A colonial document from 1930 highlights a strikingly modern dilemma:

It is as if the voice of a past government – oppressive and colonial – still echoes today in Kenya. While a century of interventions may have shifted public opinion against FGM/C,2The author will use both ‘FGM/C’ and ‘female circumcision’ where appropriate, and ‘FGM’ when referring to Kenyan laws that proscribe it. with few openly advocating for it, some communities and individuals remain willing to resist prohibitive laws at great personal risk. Just as in 1925, those committed to the practice continue to unite in defiance of the law, shielding practitioners and concealing their actions.

Understanding how punitive laws, such as the 2011 Prohibition of Female Genital Mutilation Act (hereafter the anti-FGM Act), affect diverse communities requires acknowledging the complex and painful colonial legacy of legal interventions. Now, in 2025, as we reflect on this troubled centenary, it is crucial to ask: what lessons have been learned? And where is this legally and morally charged controversy – this ongoing ‘circumcision crisis’ – headed? Even though many communities have abandoned FGM/C, its persistence continues to confound its opponents.

Such questions have both driven and unsettled me as a Kenyan female and a medical practitioner. While I agree with the movement towards abandonment of FGM/C, I am deeply concerned with how this is being implemented. The title of this chapter is intended to provoke discussion and create space for confronting uncomfortable truths. In dialogue with the extensive research on FGM/C in Kenya, my aim is to critically examine how legal interventions – both colonial and postcolonial – have shaped the practice on the ground, particularly from the perspective of a medic who has even challenged the anti-FGM Act as unconstitutional in a court of law (Ahmadu and Kamau 2022; Kenya Law 2011; see also Van Bavel et al., Chapter 10, this volume).

A central section of this chapter, ‘Some awkward propositions’, challenges some prevailing assumptions by addressing three medical realities that complicate the anti-FGM/C discourse. First, circumcision – whether male or female – is not necessary for positive health outcomes or increased life expectancy. Second, while the health consequences of female circumcision have been widely condemned, the extent of medical complications has sometimes been exaggerated, requiring a consideration of how there may be a disconnect between lived experiences and reported data. Third, an emerging gender disparity in the medicalisation of genital cutting reveals a troubling imbalance: while male circumcision is increasingly provided under stringent medical controls at national and county levels, female circumcision continues in clandestine settings without oversight or safety measures, raising ethical and policy concerns.

This chapter also examines how proposed solutions to the ‘problem’ of female circumcision may, in some cases, negatively impact the very communities they intend to help. Criminalisation has driven the practice underground, while Alternative Rites of Passage (ARPs), and the rescue of ‘at-risk’ girls, often disrupt social structures in unintended ways. Additionally, the selective targeting of certain ethnic groups – given the sensitivity of ethnic politics in Kenya – raises ethical concerns about discrimination. The reliance on community surveys to track prevalence presents methodological challenges, and the global fixation on elimination deadlines risks prioritising symbolic victories over meaningful engagement with affected communities.

The first is that neither male nor female circumcision is necessary for general health or increased life expectancy. In recent decades, a wave of interest in the potential medical benefits of male circumcision, particularly with respect to preventing sexually transmitted infections, has shaped the global policy landscape around genital cutting in decisively gendered ways. Genuine medical indications for male circumcision, such as phimosis and recurrent balanitis, are rare. The global prevalence of male circumcision is slightly less than 40 per cent (WHO 2007). This means that 60 per cent of males worldwide live uncircumcised, untroubled, and without adverse effects. Male circumcision is low in Europe, Latin America, China, and Japan. In none of these regions are there associated health benefits with circumcision. According to the World Bank, Japan had the world’s highest life expectancy at birth for men in 2022, at eighty-four years. Other sources indicate that Japan has a very low male circumcision prevalence of 9 per cent (World Population Review 2025).3World Population Review, ‘Circumcision by Country 2025’, quantifies male circumcision rates by country. See bibliography at the end of this book. A closer examination shows that this minority of Japanese men voluntarily undergo circumcision as adults because of emerging notions of genital ‘beauty’ promoted by private cosmetic surgery clinics (Castro-Vázquez 2013). This new aesthetic mirrors a trend towards the popularisation of female genital cosmetic procedures (FGCP) in some countries (see Chapter 10 this volume). In contrast, the United States has the highest male circumcision rate globally, at 71 per cent.

