A qualitative study on the unresolved problem of female genital mutilations, socio-cultural reasons, and policy issues in the Afar regions of Ethiopia

Abstract

Abstract: Female genital mutilation is one harmful traditional practice that is highly prevalent in African countries such as Guinea, Sierra Leone, the Gambia, Mauritania, Mali, and Burkina Faso, as well as in Sudan, Egypt, and Ethiopia. In these harmful traditional practices, women have an essential role as both perpetrators and victims of FGM. In developing countries, the issues of FGM receive little attention in restoring and maintaining the well-being and health of women, and the governments have not given them due attention. The socio-cultural settings also make women’s lives miserable. This study tried to assess the community perception, socio-cultural reasons, and the consequences of FGM on women’s livelihoods. It also integrates the issue of FGM in the study areas with the UN SDGs goals for 2030. In this study, a qualitative approach supported by a phenomenological study design has been employed. Twelve affected (or females) were included in the research, as were six circumcisers/female genital cutters or experts, five victim household parents, two focus group discussions, and the life histories of the three victims of female genital mutilation in the region. The findings of this study reveal that women are victims of harmful traditional practices in general and FGM in particular. Women’s cultural influence on tradition makes them accept that religion orders so. Women support FGM as they are less educated than men and because of the secondary social status they have in society. To minimize the problem, both governmental and non-governmental organizations should work collaboratively with community members.

Keywords:

• FGM
• Htps
• Afar
• women’s
• vulnerabilities

1. Introduction

Traditional practices are acts transmitted by/from past generations and are likely to be passed to the next. Traditional practices could be harmful based on the impact they could have on the practitioner or person, such as physical, social, and psychological consequences (Eram, 2017). Female genital mutilation is a harmful traditional practice (HTP) in which girls and young women’s external genitalia are partially or completely removed for non-medical reasons (World Health Organization, 2022). Female genital mutilation is being discouraged in some developed and developing countries’ cultural traditions, even though tradition-bound people are resistant to change (Malhi, 2018). Women have an essential part in harmful traditional practices (HTPs) as both perpetrators and victims of FGM (Puppo, 2016).

At the international level, the practice of female genital mutilation is understood as a harmful traditional practice that causes different forms of injuries and damages to the general well-being of women and girls; it violates the human right of women not to be injured or harmed without their will, which reflects the subordinate position of women in their community (World Health Organization & Pan American Health Organization, 2012). Nevertheless, more than 200 million women and girls have undergone FGM, and 31 countries around the world still practice this harmful tradition, providing their means of validating the case (UNFPA & UNICEF, 2020).

Different views have been expressed by researchers concerning the origin of FGM (Ahmed, 2020; Nagler, 2016). Many researchers have related the origin of FGM to African and Arab countries (Nagler, 2016). Some researchers believe that FGM was known in ancient Egypt as well as among the ancient Arabs (Ahmed, 2020; Khalil & Orabi, 2017). It is known to have existed in the Middle East and Africa before written records were kept. So it is difficult to date the first operation or determine the country in which it took place (Ahmed, 2020; Nagler, 2016).

When it comes to Ethiopia, we found that harmful traditional practices (HTPs) and FGM in particular are widely practiced in most parts of the country (Abathun et al., 2016). This practice of FGM is supported by traditional beliefs, values, and attitudes. FGM has a lot of meaning for those who practice it. On the other hand, it is a means of preserving a girl’s virginity until marriage (World Health Organization, 2022). FGM is also a prerequisite to marriage (World Health Organization, 2022). As we well know, marriage is a very significant event in the lives of individuals (Kane, 2015). Some parents in developing countries believe that FGM is critical to their daughters’ social acceptance (Malhi, 2018). But the health, psychosocial, and physical effects are given less attention (Kane, 2015). FGM results in immediate and long-term health complications in women’s lives (World Health Organization: WHO, 2023).

The prevalence rate of female genital mutilation has decreased globally in the last 25 years, where once it was a norm for all the communities in a country and for those where there was a slight engagement by their community. However, in the Eastern and Southern parts of Africa, there are girls who experienced FGM between the ages of 15 and 49, and they constitute around 37.8 percent of their age group.

Accordingly, UNFPA and UNICEF (2022) assert that there is a high risk that girls will face and undergo FGM in Ethiopia and Kenya. This kind of challenge requires coordination and cooperation by different concerned bodies to ease the risk and problems that will be likely faced by girls numbered around 41,404 million.

In this study, the researchers used the definition that states that FGM comprises all procedures that involve the partial or total removal of the external female generation or other ways to the female genital organ, whether for cultural or therapeutic reasons (World Health Organization, 2022).

