Farzana Esmail hosts fireside chat on FGC with co-founder of Sahiyo

By Hunter Kessous

Mariya Taher, U.S. Executive Director and co-founder of Sahiyo, and Farzana Esmail, survivor, mother and advocate, sat down together to have a virtual fireside chat on female genital cutting: part interview, part sincere exchange of stories, and part education. Upon introducing Mariya’s background, Farzana asks her to call on her expertise to explain female genital cutting (FGC) to the audience, using World Health Organization classifications and statistics regarding global practice. Throughout the chat, Mariya provides essential background on FGC, making this a great video to watch for people of varying knowledge levels on FGC. 

 

Farzana described her experience of discovering through Sahiyo’s Voices to End FGM/C that FGC is practiced not only in the Bohra community, but in Africa as well. Mariya explained that this misconception exists only because Africa is where the bulk of the research on FGC was occurring until recently. FGC has been recorded as being practiced in at least 92 countries. Sahiyo conducted research on the Bohra community and discovered 80% of women from their sample had been cut. 

Another finding of that same study was that 81% of women did not want FGC to continue for the next generation. Farzana asked the important question of why FGC continues to be practiced if so many women feel this way. Mariya used the concept of pluralistic ignorance to explain: the tradition lives on because nobody in the community talks about FGC and therefore, nobody knows that other women are also suffering and do not want to cut their daughters. Sahiyo’s social change platform was born to amplify the stories and voices of survivors. Mariya references a study finding that in order to achieve social change, 25% of a community is needed to reach a certain tipping point, which is slowly happening within the Bohra community. 

Mariya also discussed the shift from the Millenium Development Goals (MDGs) to the Sustainable Development Goals (SDGs) – an important global health policy. The MDGs were a UN framework created in 2000 that enlisted all countries who signed on to put an end to various issues globally and to measure their achievement towards these goals. The MDG goal to abandon FGC only applied to 29 or 30 relevant countries, which were mostly within Africa and the Middle East. The issue here is that FGC is a global issue. It is prevalent in South Asia and is practiced in at least 92 countries. The SDGs, which followed the MDGs, finally recognized that FGC is a global practice. The fifth SDG specifically calls on countries to decrease FGC globally and measure the prevalence rates within their communities. 

In a similar vein to the importance of recognizing FGC as a global practice, Mariya shares the importance of involving men in the movement to end FGC. Sahiyo amplifies not only the voices of survivors, but also of fathers, brothers, and husbands of survivors. The goal is to show that FGC negatively impacts entire communities, not only the women who undergo FGC. This is an important action toward abandoning FGC. Revealing FGC to be more than just a women’s issue or a cultural issue means every single person has the right and responsibility to get involved in the movement to end FGC. 

Many are talking about the very important issue of an increase in gender-based violence as a result of the pandemic and the lockdown. Mariya has not noticed an increase in FGC within Asian communities or within the U.S., but instead notes the distress that the lockdown causes many FGC survivors. The isolation makes it harder to seek help, and the sense of a loss of control can trigger a trauma response for survivors. It’s important to draw attention to this issue in order to provide survivors with the services they need. Read the full transcript here, and view this eye opening discussion here.

 

Let’s Talk FGC: A fireside chat with Mariya Taher and Farzana Esmail

Mariya Taher, U.S. Executive Director and co-founder of Sahiyo, and Farzana Esmail, FGC survivor, mother and advocate, sat down together for a virtual fireside chat on female genital cutting (FGC): part interview, part sincere exchange of stories, and part education. Farzana and Mariya intertwine pieces of their personal experience with the facts and information they provide on female genital cutting. This webinar explores FGC as a global practice, the many ways in which it is performed, how it impacts survivors, and related legislation. Mariya and Farzana share the progress toward abandoning FGC that has been made to date, the impact of COVID-19 on this progress, and Sahiyo’s theory for social change. 

Farzana: Mariya, thank you so much for doing this. Before I go on to introduce your illustrious background, if I could take just a few minutes to set the context of our conversation. This is a subject that is extremely personal because I have lived through this. I have long fostered the idea of bringing my story and sharing it in the hope that it triggers conversations, and, in time, banishes the fear and discomfort that surrounds it. We are discussing female genital cutting. 

