California Thaal pe Charcha allowed me to share my experiences through storytelling

By Anonymous

I grew up in India, and when I moved to California a few years ago, I didn’t know anybody from the Bohra Jamaat (congregation). The Sahiyo ‘Thaal pe Charcha’ event came at a time in my life when I had been thinking a lot about sharing through storytelling. What a powerful tool it is to get people together and find ways to let go, heal and learn from our shared experiences. Sitting in a room full of Bohra women, sharing a meal in a thaal (a large circular steel dish), and exchanging laughs and a few cries too, I felt a strong sense of belonging. I soon learned that we all had very different upbringings outside of our Bohra lives, yet very similar experiences as women within the community.

My mother had her storytelling circle her group of women friends who met once a IMG_2198month at each other’s homes, shared a meal together and talked about their lives. She always came back from those gatherings with a glow on her face, as if a heavy burden had been lifted off her shoulders. She felt safe within that group, and the group was built on trust, love, respect, and compassion for each other.

As one of the facilitators of the California Thaal pe Charcha event, I was hoping to create a similar space for all our participants. I knew it would be a challenge since this was the first time we were all meeting, and it takes time to build trust and friendship. But it was heartwarming to see everyone feel so comfortable right from the beginning. The rest of the afternoon was full of rich and insightful discussions about what it meant to grow up Bohra in California, the multiple lives and identities that a woman has to balance, what we value about the community, the pressures, daily challenges and barriers that women faced within the community.

Interactive activities throughout the afternoon allowed participants to share something unique about their lives, and think about what community and freedom meant to them. And just when we needed a break to take in a few deep breaths, and process everything that we had discussed, we were treated to a hot cup of ‘chai’ that warmed our hearts and minds!

We ended the afternoon with many questions, dreams, and hopes in our minds. And I think that is the magic of such gatherings. It pushes us outside our comfort zones but allows us a space to share, to feel important, to know that our voices, our thoughts, and perspectives are appreciated and heard, and most importantly, a reminder, that we are never alone.

I look forward to many more gatherings where we can learn and grow together.

Read more reflections on the Bay Area TPC here!

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Inaugural screening of Sahiyo Stories in California

On October 19 in Oakland, California, Sahiyo, in collaboration with StoryCenter, Asian Women’s Shelter, Asian Pacific Institute on Gender-Based Violence hosted a screening of Sahiyo Stories that included a behind the scenes short film documenting the women’s experiences in creating their digital stories.

Sahiyo Stories involved bringing together nine women from across the United States to Photo 2.jpgcreate personalized digital stories that narrate experiences of female genital cutting (FGC). These nine women, who differ in race/ethnicity, age, and citizenship/residency status, each shared a story addressing a different challenge with FGM/C. Some women who had only recently discovered they had undergone FGM/C were grappling with its emotional and physical impacts, while others were invested in advocacy to prevent it from happening to more girls. The collection is woven together with a united sentiment and a joint hope that the videos will build a critical mass of voices from within FGM/C-practicing communities, calling for the harmful practice’s abandonment.

A panel discussion on female genital cutting followed the screening, and the greater connection FGC has to gender-based violence.

To learn more about Sahiyo Stories, read:

Female Genital Cutting charges dismissed but our work continues: Global reactions to Michigan case news

By Sahiyo

On November 20, U.S. District Judge Bernard Friedman dismissed the female genital cutting charges in the historic Michigan case involving girls from the Dawoodi Bohra sect, emphasizing that FGC should be regulated by states as a “local criminal activity.” Congress enacted the 22-year-old federal law banning FGC in 1996 — the law Judge Friedman has declared unconstitutional.

Charges were dropped against two Michigan doctors, Dr. Jumana Nagarwala and Dr. Fakhuruddin Attar, and six others accused of subjecting at least nine minor girls to FGC. However, Dr. Nagarwala, Dr. Attar and his wife, Farida, and a mother remain charged with conspiracy to obstruct an official proceeding. Dr. Nagarwala is also charged with conspiracy to travel with intent to engage in illicit sexual conduct.

In light of these developments, we would like to share the responses of many Bohras and other activists working to end FGC.

