and is currently implemented in 17 countries (UNFPA & UNICEF Nigeria, 2016). Nigeria joined this global programme in December 2013, but the actual implementation commenced in 2014 in Imo, Ebonyi, Osun, Ekiti, Oyo and Lagos States (UNFPA & UNICEF Nigeria, 2016). The choice of these states was because of their high prevalence of FGM/C compared to other states, such as Delta and Akwa Ibom. According to the baseline situation analyses conducted by the Nigeria Demographic Health Survey (NPC [Nigeria] & ICF International, 2014), the FGM/C prevalence rate in South West Nigeria was the highest in the country, and little progress has been made in terms of eradicating this practice as the prevalence rate of about 57% in 2003 only decreased to 48% in 2013.

Conversely, the South Eastern region, where this study was conducted, experienced a steady increase in the practice from 40% in 2003 to 48% in 2013 (NPC [Nigeria] & ICF International, 2014), despite the reported increase in awareness resulting from the campaign of UNFPA and UNICEF in this region (UNFPA & UNICEF Nigeria, 2016). The Federal Government of Nigeria declared FGM/C illegal in May, 2015 (Obiora et al., 2020), and some studies in South Eastern Nigeria reported a slight decline in the prevalence of FGM/C after 2015; however, they reiterated that the practice is ongoing in the communities (Ikonne & Chukwuma, 2020; Obijiofor et al., 2020). In addition, globalization has influenced age-long cultural practices and beliefs, as most are now questioned, compared and abandoned by the current technology-driven generation. However, the practice of FGM/C is ongoing in many communities of South East Nigeria.

As illustrated above, the culture and belief systems of the FGM/C practicing communities, which include the experiences and perceptions of the young girls, need to be understood, so as to allow for the development of specific community-led interventions aimed at eradicating the practice. Therefore, the research question for this study was ‘What are the experiences of girls who have undergone FGM/C in South East Nigeria?’

Methods

Design, study population and sampling techniques

A qualitative descriptive research design was used as the researchers hoped to obtain unadorned answers to the research question (Sandelowski, 2000). The study population consisted of all girls aged between 12 and 19 years, who had undergone FGM/C in two communities of South Eastern Nigeria. Snowball sampling, which involved asking participants to make referrals or recommendations for other potential participants (Ghaljaie et al., 2017) was employed. Participants were recruited until data saturation was attained. According to Fusch and Ness (2015), data saturation defines the sample limit in qualitative studies, as adding more participants after data saturation does not add any value to the results. The Institutional Review Board granted ethical approval (M170834), and the directors of Primary Healthcare in the communities studied gave consent. The healthcare workers in the communities helped to identify the first participant and encouraged the community members to participate in the study. Referrals from other participants identified the remaining participants. The potential participants and their parents/guardians received an explanation about the information leaflet. Only potential participants who assented and whose parents/guardians consented to the details of the information leaflet where interviewed. In addition, the freedom of the girls to withdraw at any time during the study was emphasized. Sixteen (n = 16) girls assented to participate in the study, following the consent of their parents/guardians.

Instruments for data gathering

The first author conducted semi-structured interviews guided by an interview schedule (See Table 1). One broad opening question, also known as the grand tour question, was asked: “Please tell me about your experience of FGM/C from the day you were cut up to now,” followed by the probes and prompting questions. However, the researcher allowed the participants to lead the conversation instead of focusing on getting the questions answered (De Vos et al., 2011; Greeff, 2005). The predetermined probes for this study were not used line by line, instead the researcher listened more and allowed the probes to naturally emanate from, but not limited to, the information the interviewee provided. To make the interview more natural, the use of paraphrasing, passive and indirect probes avoided limiting the flow of information from the participants. The conducting of the interviews was in private at the homes and other quiet spaces in the participants’ neighborhood, between November 2018 and April 2019. Only the first author and participant were present during each interview. Audiotaping of the interviews and the taking of field notes was with the permission of the participants during the interview sessions. The interviews lasted about 25 minutes on the average.

Table 1.

Interview Guide.

