Abstract
This paper presents an analysis of different positions on female genital cutting, either legitimising the practice or challenging it. The framework it offers has been developed from cultural psychological theory and qualitative data collected in Maasai communities around Loitokitok and Magadi, Kajiado County, and Samburu communities around Wamba, Samburu County, in Kenya. Over the course of one month, 94 respondents were interviewed using maximum variation sampling. Triangulation took place by means of participant observation of significant events, such as alternative rites, participation in daily activities and informal talks while staying at traditional homesteads and kraals. The framework adds to understanding of why more contextual approaches and holistic interventions are required to bring an end to female genital cutting.
Résumé
Cet article présente l’analyse de différents points de vue sur la mutilation de l’appareil génital féminin qui, soit légitiment cette pratique, soit la contestent. La perspective proposée a été développée à partir de la théorie de la psychologie culturelle et de données qualitatives collectées dans des communautés masaïs au Kenya, situées dans les environs de Loitokitok et Magadi, Canton de Kajiado ; et dans des communautés samburu situées dans les environs de Wamba, dans le Canton de Samburu. Pendant un mois, sur la base d’un échantillonnage avec écart maximal, 94 répondants ont été interrogés. Une triangulation a été effectuée grâce à une observation participante d’événements significatifs, tels les rites alternatifs, la participation aux activités quotidiennes et des conversations informelles, qui s’est déroulée dans des foyers traditionnels et des kraals. Cette perspective permet de mieux comprendre pourquoi des approches plus contextuelles et des interventions holistiques sont exigées pour en finir avec la mutilation de l’appareil génital féminin.
Resumen
En este artículo presentamos un análisis de las diferentes maneras de entender la mutilación genital femenina, ya sea para legitimizar esta práctica o rechazarla. Se ofrece un contexto desarrollado a partir de la teoría psicológica cultural y datos cualitativos recogidos en las comunidades Maasai en Loitokitok y Magadi (Condado de Kajiado) y las comunidades Samburu en Wamba (Condado de Samburu), en Kenia. Para este estudio se entrevistó a 94 participantes mediante una muestra de variación máxima durante el transcurso de un mes. La triangulación tuvo lugar mediante la observación de los participantes durante hechos relevantes, tales como ritos alternativos, la participación en actividades diarias y charlas informales, instalados en viviendas tradicionales y kraals. El contexto nos ayuda a entender el motivo de que sean necesarios enfoques más contextuales y programas holísticos para acabar con la mutilación genital femenina.
Introduction
Nomadic communities in Kenya still practise female genital cuttingFootnote1 (e.g. Van Der Kwaak et al. Citation2012). This is the case for the Maasai communities around Loitokitok and Magadi, Kajiado County, and Samburu communities around Wamba, Samburu County, visited in this study (Kiage et al. Citation2014). Maasai and Samburu communities are similar in language and tradition (Spencer Citation1965). The proportion of Maasai and Samburu women in Kenya who have experienced female genital mutilation or cutting (FGM/C) is reported to be around 78% and 86%, respectively (Kenya National Bureau of Statistics [KNBS] Citation2015). FGM/C is defined as ‘... all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons’ (World Health Organization [WHO] Citation2018).Footnote2 There is evidence that female genital cutting is related to short- and long-term health risks (e.g. Obermeyer Citation2005; Reisel and Creighton Citation2015).
The practice of female genital cutting is internationally recognised as a violation of human rights (WHO Citation2008). In 2011, the Kenyan government passed the Prohibition of Female Genital Mutilation Act (Kenya Law Reports: Act No. 32 of 2011, Citation2012). As expected, this Act, in a similar manner to earlier legislation, did not bring an end to the practice. Among the Maasai and Samburu there are strong indications that the criminalisation of female genital cutting has led to it being performed secretly and at younger ages, and to less severe forms of female genital cutting such as pricking or scraping (Kiage et al. Citation2014). For these communities, female genital cutting is believed to primarily signify a transition into womanhood (Kiage et al. Citation2014; Mohamed Citation2011; Saitoti Citation1980).
