My Reflections on the first-ever California Bay Area Thaal Pe Charcha

By Maria Akhterimg_2212.jpg

On Oct 21st in a cozy home in Berkeley, CA, a team of Sahiyo activists organized
our first Bay Area Thaal Pe Charcha.

Thaal Pe Charcha (TPC) is a Sahiyo flagship program that allows Bohra women to come together in a private, informal setting so that they can bond over food and discuss issues that affect their lives, like Female Genital Cutting or Khatna. The program started in Mumbai, India in 2017 and is being piloted in the United States.

The weeks leading up to the Bay Area event were full of
excitement and anticipation for what we hoped would be the pilot of a new program
and the start of new friendships in the Bay Area.

The team and I spent a few weeks carefully crafting our invitations and considering
whom to include in this informal discussion about the norms and challenges of
being a Bohra woman.

With delicious food displayed on our thaals and a crisp Autumn breeze flowing in
the room, 13 women gathered around a living room and engaged in a unique
conversation.

We went around the circle and introduced ourselves, sharing a memory or item in a
show-and-tell icebreaker. We discussed challenges and conflicts we’d faced in the
Bohra community in the Bay Area and globally as well as various strengths and joys
we’d experienced in the Bohra community.

Familiar faces and new ones surrounded me. My mother, childhood friend, and
fellow Sahiyo activists surrounded me with a comfort in knowing that I had their
support and that I had encouraged them to join me at this event.

The Bay Area is a tough area to operate in. Bohra women are more hesitant to speak
out and form connections with Sahiyo, so I considered this TPC a huge milestone in
breaking the silence around FGM/C in the Bay Area specifically. I could tell from
conversations that rose up that many of the women wanted a space to share their
voices and to connect with other like-minded women.

My hope is that these events continue to occur and that they grow and expand in
ways that benefit the community. There was substantial tentative interest from the
attendees in continuing to meet and my goal is to turn the Bay Area TPC group into
a consistent resource for any and all Bay Area Bohra women with an interest in
open communication and positive change.

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Aarefa Johari and Masooma Ranalvi discuss FGC at We the Women Bangalore

On October 7, Sahiyo co-founder Aarefa Johari and We Speak Out founder Masooma Ranalvi participated in a panel discussion on Female Genital Cutting in India, at the We the Women summit organised by veteran journalist Barkha Dutt in Bangalore. Prominent human rights activist Srilatha Batliwala moderated the discussion.

The event was attended by more than 200 people in Bangalore and was streamed live on social media. Ranalvi and Johari shared their personal experiences of being subjected to FGC and discussed various aspects of the problem from the need to engage with the community to end the practice and the significance of a law against it.

You can watch the complete video of the discussion here.

The event was a follow up to a similar We the Women summit in Mumbai in December 2017, when Sahiyo co-founder Insia Dariwala spoke about the practice along with Mubaraka and Zohra, two survivors of FGC. You can watch last year’s video here.

Sign the #EndFGM petition on change.org

A new change.org petition calling for an end to Female Genital Cutting in the Bohra community was started in September by Ranjana Sehgal and Umi Saran.

The petition is addressed to Dr. Syedna Mufaddal Saifuddin, the spiritual leader of the Bohra community, and was started in response to the Syedna’s visit to Indore to give sermons during the first ten holy days of Muharram.

As the petition mentions, “Although the matter is already in the Apex Court if the directive to end FGM comes from the spiritual head of the Bohra community, it will be easier to put an end to this violent practice. The Government of India’s WCD Ministry has said that FGM is in clear contravention of our laws, the Indian Penal Code and Protection of Children from Sexual Offences (POCSO).”

Over 16,000 supporters have already signed, and the campaign’s next goal is reaching 25,000 signatures.  If you would like to support by signing, click here.