Section B: Main question

Please tell me about your experience of FGM/C from the day you were circumcised up to now

Probes to explore:

Motivators of FGM/C in your Community

Support for FGM/C

Data analysis

Data analysis commenced alongside data gathering. The first author, a public-health nurse and midwife who is bilingual, translated and transcribed the interviews verbatim from Igbo to the English Language. The participants’ general information was entered onto an Excel spreadsheet. Qualitative content analysis (Sandelowski, 2000), was used to analyze the data. An inductive approach (Elo & Kyngäs, 2008) was used. First, the transcripts were read and notes were written in the margins. This process was repeated to ensure all the keywords were noted. The keywords were then transferred onto coding sheets and subthemes created by grouping the keywords. Lastly, subthemes were clustered or grouped under higher order headings referred to as the themes. The first two authors were involved in the data analyses. The authors used reflexivity to become aware of prejudices resulting from their experiences, knowledge and privileged positions (Malterud, 2001; Pillow, 2003) and how they might influence the findings.

Results

Descriptive analysis

The participants consisted of 16 (n = 16) genitally mutilated girls, aged between 12 and 19 years; their mean age was 16.3 (SD ± 2.2). The girls were not married and all had reached primary level of education. Table 2 presents details of the participants’ general information.

Table 2.

General Information of the Genitally Mutilated Girls n = 16.

Participants	Age (Years)	Caretakers	Age at circumcision (and year)	Venue of circumcision	Circumciser	What was removed?	Support for FGM/C
P1	18	Parents	Not sure	Health center	Healthcare practitioners	Don’t know	Yes
P2	18	Parents	Not sure	Oba (Yam barn)	Traditional circumciser	Not sure	Yes
P3	18	Parents	10 (2010)	Oba (Yam barn)	Traditional circumciser	Clitoris	No
P4	18	Guardian	7 (2007)	Oba (Yam barn)	Traditional circumciser	Clitoris	No
P5	17	Guardian	11 (2012)	Oba (Yam barn)	Traditional circumciser	Clitoris	Neutral
P6	19	Parent (Father)	10 (2009)	Health center	Healthcare practitioners	Not sure	No
P7	18	Parents	10 (2010)	Oba (Yam barn)	Traditional circumciser	Not sure	Yes
P8	17	Parents	9 (2011)	Oba (Yam barn)	Great grandmother	Not sure	Yes
P9	19	Parents	15 (2015)	Oba (Yam barn)	Grandmother	Don’t know	No
P10	13	Parents	Not sure	Don’t know	Don’t know	Don’t know	Yes
P11	12	Parents	Not sure	Don’t know	Don’t know	Don’t know	Yes
P12	14	Parents	Not sure	Don’t know	Don’t know	Don’t know	Yes
P13	15	Parents	Not sure	Don’t know	Don’t know	Don’t know	Yes
P14	14	Parents	Not sure	Don’t know	Don’t know	Don’t know	Yes
P15	15	Guardian	Not sure	Don’t know	Don’t know	Don’t know	Yes
P16	16	Parents	9 (2011)	Oba (Yam barn)	Traditional circumciser	Clitoris	Yes

Themes and Sub-themes

Four themes and 10 sub-themes arose from the data. The themes were it is the right thing to do; the cold circumcision morning; life after FGM/C; FGM/C is ongoing. Table 3 presents a summary of all the themes and sub-themes identified in this step of the study.

Table 3.

Themes and Sub-themes.

Themes	Sub-themes
It is the right thing to do	FGM/C is our culture and father was in support A stubborn girl Beliefs and benefits of FGM/C
The cold circumcision morning	Circumcised against my wish The circumcision procedure Fear, pain and maturity
Life after FGM/C	Recovery and returning to school Stories of other circumcised girls
FGM/C is ongoing	Should we continue with this practice? Perpetuators of FGM/C

Theme one: It is the right thing to do: “They wanted me to be circumcised”

This theme consists of three sub-themes: FGM/C is our culture and father was in support; a stubborn girl; threats and benefits of FGM/C.

Sub-theme one: FGM/C is our culture and father was in support

The girls believed FGM/C was part of their culture and the expectation was for every girl to be circumcised, because their mothers and grandmothers were, so it was only natural for them to undergo the same procedure. They also believed because the boys in their communities were circumcised they had to undergo circumcision.

