by Hibo Wardere
Without the ceremony beforehand, without the party and the presents and all the delicious foods, FGM would be laid bare for what it is – not a rite of passage, but a painful and traumatic experience forced upon a child, an entirely unnecessary mutilation that is carried out on children to satisfy the belief systems of adults. I don’t doubt that the mothers and fathers of these children think that cutting them is the right thing to do – no parent would willingly harm their child if there was a choice – but the whole framing of FGM as a cultural tradition conceals the ugly truth that it is a barbaric and inhumane practice.
And of course, the nature of the area that is cut only adds to the secrecy of the abuse. If a visible part of the body was cut – an ear, an arm – would the practice then be seen differently? Instead, the pain is hidden between a woman’s legs, buried deep underneath her clothes where no one needs to see it, where no one needs to be confronted by it, or be faced with the brutality of it. Everyone – the societies that practise it and those in the West who observe it – can turn their eyes away from FGM.
In 2015, a report was released by consultant paediatrician Deborah Hodes and her colleagues from the FGM children’s service, based at University College London Hospitals.13 It was the first paediatric literature on FGM in the developed world, and a retrospective study of FGM cases seen by Hodes and her colleagues between 2006 and 2014. Over that time period, forty-seven girls under the age of eighteen were referred to Hodes by health professionals, social workers, teachers and the police, who had suspicions that the girls had undergone FGM. There were three key findings in the report.
Firstly, there appears to be a move towards what is now being classified as Type 4 FGM. Clear evidence of cutting was found in twenty-seven of the girls: Type 1 FGM (the removal of the clitoris) was found in two girls; Type 2 (the removal of the clitoris and inner labia) was found in eight girls. No clear evidence of Type 3 (the removal of the clitoris and inner and outer labia and infibulation) was found in any of the seventeen remaining girls, although there was some evidence of adhesion or sewing together of the front of the genitals in a few cases. This might be explained, then, by an increasing prevalence of Type 4 FGM, in which the clitoris remains intact and sunna (pricking or nicking) takes place – the idea of sunna being that ‘letting blood’ from the clitoris lessens its ‘effectiveness’, and will diminish sexual desire in a woman in a similar way to removing it altogether.
The second key finding is one that chimes with the global trend of children being subjected to FGM at an ever-younger age. The majority of the girls were, like me, under the age of ten when the FGM was performed.
And the third finding is – in my opinion – the most worrying: the increased medicalisation of FGM. According to the report:
In 10 of the 27 cases (37 per cent), details of the circumstances of FGM were not given or not known by the parent. In the remaining 17 cases, the person who performed FGM was described as a ‘doctor’ in six cases (35 per cent), a ‘circumciser’ in seven cases (41 per cent) . . . Twelve (71 per cent) of 17 descriptions mentioned an additional medical feature – ‘anaesthetic creams’, ‘antibiotics’, ‘injections’ or performed in a medical setting.
The increased medicalisation of FGM might appear at first to be a positive development. Compared to the cutting I and others endured without the use of any anaesthetic and in the most unhygienic conditions, the thought of a girl being cut under a local or general anaesthetic, in a sterile environment, and being properly cared for afterwards, with the help of pain relief and antibiotics to combat infection, is obviously appealing. When you consider that in some communities, girls’ labia are held together with thorns and their raw and bloody flesh smeared with mud in the belief that it has anaesthetic properties, it is not surprising that some might welcome any kind of move towards sanitisation.
In 2001, American anthropologist Bettina Shell-Duncan wrote a paper questioning whether the medicalisation of FGM could be seen as ‘harm reduction’ or as promotion of a dangerous practice.14 In her study, she explored how ‘harm reduction’ had worked in the field of AIDS, where needle-exchange programmes and education on safer drug use had been adopted in an attempt to minimise the spread of the disease. She asked whether medicalising FGM or promoting sunna as an alternative to more invasive forms of the practice could help save girls from a lifetime of health complications or indeed risk of death. I guess her question was: if it’s going to happen anyway, could we not make sure it happens in a safe environment?
In her report she cited an initiative in both the Netherlands and the US in recent years to aid immigrants who were willing to adapt their rituals to something less invasive. The Dutch government rejected the proposal in Europe, and the so-called ‘Seattle compromise’, which was based on just nicking the clitoris and allowing one drop of blood to fall, was blocked by campaigners. Shell-Duncan argued that considering medicalisation as an option for communities unwilling to give up the practice should be explored, saying that if the health of women really was of paramount importance, then surely this was a worthy alternative in the interim.
But as Hodes states in her report, ‘The “medicalisation” of FGM, although it reduces immediate medical risks, serves only to legitimise and prolong the practice in some communities.’ In 2010, the WHO issued a report as part of a global strategy designed to stop healthcare providers from performing female genital mutilation. In it, they recognised that 18 per cent of the girls and women throughout the world who have undergone FGM had it carried out by a healthcare provider, including doctors, nurses and midwives.15 This medicalisation varied greatly, with just 1 per cent reported as medicalised cuttings in some countries, and yet 74 per cent of cuttings were carried out this way in another. The WHO condemned the practice of FGM by healthcare providers in the strongest possible terms, deeming it to be against the Hippocratic Oath.16 They insisted instead that medical professionals should be educated about FGM so that they are in a position to provide support to those who have undergone it and are able to avoid being pressurised by parents to carry it out, even if they see it as harm reduction.