Mariya, you have been named one of the six experts on female genital cutting by News Deeply. You have worked for over a decade in the anti-gender violence field, from research to policy, program development, and direct service. You have attained your masters in social work from San Francisco State University and went on to pursue a qualitative study titled, “Understanding Female Genital Cutting in the United States.” You have been diligently working on the issue of domestic violence within a number of organizations. In 2015, you founded Sahiyo, an internationally recognized, award-winning organization, to empower Asian communities to end female genital cutting. You sit on the inaugural Steering Committee to end female genital cutting with the U.S. End FGM/C Network. In Massachusetts, you work with The Women’s Bar Association to pass state legislation that would ban FGC and create education and outreach programs for survivors. The Manhattan Young Democrats named you 2017 Engendering Progress Honoree and ABC News did a special feature on you. You have been a prolific writer in fiction and nonfiction essays and short stories that have appeared on NPR, The Huffington Post, the Fair Observer, and a number of credible publications. 

Mariya, the first time that I spoke about FGC with a group of friends I experienced a sense of relief. It was almost cathartic, but I also sensed disbelief, despair, and huge discomfort. There are those who have perhaps never heard of this practice, then there are those who have heard but choose not to speak about it, and then there are those, like us, who have lived through this. So if we can begin today by you just defining for us what in fact is female genital cutting?

 

Mariya: Sure, well, thank you, Farzana, so much for inviting me to speak and for that wonderful introduction. And, this is an incredibly important topic for me as well, as you have spoken a bit about my background. It is also one because I grew up in it, and I underwent it myself when I was seven years old. I wanted to just give that context first before I explain what female genital cutting is because I think it is important to recognize that many girls who have undergone it actually don’t know what they have undergone or even realize that what they have undergone is female genital cutting, or another term that it’s referred to as is female genital mutilation, but for the purposes of our conversation I will tend to refer to it as female genital cutting or FGC. 

So, according to the World Health Organization, female genital cutting involves all procedures involving cutting or removal of part [or all] of the external female genitalia for nonmedical reasons. There are various forms of it. The World Health Organization has actually categorized it into 4 types, but each of these types are very broad in itself. So, type 1 is something that usually involves cutting or excision of the clitoral hood or part of the clitoris, but it is very broad and could also include removal of all of the clitoral hood and also part of the clitoris. Type 2, which is considered more severe, involves partial or total removal of the clitoris and labia minora, with or without excision of the labia majora – so it’s the inner and outer lips of the female genitalia. Type 3 is narrowing of the vaginal orifice by creation of a covering seal, so it is generally the most severe form. It is also known as infibulation, and it can involve removing all of the labia minora and labia majora as well. Then there is type four which is considered the “other” category, and this is really something that involves anything that doesn’t fit in types 1 through 3 which can be pricking, piercing, cauterizing. Those are the 4 broad categories defined by the World Health Organization. Just to give you a little more information of the statistics that we have on female genital cutting, about 90% of women and girls who undergo it undergo types 1 and 2. So, type 3 which is the most severe form only really accounts for about 10% globally, and I think that is really important to recognize, too. 

Farzana: Sure, Mariya, you know when I started to follow Sahiyo, I also got acquainted with a lot of survivor stories, and some of these stories resonated, and I could identify completely. For most of us, the impression that I gathered was that it happens between the ages of 7 and 9. It’s almost something that is led on by either your grandmother, or an aunt, or your mother. The backdrop is a dilapidated dimly lit building where an elderly aunt answers the door and performs the practice. Immediately after that, there is a celebration. While the survivor has gone through an incredible amount of pain, confusion, and almost a sense of betrayal. However, as I went on to read and follow Sahiyo over the years I learned that this practice isn’t skewed to a community or culture, but in fact is being practiced around the world, in many geographies, by indigenous communities. How right is that assessment?

Mariya: That’s correct. What’s interesting is that when people have heard of female genital mutilation/cutting, they have often heard of it in relation to it happening within the African context or amongst African diaspora communities. It’s a myth actually that it only happens within African communities or contexts. I think what you’re bringing up is the opposite because of where you grew up knowing this is something that happens within South Asian communities and the Dawoodi Bohra community, which is the community we both grew up in, but it wasn’t publicly acknowledged that it happened within this community. 