The participants said:

…Yes, all of us were circumcised including my younger sister… my mother told us all that we were all circumcised so we can look like other girls. (P1)

Everyone must be circumcised… circumcision is our culture…boys are circumcised, girls are circumcised… (P2)

The FGM/C culture was so strong in these communities that girls who become pregnant without being circumcised, whether married or not, underwent circumcision before they gave birth.

One participant explained:

It is an abomination for a girl to give birth without being circumcised. That is what they said, so I had to go through it. (P9)

The participants believed their fathers were in support of the circumcision practice.

…so, my father told me that I will be circumcised alongside my elder sister. (P7)

Yes, he was fully in support of my being circumcised. He also believes that it is the culture in our community, and they have always done it successfully. (P5)

Sub-theme two: A stubborn girl

None of the girls subjected themselves for FGM/C procedure willingly. However, they did not want to argue or appear to be questioning their parents’ choices for them. This was because such an attitude can cause a girl to be termed “stubborn,” and might negatively influence their reputation in the community.

Yes, you see, the woman was already there to do the job and it will not be good for her to see me disobey my mother…. I did not want to be labelled a stubborn girl especially by people outside my immediate family. (P5)

I entered the yam barn in obedience to my mum…. I was afraid but I wanted to obey my mum and also be a proud girl (laughs)… (P16)

In addition, some of the participants did not think they had an option and felt they were expected to obey. They subjected themselves to what they thought was their fate.

One participant explained:

One thing I was sure of is that I knew that they wanted me to be circumcised…I didn’t think I had any option than to just do as they said, especially when they went further to explain to me that it is our culture and so needs to be done for my good…. I just obeyed them and went in for it. It was not as if I had a choice of refusing or accepting to be circumcised. Remember that I was a small girl then… (P3)

Although FGM/C was a common practice in their communities, the participants did not know what the procedure would entail until it happened to them.

One participant said:

… Although I knew that girls are usually circumcised…I didn’t know exactly how the circumcision will be… I obeyed my mother… (P8)

Sub-theme three: Beliefs and benefits of FGM/C

Some of the participants described the reasons for FGM/C they learnt from their parents and neighbors. Some believed they would have difficulty during childbirth if they were not circumcised.

…ehmm, in our village, girls are circumcised so that they will not have difficult labour, when they go to give birth. Like me, I gave birth to this my daughter about a year ago, and I did not have difficult labour. I delivered her myself with the help of my mother. I was strong and fine after the childbirth. My daughter is fine as you can see. That was because I was circumcised before the childbirth experience. That is the benefit of circumcision. No one knows the future… (P8)

Some participants believed it was a disgrace for a girl to give birth to a child if she was not circumcised. Not only would she have severe pain during labor, but would also not have her son or daughter circumcised.

One participant said:

Yes now, ask the women in our community, they will tell you the same thing I am telling you. It is an abomination for a girl to give birth to a child without herself being circumcised, whether she is married or not… In fact, if a girl succeeds in giving birth to the child without being circumcised first, that child will not be circumcised whether male or female, and so it will continue in their generation. (P8)

Another reason for circumcision was to prevent promiscuity, which would prevent an unplanned pregnancy.

…she (mother) said that if a girl is circumcised, she will not be promiscuous and so will not have unwanted pregnancy, and even if she gets pregnant outside wedlock, it won’t be called unwanted pregnancy because a circumcised girl is seen as a full woman and so can get married and have children. Also, childbirth will be easier for the person because she is circumcised. (P6)

Theme two: The cold circumcision morning: “…It was so painful…”

This theme consists of three sub-themes: circumcised against my wish; circumcision procedure; fear, pain and maturity.

Sub-theme one: Circumcised against my wish

Some of the participants reported that much anxiety and fear enfolded them on the circumcision morning.

In fact, my mother really tried to make me see reasons with her for the circumcision, but I was still very scared in my mind. I had elder sisters and girlfriends that have been circumcised, and they already told me that me that it is very painful… (P6)

One of the girls felt she was “deceived,” as her mother and elder sisters told her the circumcision was not painful. She felt betrayed when she realized some flesh had been removed from her genitals, leaving her with much pain.

