Participant Characteristics
The age of the women informants varied from 23 to 53 years old, with a median age of 39. The age when FGM was performed varied from 5 to 14, with a median age of 7. There was a range of women from across East (33%) and West (66%) Africa. They had been living in Belgium for a median duration of 6 years. The other characteristics are presented in Table 1 below.
Table 1
Summary of participants characteristics at the time of the interview (n = 15)
Variables | N (%) | Median/Range |
Age of the woman at time of interview | | 39 years [23–53] |
Age when FGM was performed | | 7 years [5–14] |
Region of origin: East Africa West Africa | 5 (33%) 10 (66%) | |
Level of education: Primary school Secondary school University | 1 (0.6%) 7 (46%) 7 (46%) | |
Length of stay in Belgium at time of interview | | 6 years [1–15] |
Method of entry to Belgium: Asylum Family reunion | 13 (86.66%) 2 (13.33%) | |
Marital status at the time of the interview: Married to an African man (same community) Married to an African man (other community) Married to a Belgian | 6 (66.66%) 1 (11.11%) 2 (22.22%) | |
Divorced once but now cohabiting with a Belgian at time of interview | 6 (40%) | |
Total number of children at time of interview | 25 | |
Number of children per woman | | 2 [1–4] |
Number of children born in Belgium | 15 (60%) | |
Woman giving birth to at least 1 girl | 11 (44%) | |
Woman with 1 child left in the country of origin | 1 (0.4%) | |
Additional file |
Our results confirmed the practice of FGM as a social norm and revealed six TPs which encouraged the women participants to begin to change their attitudes towards the practice.
Attitudes towards FGM as a mandated social norm
The women in our sample confirmed that FGM is indeed a powerfully enforced norm, and they were forbidden to speak about. It was considered taboo, and they could not discuss it with their siblings. They reported that they were forbidden by their grandmothers to look down at or touch their private parts. However, their mothers were proud to show off to new members of the community after the procedure. Certain women reported that they themselves had asked to undergo FGM, to avoid being mocked by peers and to be able to serve men tea and food. They also believed they would be considered clean, hygienic, more beautiful and likely to keep their virginity for marriage. This was believed to preserve the family honor and morality of girls and women.
At home we did not talk about it; it was taboo. We were forbidden to tell others what had happened ... Nobody spoke about how it happened ... a girl must be excised otherwise she will not be a virgin, so she will always run after men. She cannot control herself, she will run after all the men she will meet and so we must go through that to preserve our virginity and not be unfaithful after marriage ... So, virginity has a lot of weight in that sense. (Interv_6)
The other related norms embedded in the patriarchal system were for the elders to be obeyed and the grandmothers to be the guardians of the tradition, forced marriage, how women ought to behave in the community and that women must endure pain and suffering without complaining. Most women explained that after FGM, forced marriage will follow. Gender roles were carefully reinforced, either by their mothers or their grandmothers: for instance, how a woman ought to behave in the community and be submissive to her husband, and how they should endure pain and be brave.
One woman recounted how she was given a white sheet by her father as a gift on the day she was cut while she was expecting sweets and toys as she was 6 years-old. When she asked about it, she was told that it was for her wedding. She was later forced to marry an old man whom she met only on the wedding day.
My dad chose someone I did not even know, an old man, far older than I and I was forced to marry him …it's very difficult, (silence) because it's something that stays with you ... because you are being raped. I do not call that a marriage, it's a rape… (Interv_1)
The main turning points that led to changes in the women’s lives
1) TPs related to an encounter with health professionals
These TPs concerned events where the women encountered a health professional: a gynecologist, a psychologist, a social worker, etc. For example, during gynecological visits, they women reported that they were shocked to be told that they did not have a normal vulva, and shown the intact anatomy of the vulva of their daughters, different from their own, leading them to understand the difference between an intact vulva and one that has been mutilated, as well as some negative consequences of the practice of FGM. They also mentioned that this shock led to the awareness that what they had thought was a ‘normal’ vulva (one that was “pure and beautiful” after FGM) was mistaken. Other women mentioned that they were surprised, confused and felt anxiety at the news of what an intact vulva looked like. One participant had been persuaded that all women, including white women, were like her. The picture shown by the doctor brought on an understanding of the organ that had been lost and led participants to question what it means to be a ‘normal woman’. For some women in our sample, this led to taking action for a deinfibulation procedure. Others, at the time of the interview, were considering having a reconstruction of the clitoris.
So I went to see a gynecologist at a family planning clinic. She put me on the table and examined me and said you're cut and closed … She put my daughter on the table too and showed me, you see she is not cut, she is intact not like you … So for the first time I saw the difference between my daughter and myself (Interv_11)
When you visit a gynecologist, you are surprised when the doctor tells you that you are not 'normal'. With the expression of his face ... he looks and looks, he closes his eyebrows and says to you like this: you're not normal … and I was confused and anxious ... And you realize, after explanation with photos, the difference between the normal and abnormal private part. So, I say, I have never seen the thing between the legs… (Interv_8)
2) TPs related to education
This type of TP involves events such as lectures on anatomy and sexuality at school and university, where some women, enrolling at medical school and attending anatomy lectures, started changing their views. Schools and universities have been eye-openers. The knowledge gained contributed to the feelings of shock and anger experienced by most women and this made them change their attitudes towards the practice. The anatomy lectures contributed to the knowledge of the consequences of FGM and what a normal anatomy of a woman ought to be.