I think that the stories you are describing are very typical of the stories that we hear from survivors who have experienced it within the Bohra community, but there are elements that also ring true for survivors from various different communities. One of the reasons Sahiyo engages in storytelling, and a lot of work is around collecting stories and making this subject that was for so long known as taboo come out into the public, so that we are recognizing that it is okay to talk about that. It’s important to talk about that, to share your stories, and to recognize that there [are] a multitude of stories out there. So, we have heard the stories of girls who are taken by their mothers or aunts under false pretenses, and the dilapidated building you spoke about is an element of a story we hear girls who have gone to Mumbai and had it done often talk about. But, we have also had stories of girls who have been taken to health care professionals and had it [done]. We have other stories of girls who are older and have had it [done]. In the Bohra community it’s typically done around 7 to 9, but globally it’s done in many different communities. There is evidence now that it’s being performed in over 92 countries globally, and it can be done anywhere from birth to adolescence. Even adult women undergo it. So it’s very much a global issue. It is found in every continent of the world, except for Antarctica. It’s something that just in the last few years that we are really recognizing how global it is. 

Farzana: It’s interesting you say that, Mariya, because in one of the surveys I was reading on one of your webinars there was mention that there was research done with 400 women where about 80% of them said that they had undergone FGC and 81% of them, in fact, said that they would not want it to continue, and they wouldn’t do this practice on their own daughters. Then why is it that we still see the prevalence of this practice?

Mariya: That’s a good question. Sahiyo, one of the first things we did when we came together, was we realized that we needed to do a larger scale study to understand how prevalent it was in the Dawoodi-Bohra community. Previous to that there were a couple of small-scale studies, but we wanted to do something to get a larger number. We did this small study where we had women who grew up in the Bohra community globally take part, and we had over 400 women take part in it. About the statistics you referred to, we analyzed, I think, about 384 women’s data after we collected it all. We found that, out of that number, 80% of the women had undergone FGC, which confirmed for us that it was prevalent. That’s something that we anecdotally knew but didn’t have evidence. We also found that 81% said they did not want it to continue onto the next generation. That was surprising to us, and, at the same time though, what it made us realize is that female genital cutting, or khatna as it is called in the Dawoodi Bohra community, is a social norm – meaning it has been justified in all these ways, and that one way in which it is continuing is that, because it has been justified, there’s a sense of belief that even if you don’t want it to continue, you think others in your community are continuing it, so it is being continued. There’s a term in psychology called pluralistic ignorance, and that is basically what we found happening, and part of it was because nobody was talking about this. And if nobody is talking about this then, of course, nobody knows that people are suffering the physical, sexual, emotional consequences of undergoing this. People don’t know that other people don’t want it to continue. So, the first step in terms of combating that pluralistic ignorance is storytelling. It’s coming out in the open. It’s speaking about that, and that’s really the basis of our work and why we do storytelling was because of that research, because we found that there was this huge population that didn’t want it to continue, so we were like how do we break the silence. So that’s really our theory of change; that’s what we recognize and need to work towards. 

Farzana: That’s very, very interesting, again, Mariya, because I personally believe that these kinds of practices go back institutionally in terms of legitimizing fear. There is a shame around it, as well, that makes it difficult for people to have conversations on this. In fact, we are discouraged– systematically discouraged– to have any kind of discourse. What I also found interesting is the reference you made in terms of it being more than just a physical violation, because primarily this practice, that does come across as a violation of physical well being, but, in fact, is almost like an onion peel where there are so many layers that you can keep peeling and those are so deeply entrenched with fear, with purity culture, patriarchy, gender roles, promiscuity, shame. It’s, therefore, so important to be able to see this with a much wider prism, more holistically. This is not just a physical violation, but an emotional violation. It’s a mental violation. In your experience of working with survivors, what do you believe is one of the biggest challenges to overcome?