My mother was the one that woke me up. I asked her to know what the experience is in details, but she told me not to worry, that it won’t harm me. My elder sisters also reassured me that the experience was not painful and won’t take a long time … madam, it was so painful. Chai!!! Don’t mind them o. They deceived me so that I will not run away… (P2)

One participant refused FGM/C because she knew the practice was against the healthcare system’s reports; however, she underwent a forced circumcision. Despite going against her wishes, the participant considered her mother’s behavior as normal given the community they lived in.

I was circumcised in year 2012 with my younger sister. Before that day, my mother told me that I will be circumcised but I refused because I heard over the radio that FGM/C is not good and that the government and people in health services are preaching against it. However, one early morning, my mother woke me up with the news that the woman that will circumcise me and my younger sister has arrived…she dragged me to the yam barn…she thought I just wanted to disobey her or be naughty. (P5)

Sub-theme two: The circumcision procedure

Some of the participants reported healthcare practitioners as their circumcisers.

… later that morning, my mother’s sister came to our house and she took me to a health centre and there they gave me drug, which made me to sleep. I woke up later in the day with pains in my genitals. I looked around and saw that I was on the clinic bed with my mother beside me. Later in the evening that day, we went back to our house…I was given an injection, which I think made me to sleep. I think I was happy that I didn’t have to bear the pain of the circumcision being done in our house. (P6)

The participants not circumcised in a healthcare facility agreed their circumcision occurred early in the morning and that the cut was swift. An adult held down some of the girls so they would not be able to move their bodies during the procedure, and none was sure which anatomical part was removed, nor the type of FGM/C they had undergone.

…she is a traditional circumciser. My mother said that she does circumcise other women. …my heart was beating very fast (in a low tone). The woman asked me to sit on the floor and remove my pants. I did so. She then asked me to spread my legs apart. I obeyed. She went on to dig a small hole on the ground in front of my genitals, in between my legs. After that, she brought out a razor blade, held my flesh pulled it a little and then cut it off swiftly… (P2)

Hmm, I was so afraid and was even crying especially when the woman was about to cut off my flesh. So, my mother held me so tight such that I could not move my body. The woman also used her strength to immobilise my legs so that I was not able to move my legs and thigh while she did the cutting. I really wept. It was so painful… I bled for a short time… (P4)

When explaining the experience of being held down, one participant (P4) was silent for a while and then said:

… (silence)…I think that was the only thing they could do then so that I will be circumcised. If they did not hold me like that, I don’t think I would have stayed for that procedure because I was scared beyond imagination…I think I might have run away even. So, they had no option than to hold me like that for me to be circumcised. I wept so much, but that is past now. Am fine and strong… (P4)

Sub-theme three: Fear, pain and maturity

Although the participants feared the circumcision and especially the sight of the razor blade, some tried to conceal their fears in order to show some level of maturity and to act strong.

Hmm, sincerely, I was afraid within me. I was so afraid but was trying to act strong before my family. I also tried to believe that it won’t be painful, after all, my elder sisters have gone through it before me. (P2)

In addition to the pain they experienced, some were afraid of friction on the wound and tried to avoid increasing the pain intensity.

…I walked gently with my legs somehow apart after the procedure till the wound healed. Also, the fear to urinate was there. This was because of the pain I thought I will feel when urine touches the wound site… (P3)

One of the participants went into shock after undergoing the procedure.

When they released me, my mother helped me to stand up… I was feeling cold, so I wanted to stay close to the fireplace so I can have warmth, but my parents told me not to go close to the fire till the wound healed…they asked me to go and lie down and never to go close to the fire for reasons best known to them…but the morning was not a very cold one. I can’t really say the exact cause of that severe cold, but I just realised that my body was shaking vividly with cold when I entered my father’s house after the circumcision. Maybe the intense pain and crying triggered the cold. I don’t know the exact cause. (G4)

The participants also experienced undue pressure from their parents to prevent them from acknowledging the pain they had to endure. They were told not to cry out when they felt pain during the FGM/C procedure, as this was a sign of strength, and those who cried out were mocked by the other circumcised girls.