In Kenya, traditionally non-circumcising cultures view any advocacy for male circumcision as a form of cultural or religious indoctrination. Since 2008, the WHO has promoted Voluntary Medical Male Circumcision (VMMC) for HIV prevention in Kenya and other sub-Saharan countries. This initiative required extensive educational campaigns to overcome the suspicion of cultural imposition. Ethical concerns over consent, even coercion, have been widely overlooked in the scientific literature on the efficacy of male circumcision as a HIV-prevention strategy (Fish et al. 2021; Garenne 2023; Luseno et al. 2023; Rennie et al. 2021).

The majority of males in Kenya are circumcised to fulfil cultural obligations rather than to prevent HIV infection. Yet, while the government supports male circumcision, for cultural reasons as well as a public health measure, it does not support female circumcision under any circumstance or for any reason. This is discriminatory.

The second awkward proposition is that the lived experience of many circumcised women has been, and continues to be, largely uneventful – contrary to media hype and activist-driven exaggerations of harm. The notion that circumcision inevitably condemns a girl to a life of suffering, misery, and disability is a fallacy. The Kenya Demographic and Health Survey (KDHS) of 2022 indicates that 22 to 37 per cent of circumcised girls and women experience complications, including unintended sequelae and infections, some occurring long after the procedure. However, 63 to 78 per cent do not report such complications and heal without immediate issues. While statistical data highlights risks, lived experiences vary, and this distinction should be considered in debates about female circumcision, just as it is with male circumcision.

During my medical internship (1988–90) at Kenyatta National Hospital, I observed that female circumcision scars did not routinely cause obstructed labour. Even in the few cases where women presented with a tight perineum scar,4The perineum is the thin layer of skin between the genitals (the vaginal opening in the case of women) and anus. It is a common site for tears during childbirth. this was managed through an episiotomy, just as it would be for any uncircumcised woman experiencing similar issues. This clinical experience led me to realise that the anticipated complications of FGM/C, such as obstructed labour, may not manifest as frequently or as severely as commonly suggested in the medical literature.

In my own professional experience as a medical officer at Hagadera Refugee Hospital, in a busy maternity unit that served Somali women, many of whom had undergone Type 3 FGM/C (with a lesser proportion having Type 2), I was struck by the ease with which most women delivered their babies vaginally. This observation was in complete contrast to what I had been taught, specifically that women with Type 3 circumcision are prone to very difficult deliveries due to inelastic, scarred vaginal tissues. Complex cases, like breech presentations, were referred to a larger hospital in Garissa. I never experienced a case where a circumcision scar presented problems that were beyond our ability to manage, or where a baby was lost due to circumcision-related complications.

These experiences challenge the prevailing narrative that all women who have undergone FGM/C are doomed to experience significant, debilitating complications. In fact, it became clear to me that FGM/C does not necessarily lead to a life of suffering and disability, as is popularly believed. While data may highlight potential risks, the lived reality for many women may be far less catastrophic than commonly believed. This provoked in me a series of questions and concerns about prevalent understandings about FGM/C, not only in the medical world, but also in terms of programmes aimed at eliminating the practice.

Up until the onset of anti-FGM/C campaigns in Kenya, communities that practised female circumcision viewed it as a woman’s right, rather than a form of violence against women. Because the circumcision of girls occurred alongside male circumcision, it helped to unify both genders in the creation of resilient and trustworthy community members, who would perpetuate and safeguard their traditions and morality. Each gender had vital roles to play within the community, and circumcision was seen as preparation for these roles. If female circumcision were to be removed, how would young women be prepared physically and mentally for the next phases of their lives? How would girls prove they were ready to become wives and mothers if the vetting process was eliminated?