Mariya: That’s such an important question, but a very hard question. I think it’s important to also recognize that the repercussions of FGC vary from survivor to survivor. Of the stories that I have heard, personally, through our blog and in support groups, I think what I always come away with is the emotional impact that it has regardless of a person’s background, the severity they have undergone, how they underwent it – that emotional impact is something that lasts a lifetime. It comes across in many different ways: we have stories from women who don’t remember being cut, which is actually very common, because with trauma, the way your brain protects you, it switches it off. We have had stories of women who do not remember they were cut, and, sometimes, until somebody else told them they were cut, didn’t even realize it. But in determining that information it’s almost like going through PTSD again, too, and for some women it is almost like piecing together pieces of a puzzle. They are recognizing or wondering if certain impacts on their sexual lives are a part of it. It is something that, unfortunately, there’s not enough research around the sexual impact, particularly amongst Type I, we don’t really know. But, again, sexuality is very much connected to your emotional state and to your mind. So that’s one thing across communities and individuals that I come away with is that emotional impact. But, again, this is something that affects people physically, sexually, in many different ways. It’s important to recognize every survivor is going through their own journey in terms of what they are dealing with. 

Farzana: You know, in my case, if I could just use my reference, just for a few minutes here. Perhaps this analogy will sound a bit absurd, but I will go with this analogy. It’s like childbirth: you forget the physical pain, because the emotional sense is so heightened with joy. Similarly here, the physical pain is forgotten. I don’t remember the pain, but the sense of deceit at the hands of my mother has been huge. But again, I completely recognize that my mother came from a generation that was less educated, less informed, less encouraged, perhaps not encouraged at all to speak their mind. But again, it is the same woman who today hasn’t enforced on me or has expressed those views for me to practice it on my daughter. So I do believe there is a huge hope of change, and because Sahiyo is so dedicated to ending FGC. In your opinion, how far are we from the day that this is something that we won’t see happen? I know you don’t have a crystal ball but…[laughs]

Mariya: Social change takes time, it takes a lot of work. There is a lot of work to still be done, but…

Farzana: How far perhaps– sorry to interrupt– if perhaps you could tell us how far have you come from the time that you started?

Mariya: I want to recognize also that there have been women and researchers even within the Bohra community that have been bringing this to the world’s attention prior to Sahiyo, as well. I want to also just acknowledge the women from past generations and men from other communities that have been working on this topic in various cultures and communities, too. Just to recognize that is something that’s been ongoing and there has been a lot of amazing important work being done for decades. Having said that, I do think that we have seen a lot of progress in the last five years, as well, in terms of acknowledging that this happens within many Asian countries and communities. And that is something we are seeing from the largest levels from looking at systematically, even looking at the UN in terms of measuring FGM/C. There is something called the Sustainable Development Goals which have come out from the UN. The Sustainable Development Goals are a framework which every country who signs onto the SDGs they are responsible for making progress towards those goals. Then there’s SDG number 5 which is specific to FGC and decreasing FGC globally. I am bringing that up because prior to the Sustainable Development Goals, there was a platform called the Millennium Development Goals that was a similar framework towards measuring achievement towards various social ills globally. Within the MDGs they did have a target to decrease FGC globally, but it was only amongst what they considered relevant countries, so countries that had prevalence rates, which was mostly in sub-Saharan Africa and the Middle East. So at that time, it was only amongst, I think 29 or 30 countries. The SDGs, this new framework, actually accounts for the fact that it is global. It is no longer just counting the estimates within those 29-30 countries, it’s actually globally. It’s a huge, huge deal because it’s recognition that this is a global issue. That is progress within itself. I just want to mention that in terms of the highest levels. 

In terms of the lower level, the communities and individuals, we are hearing more stories. More survivors are sharing their stories. More people are coming out to publicly say we shouldn’t do this. That’s huge, and I do think that we are getting to that tipping point that we need. There’s research that shows once you get 25% of a community to reach a certain tipping point, that’s when you see change within social norms. I feel like we are getting to that tipping point. I want to recognize that I don’t think that– I want to be hopeful that it ends in my lifetime. But, I also want to recognize that change is happening, and I think we need to celebrate that change and those small wins along the way. 

Farzana: Sure, of course. Legislatively, what does it look like? Are more and more countries warming up to the idea of putting a ban to this practice? Is that something that is a huge hurdle to cross?