Introducing Sahiyo’s inaugural U.S. Advisory Board

Sahiyo is pleased to introduce our inaugural U.S. Advisory Board. As our U.S. operations and programs have grown, the advisory board will provide strategic advice to the management of our organization, and ensure that we continue fulfilling our mission to empower communities to end Female Genital Cutting and create positive social change through dialogue, education, and collaboration based on community involvement. Advisory board members will be supporting a human rights driven organization dedicated to creating a world without Female Genital Cutting through dialogue, education and direct community involvement.

Join us in welcoming the team: Maria Akhter, Renee Bergstrom, Alisha Bhagat, Insia Dariwala, Dr. Melody Eckardt, Joanne Golden, Priya Goswami, Aarefa Johari, Zehra Patwa, Maryum Saifee, and Joanna Vergoth.

Trauma and Female Genital Cutting, Part 6: Effects of FGM/C on the Lower Urinary Tract System

(This article is Part 6 of a seven-part series on trauma related to Female Genital Cutting. To read the complete series, click here. These articles should NOT be used in lieu of seeking professional mental health and counseling services when needed.)

By Julia Geynisman-Tan, MD

Background

FGM/C has no known health benefits, but does have many immediate and long-term health risks, such as hemorrhage, local infection, tetanus, sepsis, hematometra, dysmenorrhea, dyspareunia, obstructed labor, severe obstetric lacerations, fistulas, and even death. While the psychological, sexual, and obstetric consequences of FGM/C are well-documented (refer to prior posts in this series), there are few studies on the urogynecologic complications of FGM/C. Urogynecology is the field of women’s pelvic floor disorders including urinary and fecal incontinence, dysfunctional urination, genital prolapse, pelvic pain, vaginal scarring, pain with intercourse, constipation and pain with defecation and many other conditions that affect the vagina, the bladder and the rectum. Urogynecologists are surgeons who can both medically manage and surgically correct many of these issues.

FGM/C and Urinary Tract Symptoms

One recent study from Egypt suggested that FGM/C is associated with long-term urinary retention (sensation that your bladder is not emptying all the way), urinary urgency (the need to rush to the bathroom and feeling that you cannot wait when the urge comes on), urinary hesitancy (the feeling that it takes time for the urine stream to start once you are sitting on the toilet) and incontinence (leakage of urine). However, the women enrolled in this study were all presenting for care to a urogynecology clinic and therefore all of them had some urinary complaints so it is difficult to tell from this study what the true prevalence of lower urinary tract symptoms are in the overall FGM/C population.

Therefore, given the significant number of women with FGM/C in the United States and the paucity of data on the effects of FGM/C on the urinary system, my research team studied this topic ourselves in order to describe the prevalence of lower urinary tract symptoms in women living with FGM/C in the United States. Publication will be available online in December 2018.

We enrolled 30 women with an average age of 29 to complete two questionnaires on Overactive bladder 1their bladder symptoms. Women in the study reported being circumcised between age 1 week and 16 years (median = 6 years).

  • 40% reported type I
  • 23% type II
  • 23% type III
  • 13% were unsure

Additionally, 50% had had a vaginal delivery; and 33% of these women reported that they tore into their urethra at delivery.

Findings:

A history of urinary tract infections (UTIs) was common in the cohort:

  • 46% reported having at least one infection since being cut
  • 26% in the last year
  • 10% reported more than 3 UTIs in last year
  • 27% voided ≥ 9 times per day (normal is up to 8 times per day)  
  • 60% had to wake up at least twice at night to urinate (once, at most, is normal)

Most of the women (73%) reported at least one bothersome urinary symptom, although many were positive for multiple symptoms:

  • urinary hesitancy (40%)
  • strained urine flow (30%)
  • intermittent urine stream (a stream that starts and stops and starts again) (47%) were often reported
  • 53% reported urgency urinary incontinence (leakage of urine when they have a strong urge to go to the bathroom)
  • 43% reported stress urinary incontinence (leakage of urine with coughing, sneezing, laughing or jumping)
  • 63%reported that their urinary symptoms have “moderate” or “quite a bit” of impact on their activities, relationships or feelings

What’s the Connection Between FGM/C and Urinary Symptoms?