Several studies have been conducted on the practice of FGM in Ethiopia as well as in developing countries like Sudan and Somalia (Abdisa et al., 2017; Ahmed, 2020; Eram, 2017; Wakoya Anbesse et al., 2020). However, most of the studies have been focused on the medical aspects, particularly the perinatal and maternal health outcomes of FGM, and are unable to look at the socio-cultural reasons and policy issues.

This paper, unlike the cited studies, particularly focused on the perceptions, socio-cultural reasons, concerns, and consequences of FGM through the perspectives of the victims in the Afar region, specifically the Dubti woreda, which made the researchers interested because of a 92% prevalence rate of FGM practices in Ethiopia next to the Somali region of Ethiopia.

Although the practitioners believed the practice of FGM has its own values and is associated with cultural ailments, it has an impact on the health and well-being of women and children (World Health Organization, 2022). In Ethiopia, the awareness of the impact of FGM on the health and well-being of women and children and the attitude toward its eradication is very low (Abathun et al., 2016). As Abathun et al. (2016) stated, the primary reason is the lack of access to implementation. In the urban centers of Ethiopia, awareness is higher than in rural areas as a result of women’s education, changes in tradition, and the weakening of religious institutions’ power over people since the practice is highly intertwined with religious myths. FGM is a national problem since it has a great influence on the socioeconomic development of the country (Abdisa et al., 2017). The FGM cost calculator launched in 2020 indicates that FGM elimination in the world would minimize the expenditure costs for health by 60% in 2050. On the other pole, as the population increases and more girls undergo Female Genital Mutilation (FGM), the health costs will increase by 50% in 2050 (World Health Organization: WHO, 2020). In addition to the impacts on women and children, the Afar people also practice FGM with a high prevalence rate. For Afar, FGM is a manifestation of the community and is seen as an essential part of the communal ethnic tradition (Abdisa et al., 2017). It is also considered a rite of passage into womanhood. Women and children face challenges to their well-being and health. Therefore, the issues of FGM should receive special attention in restoring and maintaining the well-being and health of women in the study areas. Unlike the previous studies, this research integrated the life histories of the females who have undergone FGM and tried to assess the community perception, sociocultural reasons, and the consequences of FGM on women’s livelihoods. Besides, this study integrated the issue of FGM in the study areas with the UN SDGs goals for 2030.

2. Methodology

2.1. Study area

This study was conducted in the Afar region of Dubti Woreda (See Figure 1). According to the 2017 projections of the Central Statistical Agency of Ethiopia (CSA), the Afar Regional State has a population of 1,812,002, consisting of 991,000 males and 821,002 women; urban residents comprised 346,000 of the population, while the remaining 1,466,000 are pastoralists. However, this study area of Dubti is a woreda in the Afar Region of Ethiopia. Part of the Administrative Zone, Dubti is bordered on the south by the Somali Region; on the southwest by Mille; on the west by Chifra; on the north by Kori; on the northeast by Elidar; on the east by Asayita; and southeast by Afambo. Towns in Dubti include Dubti, Logiya, and Semera (Bedada et al., 2017). Although the government of Ethiopia, in line with SDG 2030, attempted to eradicate FGM in the Afar region, based on the progress, the issue must be minimized by at least 37 percent. Unfortunately, the issue of female genital mutilation becomes more prevalent, and the government has nothing to do with the problem. In the same vein, the Dubti Woreda is the one that experienced a toll rate of female genital mutilation and became extremely common, more so than any other place found in the Afar region (Asemahagn, 2016).

Figure 1. Study area map.

source. GPS survey, 2017.

3. Study design

This study employed a phenomenological study design. It is one of the study designs in the qualitative approach used to explore and describe the universal essence of a phenomenon (Groenewald, 2004). Groenewald (2004) asserted that the phenomenological study design enables researchers to explore people’s consciousness and day-to-day lived experiences by looking at the time, space, and personal history. Through the use of this study design, the researcher tried to examine the day-to-day experience of the Dubti woreda people and their preconceived assumptions about female genital mutilation. Since the researchers attempted to examine the practices, beliefs, and attitudes of the Dubti Woreda people by looking at their day-to-day lived experiences, this study relied on social constructivism as a philosophical reality (SARKAR, 2011). As SARKAR (2011) argued, this study design contributes to our understanding of the complexity of FGM attitudes, beliefs, and practices, as well as new ideas whose originality is actively sought via our study.

