Participants of this study produced narratives relating to their psychological lived experience of FGM/C which they structured around five temporal phases including: 1) the ‘akpapyi’ period characterized by socio-emotional suffering; 2) the emotional elevation phase following the decision to be cut; 3) the cutting procedure where girls experiences ‘flight or fight’ response and extreme pain; 4) the post-cutting period characterized by mixed emotions including elevation, trauma and betrayal and; 5) the long term period where they spoke of the psychological consequences of FGM/C.
1. The ‘akpapyi’ period. The emotional experience relating to the ‘akpapyi’ period is key to understanding why young women accept, or even request in some cases, to undergo the FGM/C procedure. It is a pejorative term used to describe the ‘uncircumcised’ female. Virtually all participants described experiencing intense negative psychological feelings during this period of their lives ranging from anger, sadness, shame and embarrassment. In some instances, these emotions were accompanied by social withdrawal with the community exhibiting extreme forms of stigma toward uncut women and girls. Furthermore, this community did not allow the akpapyi to gather with the ‘circumcised’ and if they approached such gatherings, they were asked to leave. Women across the life cycle in urban and rural areas recounted feelings of shame and anger recalling being mocked and humiliated during their ‘akpapyi’ period.
Before I went for circumcision, I used to be ashamed of the insults received from people. As they mocked me, it annoyed me. Why it annoys me is because they mock me saying I’m an uncircumcised (akpapyi) that I should look at my size. (45 years, urban)
The stigma against the akpapyi is sustained by a community discourse stating that the uncut behave badly, have increased libido (which is perceived negatively), are promiscuous and are likely to have adverse experiences when they give birth. This stigmatization also extends to their children as they are often portrayed as being considered less than human.
If I married without circumcision and eventually gave birth to a child or children, the child or children cannot be taken as a human being and are described as fools. (47 years, rural)
I heard that a pregnant woman…. in the process of her delivery, met some women to help her to deliver, when they opened her wrapper and saw her private part (she was uncut), they abandoned her to go and invite others to come and see the horrible thing they are seeing (45 years, rural)
Participant recalled that while they were an ‘akpapyi’ they responded with strong feelings of sadness, crying, feeling unaccepted and social withdrawal, depressive symptoms which included dropping out of school for some of the girls. Subsequently, many of the girls and women felt resignation toward the inevitability of undergoing FGM/C while putting aside their initial fear or apprehension of the procedure. Escaping the experience of extreme stigma during the ‘akpapyi’ period gave rise to a strong justification for undergoing FGM/C. Many describe the determination to do the FGM/C as a bid to avoid mocking and insults, remove the shame, humiliation and isolation, and be able and comfortable to participate in society.
I have already volunteered myself for the cutting because of the insult of being called “akpapyi” and if you did not circumcise, it was not good then. (48 years: urban)
When we are bathing together, my mates will be laughing at me and I was ashamed and I told my mother that I will be going for FGC. (34 years: rural)
Being among their peers and being allowed to participate in social activities was particularly important for the younger girls. They described the need to be ‘among’ or ‘belong’ as a reason for deciding to go for the FGM/C.
2. The decision to be cut: emotional elevation. Some of the girls and women recounted experiencing emotional elevation once the decision to be cut was made and as they were approaching the date of their cutting. The sense of happy anticipation was clearly evident as the girls and women approached the ‘circumcision’ day and as plans were made for the event.
I was very happy. I was even the first person to wake up and reminded my mother: “hope you said I will be circumcised today” (25 years, urban)
The anticipation of happiness was associated with escaping the akpapyi experience and what the girls and women described as great joy appears in many instances to be due to a sense of liberation and relief as seen in several of the narratives of our participants.