Urinary symptoms like the ones described above can be the result of a number of factors. pee-night-400x322Risk factors for urinary urgency and frequency, incontinence, and strained urine flow include pregnancy and childbirth, severe perineal tears in labor, obesity, diabetes, smoking, genital prolapse and menopause.

However, given the average age of women in our sample and the fact that only half of them had ever had a vaginal birth, the rate of bothersome urinary symptoms are significantly higher than has been previously reported. FGM/C may be a separate risk factor for these symptoms. Interestingly, the prevalence of urinary tract symptoms in our patients closely resembled that of a cohort of healthy young Nigerian women aged 18-30, in which the researchers reported a prevalence of lower urinary tract symptoms of 55% with 15% reporting urinary incontinence and 14% reporting voiding symptoms. The authors do not mention the presence of FGM/C in their study population but the published prevalence of FGM/C in Nigeria is 41%, with some communities reporting rates of 76%. Therefore, it is likely that many of the survey respondents had experienced FGM/C, thereby increasing the prevalence of lower urinary tract symptoms in their cohort. In the study of women in Egypt referenced above, those with FGM/C were two to four times more likely to report urinary symptoms compared to women without FGM/C.

The connection between FGM/C and urinary symptoms can be understood from the literature on childhood sexual assault and urinary symptoms. Most women who experience FGM/C recall fear, pain, and helplessness. Like sexual assault, FGM/C is known to cause post-traumatic stress disorder, somatization, depression, and anxiety. These psychological effects manifest as somatic symptoms. In studies of children not exposed to sexual abuse, the rates of urinary symptoms range from 2-9%. In comparison, children who have experienced sexual assault have a 13-18% prevalence of enuresis (bedwetting) and 38% prevalence of dysuria (pain with urination). The traumatic imprinting acquired in childhood persists into adult years. In a study of adult women with overactive bladder, 30% had experienced childhood trauma, compared to 6% of controls without an overactive bladder. There is a neurobiological basis for this imprinting. Studies in animal models show that stress and anxiety at a young age has a direct chemical effect on the voiding reflex and can cause an increase in pain receptors in the bladder. Additionally, the impact of sexual trauma on pelvic floor musculature has been well described. Women who experience genital trauma often respond with an involuntary contraction of the pelvic floor, which can develop into non-relaxing pelvic floor dysfunction and subsequent urinary hesitancy, strained flow, retention, bladder pain and overflow incontinence.

These Conditions are Treatable

There are treatments for all of the conditions. Urinary hesitancy, strained flow, bladder pain, and urgency are often treated with pelvic floor muscle therapy. That is because many of these symptoms come from an unconscious, constant clenching of the pelvic floor muscles, which then prevents them from using their full range of motion and pinches off the nerves running through the muscles. Pelvic floor therapy focused on lengthening and stretching these muscles can completely change the way that you urinate and the sensation of pain in the pelvis. This kind of physical therapy is done by all female providers in a private room. The therapy consists of a combination of external and internal work on all of the muscles of your core and pelvic floor to release trigger points of tension and teach you how to relax and lengthen these muscles. Sometimes the therapists use biofeedback devices in the vagina to help you to recognize certain muscles groups. The sessions are usually one hour long and last for 6-12 visits. You can obtain a referral to a pelvic floor physical therapist from your local urogynecologist.

If you have urinary leakage throughout the day or nighttime, this can also be treated. Your urogynecologist can help differentiate whether you have stress urinary incontinence (leakage with coughing, laughing, exercise, lifting) or urgency urinary incontinence (leakage that follows the urge to go to the bathroom or sometimes sporadic leakage without any urge). These types of incontinence are treated differently but both can be treated with a combination of medicine, office procedures or surgical treatments. To find a urogynecologist in the Unit, you can go to the website of the American Urogynecologic Society and click on patient services.