In Kenyan circumcising communities, it has long been acknowledged that complications occasionally arise during male and female circumcision. However, these incidents have not been viewed as grounds for discontinuing the practice, but are believed to result from a circumciser’s ‘bad hand’ or witchcraft. Even today, ‘botched’ male circumcisions occur every year during the circumcision season and receive considerable media attention. Indeed, there are also incidents of violence during this period, but these are largely tolerated (see Lamont, Chapter 3 in this volume). Despite this, there are no widespread calls to ban the practice. Instead, the focus is on improving safety through more stringent regulations, training and vetting circumcisers, and, particularly, advocating medicalisation to minimise risks.

This contrasts sharply with the societal response to botched female circumcisions, which typically leads to demands for tough legal action. Parents, circumcisers, and anyone deemed responsible for the procedure often face calls for arrest and imprisonment. This sharp divide stems from a perception that female circumcision is an inherently dangerous practice – one which can never be made safe.

Such views are perpetuated in public discourse and legal frameworks, including the anti-FGM Act of 2011 which distinguishes female circumcision as mutilation, while not applying this label to sex reassignment surgery. Ironically, gender normalising surgery completely alters the female genitalia, replacing it with grafted imitation male genitalia, yet in light of legal amendments (Kenya Law 2022) to the Children Act 2001, this is not considered ‘mutilation’ (Baird 2024). Such a contradiction demonstrates tensions between cultural norms and the law in Kenya.

This discrepancy in the treatment of male and female circumcision, alongside gender normalising surgery for intersex individuals, highlights significant inconsistencies in both medical and legal frameworks. This double standard is echoed in the WHO’s diametrically opposed positions on female and male circumcision (Earp 2015, 2021). The distinction between these practices raises critical questions about cultural bias, the representation of risk, and the ways in which society responds to bodily integrity and medical safety. While the complications in both practices cannot be ignored, it is important to critically examine how societal perceptions and legal frameworks may perpetuate double standards, particularly when it comes to culturally significant practices.

The third awkward proposition is that there is a perceived double standard in government and NGO approaches to male and female circumcision. While male circumcision is supported, resourced, and medicalised, female circumcision is criminalised outright, though communities wish similar safety measures were in place. One of the key inconsistencies in circumcision policies in Kenya is that while female circumcising communities also have sons, these sons receive preferential treatment from the government to access high-quality circumcision services.

The state, alongside global health organisations, NGOs, and private medical practitioners, actively promotes and funds medicalised male circumcision, portraying it as the safest and most responsible approach. The emphasis on medicalisation has led to the perception that it is the solution to all risks associated with circumcision. It is therefore unsurprising that some female circumcising communities have sought similar medicalisation strategies for girls (Kimani et al. 2020; Van Eekert et al. 2022). If the government believes medicalisation ensures safety for boys, why does it reject the same approach for girls?

Members of these communities are not passive recipients of state policies; they are deeply embedded in the country’s health sector as nurses, midwives, clinical officers, obstetricians, gynaecologists, and surgeons. They are trained in surgical ‘best practices’, infection control, and pain management. These professionals understand that the same medical standards used in male circumcision – such as anaesthesia, sterilisation, and wound care – can also be applied to female circumcision. Indeed, cosmetic genital surgery performed in private clinics uses similar surgical techniques, yet these are legally permissible. The outright criminalisation of female circumcision, even in its medicalised form, appears contradictory to communities that have adopted modern surgical practices.

Moreover, anti-FGM/C campaigns often rely on images of blood-stained dirty knives, aged, calloused hands, and distressed children to highlight the dangers of the practice. While this caricature does capture some historical concerns about hygiene and other issues, it does not align with the experiences of communities where female circumcision has moved underground and been incorporated into clinical settings. For these groups, the more accurate depiction would be that of a candidate voluntarily being attended to by a gloved clinician wearing a face mask, using modern surgical instruments and a local anaesthetic. Communities have tested and embraced new medical technologies and practitioners for female circumcision. Consequently, many people within these communities find mainstream anti-FGM/C messaging disconnected from their lived realities.

The international legal framework regards female circumcision as a violation of bodily integrity and gender equality, which informs Kenya’s legal stance. The challenge, then, is whether medicalisation alone is a sufficient basis for the continued practice of female circumcision or whether deeper ethical concerns override the possibility of regulation.