In the UK, in a 2004 academic study, eight young women claimed to have been cut in Britain in what they described as a hospital or clinic, although the health professionals they maintained were carrying out these procedures were clearly never identified.17 Eight years later, in 2012, an undercover reporter working for the Sunday Times claimed to have uncovered three men in Birmingham willing to carry out FGM on her fictional daughters, aged ten and thirteen. The men – a doctor, a dentist and a practitioner of alternative medicine – first reminded the reporter that the practice was illegal, before then suggesting that she have it done abroad, and eventually agreeing, for a fee, to carry out the procedure here in this country. The tapes and transcripts of conversations were handed over to the police, but the Crown Prosecution Service decided against prosecuting the three men, claiming that the evidence the reporter had submitted, including the statement she had for some reason refused to sign despite numerous requests, was unreliable.
FGM survivor, campaigner and former model Waris Dirie told the Sunday Times at the time: ‘We are talking here about serious crime committed on innocent baby girls. If a white girl is abused, the police come and break the door down. If a black girl is mutilated, nobody takes care of her. This is what I call racism.’ These men were willing to cut girls in this country but they were never prosecuted for this. What kind of evidence do they want? Do we wait for someone to murder a person before we prosecute them? No, we take preventative measures. It should surely make people wonder what kind of person can call themselves a doctor and yet is willing to cut pieces off children for non-medical reasons. It is worse than an ignorant village woman cutting a child, because doctors are educated, they know that a procedure like this just causes unnecessary suffering and complications for a female, and yet they are willing to do it for financial gain.
And even medicalisation of FGM doesn’t ensure that girls are
safe. In 1959, Egypt banned medical professionals from carrying out Type 3 FGM for fear that it legitimised the practice, but found that removing girls from clinics only forced the practice underground. As a result, in 1994 they reinstated the right of doctors in selected government hospitals to cut girls in an attempt to preserve life and lessen complications.18 In 2007, however, twelve-year-old Badour Shaker died after being circumcised at a private Egyptian clinic.19 Her mother had paid just $9 for a female physician to perform the procedure on her. To buy her silence after her daughter died, the same doctor offered her $3,000. In 2008, there was an outright and blanket ban on all FGM, but six years later, the same thing happened again. Thirteen-year-old Suhair al-Bataa died after undergoing FGM at Raslan Fadl’s clinic. At first the doctor denied carrying out the procedure and said she had died following an allergic reaction to penicillin. At first he was acquitted, but after an appeal he was jailed for two years for manslaughter and received three months for carrying out FGM. Suhair’s father, who ordered the circumcision, was given a three-month suspended sentence. Fadl’s clinic was also ordered to remain closed for one year. A pathetic penalty in exchange for this girl’s life.
Even in countries where ‘compromises’ have been made, the practice has not been abandoned. For example, a policy in Sudan permitted the removal of the clitoris but forbade any kind of infibulation. And yet, it is believed that 88 per cent of women are still sewn up in that country.20
It seems to me that our fear of overstepping the boundaries, of offending different cultures, means that rather than pursuing a policy of zero tolerance we’re instead more willing to compromise, and this should never be the case where child protection is concerned. We should adapt our principles and refuse to entertain any form of FGM, all of our energy, efforts and initiatives should be focused on putting an end to it. In the 2013 report, ‘Uncharted Territory: Violence against migrant, refugee and asylum-seeking women in Wales’, it was revealed that FGM is happening to children at younger and younger ages; in fact, four out of the twenty-seven cases happened to children under the age of one.21 The report speculates that this might be done to reduce the psychological impact, but there is nothing to say that cutting girls as babies is less psychologically damaging than when they’re a bit older. In Nigeria twenty or thirty years ago it was popular to cut girls as babies. These women are only now arriving at British GPs’ surgeries and antenatal clinics, and they have no idea, until they’re told by a doctor or nurse, that a part of them is missing. Can you imagine the psychological impact this would have on a woman? It is hard to comprehend what these women are going through, but I’m aware that there is a lot of anger in some of those migrant communities in Britain.
The thought of FGM carried out on any child is, of course, absolutely repugnant, but to think that babies are being subjected to this unbelievable cruelty is sickening. A child’s flesh is surely not even developed enough – what clitoris is there to take from a tiny baby? When I think back to taking my own babies for their jabs and soothing them as they cried, I wonder how any mother or father could stand by while their infant child, chubby legs still kicking, is mutilated to stem sexual desire. What happened to me when I was six years old was horrific, but at least I had a chance to know what was being done to me, at least then I could try to process it. As the report states, performing FGM on infants ‘reduces the chance of the child remembering or being aware that the practice has taken place, thus reducing the chance of presentation and of a successful prosecution’.22
Consultant clinical psychologist Amanda O’Donovan works in a specialist sexual wellbeing clinic at St Bartholomew’s Hospital in London, and often treats women who have been subjected to FGM. She believes that many societies have been guilty in the past of carrying out procedures on children which were seen as best for the child, but education and evolution have shown us that they were not.