However, as Gruenbaum has warned, ‘there is in fact no single reason or consistent set of sociocultural determinants for female genital cutting’ (Citation2005, 435). While conducting extensive ethnographic research on female genital cutting in Sudan, she noticed that when conducting interviews different reasons for the practice of female genital cutting were given by members of a single community. She suggested that the reasons given in a survey might not even be those that actually motivate an individual to commit to the practice (Gruenbaum Citation2001, Citation2005). The reality is often more complex and problematic. For example, Maasai and Samburu girls in Kenya traditionally underwent FGM/C around the age of 12 to 16 as a rite of passage into womanhood, but today increasingly younger ages are reported (Kiage et al. Citation2014). After undergoing the rite, a girl was considered a woman, and could be married off, also earning her right to bear children (Saitoti Citation1980). However, today, if she is a minor, such a marital arrangement constitutes a crime (United Nations Populations Fund [UNFPA] Citation2016).
Van Bavel, Coene and Leye (Citation2017, 2) argue that ‘Maasai culture and the practice of female genital cutting are not static but actively challenged and reinterpreted from both outside and within the community’. Based on cultural psychological theory (Voestermans and Verheggen Citation2013) and informed by discourse analysis (Potter and Wetherell Citation1987, Citation1995; Willig Citation2008), this paper presents an overarching framework that engages with the complexity of FGM/C. It enables the uncovering of more implicit and at times contrasting ways people make sense of or account for the practice. This study has practical implications for designing interventions aimed at ending FGM/C which will also be discussed.
Theoretical background
Agreements, conventions and arrangements
Voestermans and Verheggen (Citation2013) theorise that feelings of belonging to a particular group, tribe or clan can vary in depth and intensity depending on whether these groups are formed primarily on the basis of agreements, conventions or arrangements (ACAs). Feelings of belonging evoked in members of groups that are formed solely on the basis of explicit agreements tend to be superficial, while groups formed on the basis of arrangements tend to be the ones that most deeply involve people’s experience. The term ‘arrangement’ here refers to ‘that very much taken-for-granted environment that people shape themselves, and that in turn helps to shape the behaviours and feelings of people, and even triggers them’ (Voestermans and Verheggen Citation2013, 96). ‘Conventions’ theoretically mark a middle position. A certain feel is required to know conventions such as when to laugh and when not to, but, with some effort, group members are usually able to articulate them. In the study on which this paper is based, ACAs were used as identifiers of group-belonging in relation to FGM/C.
Discourse analytic approach
There are no fixed methods by which to map social arrangements. The difficulty a researcher faces is that when asking people why they do what they do, they may be unaware of the implicit ways in which different elements in their environment are arranged to trigger expectations and behaviour. When people talk about their behaviours or beliefs, for example, they often actively construct a reality that suits a particular objective, such as justifying, excusing, challenging or requesting (Potter and Wetherell Citation1987). However, in doing so, people depend upon the discursive resources available within their culture (Willig Citation2008). Exploring what these recourses are and how they operate can be a starting point to unravelling social arrangements. This analysis does not and should not preclude an analysis of what people do within their actual and tangible environment, which goes beyond mere talk and text. Examining discursive resources in combination with the organisation of time and space, architecture, adornments, tools, mannerisms and dance, and how these trigger expectations, emotions and behaviours, constitutes an analysis of social arrangements.
Dynamics of change
In an empirical study, Willig (Citation1998) showed how discursive constructions of sexual activity have implications for actual practice through the positioning of the subject (see also Davies and Harré Citation1999). Willig goes so far as to make suggestions on how to open up new discursive spaces that may affect practice in the direction of safer sex. Inspired by her study, the authors of this paper go one step further and propose that the dynamics of change are to be found in the overlapping discursive spaces of discourses and counter-discourses. Discourses are not to be conceptualised as isolated bubbles of meaning, nor are they ever watertight (Parker Citation1992). Even discourses that construct the same discursive object differently by legitimising or challenging it can be similar in other respects. For example, FGM/C can be constructed as a health risk within a medical discourse or as a preventive measure against disease and misfortune within a more traditional discourse. Both discourses are concerned with and construct cause-and-effect relationships, albeit in radically different ways.
The same people can draw upon different and even opposing discourses to justify, excuse or challenge female genital cutting as a matter of course. In some cases, in an attempt to harmonise these contradictions, new meanings are constructed, and alternative practices are adopted. In the light of the framework presented in this paper, we will critically discuss interventions aimed at ending FGM/C, such as alternative rites. These rites initiate girls into womanhood without the girls undergoing the cut – an intervention aimed at ending FGM/C by harmonising different perspectives and avoiding a ‘culture clash’.
Methods
Site selection and sampling
Data collection took place within a one-month timeframe at the end of 2016 in several communities in the areas surrounding Loitokitok, Magadi and Wamba. In these areas, alternative rites of passage are implemented during the school holiday period. These areas were also chosen because the Maa-speaking populations that live in them all have similar traditions related to, for example, the morans (the young male warriors) and female genital cutting (Spencer Citation1965). Collecting data in these specific areas was deemed suitable for building an overarching framework, rather than undertaking comparative analysis or cross-cultural research.