4. Participant and samplings

This study was conducted in one of the Afar regions, Woreda of Dubti. Since the researchers employed a qualitative research approach, purposive (judgmental) and snowball samplings were used to recruit respondents from the study areas. This research is very sensitive because it was difficult to find respondents easily. Consequently, we have employed snowball sampling or chain referral sampling methods. According to Etikan (2016), snowball sampling becomes very significant if the target populations are unknown and rare to find due to cultural and social settings. However, snowball sampling was used to obtain information from those affected by FGM. Purposive sampling, on the other hand, is used to investigate the attitudes, practices, and beliefs of society and neighborhoods in the Dubti woreda (Rogowski, 2017). And purposefully, we have contacted the community elders who have been identified and respected by the community. Besides, the Woreda women’s and children’s offices were contacted to examine what kind of measurements had been taken to mitigate the issue of FGM. The primary target groups for the study are women who have experienced or have undergone female genital mutilation. As a result, this study involved twelve affected females who had been circumcised in the in-depth interview and two focus group discussions that consisted of 10 participants in the first and eight participants in the other focus group and six FGM practitioners to obtain richer information concerning attitudes, beliefs, and practices of FGM in the target areas. As inclusion criteria, we have only involved those women who have undergone FGM, FGM practitioners who are circumcised specialists who have more than six years of experience in cutting female genitals, and parents who made their daughter circumcised in the interview.

5. Data collection procedures and ethical considerations

This research was approved by the Wolkite University IRB (institutional review board). After getting permission for research from the IRB, the study was critically evaluated by Wolkite University, Department of Sociology, staff members independently (Ref No: SOCI/856/2021). Before the data collection started, the study participants were asked about their willingness to participate in the study, and the researchers provided informed consent and/or a written letter of request from the Wolkite University research center and the Department of Sociology. To ensure research credibility and reliability, the researchers briefly elaborated on the study objectives and purpose, and we provided them with the freedom to decline if they were unwilling to participate, to promote their confidentiality. Finally, the study participants received an informed consent form, and researchers read it aloud to those who were unable to read or write, and they agreed to participate after hearing and reading about informed consent. The participant’s confidentiality was protected by removing any participant’s identifiers that reveal their profile from the study. The required data was to be collected from June 2021 through August 2021.

6. Data collection tools

For this study, data was to be collected using a qualitative set of instruments, such as in-depth interviews, focus group discussions, and life histories, until the data was saturated. The data collection was compiled from June 2021 up until August 2021.

To gather relevant information, the researchers employed both structured and unstructured interviews. The questionnaires were written in English and then translated into Amharic. To ensure the trustworthiness of the data, the researchers again translated it into English. This in-depth interview included females who underwent FGM, practitioners, FGM specialists, and circumcised female parents. The unstructured interviews were used for twelve (12) women who had undergone genital mutilation to know what their livelihood looked like and how the practice of female genital mutilation resulted in severe pain and long-term complications in the lives of victims in the study area. On the other hand, the structured in-depth interview was held between six (6) FGM practitioners and five (5) female parents or households whose daughters have undergone FGM to know the socio-cultural reason behind the practice and their beliefs and perceptions in a qualitative way. The researchers developed and prepared double-barrelled questionnaires that provide leading questions, unstructured responses, and an interview guide; they were self-developed open-ended questionnaires. The interview guide was very significant in acknowledging the interview content and objectives on which the interview was concentrated (Guion et al., 2011). During the interview, the study participants had 25 minutes to express what was on their minds in a one-on-one way. Data from the informants was collected using a tape recorder and by handwriting.

Another method of data collection employed in this study was focus group discussion. The study conducted a focus group discussion. This method of data collection is very vital for collecting data related to vulnerability and harmful traditional practices like female genital mutilation (Keerti et al., 2019). The first FGD was held between the local communities; six (6) household heads and four (4) community-respected elders were included from Dubti Woreda. It was held to examine cultural factors influencing practices, personal beliefs, and thinking. People in the first FGD have been selected based on residency duration; those who have lived in the areas for more than six years and elders known by their community for their knowledge of the practice of female genital mutilation have been identified and used as inclusion criteria. The second FGD was conducted among eight victims of FGM. Being a victim of FGM was the only inclusion criterion for the second FGD. The second FGD was held to collect data concerning menstrual problems, urinary tract infection, fistula, sexual dysfunction or discomfort, and day-to-day pain as a result of the FGM practices. While conducting FGD, the researchers identified specific themes to be discussed and developed FGD questionnaires. Before the FGD was held, the participants were asked about their willingness to participate, and after their agreement, the discussion was started by greeting and introducing themselves. In terms of time, the discussion had a duration of 50 minutes for each of the two FGDs. Most social scientists recommend having 45–90 minutes for successful FGD (Keerti et al., 2019).

The researchers also used key informant interviews as another instrument of data collection. However, the study included Woreda gender and children’s affairs, and all other managerial bodies related to FGM were asked to reveal the practice of FGM in the study areas. The interview guide and questions were also given to all participants, and they had a duration of 25 minutes each. All participants in the study were picked through purposive sampling, and the researchers selected them based on the knowledge they have of the issues on which this study focused.