Mariya: That is. I think legislation is important because it is a framework in which countries can, and it is a tool you can use for prevention. We are seeing more and more countries passing legislation. Within the U.S., it’s a very long story, but our federal statute was actually challenged, and so our Congress is working on a stronger piece of legislation. Individual states have been working on state laws. So, that has been amazing to see the past few years. Within Africa, most countries have it banned. It’s challenging within Asia. That is because Asia has only recently come on the map in terms of FGC being performed, and it is a very different circumstance where it is actually protected in various countries. We are seeing people challenging those social norms and that legislation. In India, we are seeing groups working towards passing a state law and are really urging the Supreme Court in India to have a ban on FGC. In that context it’s being challenged as, ‘Are we protecting girls from harm versus a religious minority right?’ You’re seeing different challenges, but you’re seeing overall that the conversation at a global level is increasing. Again, that is a first step in the right direction. 

Farzana: Apart from [countries in] Africa, are there any other countries that have gone ahead and banned the practice?

Mariya: Yeah, there are many countries that have laws against it. I don’t know off the top of my head the number. But, for instance, in Europe there are many countries that have legislation against FGC, recognizing that it happens in various countries there. Australia does as well. There was a court case that really brought it to light a few years ago. There’s attempts to strengthen the legislation within Australia, too. It is something that you are seeing in many different countries.

Farzana: In one of the stories that led me to further read was khatna [as FGC is called in the Bohra community] packages, travel packages. It was almost as if you could do a khatna tour. So if it was a practice that was forbidden in the country of residence, you could actually take a trip down to India for four to five days, have this practice done, and then come back again. So that was extremely disturbing to know that they were actually selling it is a package for tourists. 

Mariya: I had not heard of the khatna packages, but it is very common to hear. There’s a term I don’t really like using, but it’s vacation cutting: the idea that girls are taken to various countries and countries of origin to have their FGC done. It sounds like this is the khatna package that you have heard of.

Farzana: Yes, yes, that’s right. 

Mariya: I wasn’t aware of that term, but it can be more complicated than that, too. In my circumstance, it wasn’t that my parents took me to India to have it done, specifically. It was that we went to India to visit relatives and it was the summer that I was 7 that it happened. But it is a growing concern that, as countries are creating laws and policies, that might be a repercussion or unintended consequence that they might be taken to other countries. There also are laws. For instance, in the U.S., there is a vacation cutting provision, where if a girl is taken out with the intention to have that done in another country, a person can still be prosecuted. So that’s one thing to be aware of. As we are talking about legislation in general, I think law is an important framework, but I dont think law alone will end this practice. I do think it is really important to recognize that we need community education. We need to work in a very multi-sectoral approach. We are really looking at changing against social norms, and you really need to have community dialogue and education. It is much more important than legislation, but legislation does help to reinforce that something is not acceptable within a community. But, it is really that changing of a mindset that is what we are trying to do. 

Farzana: I completely agree. I think it becomes even more incumbent upon us to be able to come out and share these stories. Change can only come out if there are conversations happening around it. We have got to somehow muster up enough courage to share our stories and hopefully that should bring change. Mariya, you also touched upon something that I have questioned several times, and that is the role of men. How important is the role of men in this practice of FGC? 

Mariya: Involving men is very important, and something Sahiyo really tries to do, as well. We really look at FGC as a community issue, and we are really trying to show that FGC affects obviously the survivor, the women who undergo FGC, but it also affects the entire community. Particularly, we have stories from men who talk about hearing how it impacted their mothers. We have stories from men who have talked about how it impacted their wife and their own marital relationship. We have stories from brothers who have talked about learning that it happened to their sister and wondering if that is part of what divided them in terms of their relationship. It is something that we need to recognize as a community. We have to come together to work to make sure nobody is harmed – future daughters, future sisters, future mothers are protected from this form of gender-based violence, which can impact their lives in many different ways throughout their lives. It’s something that we work very hard to make sure that men’s voices are heard, that they are allies, and that they also are sharing their stories. Particularly, for a very long time within the Bohra community (and this isn’t true for every community, but is in an element that you find often). But for a long time within the Bohra community, men were not aware of this issue or it was something that was considered a women’s issue. That is changing. I think it is changing because of social media, because of technology, because people are just talking about it more, and, so now, in the younger generation, everybody knows about this issue now, it seems like. That’s a huge cultural shift, too, where you see, just a decade ago, men not being very aware of this to now recognizing that men are aware and can be allies and help protect future generations. 

