Escaping Social Rejection, Gaining Total Capital: The Complex Psychological Experience of Female Genital Mutilation/Cutting (FGM/C) Among The Izzi in Southeast Nigeria

Abstract Background: While the deleterious effects of FGM/C on physical health are well documented, the psychological experience of this harmful practice is a neglected area of research, which limit global mental health actions. As FGM/C was a traditional practice in some areas of Nigeria, the study aimed to understand the psychological lived experience of FGM/C in a sociocultural context. Methods: This qualitative study was completed in urban and rural Izzi communities in Southeast Nigeria where FGM/C was widely practiced. Ethnographic interviews were completed with 38 females using the McGill Illness Narrative Interview (MINI) to explore the psychological lived experience of FGM/C before, during and after the procedure. The MINI was successfully adapted to explore the meaning and experience of FGM/C. We completed content analysis and used the concepts of total capital and habitus by Bourdieu to interpret the data. Results: During the period of adolescence, Izzi girls who had not yet undergone FGM/C reported being subjected to intense stigma, humiliation and rejection by their cut peers. This chronic psychological suffering led many girls to accept or request to be cut, in order to end their psychological torture. Virtually all women reported symptoms of severe distress before, during and after the procedure. Some expressed the emotion of relief from knowing their psychological torture would end and that they would gain social acceptance and total capital from being cut. Newly cut girls also expressed that they looked forward to harassing and stigmatizing uncut girls, therein engaging in a complex habitus that underscores their severe trauma as well as their newly acquired enhanced social status. Conclusion: As FGM/C is profoundly embedded in the local culture, prevention strategies need to involve the whole community to develop preventive pathways in a participatory way that empowers girls and women while preventing the deleterious psychological effects of FGM/C and corresponding stigmatizing behaviour towards the uncut. Results suggest the need to provide psychological support for girls and women of practicing Izzi communities of Southeast Nigeria.Lay abstractWhile the deleterious effects of FGM/C on physical health are well documented, we have little knowledge on the psychological experience of this harmful practice. This study aimed to understand the psychological lived experience of FGM/C in Izzi communities in Southeast Nigeria where FGM/C was widely practiced. In depth ethnographic interviews were completed with 38 females to explore the psychological lived experience of FGM/C before, during and after the procedure. Our results found that during adolescence, Izzi girls who had not yet undergone FGM/C reported being subjected to intense stigma, humiliation and rejection by their cut peers. This chronic psychological suffering led many girls to accept or request to be cut, in order to end their psychological torture. Virtually all women reported experiencing severe distress before, during and after the procedure. Some expressed relief from knowing their psychological torture would end and that they would gain social acceptance and a rise in status from being cut. Newly cut girls also expressed that they looked forward to harassing and stigmatizing uncut girls, therein engaging in a complex behaviour that underscores their severe trauma as well as their newly acquired enhanced social status. Our results suggest that prevention strategies need to involve the whole community to develop preventive pathways in a participatory way that empowers girls and women while preventing the deleterious psychological effects of FGM/C and corresponding stigmatizing behaviour towards the uncut. Results suggest the need to provide psychological support for girls and women of practicing Izzi communities of Southeast Nigeria.