Interview respondents were targeted through maximum variation sampling. They were not only selected on the basis of age and gender, as represented in Table , as an effort was also made to include people with a variety of community roles and vocations. Most, but not all, of the younger interviewees (9 to 17 years) attended school. All of the older men (≥ 40 years) in the sample were pastoralists, some of whom also held municipal governance positions. The older women were midwives, teachers, small business owners, women’s rights activists or had traditional roles around the household. This picture is similar to the men and women aged 18 to 39 years in our sample, with the addition that some of the younger men and women were students and the proportion of women working as primary school teachers was relatively high.
Table 1. Respondents by age and gender in three research areas.
The necessary information for selection was obtained through key informants and members of our own research team. Ninety-four respondents volunteered to be interviewed. This relatively high number was needed to achieve saturation and allow us to build an overarching framework.
Data collection
Interviews
The interviews were semi-structured around themes such as work, health, gender, change, important others, pleasure and issues respondents themselves deemed important in relation to the main theme of female genital cutting. All of the interviews were conducted by the principal investigator (EG), who was always accompanied by a translator conversant in both Kiswahili and Maa if respondents did not speak English well enough.
The interviews lasted between 30 to 90 min. Respondents were interviewed individually. All of the interviews were audio-recorded and transcribed, anonymising names and exact locations. By building rapport, paying attention to cultural sensitivity and careful probing, the interviewer found that many respondents were willing to share intimate personal experiences on topics such as sexual orgasm, adultery, personal losses and their hopes and disappointments.
Participant observation
During the course of the study, the principal investigator attended several significant events and took part in a variety of activities, such as meetings of community-based organisations, religious ceremonies, a two-day male circumcision ceremony, multiple overnight stays at traditional kraals, visits to cattle markets and three alternative rites of passage ceremonies in Loitokitok, Magadi and Wamba, respectively. During or immediately after these activities and events, field notes were made that were later worked up into an expanded observation protocol.
Data analysis
Documentary analysis also took place. The main documents analysed for formal perspectives on female genital cutting were an interagency statement (WHO Citation2008), the Prohibition of Female Genital Mutilation Act (Kenya Law Reports: Act No. 32 of 2011, Citation2012), a vision statement on ending female genital cutting by 2030 (Amref Health Africa Citation2017) and a draft version of the indigenous Maa constitution of 2017. Relevant conventions could be extracted from the interview transcripts.
To uncover the social arrangements pertaining to female genital cutting among the Maasai and Samburu communities visited in this study, discourse analysis was conducted on 48 interview transcripts that were deemed suitable for further analysis. The other interview transcripts either lacked depth or scored too high on social desirability. Considering the still relatively high number of interviews and in light of the aim of this study, Willig’s (Citation2008) six-step approach to conducting Foucauldian discourse analysis was chosen over methods suggestive of more steps or conceptually more complex forms of analysis (e.g. Kendall and Wickham Citation1999; Parker Citation1992).
After selecting fragments in which female genital cutting is talked about and constructed, an attempt was made to locate these constructions within wider discourses. A next step involved exploring how these discourses were deployed within the transcripts and the subject positions they facilitated. Positioning the subject allows for the mapping of possible behavioural patterns – in other words, an outline of what behavioural opportunities subjects have by being located or having located themselves within a particular discursive frame. Finally, a tentative delineation of what subjects feel or experience within these discursive frames could be made. The discourses, as well as the subject positions that could be taken up within them, were further refined and sharpened during peer-debriefing sessions within the research team. Findings were triangulated with what was observed in the field and also compared to the existing literature.
In June 2017, the results of the study were presented to all of the participants in the area around Loitokitok, at which some of the community leaders from the other research areas were also present to attend a workshop. This was done by the principal investigator, who was assisted by a translator, by means of presentations, posters and focus group discussions. The feedback the principal investigator received led to minor revisions.
The theoretical framework, methods of data collection and data analysis are summarised in Figure . Relevant conventions were explained by gatekeepers, key informants and respondents. By becoming aware of these conventions at an early stage in the study, especially those on the practice of active dissimulation or concealment from outsiders, the principal investigator was able to dig deeper into social arrangements related to female genital cutting.