Farzana: And that’s reassuring. Again, here if I can use an anecdote of my personal story where my father was an extremely protective father. He was extremely careful about the way that we were brought up. But, this was one of those issues where he was almost sidelined by my aunt, by the women in the family, because this was something that men did not get into. Like I said, systematically this is devised to be so patriarchal in nature, and that’s why it’s thriving. It’s also sprinkled with fear. It’s almost, you can’t be questioning the establishment and, therefore, you can’t be questioning the practice. That, I think, is intrinsically one of the reasons men don’t know enough about it, don’t know about it at all, and those who know about it perhaps couldn’t say very much. But, it is reassuring to know that’s changing because that is important. They are also stakeholders in this process of change. 

Mariya: I agree. 

Farzana: Mariya, we possibly cannot reflect on the times we are living in, which is the pandemic. It is really, really disheartening when one reads that across the world we are seeing a huge surge in domestic violence during this period of lockdown. There are some estimates that the UN has put out saying they are expecting about 31 million new cases to emerge if the lockdown continues another six months. That’s a hugely staggering number. How does FGC fit within the spectrum of the pandemic?

Mariya: That’s a great question. I was actually listening to a webinar the other day and right now it seems like there might be a difference in terms of the impact of COVID within African communities and amongst Asian communities. I think last week even there was a headline that came out with some initial findings from an organization in Somalia. FGC had increased significantly there because people were at home, so they were taking advantage of the fact that girls were not at school, so they would have the time to heal. Cutters were going door to door. Their economic well-being depended on this business, so they were looking to see if they could cut girls. So you are hearing that happen. Anecdotally within Asia, you’re not hearing that as much. The speakers on the webinar, one of them was my fellow co-founder Aarefa (I should mention I co-founded Sahiyo with four other women) – so, Aarefa was on that webinar and me and her have had some conversations on this issue about what we have been hearing. Anecdotally, we are not hearing an increase of FGC amongst the Bohra community at this time. I think there might be several reasons. One part might be that it tends to be more medicalized now, and so as hospitals and health care professionals are overwhelmed with COVID, that’s sort of becoming secondary. But also the fact that within the Bohra community it doesn’t have to happen at seven. Seven is sort of the minimum age, so people could potentially be waiting a few months, or however long, to have it done. A couple of the other guest speakers from countries within Asia were saying that they feel it might be being postponed, too. I think within Asia, too, we do see it happen as a more medicalized version, and we do see Type 1 and Type 2 much more often than we see Type 3. Again, there is no official high level data on this, but anecdotally it might be actually halted right now due to the pandemic. So it’s interesting to see the difference in how it is emerging amongst different continents. I think we will really see the impacts after the pandemic is over and once we are really able to collect more data on this. What I do want to say though, is even if the prevalence rate might be different, the fact that there’s survivors seeking out support – that is something that is having a huge impact right now. Sahiyo has had a few support groups and some of the things that we are hearing is the sheltering in place, the pandemic type atmosphere that we are having is actually triggering some trauma responses by being in lockdown, and feeling like having a lack of control. And the fact that it’s harder to seek out support right now in terms of mental health professionals or being able to chat with others. That is an impact that we are seeing, in terms of being able to receive services if you need it, as a survivor. 

Farzana: Yes, this pandemic has been unprecedented for many reasons and this is something perhaps that if we can reach out with more and more stories hopefully we will be able to give comfort. Mariya, we can go on, but I am also cognizant that we have a time limit. Thank you so much for doing this. Kudos to your team, to you, for having done such wonderful work. May you continue to make a difference, change lives, and hopefully come to that point in our lifetimes where we could probably see the end to this practice. If I can just end the conversation on a quote by Martin Luther King, Jr: “The ultimate tragedy is not the oppression and cruelty by the bad people, but the silence over that by the good people.”

Mariya: That’s a wonderful quote to end with. Thank you so much for inviting me.

