Female genital mutilation and its medicalizationa qualitative study among healthcare professionals and community leaders in Kisii County

Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Prof. Marleen Temmerman

Second Supervisor/Advisor

Prof. Violet Naanyu

Third Supervisor/Advisor

Dr. Njeri Nyanja


Family Medicine (East Africa)


Background: According to the World Health Organization (WHO), female genital mutilation (FGM) includes all procedures that involve removal of the female genitalia and / or injury to the female genital organs for cultural and / or any other nonmedical reason. The practice poses serious threats to women’s health hence violating their health and rights. FGM, also referred to as genital cutting, is deeply rooted amongst the Abagusii community of Kenya, with 84% of the girls cut as per Kenya Demographic Health Survey report of 2014 and the medicalized form slowly replacing the traditional cut. Overall in Kenya, the medicalized form stands at 14% as at 2014.

Although FGM is illegal in Kenya, and the existing strategies by government through various laws and policies to curb FGM notwithstanding, its prevalence among the Abagusii community remains unacceptably high and medicalization seems to be increasing. Understanding the experiences and perspectives amongst healthcare professionals and community leaders in this community, will help inform new strategies to curb the practice.

Objectives: Primary objective: To explore the experiences and perspectives of health professionals and community leaders towards FGM and its medicalization in Kisii county. Secondary objectives: To establish the experiences and perspectives among health professionals and community leaders on factors that contribute to the continued practice of FGM in Kisii county and secondly, to elicit views of health professionals and community leaders on new strategies that if used, could help curb the medicalization of FGM in Kisii county.

Methods: A qualitative study using a focused ethnography approach was conducted to explore the experiences and perspectives of health professionals and community leaders towards FGM and its medicalization in Kisii county. Sampling was purposive. Twenty-six participants (18 health professionals and eight community leaders) from two sub-counties of Kisii County were recruited. Signed informed consent was acquired from all participants. Data collection was done using audio-recorded semi-structured interviews. All audiorecordings were transcribed in English. A thematic approach was used for analysis supported by NVivo version 12 plus software.

Results: A total of 18 healthcare professionals (six doctors, six clinical officers, six nurses), eight community leaders (two representatives from local community-based organizations relevant to the study topic of interest, two religious leaders and four chiefs/assistant chiefs) were interviewed. Among health workers, doctors demonstrated more understanding on FGM compared to the other healthcare professionals. All the study participants demonstrated little knowledge on existing laws and policies. The general attitude towards FGM was in favour of its discontinuation. Increasingly, financial gain was a motivating factor among female nurses and clinical officers carrying out FGM. Current strategies including laws against FGM have not helped in curbing the practice. The participants proposed that finding alternative rites of passage rather than legal redress alone would be the better strategy to end FGM.

Conclusions and recommendations: Overall, the Abagusii community demonstrate a desired trend towards abandoning FGM. The level of knowledge on female genital mutilation is generally low among healthcare professionals. There is good will among the community leaders and healthcare professionals to eradicate. Culture still remains the main contributing factor to the continued practice of FGM and health professionals seem to favour its medicalization as a way of containing the complications arising from traditional surgeons.

Laws and policies on FGM have not been reviewed to address the ever-evolving nature of the FGM which now is highly secretive therefore difficult to identify the burden in this community. There is a need for training of health professionals on FGM with a view to empower them with skills, knowledge and use them as agents of change, which may contribute towards successful discontinuation of FGM.

This document is available in the relevant AKU library