The 2011 legislation is remarkable in its sweeping powers to arrest and prosecute a wide range of persons implicated in performing or abetting FGM/C. Who can be charged with a crime under this legislation? Basically, any member of a circumcising community who knows anything about a circumcision, or who participates in one, or who funds any part of these procedures, can face charges. Criminal charge sheets generally show that ‘victims’, cutters, premise owners, and bystanders are the main categories of accused persons, with about half of these being ‘victims’ who ‘procured’ circumcision (American Bar Association 2024:22). One can be arrested for failure to report an act of FGM/C, aiding and abetting FGM/C, allowing premises to be used, procuring FGM/C, or performing it. But in addition – and shockingly to many – this law can also charge individuals with the crime of using derogatory or abusive language against a woman who has not been ‘cut’. To many Kenyans from circumcising communities, this strikes a raw nerve, since vulgarity and mocking the uncircumcised are social norms, particularly during the circumcision season when songs and dances often make a sharp moral distinction between the cut and the uncut. And the punishments for FGM/C-related crimes are severe: aiding and abetting FGM/C carries a penalty of three years’ imprisonment, a fine of 200,000 Kenya shillings (approximately USD 1,600), or both. If the procedure results in accidental death, those involved face life imprisonment.

From the outset, affected communities viewed these laws as externally imposed rather than a response to their needs. The laws were enacted when medicalised circumcision had begun to gain traction and was linked by global health organisations to improved sexual reproductive health. This created confusion: why ban a practice that communities had adapted to improve safety? Additionally, the criminalisation of adult women’s participation in the practice raised questions about bodily autonomy and gender equality.

One notable case involved seven women arrested for undergoing circumcision in Trans Mara East, Narok County, in December 2013. When interviewed on local television, they confidently stated that their decision was voluntary and that no one had coerced them. They appeared to misunderstand, believing the law only prohibited forced circumcision. They were, nevertheless, charged with the offence of procuring FGM/C.

Following the ban and its enforcement, the practice largely moved underground. In some communities, it shifted toward performing the procedure on very young children who could not report it (Derowa et al. 2021; Meroka-Mutua et al. 2020). Where adolescent and young adult circumcision persisted, secrecy became paramount (Mwendwa et al. 2020). Although unverified by academic sources, there are media reports of communities going to elaborate measures to protect participants of FGM/C. During the 2020 COVID pandemic lockdown, for example, thousands of Kuria girls were reportedly operated upon during a lapse of law enforcement.6Chacha (2021). Gardy Chacha, ‘New report shows over 700 girls underwent FGM in Kuria over 2020’, The Standard Online, Nairobi, Kenya, 4 June. https://www.standardmedia.co.ke/business/nyanza/article/2001414748/new-report-shows-over-700-girls-underwent-fgm-in-kuria-in-2020. Citizen TV (2020), ‘FGM continues in Kuria after schools were closed over COVID-19’, Nairobi, Kenya, 17 October. https://www.youtube.com/watch?v=nZ91aES1ghc [Both accessed 9 July 2025]. Videos taken of these events in Migori County also show Kuria ‘warriors’ and community members escorting the girls to the circumcisers, armed with pangas (machetes) to deter police intervention. Police raids have sometimes led to violent clashes. Regular reports of clandestine FGM/C continue to emerge in the media.

Despite these legal measures, anti-FGM/C campaigns often struggle to achieve cultural transformation. Communities generally listen to activists out of respect for the law, but activists living in the community remain ineffectual against determined traditionalists (Kiš et al. 2023; Matanda et al. 2022; Mwendwa et al. 2020).

One of the key challenges of ARPs is their external influence, which has led to the formalisation of cultural training into a structured ‘curriculum’ designed and controlled by programme organisers. In traditional female initiation, the period of seclusion served as a time not only for healing, but also for older women to pass on cultural values and mentor the initiates. However, in ARP, instruction is often provided by individuals who are not from the community concerned. If initiates are taught by people they will never see again, who will they turn to for guidance? If they are introduced to ideologies which conflict with their social norms, who will support them in applying this new knowledge?