Ethics statement
The Ethics and Scientific Review Committee (of AMREF Health Africa in Kenya)Footnote3 approved this research protocol (REF: AMREF-ESRC P277/2016) on 27 October 2016. All of the interviewees were required to sign an informed consent form. If the interviewee was below the age of 18, a legal guardian was required to give permission on behalf of the minor. Prior to participant observation, community consent was obtained from a leading figure, who then informed all members of the group, family or community about the researcher’s presence and the subject of the research.
Results
The different discourses within which constructions of female genital cutting were found to be embedded are presented below. Within the ACA framework social arrangements are denominated by their corresponding discourse. In the space available here, we can only present a general outline, since a detailed report of the analytic stages is not feasible within the scope of this paper. Our goal though is to show how these different discourses and counter-discourses interact to effect change.
Using discourse analysis to map social arrangements
In total, seven discourses emerged from the analyses, three legitimising the practice of female genital cutting, and four challenging the practice (Table ).
Table 2. Summary discursive constructions, discourses and counter-discourses.
Constructions of female genital cutting related to marriageability, bride price or cutting as a service provided by a traditional birth attendant locate it within an economic discourse of supply and demand that legitimises the practice. In many accounts, marriageability was provided as the rationale for cutting, either as a means of survival for a young uneducated woman or as a requirement for fathers to exploit their daughter’s bride price:
If she [one of my daughters] is educated, if I do not rush for circumcision, she will also get married and I will go there and demand dowry. So, I will get my wealth anyway. But if you get her circumcised you can marry her off right away and get livestock and wealth quicker. That is it. (Michael, Magadi, elder, pastoralist, 4 December 2016)Footnote4
What else could I do? When my husband passed away, I had no cows, I owned no land. To me it was something like a business opportunity. (Bernadette, Loitokitok, widow, former circumciser, 17 November 2016)
My elder sister was promised in marriage. So, I was circumcised with my elder sister, together. My father said: ‘It would be a loss if I circumcise her and let you wait for next year’. Because they will prepare a ceremony. So, it will be expensive for him to circumcise me at some other time. (Nancy, Magadi, teacher, 1 December 2016)
If she [daughter] becomes pregnant and delivers [while being uncircumcised] I need to compensate the midwife with a goat. (Patrick, Magadi, elder, pastoralist, 5 December 2016)
Why should I do this? I was born like that. God did very well. He gave me all parts of my body. (Abigail, Magadi, nursing school, uncircumcised, 5 December 2016)
Always He [God of the Bible] gives you something that matches your strength. The way of your strength is the way of your challenge. So, I say: ‘No, I have to fight for it!’ (Abigail, Magadi, nursing school, uncircumcised, 5 December 2016)
It was so painful. You cannot imagine. But there is nothing you can do about it. You cannot cry, because you do not want to be seen as a coward. (Grace, Loitokitok, widow, former circumciser, 25 November 2016)
We Maasai … we don’t trust our women. If you leave the homestead and you come back, she will sleep with other men. If you do not circumcise her, she will run away at night looking for sex like a prostitute. (John, Magadi, elder, pastoralist, 2 December 2016)
It is our tradition. We know this. It is true. So, if a girl who is not circumcised becomes pregnant, she is chased away … she will go to the forest where wild animals will attack her ... she will die. She cannot give birth in the homestead. That cannot be. If she is a girl that is not circumcised but still becomes pregnant, this girl will bring disaster to the boys. So, what we normally do is to chase away the girl. (William, Loitokitok, elder, pastoralist, 22 November 2016)
A discourse on love, care and intimacy challenges female genital cutting by constructing it as the inability to experience the sweetness of love:
Yah ... [whispering] the senses are destroyed. You see, when I look at my husband … yes, I feel like loving him … but when you are cut, that urge of sex is not there and it is that which brings a family together. It is very important. But … mmm … it is very hard for me ... even to this day. It takes out that urge for loving. (Mary, Wamba, teacher, university education, circumcised, 7 December 2016)
When you indulge in sex it does not bring you that pleasure. Yeah … they [orgasms] are not there. And that is why a Samburu man who has a woman of my age, they go and marry the second one, because they are looking for that sweetness in sex. But they can’t get it. They get the second one, but she is circumcised. They get a third one … They go on like that until they grow old and sometimes have fifty wives [laughing]. (Mary, Wamba, teacher, university education, circumcised, 7 December 2016)
When a girl is cut, that is when the clitoris is cut, only the upper part is removed, meaning that some roots of the clitoris remain. So, this does not reduce the urge to have sex, but what affects girls during sex is the trauma; the psychological issue of … when I have sex, maybe I will not enjoy sex, because I am cut. That is according to teaching. (Charity, Kimana, teacher, single mother, circumcised, 23 June 2017)
Table 3. Agreements, conventions and arrangements.
