title: Injured bodies, damaged lives: experiences and narratives of Kenyan women with obstetric fistula and Female Genital Mutilation/Cutting.
abstract: BACKGROUND
  It is well acknowledged that Female Genital Mutilation/Cutting (FGM/C/C) leads to medical, psychological and sociocultural sequels. Over 200 million cases of FGM/C exist globally, and in Kenya alone, a total of 12,418,000 (28%) of women have undergone FGM/C, making the practice not only a significant national, but also a global health catastrophe. FGM/C is rooted in patriarchal and traditional cultures as a communal experience signifying a transition from girlhood to womanhood. The conversations surrounding FGM/C have been complicated by the involvement of women themselves in perpetuating the practice.
  
  
  METHODS
  A qualitative inquiry employing face-to-face, one-on-one, in-depth semi-structured interviews was used in a study that included 30 women living with obstetric fistulas in Kenya. Using the Social Network Framework and a feminist analysis we present stories of Kenyan women who had developed obstetric fistulas following prolonged and obstructed childbirth.
  
  
  RESULTS
  Of the 30 participants, three women reported that health care workers informed them that FGM/C was one of the contributing factors to their prolonged and obstructed childbirth. They reported serious obstetric complications including: the development of obstetric fistulas, lowered libido, poor quality of life and maternal and child health outcomes, including death. Fistula and subsequent loss of bodily functionalities such as uncontrollable leakage of body wastes, was reported by the women to result in rejection by spouses, families, friends and communities. Rejection further led to depression, loss of work, increased sense of apathy, lowered self-esteem and image, as well as loss of identity and communal sociocultural cohesion.
  
  
  CONCLUSIONS
  FGM/C is practised in traditional, patriarchal communities across Africa. Although the practice aims to bind community members and to celebrate a rite of passage; it may lead to harmful health and social consequences. Some women with fistula report their fistula was caused by FGM/C. Concerted efforts which embrace feminist understandings of society, as well as multi-sectoral, multidisciplinary and community development approaches need to be employed to address FGM/C, and to possibly reduce cases of obstetric fistulas in Kenya and beyond. Both government and non-government organisations need to be involved in making legislative, gender sensitive policies that protect women from FGM/C. In addition, the policy makers need to be in the front line to improve the lives of women who endured the consequences of FGM/C.
authors.affiliation: Discipline of Public Health, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 2, Health Sciences Building, Registry Road, Bedford Park, South Australia, 5042, Australia. lillian.mwanri@flinders.edu.au.
authors.forename: Lillian
authors.identifier: http://orcid.org/0000-0002-5792-7785
authors.initials: L
authors.lastname: Mwanri
authors.affiliation: School of Arts & Social Sciences, Southern Cross University, Gold Coast Campus, Gold Coast, Australia.
authors.forename: Glory Joy
authors.initials: GJ
authors.lastname: Gatwiri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019093:Circumcision, Female / Q000009:adverse effects*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya; D008875:Middle Aged; D013513:Obstetric Surgical Procedures / Q000009:adverse effects*; D011788:Quality of Life; D014624:Vaginal Fistula / Q000209:etiology*; D055815:Young Adult
keywords: Female Genital Mutilation/Cutting; Kenya; Obstetric fistulas; Prolonged obstructed labour; Women