Finally, the study employed life histories as a means of data collection. The researchers used life histories to better understand how FGM caused severe pain and long-term complications in the lives of victims in the study area (Gonzŕlez-Monteagudo, 2012). As a result, this study involved three females who underwent FGM in the study areas, and data was to be collected through a tape recorder. The names of the participants were cited in the manuscript, but before that, the researcher asked the female participants if they agreed to their names being used in the study, and their parents agreed based on the informed consent provided before data collection began.

7. Data analysis

Qualitative or thematic analyses were used in this study. The data analysis in this study followed five consecutive steps. The first steps included preparing and organizing the collected data. It included printing out the transcripts, marking sources, and identifying data or information that was significant for data analysis. Second, the researchers explore and review the data that it contains. The researchers read it several times during this phase to get a sense of what it contained and its relevance to the specific objectives outlined, and they removed any redundant sections. In the third stage, initial codes were assigned to the data collected for the study. The researchers use highlighters, notes in the margins, and concept maps that are vital to connecting the data collected for the study. In the fourth stage, after assigning codes to the data collected for the study, the researchers revise and review the codes and combine them into a theme and sub-themes. Finally, themes and sub-themes were put together in a cohesive manner depending on the objective of the study.

8. Results and discussions

The result of this study was analyzed in line with the specific objectives outlined in the manuscript. The research obtained data by using in-depth interviews with twelve victims (all female), six FGM specialists, five victim household parents, two focus group discussions, and the life histories of the three victims of female genital mutilation in the region. Nevertheless, the data analysis had three parts. The first part indicated the attitudes toward the issues, and the second discussed the socio-cultural reasons for the practices and their complicated impacts on female victims by using the selected life histories of the participants. The researcher came up with a wide range of existing and first-hand information from the community in general and the participants of the study in particular about the overall scenario surrounding the practice of female genital mutilation and ways forward to combat it in the study area of Afar.

9. Perceptions toward the practice of female genital mutilation

Although there have been several initiatives conducted on mitigating the practice, as it is a harmful traditional practice in the study area, it is mentioned that there was and still is a higher rate of prevalence of female genital mutilation in the Afar region of Ethiopia (Hall, 2016; Malhi, 2018; Shetty, 2007). Therefore, it’s very important to identify and know the reality of the behavior attached by the community to the practice of female genital mutilation. If some practices are sustainable for a longer period, there should be something concrete to validate and continue them (Shetty, 2007).

According to circumciser specialist #1 and victims’ household parents #3, FGM is a requirement, not an option, a means, or a pre-requisite for girls to be considered mature enough for marriage. They also emphasized that this practice is one of our traditions that demonstrates our community’s identity and that it is thought necessary for the formation of social relationships among individuals, families, and the entire community through affinal ties. Concerning the community’s associated marriage engagement and preservation of girls’ virginity, informants (victims’ household parents #4) reflected on how the community’s values and beliefs support the practice of FGM because it reinforces the solidarity and coexistence of their community, as it is a criterion for forming marriage, which in turn builds strong relationships between the individual, family, and society. During a discussion held with focus group #1, they mentioned that FGM is a normal practice that they inherited from their foremothers and one of their traditional rituals that need to be continued into the next generation as it produces a paramount significance for a girl to hold an accepted status of cleanness, fidelity, and marriage readiness. One of the worst fears a mother could have is not circumcising her daughter and having her considered an outcast by the community.

In line with the preceding cases on the attitude of the local community towards FGM, a discussion was held with female circumciser #6. She pointed out that practicing FGM is one of their traditional rituals that prepares young girls for the state of womanhood and makes them ready for their inclusion and acceptance into the wider community. They assume FGM has a ritual role and consider it a “rite of passage” where girls, at the end of undergoing the practice (FGM), instantly become women. Again, the female circumciser number four reflected that she practices FGM not only because it’s in their tradition, which they inherited from their previous generation, but also because it is their only means of generating financial resources or income as their livelihood strategy. In addition, being a circumciser in the community gives me a prestigious status and a privilege over other segments of society.

Subsequently, the researchers conducted a discussion with females who have undergone FGM to grasp their attitude towards the practice. Victims of FGM #1 and #2 argued that:

The practice was important in their lives as it brought them into the new status of being a woman or a wife to somebody.” We became wives and mothers of children as a result of FGM; without it, no man would take us as their wife or regard us as faithful in our marital relationship.

Furthermore, victims of FGM #3 and #4 stated that the social pressure of not being circumcised results in the exclusion of girls from the entire community, with the assumption that such girls are promiscuous, unfaithful, and impure, which may bring a curse to the entire community. Therefore, FGM is an order forwarded by the larger community to females to agree to it and undergo the practice. Females express no objections or regret because they lack the option and means to do so. They also argued that FGM had an impact on their lives after moments of being circumcised, specifically mentioning the physical pain they encountered during and after having undergone FGM. The community has a strong attitude and commitment toward the practice of FGM as their compulsory activity, which resulted in the stronghold position of the practice for a longer time, despite the efforts and initiatives taken by concerned governmental and non-governmental organizations to combat it in the region. In the same vein, the findings of Bagness (2019) supported the traditional values, beliefs, and attitudes of the community encouraging FGM and attached a lot of meaning as it assumed marriage and the preservation of the girl’s virginity as one of the reasons mentioned, among others. In conclusion, for the Afar people, it is clear and simple to infer that the practice of FGM is more valuable than just marriage requirements and the preservation of a girl’s virginity.