 

About Julia Geynisman-Tan

Julia is a Female Pelvic Medicine and Reconstructive Surgeon in the Department of Obstetrics and Gynecology at Northwestern. During her residency at New York Presbyterian – Weill Cornell, she founded the Survivor Clinic of New York City, a dedicated clinic for women who had experienced sexual violence, including trafficking, female genital mutilation, and torture in war. Now in Chicago, Dr. Geynisman-Tan has founded the Northwestern ERASE Clinic for survivors of human trafficking and is an asylum evaluator for Physicians for Human Rights. She is currently a co-chair of the American Women’s Medical Association Physicians Against Trafficking of Humans Committee, on the board of the America Hospital Association’s Human Trafficking Consortium and serves on the Cook County Human Trafficking Task Force.

To ban or medicalise? Sri Lanka grapples with debates on Female Genital Cutting

(Please note that a version of this article appears on LankaWeb.com. It has been republished here with permission from the author.)

By Fatima Yasmin  

Country: Sri Lanka

Muslim religious organisations in Sri Lanka have called on the government to medicalise female circumcision to ensure the procedure is done under hygienic conditions. In their submission before the Parliamentary Committee on Women and Gender early in September, the Muslim groups stated that the Muslim community was very concerned about moves to ban the procedure on the grounds that it was Female Genital Mutilation (FGM).  

Spokeswoman Noor Hazeema Haris has reportedly said that although Muslims wholeheartedly have supported the abolition of traditional practices harmful to women and children such as Female Genital Mutilation, the Islamic practice of female circumcision was very different.

She pointed out that the distinction is that female circumcision as practiced by Muslims in Sri Lanka, was a minor procedure, in which only the prepuce or hood of the clitoris was removed.

“It is something that is arranged and done by women. Those who say this is male oppression against women are mistaken. It is we who do it just like our mothers and grandmothers and countless generations of our women have done. We continue to practice it because we know it benefits us. Even educated Muslim women support it wholeheartedly,” she said. “If medical complications have arisen among some women circumcised by Osthamamis (traditional female circumcisors without medical training) as alleged by women’s rights groups, it is all the more reason to medicalise the procedure instead of prohibiting it, which will only drive the procedure underground and put girls and women at unnecessary risk.”

The move is a very dangerous one since it could lead to greater acceptability of FGM. There have been many complaints raised against traditional practitioners including the use of unsterile instruments and harming the clitoris in some cases. However, I believe the solution is to ban it altogether rather than medicalising it.

But analysts warn this could lead to an uproar from religious parties and have political implications since parties that come out against FGM risk losing a large and influential Muslim vote bank. The All Ceylon Jamiyyathul Ulama, an organization of religious scholars in the country issued a fatwa in 2008 stating that female circumcision was obligatory, and was among the parties that made representations to medicalise the practice early in September.

It is also a matter of concern to women’s rights groups that the said Parliamentary committee agreed to accommodate the representations and requested that medical evidence is submitted to prove that female circumcision of the type prescribed in Islam, as stated by these religious groups, causes no harm and benefits women.

A female doctor who performed the procedure before a health ministry circular prohibiting medical professionals from performing it came into effect in the country in October, and whose name has been withheld here by her request, said that she welcomed the move to medicalise it:

“I performed about 25 circumcisions a day in a private clinic, mostly infants. But there were women, too. Some were newly married and wanted to be circumcised at their husbands’ request. All I do is remove a little bit of skin covering the clitoris. I use a very fine instrument for the babies. It takes only a few minutes. In the case of adults, I inject an anesthetic before proceeding to circumcise them. My patients tell me it’s only the injection that hurts a bit and that after that they don’t feel a thing. It’s sore for a few days but heals fast. There is a huge demand for this service. It’s a shame that it’s now going back into the hands of untrained women who have no proper medical knowledge and who use unsterilized instruments for the purpose.”

A young mother who had her infant daughter cut by a traditional practitioner also agreed.

“Doctors refuse to do this now, and I was forced to get it done by an Osthamami. She took out a blade which looked as if it had been used many times and made a cut to my daughter’s genitals. Some blood came out. I could not bear to look. Later I checked it and noticed a cut had been made in the skin over the clitoris but the foreskin had not been removed. This is an improper circumcision according to my sister who is an Aalimah (religious scholar) and so I will have to get her circumcised again. Why are these so-called women’s groups against doctors doing it? We will practice it whether they ban it or not.”

