Time will tell
Authors: Dawn Starin
Journal: Journal of the Royal Society of Medicine (2008)

Rainy season upcountry rural Gambia, is green. It is a warm, inviting blend of a thousand greens. It is a mixture of beautiful, calm, peaceful mingling greens.

Digging beneath the surface, however, it is immediately clear that soil erosion is out of control, crop yield is extremely low, people are poor, many children are malnourished, many adults have type 2 diabetes, pneumonia is common, malaria is widespread especially among pregnant women, and the division of labour is anything but equal in this green landscape. Necessities are scarce. Luxuries are almost non-existent. There are very few commodities here, except time. Time is one commodity everyone has plenty of. Time is relative. People take their time. They have nowhere to go, nothing to buy and no money to buy it with. The hours seem to pass more slowly upcountry, especially for the women.

As I look around and soak in the reality of it all I remember that life, for most of the women, is hard; toiling long hours in the fields, tending domestic livestock and vegetable gardens, gathering firewood, fetching water, cleaning clothes, preparing and cooking food, taking care of children and managing household food distribution. The average rural Gambian woman works at least 16 to 18 hours a day, 7 days a week. The workload is never-ending and even now, during the fasting period of Ramadan, the rural women are still working in the fields, still carrying out their domestic chores and still carrying all the heavy loads on their heads.

Young girls walk along the paths carrying even younger children on their backs and small bundles of fire wood on their heads, practising for their future roles. Up here in the now-green rainy season fields, it is very clear that women are women and girls are women in waiting. And like their mothers and grandmothers and aunts and older sisters and 140 million other girls and women worldwide, most of these young girls will be circumcised. Because no formal studies have been done, it is difficult to estimate how many females in The Gambia have been circumcised. Rough estimates run from 68% to 93%.

In The Gambia, female circumcision, also known as female genital mutilation or female genital cutting, usually involves the removal of the clitoris and excision of the labia minora, by a ‘circumcision doctor’, usually the traditional birth attendant. The girl is usually blindfolded, held down and cut with a dirty razor blade. Anaesthetics are not used and the wound is sometimes doused with bleach, covered in cow dung or smeared with Vaseline.

The type and seriousness of the immediate complications depends on the skill of the circumciser, her eyesight, the sharpness of the instrument used and the cooperation of the initiate; a girl who struggles may be more damaged than a girl who does not. In many cases if health problems develop, they are not seen as a consequence of circumcision but blamed on evil spirits or witchcraft.

Because women are often circumcised in groups with the same dirty razor or knife, HIV could be transmitted between them. Certainly there is a higher incidence of HSV2 and bacterial vaginosis among circumcised as opposed to uncircumcised individuals – whether this is due to the same blade being used over and over again is not clear.

Female circumcision has been condemned by the World Health Organization, the United Nations, the World Medical Association, the International Federation of Gynecology and Obstetrics, the American Medical Association, and the American Academy of Pediatrics. In 1999 neighbouring Senegal legally banned the practice. Burkino Faso, Central African Republic, Djibouti, Ghana, Guinea and Togo followed suit. Not The Gambia.

In The Gambia, female circumcision is widely accepted and practiced. Over the years I have heard many reasons given to justify the practice. Some people claim it is a duty under Islam; some say that it marks the beginning of womanhood; some say that it is for protection against the evil eye; some say that it is done to reduce a woman's sexual pleasure and stop her from being promiscuous; some say that it is done to ‘stop the ugly clitoris from growing too long and damaging the penis during sex or harming the infant during childbirth’.

This evening I can hear the drums in the neighbouring village heralding the presence of the female ‘circumcision doctor’. One woman from the village tells me that she has not allowed her daughters to be circumcised and that ‘many people are stopping it now because they are aware of the problems it can cause. Radio programs tell us that it is a violation against children.’ In some cases, however, the radio programs may be counterproductive.

I know a father of two young girls who feels that ‘the aid agencies are walking into our country with their ideas and theories and calling female circumcision female genital mutilation. They have no right to interfere in our culture. I was not going to have my girls circumcised but as soon as the aid agencies and the radio programs said that it was wrong I immediately sent my girls to be circumcised. No one, especially not foreigners who know nothing about our traditions or people who talk about sex on the radio, has the right to tell me what to do and not do.’

This father is not alone. There are many, men and women, who view Western opposition to female circumcision as just another form of colonial domination and cultural imperialism.

Unfortunately, the anti-female circumcision messages are also having unforeseen effects. Nene, a rural health worker, explains to me that women are now circumcising their babies because young girls are being taught in schools that circumcision ‘is an abuse against their person’. Mothers and grandmothers, unwilling to put up a fight, now arrange for circumcision when the girls are too young to know better and too small to struggle. The idea that circumcision marks an important step into womanhood is gradually being dispelled as younger and younger girls – some of them only a few months old – are being circumcised.

When the circumcision doctor arrives in a village, the women, old and young, rejoice. The girls, almost always unaware of what is about to happen to them, dance and sing. This secret ritual, seen as barbaric in the West and full of immense joy in some parts of The Gambia, binds the women together. It cements them as a group, separates them from the ‘others’ – the men and the world outside. It ties the initiates to their mothers and their grandmothers and all the women before them. The perpetuation of female circumcision occurs because the mothers and grandmothers insist upon it. It is a traditional practice, maintained by women on young girls so that everyone fits in and no one is considered a ‘freak’. In many communities it would be unthinkable to not be circumcised. Community identity is important. One must conform to the community's rules and traditions. Being circumcised is considered a necessary part of this. The mothers and grandmothers who perpetuate this practice are not doing so out of cruelty. They are simply re-enacting an age-old custom so that their daughters and granddaughters will become accepted members of society.

Nene feels very strongly that ‘this tradition does not represent the best of Gambian culture. It simply represents what has survived from the past and has no place in today's world.’ She has tried to convince many of the circumcisers that this traditional practice must stop. She is not sure, however, how much success she is having. ‘Sometimes’, she says, ‘I just feel as though it will never end and generations of young girls will continue to be harmed and violated because of this barbaric practice. Village life may seem exotic to some but for many of the young girls and women here it is full of personal violence and for some of them it is full of death.’

But, I think things are changing. And so I ramble off some facts to Nene. Sitting with her, waiting for the fast to break so we can sip tea and eat loaves of tapa lapa bread I say ‘ten years ago no one ever discussed it. Many men did not even know that it occurred. It was a woman's secret. It being the operative word. The secret word about a secret world. Now female circumcision is discussed by members of the National Assembly, some Islamic religious leaders are actually calling for its elimination, newspapers are printing articles about it and schools are incorporating anti-female circumcision messages into the curriculum. Gamcotrap, a Gambian NGO, campaigning for the sexual and reproductive health rights of women and children and against harmful traditional practices, has had much success in educating the public and getting some traditional birth attendants to put down their circumcision blades. Don't you think this is encouraging?’

Looking at me Nene says ‘Our village just buried a two-month-old. She bled to death after being circumcised and the mother blamed it on witchcraft. There is nothing positive or encouraging about that.’