Based on the above analysis, in Figure we outline a framework that might enable different stakeholders to locate the discourses that emerged from the data in an integrated manner.
Opportunities for change
As can be seen in Figure , the discursive spaces in the overlapping areas of discourses and counter-discourses have been given descriptive terms. While we do not claim that these terms comprehensively cover the dynamics present within each of these spaces, nor imply that they point to clear-cut forms of interventions, they do highlight different issues that need to be addressed in the design of more holistic programmes to eliminate female genital cutting.
During a meeting of women’s rights activists, the first author asked the group what they thought was the most important thing in life. Different women mentioned ‘dressing’, ‘housing’, ‘food’, ‘unity’ and ‘peace’, respectively. In one-on-one interviews, these same themes were frequently mentioned. One father, who was still shifting between various positions on whether female genital cutting needed to be abolished, articulated his primary goal in life in the following manner:
It is simple. I want my daughters to live a happy life. I want them to finish their school. Some can even become pilots if they want. I want them to do research like you are doing. So, they must go to university. I want a very good life in all my kids … also the girls. (William, Loitokitok, elder, pastoralist, 22 November 2016)
Actually, I did not send her [oldest daughter] away … she ran away because I insisted she’d be circumcised. But I do not want my other daughters to run away like that … my opinion on FGM has changed … I am very close to my daughters. (William, Loitokitok, elder, pastoralist, 22 November 2016)
Alternative rites at the discursive overlap of the discourse of modernity and martial-pastoralist discourse highlights a search for interventions that seek to avoid a ‘culture clash’. However, one question that needs to be addressed in this regard is whether these rites are truly understood as alternative rites of passage and not, for example, as alternatives to rites of passage or rites of delayed passage. From observations, interviews and informal talks, it appeared that girls who underwent the alternative rites of passage did not feel themselves to be women, nor were they considered women by others. This opinion was shared by some sceptical interviewees and expressed by an elder in the following manner:
How can you do a ceremony if you don’t circumcise your girl? What is the use of that? It is not the same. (Peter, Magadi, elder, pastoralist, 4 December 2016)
Transcendence at the discursive overlap of magical discourse and religious discourse highlights the dynamic of change, whereby Maasai or Samburu are told by pastors or missionaries not to fear the curse of their ancestors but rather the wrath of God for continuing a practice that is performed against His will.
Higher order at the discursive overlap of martial-pastoralist discourse and religious discourse highlights the influence of Christianity on the most confidential of cultural practices. Although cultural elders, who as the guardians of tradition frequently deploy martial-pastoralist discourse, facilitate open-air sermons held at their kraals, according to one key informant, these elders stand in opposition to religious leaders on key issues such as those related to female genital cutting and moranism. In turn, religious leaders tend to view cultural elders as ‘illiterates’ and a somewhat ‘backward’ class of men. An observation that seems to underscore this difference is that preachers, even those of Maasai origin, never wore traditional attire, even when present at traditional ceremonies.
Awareness at the discursive overlap of medical discourse and magical discourse highlights the possibility of interventions aimed at creating awareness of sexual reproductive health. It is often assumed that creating this awareness challenges traditional beliefs about health, but this is not necessarily the case:
It is all FGM, FGM, FGM. Our kids are being taught negative things about circumcision. I don’t see anything bad about it. Why are you people telling me not to do this practice? You see, I am careful, because I fear the law. I don’t want trouble. But I have cut so many girls and I have never seen anything bad happen. Some girls bleed, but no one has died. All these complications you people are talking about, I have never seen it. (Grace, Loitokitok, widow, former circumciser, 25 November 2016)
Discussion
By using discourse analysis to uncover implicit social arrangements, we were able to develop an analytic framework that engages with female genital cutting in an integrated manner. This framework can, we believe, be used to communicate about the different and sometimes opposing positions people take in relation to FGM/C. Understanding these different positions and integrating them into an overarching whole is helpful for the design of more holistic interventions.
Various non-governmental organisations and governments in Africa have worked tirelessly to eliminate female genital cutting (Skaine Citation2005). However, legal prohibitions and awareness campaigns about sexual reproductive health and rights have met with limited success and might even be misguided. Repeatedly emphasising human rights and the possible health risks associated with FGM/C will have a limited effect if people still have other social concerns (Boyden Citation2012) influencing their decisions, such as those related to marriageability, honour and shame. As Willig (Citation1998, 385) stated: ‘It is important to examine the relationship between a source’s and a recipient’s discursive frames in order to understand the impact of a message’.