As long as ARPs continue to be externally guided, they are unlikely to gain genuine community ownership. While communities may participate in ARPs for the benefits they provide – such as feasts and financial incentives – the practice remains performative rather than transformative (Prazak 2007; Hughes 2018, also Chapter 14 of this volume; UNICEF 2025). Some communities have also been known to supply a large quorum of girls for ARP graduation ceremonies to satisfy the expectations of donors and organisers.7Confidential information supplied to this author by a member of staff of a local NGO involved in anti-FGM/C activities in Kenya. These groups often include already circumcised girls. Other girls often undergo secret FGM/C soon afterwards.

One major challenge is that most shelters cannot support girls beyond secondary school, forcing them to return to their families with little or no further assistance. Families may give assurances that the girls will be welcomed back, but this is by no means guaranteed. Reintegration remains fraught with difficulties. Many girls face stigma and social alienation for rejecting cultural norms, and may be forced to move again to escape their pariah status.

The dilemmas faced by rescued girls today echo historical debates on African girlhood and social intervention in Kenya. Tabitha Kanogo’s (2005) African Womanhood in Colonial Kenya, 1900–50 provides insight into how colonial authorities, missionaries, and African communities negotiated issues such as education, marriage, and labour. Although Kanogo does not explicitly discuss modern rescue shelters or hostels, her work examines how missionary efforts to educate girls sometimes involved removing them from traditional settings deemed ‘risky’ by colonial authorities, educators, and missionaries. Schools run by the Church Missionary Society (CMS), for instance, occasionally served as spaces where girls were ‘rescued’ from practices like female circumcision and forced marriage. However, as Kanogo notes, these interventions were often motivated more by European moral agendas than by a concern for girls’ autonomy or rights.

In the worst cases today, rejection by their families and relentless community pressure drive some women to undergo FGM/C despite their initial escape. In such instances, circumcision is merely delayed, with the primary benefit being the completion of their high school education. The lack of long-term follow-up increases the risk of giving in to community demands, underscoring the need for a more sustained and holistic approach to protecting at-risk girls. Support should extend beyond adolescence, ensuring that reintegrated young women have pathways to financial independence and social acceptance. This requires comprehensive government planning and funding, making the eradication of FGM/C not just a short-term rescue effort but a life-long commitment.

An often overlooked consequence of inadequate follow-up is the legal vulnerability of women who, after years of resistance, ultimately choose to undergo FGM/C. Women unable to pay the stiff fine must serve a jail sentence, after which they return to their communities burdened with the additional stigma of a criminal record.8KTN News Kenya (2017). ‘It was fun and dance at Kisii women’s prisons as prisoners preach against FGM’. KTN, Nairobi, Kenya, 25 September. https://www.youtube.com/watch?v=-o5Eaosybrs [Accessed 9 July 2025]. This shows an interview with a prison inmate who procured FGM/C in order to be accepted by her peers. This complicates their ability to secure employment and find a marriage partner, further marginalising them. Ironically, in seeking community acceptance through circumcision, they create new barriers to reintegration.

The Somali and the Kisii communities, despite having some of the highest FGM/C prevalence rates in Kenya, often appear to resist rigorous enforcement (Matanda et al. 2018). According to the latest KDHS (2022) and a UNICEF (2020) profile on FGM/C in Kenya, 66 per cent of young Kisii women underwent medicalised FGM/C, a practice that is also outlawed (Kimani et al. 2020; Njue and Askew 2004; Van Eekert et al. 2022).9This percentage for Kisii women aged twenty to twenty-four is given in Fig. 5, ‘Circumstances around FGM. Practitioners, types of FGM and age at cutting’, p. 9 of UNICEF, A Profile of Female Genital Mutilation in Kenya (March 2020). Yet, prosecutions in these communities remain rare when compared to others.

