Challenges, small wins in fight to cut circumcision of West Pokot girls

At a health centre in West Pokot's Masol community, a woman is seated on a hospital bed, breastfeeding her newborn baby.

Her friend, also with a child, is keeping the new mother company as she nurses the two-hour-old baby.

"This one just delivered this evening so I can't let her go home yet. I need to observe her and if all goes well, she can go tomorrow," says Edinah Chepchumba, the nursing officer in charge of Masol Dispensary in West Pokot County.

In a county where the practice of female genital mutilation (FGM) is rife, Edinah lives for such rare moments when deliveries go well, enabling mothers to bring children to the world without health complications that put their lives and those of the babies at risk.

The prevalence of FGM in West Pokot County is approximately 74 per cent based on a 2017 Unicef report.

This has been a major contributor to the high cases of maternal and child deaths in the region.

According to a World Health Organisation (WHO) collaborative study that was published in the Lancet Medical Journal, women who have undergone FGM are more likely to experience difficulties during childbirth. Their babies also have higher chances of dying.

Nurse Chepchumba, who has delivered more than 300 babies at the dispensary since 2016 notes that all pregnant women who sought services at the health centre had undergone FGM.

She states that female circumcision usually makes the vaginal openings of women narrower and inelastic, leading to prolonged labour as the baby struggles to come out.

This can lead to severe vaginal tears, resulting in haemorrhage (severe bleeding) that is a leading cause of maternal deaths in Kenya.

Research shows that a mother who has been circumcised also runs the risk of having a stillbirth, as well as delivering babies with breathing complications who will require resuscitation after birth to allay brain damage and death.

Nevertheless, the WHO estimates that death rates among babies during and immediately after birth is between 15 percent and 55 percent higher among circumcised mothers compared to uncut women.

"Culture is deeply rooted in this community. Girls as young as 10, 14 or 15 years will be circumcised. And once this happens, they are considered ripe for marriage," says Ms Chepchumba.

"So they will be carrying babies when they themselves are still children with bodies not yet fully developed to carry pregnancies. This endangers their lives."

She notes that enhanced awareness on the significance of hospital deliveries and ante-natal care check-ups is crucial to curtailing complications among circumcised women who are considered to have high risk pregnancies.

"Many girls and women here prefer seeking the services of traditional birth attendants (TBAs) who are unable to deal with the complications. So women are usually brought here when things are bad and it may be too late."

The nurse states that some of these TBAs also double up as female circumcisers. As such, they are usually reluctant to offers services to uncircumcised mothers. This puts pressure on girls in the Pokot community to undergo FGM before conception. Sometimes, the women may be circumcised when they are already pregnant.

Government statistics show that only 18 percent and 26 percent of pregnant women in West Pokot have the recommended ANCs and deliver at hospitals respectively.

To further save lives and allay adverse outcomes, Ms Chepchumba states that health centres frequented by communities need to be well equipped with supplies and trained clinicians that can effectively handle pregnancy complications when they arise.

"In instances where the affected woman needs to be transferred to a higher level facility, easily accessible ambulances should be within reach for fast transportation. Our terrain here is bad and referral hospitals are far away. So adequate transport is important."

Mr Patrick Mugun, the County Child Protection Director in West Pokot states that due to ignorance and low education levels, the community still clings to their culture, which strongly advocates for FGM.

The government in partnership with NGOs such as Unicef and World Vision have been rolling out a life skills training initiative dubbed ‘Alternative Rights of Passage’ which sensitises both boys and girls on the ill effects of the practice.

"This is helping to spread the anti-FGM message and to create advocates — both boys and girls — who are against the practice," says Moses Chepkonga, the education and child protection manager of World Vision in West Pokot.

He notes that sustained political will in the FGM fight is paramount for ending the practice.

"Political leaders here are still afraid to condemn the practice in public for fear of losing votes. This needs to change because we need them to be fully committed to ending FGM."

To effectively beat female circumcision, Mr Mugun states that interventions should cover all parts of the county.

"Due to minimal resources, most interventions are concentrated in just a few areas. Therefore, when circumcisers feel the heat in one area, they move to other parts and continue with the practice."

In North Pokot and Central Pokot, the prevalence of FGM is close to 90 percent, compared to Pokot South and West Pokot sub-counties that have a prevalence of about 50 percent due to interventions rolled out in the areas.

"These disparities create loopholes for people perpetuating FGM. Therefore, parents wanting their children to be circumcised usually travel with them to the neglected areas where they are unlikely to be caught. Once they are done, they come back home and marry off their daughters."

Numerous rescue centres established in West Pokot County are playing a key role in enabling girls running away from FGM to stay in a secure environment where they can pursue education without the fear of forcefully being circumcised.

The government in partnership with key stakeholders are also sensitising elders, religious leaders and other influential community members on the need to eradicate FGM, which is illegal in Kenya.

“By building the capacity of the Police Service on FGM and legal processes surrounding the practise, we are increasingly arresting and charging anyone found to be engaging in female circumcision so we can eventually do away with this injustice,” states Mr Mugun.