But during my studies, I realized some things and it was a shock … The first time I saw the genital organ of a woman, I said ah ... so I lost this part of me in the excision ... But hey, it's a bit what like I looked as well. But it must be said that this operation is very traumatic. We only perpetuate the tradition of our ancestors. All you gain is pain and sorrow. (Interv_13)
3) TPs related to social interactions
These TPs relating to social interactions are two-fold. One is in relation to interactions with other cultures and involved events where the women heard the noise of urine at refugee centers, got married or had a relationship with a European man when they came to Belgium. Migrating from their country of origin to Belgium contributed to raised awareness of difference of cultures, and a sense of not being defined exclusively by FGM. The shock provoked by the noise of urine and as the women noticed that “women are urinating like men” made them question something that they had previously thought was normal. They no longer viewed women as having to endure pain and suffering when men from other communities made them aware of the possibility that their sexual lives could be experienced without pain or complication during intercourse.
When you come here, you discover that not all women are like you. Because you see women go to the bathroom, and their pee makes a noise ... (laughs). So I asked myself ‘What have they got there?’ And I asked my doctor once, ‘You're not circumcised?’ She says 'No'… then I understood why their pee makes noise. (Interv_14)
The second interaction is within the women’s own culture, when they were told of the reasons why FGM is performed – in order for them not to be promiscuous before marriage –and they saw the opposite happening around them in the community. This made them realize the lies and the deceit.
On the one hand I saw that it was false, that we were told lies, because I saw Fulani women who prostituted themselves, and I asked myself some questions ... these circumcised girls prostitute themselves – how does it happen? ... I also saw some circumcised girls who became pregnant before marriage and brought shame upon their families. (Itnerv_2)
4) TPs related to motherhood and the urge to protect their daughters
The women in our sample wanted the best for their children. Those of them who had girls reported that at some point or other they had been put under pressure by mothers, mothers-in-law and grandmothers or aunts, the keepers of the tradition, to put their own daughters through FGM. The pressure from other women in their families made them recall their own experiences and brought back vivid memories of the whole procedure. Some talked about pain in the womb, anger, nightmares and the urgent need to fly away to escape the danger. The prospect of perpetuating the tradition on to the next generation through their own mothers, mothers-in-law and grandmothers triggered a change in views about the practice for several women, creating a sense of apprehension as well as a duty to protect their daughters, which in turn changed their views of what it means to be a good mother. According to their previous beliefs, a good mother would put her own daughter through FGM; after becoming mothers themselves, they did not want to put their daughters through what they had experienced. They were caught in a dilemma of loving both their mothers and their daughters thus, disappointing their mothers by not wanting to destroy their daughters through FGM.
My husband could not say 'no' to his mother and it had become very serious, something had to be done to protect my daughter from the influence of my mother-in-law ... I tried to tell him we shouldn’t listen to his mom for everything and he answered me, “Aren’t you yourself excised? So why not your daughter? You see?” And I did not want that for my daughter… (Interv_4)
I was destroyed by my mother and my grandmother – I can say that, since they have done something horrible to me ... I love them but when my in-laws wanted to excise my daughter, as was usual. But I opposed. (Interv_15)
5) TPs related to repeated pain during sexual and reproductive activity
The sexual and reproductive aspects identified as TPs were mainly related to repeated pain, childbirth and sexual activity: pain felt during the procedure of FGM when the participants were little girls; painful monthly periods as adolescents; pain during their first experience of sexual intercourse after their marriage; and pain during childbirth. The repeated pain during sexual intercourse ensured the women only took part in it out of duty towards their husbands, rather than for pleasure. They used to think that experiencing pain during sexual intercourse was normal until they developed an awareness of what could be a sexual activity. They then came to understand the true consequences of FGM.
But then what we do not understand is how much it hurts ... it's horrible and it follows you everywhere ... even in adulthood, in your teenage years when menstruating, when you get married, when you have sex with your husband, if you give birth, if you go through a caesarean…you see? The pain follows you everywhere and it's horrible. (Interv_9)
I had convinced myself that I would not be able to have a fulfilling sex life, and I was right because when I got married, it opened the door to another phase of a woman's life of suffering ... It gives no benefit, just suffering and I find that men also suffer, not only women. (Interv_10)
6) TPs related to the fact of witnessing some harmful consequences of FGM towards loved ones
These TPs are related to events that happened to the women’s loved ones and that gave rise to stressful emotions for them. For instance, the participants in our sample reported events such as the death of a sister after the procedure, witnessing their husbands being battered by their own families for not wanting to comply with the tradition, and the death of a sister in childbirth. Such events made the women realize the harm caused by FGM.
… Because after our excision, we stayed with an old woman for 20 to 30 days, but my sister only made it for 6 days. She had a high fever and she bled a lot and the old woman she kept changing cloths and was made to drink various concoctions, until she died the following day… (Interv_12)
So, the day I had to flee the country came when we were all sitting together as a family, my family, my husband’s family and my husband was tied up and beaten in front of the children because he dared to say ‘no’ to his family. I agree with my wife, I am not going to cut my daughter. Because my husband being a nurse knew the consequences too. So that’s when I had to run away. (Interv_3)