Meanwhile, members of communities with lower FGM/C rates are often arrested and publicly paraded.10Kirui (2020). Kiplangat Kirui, ‘Police arrest 10 women for undergoing FGM’, The Star Online, Nairobi, Kenya, 8 November. https://www.the-star.co.ke/counties/2020-11-08-police-arrest-10-women-for-undergoing-fgm?utm [Accessed 9 July 2025]. Law enforcement raids on clandestine circumcision camps in rural regions like Marakwet, Baringo, and West Pokot have escalated into violence.11Wafula (2023). Caroline Wafula, ‘Gang kills policeman after officers rescue 6 girls undergoing FGM in Embobut Forest’, Nation Online, Nairobi, Kenya, 12 December. https://nation.africa/kenya/counties/elgeyo-marakwet/gang-kills-policeman-six-girls-rescued-fgm-embombut-forest-4461344 [Accessed 9 July 2025]. This pattern of preferential policing is observed by other female circumcising communities and fuels defiance.

The high prevalence of FGM/C among the Kisii and Somali communities sustains social norms resistant to change, making the enforcement of anti-FGM laws more complex. In these contexts, medicalisation of FGM/C – where healthcare professionals perform the procedure – reduces its visibility and makes gathering evidence for prosecution more difficult (Parsitau 2018).12Damaris S. Parsitau. https://www.brookings.edu/articles/how-outlawing-female-genital-mutilation-in-kenya-has-driven-it-underground-and-led-to-its-medicalization/ [Accessed 9 July 2025]. See bibliography. The underground and secretive nature of the practice further hinders authorities from identifying and prosecuting offenders.

Despite the legal framework established under the 2011 anti-FGM Act, prosecutions remain limited, with only 151 individuals accused under the law, and the number of victims charged with a crime outweighs that of perpetrators (American Bar Association 2024; also see Njenga, Chapter 11 of this volume). This disparity raises concerns about the legal process and potential human rights abuses. Moreover, cultural resistance remains strong, as social identity is deeply tied to traditional practices, and resistance to legal intervention persists despite the law’s comprehensiveness. Given the low rate of successful prosecutions, questions arise about the effectiveness of the 2011 anti-FGM law and policing efforts (Meroka-Mutua et al. 2021). Is the state’s failure to enforce the law due to political considerations, cultural sensitivities, or the challenge of policing new methods of evasion?

According to a 2024 American Bar Association report on FGM/C prosecutions in Kenya, 55 per cent of those charged were victims, including minors, while only 6 per cent were cutters. The remaining 39 per cent were owners of premises (16 per cent) and bystanders (23 per cent), often prosecuted for failing to report the practice.13These charges are made under Sections 19, 20 (a), 20 (b), 21–5, and 28 of the 2011 Prohibition of Female Genital Mutilation Act (Office of the Director of Public Prosecutions 2021). This suggests that enforcement disproportionately targets victims and their families rather than those performing FGM/C.

The broad legal definition of ‘perpetrators’ – which includes victims and bystanders – poses challenges for courts, making it difficult to apply the law consistently or secure convictions based on conclusive evidence (American Bar Association 2024). The uneven application of the law also complicates efforts to monitor and assess FGM/C prevalence. Reliance on community surveys to track prevalence may not provide a complete or reliable picture, raising concerns about the accuracy of enforcement and intervention strategies. This issue is central to the discussion of external ‘solutions’ to FGM/C continuity in the following section.

One major issue is self-reporting bias. Since the survey relies on individuals to disclose their experiences with FGM/C, there is a risk of under-reporting, especially as legal and social pressures against the practice increase. Women and families may conceal or deny FGM/C to avoid legal consequences or social stigma, leading to incomplete or inaccurate data (Shell-Duncan et al. 2017).

Another concern is the lack of medical verification in the KDHS. The survey depends on respondents’ knowledge and willingness to share information about FGM/C, without verifying whether the practice has occurred. This is particularly problematic in cases of medicalised FGM/C, where the procedure is carried out in healthcare settings and may be less visible, making it harder to detect through self-reporting. Additionally, the survey methodology, which relies on household-based sampling, may fail to capture clandestine or secret FGM/C practices, especially in urban or migrant populations.

The KDHS also has limitations in tracking changes in FGM/C practices over time. It primarily focuses on women aged fifteen to forty-nine, neglecting younger girls who may undergo FGM/C at an earlier age, leading to delayed detection of trends. Furthermore, the surveys’ definitions and questioning around FGM/C can vary, making comparisons over time difficult. The surveys’ reliance on maternal reporting also poses challenges, as decisions about FGM/C may involve extended family members. Alternative approaches, such as the use of ethnographic studies and medical records, are needed to provide a more complete picture of FGM/C trends in Kenya.