However, a member of a prominent women’s organization said that prohibiting the practice is the right thing to do.

“FGM has been condemned as a violation of the rights of women and girl children by the World Health Organisation. WHO makes no distinction between FGM and the type of circumcision practiced here. It’s all the same. How can you cut these girls and call it a religious obligation? I understand there is a strong religious argument for the practice, but we cannot let religion affect the health of girls and women.”

And so the debate goes on – to ban or medicalise. One thing is for sure. It won’t be easy. Not only does the religious establishment in Sri Lanka, unfortunately, support the practice, but many local women are for continuing it, meaning the government and activists working to end FGM will face many challenges ahead before FGM can be abandoned in Sri Lanka.

Sahiyo Stories to host first screening in Oakland, California

On October 19 in Oakland, California, Sahiyo, in collaboration with StoryCenterAsian Women’s ShelterAsian Pacific Institute on Gender-Based Violence will host a screening of Sahiyo Stories with a behind the scenes short film documenting the women’s experiences in creating their digital stories, followed by a panel discussion on FGC.

To RSVP for the event, visit http://bit.ly/SahiyoStoriesOct

As a reminder, the project brought together nine women from across the United States to create personalized digital stories that narrate the experience of undergoing female genital mutilation/cutting (FGM/C) and/or the experience of their advocacy work to end this form of gender violence. You can watch all these brave women’s stories by visiting the Sahiyo Stories YouTube Playlist.

If you’re interested in learning more about the project or hosting a screening of Sahiyo Stories, contact mariya@sahiyo.com

World Bank Group hosts an informative workshop on FGM/C

On September 13, the World Bank Group hosted an informative workshop titled, “Emotional and Psychological Impact of Female Genital Mutilation/Cutting.” Experts and activists shared their research, experiences, and approaches used to address FGM/C. The workshop also focused on a discussion around meeting the psychosocial needs of those affected by FGM/C. Speakers included Leyla Hussein (keynote speaker), Mariya Taher, Ghada Khan, Angela Peabody, Seydou Bouda, Sameera Maziad Al Tuwaijri, and Khama Rogo.

To watch a recorded video of the event, click here.

Looking from the Outside-In: Initial Perceptions of FGC

By Batoul Saleh

A campaign event for Minnesota Rep. Ilhan Omar and former Michigan rep. Rashida Tlaib was disrupted on August 11 by Laura Loomer, a conservative media personality. Invading the event, Loomer claimed that Omar, a Somali-American, supported Female Genital Cutting/Mutilation (FGC/M), along with other accusations about her African culture and background, essentially questioning her ability to successfully fulfill political office because of her origins.

Laura Loomer is an “investigative Journalist [and] Former Project Veritas operative” and according to the Minneapolis Star-Tribune, she has also been “investigating Muslim candidates” across America prior to the August 11 incident. She later rationalized her unannounced and uninvited appearance at Omar’s event saying that she was “helping Minnesotans “break free from Sharia”.

However, Loomer’s assertion that “[Omar] voted against legislation that would have made Female genital mutilation a felony in Minnesota” because “she didn’t want to offend the Somalian community” while saying that she is “ Somalian first” and “Anti-American” goes no farther than being a rash, racist comment made to instill fear in Minnesotan voters. In reality, the bill that Loomer was referring to, H.F. NO. 2621, which looks to “expand the crime of female genital mutilation; updating requirements for education and outreach; expanding the definition of egregious harm; [and] expanding the definition of a child in need of protection or services to include a victim of female genital mutilation” only had four representatives vote against the bill: David Bly, Rena Moran,  Susan Allen, and Tina Liebling — Ilhan Omar, in fact, voted in favor of the legislation.