On the other hand, from a key informant interview and discussion held with a senior government official from the Gender and Children’s Affairs department of Dubti Woreda, the researchers understood that the practice of FGM is a national problem that affects the physical and psychological well-being of many women in general and the study area of Afar in particular. They emphasized that the practice has long endangered the lives of women because of the harm it causes to their health and physical well-being and that it should be condemned as a traditional harmful activity or banned from the community at all costs. Although they exist for political reasons, they have nothing to do with the issues of FGM.

To its extreme, the Women’s and Children’s Affairs chapter implied that FGM has become a concern for human rights as it violates or alienates girls’ and women’s rights to the highest attainable standard of physical, sexual, and mental health. The discussants in the in-depth interview associated the practice of FGM with gender inequality in the study community, where girls and women, without their will or say, are expected to go through life-threatening surgical procedures to be accepted by their community, while men are accepted without any precondition and by default.

Moreover, they informed the researchers that they are struggling to abolish the practice in awe of its cultural importance as associated with the Afar community. However, they stated that they were organizing several initiatives and training for the religious leaders, local elders, women and men, practitioners, and specialists on the impact of FGM on children, girls, and women to combat the practice.

Similarly, OHCHR (2023) asserted that FGM is against international conventions that indicate the right of human beings not to be injured against their will and consent because female genital mutilation (FGM) pertains to any treatment that involves cutting or injuring the female genitalia for non-medical reasons and is widely seen as a violation of girls’ and women’s human rights.

10. Socio-cultural reasons behind the practice of FGM

The participants of the study identified the major reason behind the practice of FGM as societal and cultural pressure from the community. As it was discussed in the previous theme under study, the Afar community has a strong affiliation with the practice of FGM and considers the practice as a ritual part that makes girls acceptable and eligible to the whole community.

Corresponding to this argument, victim household #5 said that, if a girl is not circumcised, they will not consider marrying her due to the culturally attached meanings behind being an uncircumcised girl. There is a community saying about uncircumcised girls;

If a girl is uncircumcised, she is considered as an infidel to her husband, promiscuous in her sexual desire, impure and can bring a curse to the whole family

In accordance with these findings, the findings of Khalil and Orabi (2017) revealed that the cultural practices of the Afar community do not allow the males to marry a girl who didn’t undergo FGM but rather encourage them to humiliate her publicly in front of the wider society.

Another important reason behind the practice of FGM, as mentioned by the parents of victims # 2 and # 3, is religious justification. They indicated that girls should get circumcised due to the religious order of the Muslim religion against the practice of FGM. Some girls who may not want to undergo the practice, for fear of being against the sacred order and receiving rejection from the community, conform grudgingly to being involved in FGM. Based on the information collected from the informants, they practiced FGM because they believed that it was sanctioned by Islam.

The key informant discussion held with government officials shows that FGM has no valid justification other than its negative impact on the lives of girls and children. It is highly condemned by medical professionals due to its effect on women’s health and well-being during child delivery and other sexual problems. They constantly pointed out that, in the name of any vindication, neither girls nor children should be injured physically, psychologically, or socially.

On the contrary, the elder informants in FGD #1 mentioned that they are very concerned and want to be sure that the practice of FGM is transmitted to the younger generation. In doing so, they exerted extensive pressure on teenagers to make them conform to the traditions of their culture in general and the practice of FGM in particular.

In an FGD #1 session conducted on the reasons behind the practice of FGM in the study area, a community elder who has two daughters said:

Usually, FGM is considered a women’s business, like mine. But men would not be willing to marry a woman who was not cut and stitched. Our tradition teaches us that open women who are left uncut are unfaithful in their marriage and probably were sexually active before marriage. He also mentioned that “I am also planning to get my twin daughters circumcised once they get older, bearing in mind that being genitally mutilated or stitched has a personal dignity and privilege within the community. “I am very glad that my daughters will be engaged in circumcision.”

Similarly, the findings of Shabila et al., (2017) suggested that religious, cultural, and social pressure from the community at large is listed as a crucial and major factor for the practice’s persistence and escalation in the studied region.

11. The concerns and consequences of FGM

In this theme, informants and discussants from different sections of the community clarified the consequences of FGM after the operation is performed. The researchers have categorized the results into three parts: immediate, long-term, and psychological difficulties.