The national FGM/C prevalence has declined at a steady rate since the 1998 KDHS, dropping from 38 per cent in 1998 to 27 per cent in 2008–9, 21 per cent in 2014, and 15 per cent in 2022. If this downward trend continues, national prevalence is expected to be around 9 per cent by 2030. However, the decline within the four major circumcising communities has been minimal since 1998, explaining the persistently high rates recorded in 2020. Historical patterns also indicate that change takes time. The Kikuyu community is a good example of this.

According to UNICEF’s 2020 Profile of FGM in Kenya, the Kikuyu ethnic group had near-universal FGM/C in 1920, but this only reduced to 15 per cent by 2020, following a century of sustained campaigns. Expecting the Somali and other groups to move from 94 per cent to zero in just five years is therefore unrealistic. Without a new catalyst to accelerate change, efforts to eliminate FGM/C in Kenya may continue for another century.

Current anti-FGM/C strategies have succeeded in widely communicating the government’s opposition to the practice but have not achieved total abandonment. Addressing this gap requires new approaches, greater creativity, and a shift away from unrealistic elimination deadlines that fuel confrontation with practising communities, leading to entrenched resistance. Additionally, elimination campaigns must clarify why the right to practise female circumcision is denied under the Bill of Rights in the Constitution of Kenya 2010 while male circumcision remains culturally protected (Kenya Law 2010).14See the Bill of Rights, Chapter 4 of the Constitution, Articles 32, 44. Article 44 is about the right of every person to enjoy their language and culture of choice. However, Article 44(3) also states: ‘A person shall not compel another person to perform, observe or undergo any cultural practice or rite.’ Without addressing this inconsistency, opposition to anti-FGM/C efforts may persist.

The criminalisation of female circumcision has further entrenched resistance among affected communities. Some groups face stricter enforcement than others, which has only hardened the resolve of those determined to continue the practice. Additionally, the promotion of ARPs since 1996 has largely failed to replace traditional circumcision. This failure highlights the need for a reassessment of current approaches, as communities cannot be indefinitely guided by external agencies. Sustainable change must come from within, with strategies that align with community values while addressing concerns about health and rights.

The increasing medicalisation of FGM/C has also contributed to its persistence. By shifting the practice to clinical settings, medicalisation has reduced the number of reported botched cases, thereby lowering the visibility of FGM/C and decreasing the number of complainants. While this may improve health outcomes for those undergoing the procedure, it also makes eradication efforts more challenging, as it allows the practice to continue in a less detectable form. Addressing medicalisation requires a nuanced approach that acknowledges the reasons behind this shift while reinforcing broader efforts to end the practice.

Cross-border FGM/C is a growing trend across certain parts of Africa, e.g. in East Africa across the Kenya, Tanzania, Ethiopia, Somalia, and Djibouti borders, and in West Africa across the Guinea, Sierra Leone, and Liberia borders. Girls and women living in border areas are at high risk of FGM/C – often higher than the national average.

Drivers of cross-border FGM/C include lack of laws or law enforcement in some countries, remoteness of border areas which allows people to cross undetected, and the perception that it is easier to get girls ‘cut’ in a neighbouring country where there are fewer prosecutions and lower penalties.

In general, there is a lack of collaboration between governments, local authorities, police, and legislators. Some African governments have agreed to harmonise their policies and introduce regional monitoring mechanisms. But more needs to be done. A UNFPA report (2022) on Somalia, Ethiopia, Kenya, Tanzania, and Uganda found there are still no harmonised provisions. A regional action plan was agreed in 2019 but ended in 2024.

The UN sees these as key priorities:

1. Harmonising legislation and policies to include common standards on cross-border FGM/C;

2. Strengthening intergovernmental collaboration for effective implementation of a multisectoral plan of action, especially in border towns;

3. Measuring changes; developing interventions that are informed by evidence and effective in reducing cross-border FGM/C; and investing more in research to capture new trends.