One participant explained:

…I was crying… but I did not shout while crying because my mother said that if the other circumcised girls get to know that I cried out during the procedure… they will come to our house in a group and request me to pay a penalty to them for disgracing other girls… Also, people can use that to mock me that I can’t endure pain…it is a sign of strength and courage for a girl not to cry during circumcision. It is something girls boast of when they are with their peers. So, my mother told me not to cry so that other circumcised girls will not hear me and then come and make mockery of me and then collect penalty from my mother. I still cried so much but with a low tone. (P7)

Theme three: Life after FGM/C: “Mother cooked special food…”

Two sub-themes arose from the data - recovery and returning to school, and stories of other circumcised girls.

Sub-theme one: recovery and returning to school

The participants had the sheer will to endure the circumcision pain. Also, they experienced their family as supportive after the circumcision.

My family members were very supportive during the period. They were so happy that I was circumcised, and they tried to render every assistance they could to me. My siblings ran errands for me while I laid down to rest. My mother cooked special food for me the day I was circumcised, so I was able to eat that day despite the pain because my favourite food was served. (P4)

Participants attending school had to wait for their wounds to heal before resuming schooling. The duration of recovery varied, and they were not sure how long they stayed at home before returning to school. Some of the participants rationalized that FGM/C did not affect their learning.

One participant explained:

…No, normally our parents will tell our class teacher that we were sick and so won’t be in school till we recover. They could also send a sibling or a neighbour’s child to go tell our class teacher to excuse us from school because of ill health. The teachers don’t complain about that. The best they can do is to send a message that the pupil should take enough rest and recover fast. We don’t tell them exactly what happened. I wasn’t absent from school for a long time. (P5)

However, another participant who had challenges when returning to school reported:

Well, it does sometimes as I have to be scratching my body secretly when a teacher is in class or when am alone. It makes me worried and uncomfortable…I try to take my bath as often as possible and good smelling cream. I go to a secluded corner to scratch the place when the itching becomes intense. I have been coping with it, though it has not been so easy for me. I also take the medications my mother got for me, both herbal and modern ones. Some of them bring temporary relief. (P9)

Unfortunately, some of the girls experienced fever and some had genital infections resulting in foul smelling genital discharge shortly after their circumcision.

The participants explained:

I later had fever for some days, was treated with some natural herbs and it later stopped…my body temperature was so high, and I was having cold… (P7)

My wound lasted longer than was expected because of that dirty discharge that started coming out from it then…it was a white capsule with white powder inside it. So, I use to open the capsule and apply some of the powder on the wound daily till it dried up… (P9)

Sub-theme two: Stories of other circumcised girls

Some of the participants shared FGM/C stories of other girls.

One participant explained:

…I went to stay with my mother in the city…one day, the woman’s daughter who is also my friend but much younger than me began to yell and scream for pain. Neighbours rallied round to know what the problem was. They now saw that she was bleeding from her genitals. She held her tummy and was crying from pain. She was then rushed to the hospital where they succeeded in controlling the bleeding and her life was saved. Later, her mother told mum that the girl just got circumcised at a health clinic a day before the bleeding incident. She said that such use to happen to girls who have known a man before circumcision. They said girls of this generation get exposed to sexual intercourse early, so they should be circumcised at an earlier age. My mother was so scared with the incidence, she said she will not get my younger sister circumcised since she is not sure if she has known a man or not…. I was very scared that day. (P6)

Theme four: FGM/C is ongoing: “It is a must for every girl in our community”

Theme four consists of two subthemes: should we continue with FGM/C, and perpetuators of FGM/C.

Sub-theme one: Should we continue with FGM/C?

There was a division amongst participants in terms of the continuation of FGM/C. Some heard FGM/C was not good and should cease, whilst others believed the practice should continue.