According to FGD #2 sessions, most female informants who undergo the practice shared their experiences and said that they are exposed to severe pain immediately after they undergo FGM as anesthesia is not applied to the procedure. They also inflicted injuries due to the poor hygiene and sanitation of materials used in the procedure of cutting, which resulted in infection. They used unsterilized instruments and herbs to heal the wounds, also making them susceptible to bacterial contamination. They talked about how it’s so painful to see themselves lose a lot of blood straightaway after the operation is performed.

However, circumcised females in FGD #2 added the complication of FGM, saying that the practice makes them suffer during urination due to the swelling and inflammation around the wound. They also mentioned the difficulties of urine retention. More importantly, it’s the severe pain they suffered during menstruation that they stressed as a major consequence or complication. Difficulty in urinary passing, infection, and fistula are pointed out and raised by some of the informants as other complications associated with FGM. However, most of them are not aware of whether these complications are related to FGM or not as the problems exhibit themselves after the operation.

The discussion conducted with the practitioners of Female Circumcision #3 of FGM explained that immediately after the girls went through the practice, they were affected by physical pain and the loss of a lot of blood, which is normal and not severe. They indicated that:

FGM gives much better comfort and confidence for the girls in the community rather than harming them.

Nevertheless, the findings of Abathun et al. (2016) support these study findings in saying that most of the time in Somalia’s regions, even though they perceive FGM as very bad for females, circumcisers neglect and hardly talk about the negative consequences of practice of FGM, which makes the women suffer by overly underlining the social and cultural significance associated with FGM.

The discussion held with key informants from gender and child office administrators shows that FGM can result in immediate and long-term problems for women. The women faced severe pain and injury during and after the procedure took place. They were exposed to injuries in their urethra and vagina. Shock, urine retention, and infections are also the other complications raised by the discussants.

Menstrual problems, urinary tract infection, fistula, and sexual dysfunction/discomfort were all mentioned by the participants in FGD #2 as long-term effects that can be observed after some time and cause severe pain. The psycho-social complications of undergoing FGM, which most of the discussants abandoned, were furthermore cited by informants of extensive workers; FGM is commonly performed when girls are very young and are often preceded by acts of deception, pressure, intimidation, and forcefulness from parents, relatives, and friends. The girls in this situation lack the real power to resist and go against the practice.

The female informants in FGD #2 said that because it physically restrains them, the practice of FGM leads to the psycho-social complication of fear of experiencing the operation (FGM), and it is an occasion marked by shyness and suppression of feelings. Most girls are feared and hide their personal experiences, but their obvious anxiety and sometimes tearfulness reflect the depth of their emotional pain. In addition, some of the informants who were circumcised showed that they were exposed to sleep sickness and nightmares.

Although several mental and psychosomatic disorders were mentioned, the majority of the participants in FGD #1 explained the psychosocial significance of FGM to the girls. They see FGM as conformity to the social norms of the community, where girls become faithful, pure, and marriageable, whereas if a girl were left uncut, parents would have concerns regarding their daughters’ reputation and ability to control their sexual appetite, which in turn could bring shame to the family and exclusion from the wider community.

Similarly, Bedada et al. (2017) argue that even when you want to go against circumcision, you don’t want to open your mouth and say it. You’ll feel scared. Because you don’t want to be lonely in society, even if you don’t like it, you don’t want to say it.

It’s very hard to talk against the practice of FGM in the study area where you can be socially sanctioned from social interaction and relationships like marriage exclusion and women who are left uncut feel stigmatized.

As Bagness (2019) argued, FGM has several negative consequences resulting in harming the physical, psychological, and social well-being of girls, but no one will come out stronger to fight against the odds of being rejected from the community, and there is also a considerable “positive” magnitude where the practicing community perceives them as important and mandatory for the girls as well as the community in general as a conformity to the societal norm and values.

Therefore, it’s not helping to fight against the practice solely; the fight should be against the socially and culturally attached norms behind the practice. It should be given priority to changing the attitude of the community, which requires substantial effort and time and can practically lead to lowering the magnitude and escalation of the practice.

12. Life stories of the selected participants

The following three case studies also show how the practice of FGM resulted in severe pain and long-term complications in the lives of victims in the study area.

Amina Musa is a resident of the Dubti district. After a brief introduction, we asked her age, and she replied, “I don’t know.” But she looked to be about thirteen or fourteen. In her community, the age of girls for marriage is usually fourteen. By their fourteenth birthday, the girls are given to their husbands, by whom they are supposed to be circumcised before the wedding. Amina said that “most girls undergo FGM by the age of twelve.” Amina was married when she was sixteen years old. Before she even experienced the life of being a wife, she was exposed to the most severe form of FGM, which traumatized her physical and psychological well-being. Amina is still feeling the pain she encountered on day one of the operations on her body and soul.

