Polyvictimization and Mental Health Consequences of Female Genital Mutilation (FGM) Among Somali Refugees in Kenya

Background & Purpose: Female Genital Mutilation (FGM), or female circumcision, is an internationally recognized human rights violation and form of extreme child abuse that impacts approximately 200 million women and girls worldwide. Despite being outlawed in many countries, FGM continues for a plethora of social and cultural reasons, which are often rooted in traditional norms and beliefs. Well-documented consequences of FGM include devastating repercussions on victims’ physical and sexual health. Emerging data also suggests a troubling impact on mental and psychological well-being, such as post-traumatic stress disorder (PTSD), affective and anxiety disorders, and somatization. This study seeks to further explore the impacts of FGM on mental health and psychosocial factors by placing FGM in the context of childhood adversity and polyvictimization.

 

Methods: It is estimated that between 80 and 98 percent of all Somali women have undergone FGM. Using a snowball sampling method, this study recruited 143 Somali refugee females, aged 14 to 35 (M=20.33, SD=3.24), who reside in Eastleigh, Kenya. A cross-sectional survey was conducted and 57 reported FGM (40%). Based on the Childhood War Trauma Questionnaire, a 19-item trauma checklist was developed locally to investigate polyvictimization experiences commonly reported and experienced by females in the Somali refugee community. To assess FGM’s association with mental health problems as well as other psychological and resilience factors, this study adopted measures on PTSD, depression, culturally grounded somatic symptoms, a sense of community, social support systems, mental health awareness and others.

Results: Bivariate analyses revealed that those who experienced FGM reported significantly higher incidences of multiple traumas, such as child abuse, sexual abuse, harsh physical punishment, exposure to community violence, and police harassment. Compared to the non-FGM respondents, FGM victims presented much higher incidences of trauma exposure (3.44 vs. 7.72, t= -6.546, p=.000). Additionally, a comparison of FGM and non-FGM groups indicated significantly higher mental health and psychological issues among the FGM victims, such as PTSD (t= -2.774, p=.006), depression (t= -4.214, p=.000), anxiety (t= -3.314, p=.001), somatization (t= -2.647, p=.009), suicidal ideation (t= -2.419, p=.018), and substance abuse (t= -3.398, p=.001). There were, however, no significant differences in resilience factors, such as perceived social support, sense of community, awareness around mental health symptoms, and empathy. FGM was also found to be highly associated with poor physical health and certain living arrangements (i.e. living with the mother).

 

Discussion: This study reveals the prevalent risks for polyvictimization and associated mental health sequelae among Somali refugees who had experienced FGM. This demonstrates high vulnerability and frailty of Somali females with FGM, indicating the detrimental impact of multiple childhood adversities in addition to war trauma among refugees. This study highlights the need for a specialized intervention to FGM victims, considering the contextual hardships and challenges associated with the societal conditions of FGM and the vulnerability of affected individuals. Implications for future research will be also discussed to understand how FGM is practiced in the context of other childhood adversities as well as family support and gender roles.