I was happy when they told me that I was going to undergo circumcision because I have been embarrassed enough. (19 years, urban)
The way it was to me is that I’m unhappy because any time I go out, my mates will be mocking me. One day, I told my mother how my mates had been molesting me about being uncircumcised and I asked her to let me be circumcised. She accepted and after a while she asked me to prepare that she will take me to the place I will be circumcised, and I was happy. (30 years, rural)
My age mates insulted me so much by calling me names like “akpapyi” any time I am in their midst and I used to feel so bad, so when I had the chance to have it performed on me, I was so happy and ran to the woman’s house to have it done. My family members were not even at home when I ran to the woman’s house with my friends to have it done! (20 years, rural)
Narratives also revealed that this feeling of happiness was also associated with the clear rise in social status provided by the cutting which was seen as a rite of passage to womanhood and respectability.
What I saw then that made me feel happy was that since the circumcision can make me complete as tradition prescribed, I said let me do it just as my mates are doing it. Just as you know that there is a difference between a girl and a woman, and the beginning of womanhood starts with this circumcision. That is why I was glad to do it as this will lead me into womanhood. (46 years: rural)
3. During the FGM/C procedure: ‘fight or flight’ response. As they stood in queue waiting for their own turn to be cut, many expressed intense fear from hearing the shouts of those who had just gone through the procedure.
Before the circumcision, I was afraid and shivering because I heard the cry of the first person, and I started shaking because I did not know how mine will be. (28 years, rural)
Whether waiting in line or during the actual cutting of their genitals many interviewees described experiencing an acute physiological response of ‘fight or flight’ in reaction to the extreme stress and fear imposed by the imminent danger and pain they experienced. They explained experiencing fear and immense anxiety, palpitations, and trying to run away from the terror of being cut. They knew this procedure could cause serious complications such as pain, bleeding or ultimately death. Their narratives report that in response to the fear exhibited by the girls, the cutters commonly used aggression to obtain their compliance.
When I saw others cry and bleed during their circumcision, I was terrified. And when it was my turn, and I was held hands and legs down, I was terribly frightened. (20 years, rural)
Reports of crying and shouting during the procedure were common in the narratives and the reactions of the cutters to this reaction varied with either leaving those to be cut for a while or getting strong men to hold them down and in some cases, sitting on the young girls during the procedure to keep them still.
It was paining me and due to the pains and cry, the woman that was giving the cut now started feeling for me and said they should leave me and continue with others. After theirs, she will now finish my own. (26 years, urban)
If you are the type of person that does not know how to sit or may cry, someone will sit on your chest, a strong man and he will hold your two hands so that you will not be shaking your bottom. (60 years, urban)
The first people that were circumcised laid down but I was so much afraid that I was held by people in a sitting and leaning position and they held my two legs. (34 years, rural)
Many girls also reported that they were told that crying and shouting means weakness.
What actually happened was that during the cutting, if you eventually cry and people were asked to hold you, it means that you are not strong and will be ashamed of yourself just like during my own circumcision; so because of that, people don’t tell the story about it. (47 years, rural)
Possibly due to flashbacks from the cutting event, evidence of distress was for example recorded in a 28 year old rural dweller as she took deep breaths and paused when describing the event which in her own words ‘tore her body apart’.
4. Emotional states after the cutting. Our participants expressed a variety of different emotions and feelings after the cutting was completed. These varied from having mixed feelings, betrayal, anger, fear of dying from the extreme pain or blood loss, but also feeling of happiness from escaping stigma and gaining a higher status that conveyed respect and their reintegration into the community.
I became happy because I hate being called ‘akpapyi’, it put an end to insults. (34 years, rural)
I was so glad to have done it because that brings about the end of the insults I used to receive, with a welcome into the community. (45 years, urban).
I can’t really say but the only thing I know is that after the circumcision, I was so happy that each time I see my friends I will tell them that I have done the circumcision. Because I am no longer akpapyi, and my friends will not be abusing me again.
During the procedure it was painful and after the procedure I was happy because I can go to any place, no more embarrassment and partake in events with my age mates. (55yers, rural).