‘At one conference I went to, one woman said that back in the seventies, lots of kids were having their tonsils out, particularly English, middle-class kids, because it was seen as being better for children’s health. So everyone went along to have their child undergo a general anaesthetic and a surgical procedure because it was seen to be something that was good for the child; it was culturally sanctioned. I’m not comparing the two, but it’s the idea of having an understanding of why and how something happens within society.’
Is removing tonsils a necessary ‘mutilation’ of children’s bodies? Making them go under a general anaesthetic – and all the risks that entails – purely because a mother has decided a child would be better off without their tonsils? And then you could go on: perhaps some might argue that Western women who undergo breast augmentations, or labia surgery, or piercings are, to a lesser or greater degree, mutilating themselves. People in some FGM-practising communities have even used this as a defence of their own choices – that white women in the West are allowed to trim their labia but African women aren’t. And then aren’t those women also doing it to fit into society’s idea of what’s beautiful, and specifically men’s idea of what is attractive? As O’Donovan says: ‘Women modify and commodify ourselves in every way – why do we wear high heels, for example?’
And yet these things have been seen as acceptable in British society – just like removing the clitoris was to some in Victorian times. It is impossible and categorically wrong to compare a child being forced to undergo FGM to a grown woman deciding to have a boob job. But is there a case to be argued that, at completely opposite ends of the scale, they represent a woman’s desire or the pressures of a society on women to live up to the perception of what men want? They are females adapting themselves – or, in the case of children, females adapting one another – for the male ideal, to be more socially acceptable and therefore a more attractive prospect to men.
While we accept that FGM performed on a child is child abuse, some have contended that a grown woman has a right to choose whether to undergo the procedure, even if in truth that woman is only cutting herself to avoid being ostracised by her community.
But in my view, even a teenager who is considered a woman, and who seemingly goes along with her own mutilation, is not doing so because she is fully informed. She is coerced and brainwashed into thinking that it will make her a woman in the eyes of her community, her peers, her mother and her future husband. Someone being subjected to that amount of pressure cannot possibly make a choice from free will alone – whatever their age. I do agree that women everywhere are under pressure to look or behave in a certain way because they believe that’s what men or the society around them wants. It is a sad admission that women’s bodies are constantly being dictated to in many different ways, and all over the world.
Sunna and medicalising FGM will do nothing but collude in the subordination of women in a patriarchal society, when women around the world are fighting for rights that are equal to those of men. We can’t on the one hand argue that Western women should receive equal pay with men, and then allow African or Asian women to be cut in the name of chastity. Surely equal rights mean parity among all women, regardless of their skin colour or the country where they were born? Culture is no excuse for the mutilation of women, nothing is. And it doesn’t matter where or when or how you do it, the effects of FGM are catastrophic. There must be a zero tolerance to FGM, and this is from a woman who has been through it and knows the consequences. I didn’t need to arrive in Britain to know that FGM was wrong; I knew it from when I was six years old.
17
Moving On
As with any kind of child abuse, the pain doesn’t end when the act does. There are long-term physical scars that need to heal, not to mention the psychological ones. To this day I still haven’t had any kind of therapy to deal with my experiences; my healing has come from sharing my story. I like to think it’s worked for me, but it is also an ongoing process. It was only in the last few months, for example, as I wrote these pages, that I was able to look between my legs for the first time with a mirror. A
nd it wasn’t as frightening or horrific as it had once been, when I’d seen those photographs all those years ago. Perhaps because I’d come to terms with my story, and I’d learned to love myself and my body for all the positive things it has done, like giving birth to seven children. I realised I had more to be grateful for than angry about.
But it has taken me years to get to this stage, and many women who have gone through FGM might not have identified themselves as victims of abuse yet. It might only be when they go for their booking-in appointment with a midwife that they are asked the question about whether they have been cut, and for the first time in their lives they are offered help. It is wonderful that we can now offer women the chance to talk, especially when I think back to my own antenatal experiences. But we have to take a holistic approach to deal with survivors of FGM – it’s about more than just ending the practice; it’s also about supporting the women who are still suffering. In the summer of 2015, I met with doctors who are opening a specialist FGM hospital clinic in my borough, a place where women can be deinfibulated, receive counselling, perhaps even undergo reconstructive surgery if that’s what they feel will help them to come to terms with their body. But as with anything, it is all dependent on funding, and the government is only just realising they have an obligation to provide the right services to help these women.
The physical side effects suffered by victims of FGM impact on them constantly. In a 2004 study of young Somalians living in London, many women talked of how their circumcision had altered their way of life, how they had even adapted themselves to walk differently for fear of breaking open their wounds.23 This was always my worst fear after I was mutilated too, the terror that I might come unstitched and would need to go through the agonising experience all over again – there was no more running, skipping or jumping for me, or for any of these girls, after that day.