The participants said:

… I heard over the radio that FGM/C is not good and that the government and people in health services are preaching against it… I don’t really know the reasons, but I heard it with my own ears… (P5)

…I have heard a male teacher say something like that to us in school…I think he said that FGM/C is not good and that the government said that people should stop it…All I know is that my mother said that a girl must be circumcised…I don’t know what the teacher was talking about (said with a mean face). (P1)

Concerning the personal opinion of the participants on the continuation of FGM/C, it was interesting to note the same girls who shared experiences of uncertainty, pain and even some health challenges, which they attributed to FGM/C, boldly supported the continuance of the practice. Their opinions about the continuation of FGM/C, as well as their reasons are as follows:

Oh yes. It is our culture and for our good. I have told you the reasons I know why it is done. My mother was circumcised, so also my grandmother. It will not stop in my time… It is a must for every girl in our community. (P7)

A few indicated they do not want FGM/C to continue, while one of the girls was neither in favor of the practice nor against it. Some explained they would circumcise their daughters later in life.

One participant said:

Since they said it is our culture, when I get married and have a daughter, I will circumcise her just like my mother circumcised me… I have not suffered any problem because of circumcision. (P16)

Sub-theme two: Perpetuators of FGM/C

Various factors contributed to the perpetuation of FGM/C: peer pressure, circumcised mothers, circumcised relatives, fathers and some healthcare practitioners. Peer pressure seemed to be one of the greatest perpetuators of FGM/C. Some of the participants mentioned it was a thing of pride to be a circumcised girl in these communities.

One participant said:

In fact the reigning thing now is that circumcised girls make mockery of the uncircumcised girls… We sometimes move away from an uncircumcised girl or make sure that she is not in our circle of close friends. Circumcised girls are happy and proud you know… (laughs). There are other girls too who get convinced to request for circumcision so that they can be like us. It is a thing of pride to be a circumcised girl… (laughs). (P2)

Being born to a circumcised woman was another high-risk factor for FGM/C.

She said FGM/C is our culture and that herself was circumcised by her mother with no consequence up to date. She said I just had to undergo it for my good…She insisted that I must be circumcised. (P5)

Some of the relatives, especially their elder sisters, aunties, grandmothers and great grandmothers, circumcised the girls, or persuaded them to undergo the procedure.

The participants explained:

I have three elder sisters and they were all circumcised…My elder sisters also reassured me that the experience was not painful and won’t take a long time. So somehow in my mind, I believed them. (P2)

Although none of the participants reported their father having circumcised them or actively participated in ensuring their circumcision, they still opined they were aware of the circumcision plan and were in support of it. They therefore appeared to have support for the practice.

Some of the participants said:

My father told me that I will be circumcised alongside my elder sister. He said that they don’t want to delay my circumcision so that what happened to my elder sister (unwanted pregnancy) will not happen to me. (P7)

A few of the participants mentioned some healthcare practitioners taught against FGM/C, whilst others reported healthcare practitioners had circumcised them.

One participant said:

… later that morning, my mother’s sister came to our house and she took me to a health centre and there they gave me drug, which made me to sleep. I woke up later in the day with pains in my genitals… I think I was happy that I didn’t have to bear the pain of the circumcision being done in our house. (P6)

Discussion

It appears this is the first study conducted in a country with a high FGM/C incidence, which describes the experiences of genitally mutilated girls. The general information of the participants revealed that the girls who could recall their FGM/C experiences underwent circumcision between 2007 and 2015; it is noteworthy the Nigerian government banned FGM/C in May 2015 (Obiora et al., 2020). Some of these girls mentioned their younger sisters had undergone circumcision, or would undergo the procedure. This suggests FGM/C persists and is ongoing in these communities, just as UNICEF and UNFPA (2018) documented.

Half of the girls interviewed said their parents informed them they had undergone circumcision. This practice of circumcising a girl during infancy or as a toddler means she grows up without any remembrance of her circumcision experience. This agrees with the report of Onyima (2015), that in Nigerian cities FGM/C is done mainly at infancy, especially eight days after birth. Onyima explained that mothers prefer infant FGM/C to avoid the stress of having to convince a grown-up girl to submit herself for such a painful procedure (Onyima, 2015). It is also possible that early-age FGM/C could partly be due to the fear of the anti-FGM/C law and awareness campaigns in Nigeria. There is no report of anyone being arrested for FGM/C (Daly & Carson, 2016; Nigeria28 Too Many, 2019), but people could have a silent fear for the law, especially those living in cities.