Although she was reluctant to open up at first, she told us, “It was never an easy experience for me during menstruation.”

She also shared her experience of becoming a mother:

It was not without agonizing labor to deliver all of her children.” She was ill for almost the next five days while trying to deliver the baby. It gets worse by the day. Sadly, she told me that after a period of struggle, “I was taken to the hospital, but the doctor told me that my body couldn’t deliver the baby due to the severe form of FGM I had, and it was too late to save the child since my baby was stillborn.

Several women will probably relate to and share my story in the community.

She said, “I have suffered for so long.”

The second victim of FGM also shared her life story, which is as follows:

My name is Medina Mohammed, and I’m a mother of four daughters and two sons. This is my true story, reflecting on being circumcised and living with its consequences in the Afar community. “I used to be one of the circumcisers in my area.” Looking back, she said, “I and my ex-fellow circumcisers had to perform FGM out of ignorance.”

She mentioned that FGM is their good tradition, and they had to cut girls because it was inherited from their foremothers, who were circumcised and felt it necessary in the lives of women.

“FGM is culturally appropriate and a natural practice of a rite of passage for us.” Medina said that they were “If anyone were to question FGM, he/she would be considered an outcast and will be stigmatized.” Usually, we used to cut the girls into groups. In some cases, we would operate thirty girls at once using the same cutting instrument.

In her closing statement, Medina raised that: “There were girls who died from uncontrolled bleeding, but it is always taught as God’s will that the girl has died.” They never realized the real reason was due to FGM.

The third victim of FGM also shared her life story, which is as follows:

Hawa Adem Mohammed was born and raised in Afar. She underwent the most severe form of FGM, infibulation, when she was nine years old, at the hands of her aunt in a small village. The procedure was carried out without numbing and with basic tools and thorns. She started sharing her story, saying:

My mother told me at the age of nine that they were taking me to the sacred woods to perform a certain ceremony, and that afterward, I would become a real woman. As an innocent child and young girl, I was taken away, and when I came back, I was never to be the same again. Once we entered the sacred bush, I was taken into a very dark room in a hut and undressed. I was blindfolded and stripped naked. There was nothing that could indicate to me that I was going to live a nightmare that would change my life forever and haunt me. They made me lie on my back while strong women held my legs and thighs. One woman sat on my chest in a bid to prevent my upper body from moving to scream, and the operation began. I couldn’t put up a fight. The pain was terrible and agonizing. I was badly cut and lost a lot of blood.“After the operation, no one helped me. “I was all alone and abandoned through all of my pains and anguishes, and told to walk right after.” I was dazed by the pain, and some herbs were crushed and then put on my wound. When I wanted to urinate, it turned out to be another physical and psychological torture experience. The urine would spread over the wound and cause fresh pain all over again. Therefore, I always prefer not to urinate, fearing terrible pain. I had nightmares and still have them today. I was not given any anesthetic during the operation to reduce my pain, nor was I given any antibiotic to fight infection. Afterward, I bleed profusely and turn anemic. I have suffered a lot for a long time from vaginal infections. I believe all these complications are attributable to witchcraft, and I was even branded by my neighbors as a witch who had refused to accept the will of God or been rejected by him.

By considering that those individuals shared their stories through narratives of their whole experience of being circumcised and its complications in the Afar community, it is not misleading to understand that FGM has brought them physical and psychosocial pain, which is very difficult to bear. They have labeled themselves as victims of FGM.

13. Integration of the practice of FGM with policy issues

In this section, the researchers go through different international and national conventions, policies, and criminal codes on the prevalence of female genital mutilation. Eradicating FGM was given great attention all over the world by different governments and non-governmental organizations, and it became an international development agenda since its inclusion in the Sustainable Development Goal (SDG) target 5.3, which aims to eliminate the practice by 2030. Ethiopia as a nation has a program to end the practice of FGM by 2025 and to attain the sustainable development goal (SDG) target 5.3, which is to eliminate all harmful traditional practices including FGM by 2030 (UNICEF, 2020).

In attaining the sustainable development goal, Ethiopia outlines a criminal code to criminalize any form of violation of women and girls, including female genital mutilation under Articles 564–565. It condemns the practice as a violation of human rights (The Revised Criminal Code of the Federal Democratic Republic of Ethiopia, 2004). However, in Ethiopia, there is still a high prevalence rate of FGM practiced, particularly in the Afar region, even though there have been initiatives and training conducted to raise the level of awareness in the community regarding the negative impact of FGM on girls and women.

In this regard, as UNICEF (2020) wrote, Ethiopia has shown in the last three decades good progress in decreasing the practice of FGM faster than other eastern and southern African countries.

It is predicted that if the progress of the last fifteen years continues, the prevalence of FGM could fall to below 30%.