Interventions to eliminate female genital cutting must be aligned with these frames in order to resonate with a specific target-group. Boyden (Citation2012) argues that alternative rites are an important part of more contextual approaches to change. Our analysis supports such a position by placing alternative rites in the overlapping discursive space of a modernistic discourse and a dominant martial-pastoralist discourse that legitimises female genital cutting as a rite of passage. Enforcing the law, creating awareness and providing education remain crucial elements within an integrated approach to change. Each element must be in place if the abolition of female genital cutting is the goal. Similarly, circumventing religious discourse and the levers of change this particular discursive frame offers would drastically decrease the effect of an integrated approach aimed at people for whom religion is a central aspect of life. The more holistic the approach to change, the fewer options proponents of female genital cutting will have. They will be presented with alternative perspectives and options everywhere they look.
Integrating the results of discourse analyses into Voestermans and Verheggen’s (Citation2013) cultural psychological framework, as in Table , helps to better understand why merely making rules and enforcing them will not guarantee success. The explicit and external order imposed may be in opposition to more immediate and experience-based social arrangements that are more difficult to articulate but feel very real and natural. This dynamic can even be observed between different social arrangements, as in the account of a former circumciser, a staunch proponent of the practice, who considered that the rite carried little risk, but confided that within the privacy of her own home and with the tutelage of her own daughters she preferred to perform less traumatic forms of circumcision that carry less risk and are less painful. In discourse analytic terms, at times, the subjugated discourse on love and intimacy here takes precedence over a more dominant martial-pastoralist discourse that sets the rules (note the semi-written Maa Constitution in Table ). Transgression of this traditional martial-pastoralist order proved to be an important theme throughout this research, especially in relation to loving relationships, most notably romantic love.
There are several limitations to the empirical study underlying this framework, mainly in relation to the timeframe for data collection and the generalisability of findings. Firstly, the data were collected during a four-week period in areas where one particular organisation is implementing and/or facilitating alternative rites of passage. Although the authors assume that most social arrangements are relatively stable, the framework presented in this study can best be conceptualised as a snapshot capturing the state of events at a certain time. The replication of this study at different times in the same areas, or via additional longitudinal designs, will allow change over time to be more reliably captured.
Conclusion
Overall, the aim of this paper has been to design and present an overarching framework on different positions that can be held in relation to female genital cutting based on empirical data, and to discuss possible implications this framework might have for the design of interventions in these communities. By undertaking feedback sessions on this framework with the participants of this study, and also by using it as an educational tool in different settings (schools, universities and workshops on anti-FGM/C and gender equality), participants were able to better reflect on their own constructions of FGM/C and what these imply for their interaction with people who construct female genital cutting differently. As for implications for practice, this framework shows why and how one-sided approaches do not work, whether they are alternative rites, awareness campaigns, legislation or economic incentives. As other researchers on female genital cutting have argued (e.g. Boyden Citation2012; Gruenbaum Citation2001, Citation2005), more contextually developed approaches and the design of holistic interventions are required.
Disclosure statement
No potential conflict of interest was reported by the authors.
Funding
This study was a joint project of Amref Health Africa in Kenya and the VU Universiteit Amsterdam, with funding from TEN HAVE Change Management, a consultancy firm based in Utrecht, the Netherlands; and VvAA, an organisation for medical care providers in the Netherlands.
Acknowledgements
We thank Nice Nailantei Leng’ete, Alice Masinte Tipango, Douglas Meritei, Peter Sarinjore and Lelein Kinyanjui Kanunga for their assistance. Finally, we thank the anonymous reviewers for their insightful feedback on earlier drafts.
Notes
1. The Maa term for both male and female genital cutting is emorata. In this paper, the term ‘female genital cutting’ is used, alongside ‘circumcision’ and common abbreviations such as FGM, FGC or FGM/C (female genital mutilation/cutting).
2. Female genital cutting is classified into four types (WHO Citation2008). It has been established that the communities visited in this study practise type 1 (clitoridectomy), type 2 (excision) and increasingly type 4 (pricking, scraping, etc.) (Kiage et al. Citation2014).
3. The ESRC is accredited by the Kenyan National Council for Science and Technology to perform the ethical review for research protocols involving human subjects.
4. Interviewees have been given fictional names to preserve their anonymity.
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