The girls in this study were told by their elders that FGM/C was necessary for cultural reasons which no one dared to question, as it means challenging the wisdom of the aged. Any girl who dares to question her parents’ decision receives the label “stubborn,” which is undesirable for a girl in the Nigerian culture. Using this kind of label resulted in girls surrendering themselves to be circumcised so they would feel accepted by their families and communities (Jacobson et al., 2018). Since FGM/C is a deeply rooted cultural and societal requirement, the need for social acceptance and a good reputation outweighs the fear, uncertainty and pain of FGM/C. According to Bogale et al. (2015), conformity meets with social approval, and brings respect and admiration.

Several reasons for FGM/C have been documented in literature (Obi & Igbinadolor, 2018; WHO, 2018), however our study revealed some of these reasons were unfounded and were cultural beliefs for anyone who refused FGM/C. Examples were that FGM/C prevents difficult labor and it beautified the female genitalia. This explained the reason uncircumcised pregnant girls were circumcised before they gave birth to their babies. This finding concurs with the report of a girl who was circumcised during pregnancy in a documentation by UNFPA and UNICEF Nigeria (2016).

The study provided evidence that FGM/C was rarely discussed, despite being a common practice; this finding concurs with the reports of Jacobson et al. (2018) and Nour (2008), that there is a culture of silence regarding FGM/C in certain communities. As seen in the current study, many of the girls did not know what the practice entailed until they underwent circumcision. However, some of the girls had hints from their friends that the practice was associated with severe pain. In addition, one of the girls felt she was “deceived” as her mother and circumcised elder sisters told her the procedure was not painful; she was disappointed when she experienced terrible pain because of the cutting. This kind of “deception” was the way mothers and relatives convinced the girls to go for the procedure, so her case was not an exception. Considering the above, the deduction is that relatives devise various means, including deception and undue pressure, to convince girls to go for FGM/C.

Furthermore, some participants reported a “nurse” conducted their FGM/C in a healthcare facility. The type of the healthcare practitioner who did the circumcision was not clear, as the people in these communities refer to all female health workers as “nurse.” This report confirms that medicalization of FGM/C exists in these communities, which is in agreement with the report of Ekenze et al. (2007), who reported that 33.3% of their respondents in South East Nigeria said they were circumcised by nurses. One participant underwent sedation, or anesthetization, in the community health center to reduce pain caused by the FGM/C procedure. A similar experience was also reported by Jacobson et al. (2018) among Somalian-Canadian women who had FGM/C under local anesthesia. Irrespective of the reason for which FGM/C was done by a healthcare practitioner, it is strongly condemned globally as a violation of human rights (Leye et al., 2019).

In line with the report from previous studies (Obi & Igbinadolor, 2018), most of the study participants did not know which anatomical part was removed during the circumcision. The belief was that the traditional circumcisers were experts in the procedure, therefore the mothers entrusted their daughters to these circumcisers. According to Ekeanyanwu (2017), it is always difficult to explain the possible consequences of FGM/C to its believers who patronize traditional circumcisers and hospitals, as they will most likely attribute the cause of the complications to other reasons.

Due to the forceful restraining, some participants felt helpless during the procedure. However, they still tried to defend the action of the adults with the explanation that such behavior was the norm in their communities. This is vivid evidence of the power of culture in which, according to the theory of ethical relativism, morality is relative to the norms of one’s culture (Velasquez et al., 1992). In addition, some of the girls experienced fear and pain during and after the circumcision. As supported by reports of Somali-Canadian women in Jacobson et al. (2018), the girls were afraid to urinate due to the pain post-FGM/C. However, our participants mentioned it was a sign of maturity for a person to conceal pain; the girls were expected to endure and conceal the pain so as not to disgrace their peers and to prove they were mature (Klein et al., 2018).

It was interesting to find the girls were of the opinion that FGM/C did not affect their schooling, because their parents informed the teachers they were sick. The teachers would never know the girls had undergone FGM/C, and the circumcised girl would re-join other learners whenever she resumed schooling. This seems to portray the low importance parents and people in these communities attach to education compared to their cultural rituals; this highlights the strong power of culture. Some of the participants had hyperpyrexia and cold (fever), while some had some foul-smelling discharges from the wounds shortly after the FGM/C procedure, and some recurring infections over the years. These must have increased the duration of their absence from school, as they reported they stayed home until their wounds healed properly before resuming schooling. These symptoms reported by the participants have been reported in previous studies as complications of FGM/C (Obiora et al., 2020, 2021; WHO, 2018).