Some of the things that brought on joy and happiness were also the change that came with FGM/C that made them thereafter eligible for marriage or it meant they would be receiving special attention from family and friends such as having a special meal cooked for them. Many also expressed being happy because of their desire to participate in mocking the other ‘akpapyis’, a severe stigmatizing situation from which they had just recently escaped from.
Ah! It sweets my mind (made me very happy), because I know that I will follow and make mockery of the others. (45 years, rural).
Others described a period of mixed feelings in the immediate aftermath of FGM/C. One described it as neither happy nor sad and others as mixed feelings.
I was not happy again, but with time I ignored the pains. I can’t say that am sad but I was not happy because of the pains. (26 years, urban)
My feeling then was mixed up. (58 years, rural)
Moreover, some were afraid of dying because of the extreme pain or important blood loss they experienced. Others may have had organic mental health manifestations due to excessive blood loss, with what appears like clouding of consciousness and fainting.
After the cutting, it bled so heavily that I nearly died and for two days I did not get myself. The bleeding was so heavy that all my energy was lost and I nearly fainted, until the end of that day I did not get myself. (48 years, urban).
(Hmmm) yes, I was filled with regrets and lamenting that is this how my life will end just because of circumcision. I was afraid because then I used to have constant dizziness thinking that I have lost all my blood that I will soon die. (30 years, urban).
It was so painful and I experienced much bleeding, I never knew I will live to survive that day. I felt bad about it especially when I got home; after the procedure I still couldn’t get myself and thinking if I could survive it or not. (45 years, urban).
Feelings of betrayal by a loved one was expressed by a few who had been lied to about the procedure. Others expressed anger and regret about doing the FGM/C because of the weakness, pain and blood loss they had experienced.
Hei! My body was so weak that I regretted doing it and I was so angry for doing it. (48 years, urban).
5. Long Term Psychological Consequences of FGM/C. The narratives reveal two distinct psychological long-term responses to undergoing FGM/C. Some expressed emotional elevation from not experiencing any complications following the physical healing period and others experienced clear emotional turmoil suggesting symptoms of PTSD.
Emotional Elevation in the Absence of Complications. A feeling of happiness was described by some because they had survived the procedure and the FGM/C procedure was over and done, suggesting a sense of relief.
After the circumcision, I was so happy because I know that am not going to undergo the circumcision again. (26 yeas, urban).
I have heard because when they were announcing things they said some people died due to excessive bleeding while some were rushed to the hospital but I am happy because all these things did not occur in my own situation. (25 years, urban).
Other women experienced long term emotional turmoil after undergoing FGM/C with experiences of flashbacks, symptoms of anxiety and depression, a situation suggestive of Post Traumatic Stress Disorder (PTSD).
What I remember is that, it is usually any moment I...it is usually any moment I see razor now, any moment I see...razor or scissors, I will remember....and it is what made me now, I don’t use razor to cut nails because, if I see razor ‘aphufuru ekwo nta (razor that is unwrapped now, I will remember when I was circumcised, how it did to my body. That whenever I see razor or scissors, I will remember that circumcision I cut that time. And it is usually when a person has accident, he has wound, that he is sewn something or that....they put scissor to his body or razor, my heart will run to...when they circumcised me, that...that thing was what touched my body (something that has affected me or deeply touched me), it boiled me in the body. (22 years, rural).
Anger, grief and regret were expressed by a 48 years old woman, whose wound had sealed and who subsequently have difficulty in childbirth.
After the circumcision was done, the place sealed back, I really suffered as I told you that my body was torn before I was able to deliver my baby as there was no hospital then. Whenever I remember that day I was circumcised, I do get angry and grief and I don’t know whether it is because of the circumcision I did that I don’t use to find it easy when I am pregnant and during child delivery. If I had known I wouldn’t have even thought of it let alone doing it. Even now I cannot take my children for that. It is a regretful act. (48 years, urban)