Farzana: Thank you, I really appreciate this. Thank you so much.

The Disturbing Trend of Medicalising Female Genital Mutilation

by Lorraine Koonce-Farahmand

In the Zero Tolerance campaign to end Female Genital Mutilation (FGM), what has been noted is the arc of progress. Increasingly, women and men from practising groups have declared support for ending FGM; and in several countries, the prevalence of FGM has decreased significantly. A BMJ Global Health study reported that the rates of FGM have fallen dramatically amongst girls in Africa in the last two decades. Using data from 29 countries going back to 1990, the BMJ study found that the biggest fall in cutting was in East Africa where the prevalence rate dropped from 71% of girls under 14 in 1995, to 8% in 2016.  Some countries with lower rates – including Kenya and Tanzania, where 3-10% of girls endure FGM – helped drive down the overall figure. Nevertheless, UNICEF’s groundbreaking report shows that whilst much progress has been made in abandoning FGM, millions of girls are still at risk.

FGC infographics_3

Flourishing against this backdrop is the compromise of medicalisation of FGM that competes against progress in the Zero Tolerance Campaign. A disturbing number of parents are seeking out healthcare providers to perform FGM. According to the World Health Organization (WHO), medicalisation is when a healthcare provider performs FGM in a clinic or elsewhere. Such procedures are usually paid for under the assumption that medicalisation is not FGM, and is done to mitigate health risks associated with the practice. Consequently, in recent years, the medicalisation of FGM has taken place globally, particularly in Egypt, Indonesia, Kenya, Malaysia, Mali, Nigeria, Northern Sudan, and Yemen. In many of these countries, one-third or more of women had their daughters cut by medical staff with access to sterile tools, anesthetics, and antibiotics. The non-governmental organization, 28 Too Many has investigated the involvement of health professionals and has highlighted what must be done to reverse this trend. 28 Too Many reported that the medicalisation of FGM in Egypt is an enormous challenge. Currently, 78.4% of incidences of FGM in Egypt are carried out by health professionals. Egypt had the highest rate of health workers performing FGM at 75%, with Sudan at 50% and Kenya at 40%. A 2016 study by The United Nations International Children’s Emergency Fund (UNICEF) and the Africa Coordinating Centre for the Abandonment of FGM/C (ACCAF) also found that FGM is increasingly being performed by medical practitioners.   

Parents and relatives seek safer procedures, rather than outright abandon FGM. The medicalisation trend has conveniently forgotten that FGM violates women’s and children’s human rights to health, to be free from violence, to have the right to physical integrity and non-discrimination, and to be free from cruel, inhumane, and degrading treatment. The “just a nick” is essentially gender-based violence (GBV). What is being “nicked” is still part of a woman’s labia majora, labia minora or clitoris. The medicalisation of FGM perpetuates that women are inferior human beings. This is not in harmony with international human rights standards.

There is also clearly an economic incentive for promoting medicalisation. Medical personal perform it for financial gain under the premise that if the crux of the issue is the health side effects and pain, by using sterilised instruments and medication the problem has dissipated. The misguided assertion that medicalisation is a viable option is ignoring the fact that all types of FGM have been recognised as violating human rights. These rights that have been codified in several international and regional treaties mirror worldwide acceptance and political consensus at various UN world conferences and summits. Committees such as The Committee on the Elimination of All Forms of Discrimination against Women, (CEDAW), the Committee on the Rights of the Child, and The Human Rights Committee have been active in condemning FGM. Medicalisation goes against the principles enshrined in these treaties and conventions.

The disturbing medicalization trend continues to argue that this less severe form of FGM can protect girls and women from harm. This was echoed in The Economist article of June 18th, 2016, Female Genital Mutilation: an Agonising Choice’. In the article, it was asserted that because three decades of campaigning for a total ban on FGM have failed, a new approach is warranted. The article advocated “nicking” of girl’s genitals by trained health professionals as a lesser evil. This reasoning was echoed in the Journal of Medical Ethics by two U.S.-based doctors, Dr. Kavita Shah Arora, Director of Quality, Obstetrics, and Gynaecology at the MetroHealth Medical Center in Cleveland, and Dr. Allan Jacobs, Professor of Reproductive Medicine at Stony Brook University. They wrote that “we must adopt a more nuanced position that acknowledges a wide spectrum of procedures that alter female genitalia.” They assert that they do not believe minor alterations of the female genitalia reach the threshold of a human rights violation. They also asserted that the nicking of the vulva and removing the clitoral hood should not be considered child abuse. They posit that by undergoing these acceptable procedures in the U.S. during infancy, girls can avoid the risk of being sent abroad for more extensive procedures.