This is just a single incident of bigotry; however, for those who have not experiencedScreen Shot 2018-09-20 at 7.47.18 PM.png it themselves or were not raised in a community where FGC is prominent, uninformed and insensitive judgments about FGC/M can be passed on as fact, leaving those who are from those communities stereotyped, ridiculed, and shamed for where it is they come from.

After this incident, many Americans, without knowing the truth about Ilhan Omar’s position on the FGC/M case, replied with intense anger and racism against her. With false information coming from alt-right politicians and journalists, the truth is easily distorted, and those individuals can spread those initial misconceptions about Female Genital Cutting just as easily as journalists like Laura Loomer did to encourage division and xenophobia, as shown in the tweets above. (See Sahiyo’s Media Toolkit on effective and sensitive reporting on FGC)

The accusation that Loomer created and spread publicly stems from her failing to separate the values of a person’s country and that country’s political and social beliefs from the personal beliefs of the individual. Just as a considerable amount of Americans now do not align themselves to the US government’s values and decisions, women of African, Middle Eastern, and South East Asian origins are just as much, if not more, unbounded by the uncontrollable beliefs of their government and community. In fact, a US National Library of Medicine National Institutes of Health study concluded that  “prevalence of supporting the continuation of FGM among adolescent girls in Kenya is only 16%, Niger 3%, Senegal 23%”. It has also been recorded by Sahiyo that 81% of the female Bohra community disagreed with the continuation of FGC. Though the prevalence of FGC in the respective countries is high, adolescents girls in these countries are in opposition to its practices.

Thus, there is a clear distinction between someone’s cultural norms and the attitudes they hold, and from an outsider’s perspective, it is vital that the media coverage and education they receive about Female Genital Cutting/Mutilation should be just as nuanced and integrated as the reality of FGC/M.

Sahiyo co-founders win Laadli and ShoorVeer Awards in India

Sahiyo’s investigative report on the previously unknown prevalence of Female Genital Cutting in the Indian state of Kerala won the prestigious Laadli Media and Advertising Award for Gender Sensitivity for the year 2017. The report was authored by Sahiyo co-founder Aarefa Johari and independent writer and activist Aysha Mahmood.

Johari received the Laadli award on behalf of both authors at an event in Delhi on September 14 by Laadli’s founding organisation, Population First. Eminent journalist P Sainath was the chief guest at the event.

Johari and Mahmood’s investigation uncovered, for the first time, that FGC was being practiced covertly by two doctors in a clinic in the city of Kozhikide (Calicut) in Kerala. The doctors admitted to cutting girls and women of all ages from various Sunni Muslim sects in Kerala. Previously, it was widely believed that the Bohras were the only community practicing FGC in India. (Read the Sahiyo investigation report here.)

The Sahiyo investigation caused a furore in Kerala after Mathrubhoomi, a prominent Malayalam newspaper, conducted a follow-up exposé of the same clinic, and published a first-person account of a young woman from Kerala who had undergone FGC as a child. The exposés led to a temporary shut down of the clinic in Calicut where girls were being cut and prompted several religious leaders to publicly condemn the practice. The health minister of Kerala also ordered the state police to take strict action against anyone found practicing FGC.

ShoorVeer Awards

Sahiyo’s co-founders Insia Dariwala and Aarefa Johari won the ShoorVeer Awards 2018 in Mumbai on August 10. The awards, given by the organisation Ample Missiion, were instituted to honour the bravery and courage of “common men and women who have done uncommon things”. The word “ShoorVeer” is Hindi for a brave warrior.

A total of 14 individuals from across India were awarded ShoorVeer awards this year, including two police officers who have excelled in their duties, two children who saved their friend’s life, an amputee sportsman and several women and men working in the fields of education, health, and human rights.

Aarefa won the award for her work as a Sahiyo co-founder to end the practice of Female Genital Cutting. Insia’s award was a recognition of not just her work to end FGC, but also her work to raise awareness about child sexual abuse through her organisation, The Hands of Hope Foundation.

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Insia Dariwala receiving her ShoorVeer Award.
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Aarefa Johari receiving her ShoorVeer Award.