One of the girls reported chronic genital infections and some menstrual disorder, which has had a negative impact on her life since her FGM/C procedure in 2015. In line with our findings is the report by (Njogu, 2018) that FGM/C has devastating effects on the education of young girls in schools. It causes some to drop out of school as it gives the impression the girls are now complete women and so can get married and raise their own children. According to Njogu (2018), FGM/C could hinder the girls from participating actively in education and cause chronic absenteeism from school, which might cause dismal academic performance in class and eventually result in high dropout rates from school. Contrary to the report of UNFPA (2017) that school holidays are mostly FGM/C periods in Somali, communities in South East Nigeria perform FGM/C any time the parents decide, irrespective of the impact of the days of absence from school on the learners.

Despite the reports of fear, uncertainty, pain, anxiety and even health challenges the participants associated with their FGM/C experiences, and the fact they all claimed to have heard something about FGM/C not being a good practice, the majority (68.8%) indicated support for the continuation of the practice; some girls explained they will circumcise their daughters when they have them. Besides, it was obvious from the data in Table 2 that all the girls against FGM/C were ages 18 or 19, while those of age 16 or younger all said they supported it. This could mean that as the girls become older, more mature or more educated, their opinions change or that they become bolder to express their true thoughts about the practice of FGM/C. The most common reason for indicating support for FGM/C was that it was their culture, and they had no harm from their own circumcision experience.

It is evident that FGM/C is deeply embedded in their culture (Edeh, 2017; Onuoha, 2018; Yaya & Ghose, 2018). The claim that FGM/C caused them no harm, from the same girls who shared some painful FGM/C experiences, is debatable. This again shows the power of culture/tradition (Onuoha, 2018; Velasquez et al., 1992). According to UNFPA (2017), some parents who migrated from FGM/C practicing communities to western countries still send their daughters back to their local communities to undergo FGM/C. Therefore, a community-based and convincing anti-FGM campaign is important to disabuse the minds of these community members about FGM/C.

From the interview data, circumcised mothers often encouraged the circumcision of their daughters. It was clear from the interviews, and confirmed by previous studies, that daughters of circumcised mothers and relatives were at high risk of FGM/C (Obi & Igbinadolor, 2018; Obiora et al., 2020, 2020). Other perpetuators of FGM/C were peer pressure, father’s quiet support for the practice and some health workers who medicalise FGM/C.

Implications of the study

The eradication of FGM/C is not simple, as there was overwhelming support for its continuation, and the belief that culture dictates the process. However, strategies such as including FGM/C as a topic in the curriculum of schoolchildren, in addition to the ongoing anti-FGM/C awareness programmes, may enhance the eradication of FGM/C.

Also, it could be beneficial to involve teachers in these communities in the anti-FGM/C awareness programmes, as they can report to the necessary authorities for immediate investigation of the perpetrators whenever they suspect a girl is at risk or has had FGM/C. Similar to the tentative plan to include FGM/C in school curriculum in England, as reported by Female Genital Mutilation: Children to Be Taught Dangers – BBC News (2019), the teachers in South Eastern Nigeria could be motivated to teach and convince the learners of the consequences of FGM/C and also what to do whenever they suspect their parents are making plans to circumcise them.

Limitations

There was a possibility of a recall bias for the participants as they shared their experiences of FGM/C. As this was a qualitative study, it may not be possible to extend the results to a wider population. In addition, the raw data allows for multiple interpretations and therefore the results do not reflect the only truth about the phenomenon under study.

Conclusion

This study described the experiences of girls aged 12–19 years who had experienced FGM/C in South Eastern Nigeria. Some underwent circumcision in early childhood, and could not share their personal experience of the FGM/C procedure, while others reported feelings of fear, uncertainty, pain, and helplessness to be associated with the practice. All the participants reported there was a culture of silence toward FGM/C in their communities, while the majority indicated support for the continuation of the practice for reasons such as culture and influence of peer pressure.

Conflict of Interest statement

The authors disclose no conflict of interest.