Infibulation Rates by Country in Africa.  



The following is perhaps one of the most interesting articles I uncovered during my review of the early 19th century Medical Repository. It represents what is likely an early clinical review and investigation into African children who became pregnant by the time they reached their fertile teen-age years, and who could not deliver their children due to an undersized vaginal orifice (to put it lightly). According to their physical exam, the physician’s immediate review of the anatomy suggested something was missing. In theory it should have been impossible for them to become fertilized due to the size and shape of the orifice. Thus the reason for the author’s query. The cases discussed here are probably some of the earliest examples of the African practice carried out on young girls known as infibulation. With infibulation, the labia are closed for the most part, and a small opening left in order to allow for normal urinary and menstrual flow. The fact that these young women lack vaginal cavities and are pregnant suggested to doctors some very interesting social and moral issues for the time. This speculation also in turn led to a number of related clinical and biological questions, which the author provides us with his personal observations about. Aside from the obvious questions related to the practice of infibulation, one has to wonder if and how the following questions were probably considered by the physicians:

  1. Could the women have become pregnant even with the vaginal opening so tightly closed?
  2. If not, did she become impregnated “unknowingly” or without signs thereof before having this procedure done?
  3. If the latter is the case, was this process engaged in mostly for cultural reasons, or reasons related to their future as slaves, or perhaps a little of both?
  4. Who made the decision to have this process done? Was it carried out because it was considered a cultural norm and therefore culturally correct? Or was this because the merchants and investors participating in slave trade found good cause to prevent pregnancy from becoming a part of a very young girl, future servant’s life?
  5. How was this process carried out, with surgical skills or some local, native process that left the changed tissues seemingly natural in appearance, with minimal signs of surgical change and/or scarring?

Other interesting topics were reviewed in this article as well, including interracial intercourse and impregnation and the related biological and clinical observations about the process and biology involved, mixed color or heritage fraternal twins, and important biological, medical and social issues related to mulatto children. All of this was happening around 1800, a period when Lamarckian evolution theory prevailed. The author of this article is John Archer of Hartford, Maryland. His home town is a region that would later be considered the northernmost edge of where the most efficient utilization of slaves would exist, due to the acclimation habits and ability of African immigrants. Most likely the slaves with infibulation were acquired by way of the African-Sudan Muslim trade routes, for it was the Sudanese culture that bore many of the mores required for this process to be practiced. This also suggests that by better mapping slave trade with a focus on Arabic-Sudanese-Muslim culture, the cultural migration process for this practice can be better understood for the purposes of documenting the history of this unique sociocultural group. The practice of infibulation remains a highly controversial topic to this day, with a very recent rebirth in this practice and its publicized controversies modern day US practitioners of medicine can be with. For more on this topic see: Clitoridectomy and Infibulation. Cultural Survival. February 17, 2010. BME article, Western History of Female Infibulation, August 26, 2008. Google Search. (contemporary writings) Google search on early 19th Century books about African Slavery (google book search, limited years) Selected Readings: Johann Friedrich Blumenbach. The Elements of Physiology. 1828. Johann Ludwig Burkhardt. Travels in Nubia . . . , 1819 (or 1822 edition). See pp. 331-333, or 295-297. William Cummin. Lectures on Forensic Medicine. Lecture IX. The London Medical Gazette, vol. 19, November 26, 1836. pp. 289-295. I have a separate page with Infibulation mapped coming together–a 3D rotating map algorithm was created depicted the regional distribution of this sociocultural ICD. In my population health ICD study, four very specific peak ages for risk were defined for infibulation involving women: children around 5 to 9 and in their teen-to-young adult years demonstrated peaks of high risk, recurring over a ten year study period. Since these were younger at their age of diagnosis, there is the possibility that they underwent this process as U.S. citizens; as teen age to twenty year olds, the younger they were at the time of the experience, the more likely it becomes that they were US citizens. If they are very young and their parents are US citizens, this implies a local procedure within the US is possible. This also suggests that more than likely these children were children not at all involved with the final decision making process – – making this highly controversial procedure indeed! .

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