These doctors and writers from influential respected journals are often held in high esteem by decision-makers, policy-makers, and experts. However, the advocation of medicalisation grotesquely undermines the hard and courageous work undertaken to end FGM worldwide. The medicalisation trend has ostensibly failed to recognise that the proposal of removing the clitoral hood and “just nicking” the vulva contradicts the WHO’s statement that there is absolutely no reason, medical, moral or aesthetic, to cut any part of these exterior organs.

There are compelling reasons why the medicalisation of FGM is fundamentally wrong.

  • The medicalisation is and would be carried out on young girls between infancy and the age of 15. Medicalisation is an attack against the sexual and psychological integrity of young girls. Many are not in a position to say no, unable to give informed consent or to effectively resist the practice.
  • Medicalisation reflects a deep-rooted inequality between the sexes and constitutes an extreme form of discrimination against women. In some communities in order to be married a female is not considered an adult and “marriageable” without undergoing FGM, which may be performed to define her gender and/or ethnic identity. In many African communities, marriage is a women’s predominate source of economic survival. The medicalisation trend reinforces and supports this lack of choice women must make in order to be accepted in their society.
  • Accepting certain types of FGM would lead to confusion for communities and health professionals. It will adversely affect the work done on raising awareness of FGM and prevention and protection of girls.
  • The risk of a well-founded fear of persecution would be seriously undermined for asylum seekers. Asylum seekers with potential claims for international protection, either for themselves or for daughters, could plausibly be denied refugee status if confusion is created on whether or not the type of FGM they would be potentially subjected to constitutes a well-founded fear of persecution.  

The medicalisation of FGM is not an appropriate response to the health risks associated with FGM. All FGM causes a variety of negative outcomes for the health and psychological well-being of women and girls. Medicalisation fails to eliminate long-term gynaecological and obstetric complications, as well as the lifelong emotional, psychological and sexual problems. It does not prevent the feelings of anxiety, betrayal, depression, low self-esteem, panic, phobia nor other psychological issues. As FGM has no proven medical benefits, as professionals who have sworn to the Hippocrates oath to do no harm, ultimately, it is unethical to contribute to the continuation of a procedure that is quite harmful and disabling for women. Medicalisation of FGM gives it an aura of normalcy, legitimacy, and acceptability. The mutilation of females is outrageous when considering that the alterations proposed are both traumatic and life-changing.

An additional concern of the medicalisation trend is the bleak message that removing a female body part for non-medical reasons is acceptable as it is just a “nick.” Who will be there to determine the measure of the “nick”? What part shall be nicked? The clitoral prepuces? The labia minora? Near the special receptacles of nerve endings that are clustered in the clitoris?  The skin of the inner surface of the labia? Is the medicalisation trend assuming that this undefined “nicking” by a chosen trained professional now is safe and correct?

The implication that it is just a nick obscures and trivializes the underlying degradation that this nick imposes on a woman and the senseless attack on women’s’ genitals for no other reason than that they are female. It reinforces the sense of inferiority on this already marginalised gender.

FGM is not open for debate without violating international law and medical ethics. As long as it is accepted in any form, FGM will thrive. Partial FGM is simply not acceptable. A nick is simply unacceptable.  The key phrase is zero tolerance.

More about Lorraine:

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Lorraine is is a British solicitor and a New York lawyer. She is currently an international law professor in the Anglo-American Law degree programme at the Universitié De Cergy where she lectures on gender law and human rights, and at the Universitié De Paris-Dauphine where she lectures on the Legal Aspects of Gender Violence. She is often an invited speaker on GBV and FGM. Recently, she was invited as a speaker to lead the medicalisation workshop at the End FGM European Network conference that was held in Paris.