However, the decline in the magnitude of FGM practice in Somalia and Afar is not as accelerated as in the other regions of Ethiopia (UNICEF, 2020).

The findings of this study showed that it’s not unclear to state that even though the community at large is aware of the negative implications of female genital mutilation on women’s and girls’ wellbeing, they still prefer to continue while giving a paramount priority to the social and cultural values attached to the practice. They prefer to suffer from female genital mutilation rather than let it go and be enjoined.

They value the international and national conventions on the practice less than the values they associate with FGM. It’s therefore required to devise strategies to dismantle their held beliefs in the practice and to weigh the power of international conventions to be respected by them. Therefore, the practice of FGM is still demanding great attention and effort from different concerned bodies for its decline and eradication in the study area.

14. Conclusion and recommendation

Women are victims of harmful traditional practices in general and FGM in particular.

The practice of FGM (female genital mutilation) has been highly intertwined with society’s cultural ailments and religious myths. In doing so, most women, including the elders, accept the practice of FGM as religious orders and principles found in their holy book (World Health Organization: WHO, 2023). Women practice FGM because they believe it is necessary for their daughters’ marital life, and they believe that FGM protects them from being promiscuous and preserves virginity. Some of them also practice FGM because they believe that it is a religious order. It is very important for their social acceptability, yet some women discourage FGM due to the serious consequences it has on them.

Female genital mutilation has severe health and psychological complications. To abolish this harmful traditional practice in the study area, both governmental and non-governmental organizations have been working in conjunction with and coordinating with community members. The NCTPE (National Committee on Traditional Practices of Ethiopia) takes a major role in activity by organizing training and teaching community leaders. Some people of the woreda have a strong belief that FGM is a religious order. The community resists any kind of modification. Generally, people are unaware of how the Islamic faith views FGM and its effect on women.

The majority of the study participants had many traditional practices in common and agreed on the health-related impacts of FGM practices. They believed education had a significant effect on the attitudes of the informants and respondents toward FGM. Some accuse the practice due to the consequences it caused them and the information they got from health centers. On the other hand, some people support FGM. The main reason given is a religious order. Likewise, pressure from society is another reason that influences them to conform to the practice of FGM. Preservation of virginity is also stated as a major reason. It shows that people are giving greater attention and presenting various reasons for FGM practice.

The prevalence of FGM in the study area is seen among Muslim followers and elderly women with low educational status.

Concerning the consequences of FGM, more responses are given concerning the immediate consequences, and fewer answers are related to the long-term psychological consequences. Most informants were not aware of the long-term consequences. They are not aware of the complications that are related to FGM.

Even though tradition has more influence in countries like Ethiopia due to the effects of governmental and non-governmental aggregations, some sort of awareness and knowledge has been created about the impacts of FGM. Education could also have a significant role in abolishing FGM through the help of health extension centers and workers.

However, it is a long way from being practically eliminated from the study area since there is a high prevalence rate. It is therefore required to fight against the socio-cultural meanings and reasons attached to the practice of female genital mutilation by the Afar community. It is impossible to eliminate the practice by only raising awareness of the biological complications it results in for women and girls in the community. It is also mandatory to dismantle the social and cultural beliefs underlying the practice of FGM. Therefore, there should be a shift in focus by responsible governmental and non-governmental bodies in dealing with these kinds of sensitive issues on a continent like Africa, where culture and religion are very powerful in governing the everyday lives of society. A culturally friendly mechanism should be developed to attain the SDG of eradicating FGM in Ethiopia by 2030.

15. Study limitations

The findings of this study have some limitations. The first is that some of the respondents were not willing to give an adequate response regarding female genital mutilation. This can affect the internal validity of this study. This resulted in an unclear level of internal validity. Therefore, further research that will be conducted by the locals is needed to get more rich data and discuss it freely with the respondents. The remoteness of the area was also one of the difficulties the researchers faced, which affected the findings of the study because of the less frequent contact with respondents. Another limitation was the lack of previous comprehensive studies in the specific study area (Dubti Woreda), which led to huge difficulties in triangulating data with other local studies in Dubti.

Correction

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

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No potential conflict of interest was reported by the authors.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Habtamu Wondimu

Habtamu Wondimu is a Lecturer and researcher in the Department of Sociology at Wolkite University, Ethiopia. He has published numerous articles in various international journals. His research interests include gender issues, vulnerability, child indicator research, and environmental challenges

Girum Melkamu

Girum Melkamu is a lecturer and researcher in the Department of Sociology at Wolkite University. He has involved in various community services and reviewed several research papers at the university level. His areas of interest relied on the cultural and ethnographic studies.

Kassahun Dejene

Kassahun Dejene is a Lecturer in the Department of Sociology at Wolkite University, Ethiopia. He obtained his M.A degree from the University of Debrecen, Hungary. His research interests relied on medical sociology and child indicator research.