“What is so disappointing to me is that justice will be delayed in this case. There is a growing, global movement against khafz/FGC and we need positive judgments to send a strong message to our community that this practice is harmful and illegal. We must protect future generations of Bohra girls.”
~ Farzana Doctor, Canada  

“By declaring the federal ban on FGM/C unconstitutional, Judge Friedman opens the door for parents to do exactly what was done in this case — take their daughters from states that ban FGM/C to states that don’t so they can be cut.”
~ Umme Kulsoom Arif, USA

“The ruling on the jurisdiction of this case is giving some folks a perceived green light to proudly say that khatna/khafz/FGM/C is not illegal in the US after being afraid to say it out loud after Nagarwala was arrested. But people should understand that there are many state laws still in place (including in Michigan now) and the judge said that FGM/C is a ‘criminal activity’ so parents beware. This does not give you permission to cut your daughters. It will be a regrettable time in history if there is an uptick in the practice of FGM/C in the US because of this technicality in the jurisdiction of this case.”
~ Zehra Patwa, United States

“Shameful really! While 30 other countries have made FGM illegal, US, the supposed defender of human rights, has just shown the world what American justice is…women’s rights are not just not important for the federal court.”
~ Saleha, Canada

“Shocking judgment. But at the same time judgment gave us more spirit to work hard and achieve the desired goal to end FGC. To bring social change takes time but nothing is impossible. I’m sure through our collective efforts we will achieve our goal one day.”
~ Chandni Shiyal, India

“While on our climb towards the summit, we are going to face slips and stumbles but the climb must go on…..this judgement though disappointing is a mere stumble or slip….”
~ Fakhera, India

“This judgment is clearly based on a technicality of the federal versus the state jurisdiction. Irrespective, FGC still continues to be a violent act against 7-year old girls. Are we disappointed to hear this decision? Most certainly. However, it’s only a matter of time until people open their eyes and see the truth. Tradition without any logic can only hold its ground so long. Sati used to be tradition too, in this very land. Look where we are now.”
~ Alifya Thingna, India

“One of the most disheartening outcomes of this case is the lack of outrage among our elected officials. Two, recently elected, Muslim women representatives from Michigan and Minnesota (the two states involved) have failed to use their platforms to proactively address this issue. FGM is an issue that affects the safety of women and girls, and constituents in their communities. This decision (and the lack of public outrage) sends a signal to communities who practice FGM that there will be no accountability.”
~ Maryum Saifee, United States

“It’s a sad day for silent seven-year-old girls when there is no clear US law to protect what is truly theirs!”
~ Rashida Rangwala, United States

“I am so disheartened by this decision! It’s actually shocking. I thought at least USA law would give justice to innocent girls.”
~ Alifya Sulemanji, United States

“No little girl in this world should have to go through the trauma of female genital cutting. Cultures should not be empowered to take away the human rights of their members.”
~ Renee Bergstrom, United States

“I feel angry and deeply disappointed. This isn’t over but it’s incredibly discouraging to see our legal system disrespect and let down girls and women being violated in this country.”
~ Lara Kingstone, United States

“यह केस 23 US राज्यो में FGM कानून के अभाव में जीता गया है। यह एक ही टेक्निकल ग्राउंड है। अब यह केस अमेरिकन सुप्रीम कोर्ट में जाएगा। UN कानून के तहत अमेरिका बाध्य है। अब वहां सुप्रीम के आदेश पर फेडरल कानून बन सकता है। कोई भी संघर्स लंबा समय मांगता है कभी जीत कभी हार होती है। हरेक निष्फलता अगली सफलता का बेज़ (फाउंडेशन) बनता है। भारत के कोई राज्य में ऐसा FGM कानून नही है। मगर हम भी UN के सदश्य है। भारत मे भी ऐसा कानून आज नही तो कल बनेगा।”
~ Ibrahim Patel, India

“There are many practices which have been blindly followed from decades. Some of them have been changed, modified or amended in the course of time, with the advancement of research and scientific development. We are just trying to tell the world the actual fact that women undergo suffering with no fault of their own because of FGC.”
~ Insiya Ganjifrockwala, India

“Regardless of the impending appeal, this decision may inevitably embolden many to continue cutting girls. We should take this opportunity to continue to pressure our leaders to stand against FGC as a human rights violation, to bring awareness to the issue, and to protect our girls.”
~ Jenny Cordle, United States

“I would call this verdict as a legislative failure as no justice has been given to the child, and this gives a loophole to people in that country to keep practicing FGC.”
~ Insiya Lokhandwala, India

“This is horrible! As a victim of FGC myself, I really wanted to see this doctor punished and her punishment to set a strong example for others in the community who practice FGC/ khatna thinking it’s the right thing to do. I feel like we women are never going to get justice for the wrongs done to us. What’s more, these wrongs will continue to go on and little girls will continue to be traumatized. It’s so frustrating and just makes me want to scream.”
~ Shabana Feroze, Bahrain

“I am shocked and deeply disappointed that a Federal judge in the USA has lifted the ban on FGM. It is so, so important that the USA as a world leader takes an unequivocal stand on this human rights issue afflicting women and the girl child.”
~ Zarina Patel, Kenya

“As I was reading, ‘Judge dismisses female genital mutilation charges in historic case.’ My blood was boiling. Where’s the justice for these women? What message is our federal government sending out to all doctors, mothers, and members who carry out this act? That it’s okay for them to violate girls without any real consequences. And what message are they sending out to our young girls? That their bodies are up for grabs? Or that what they’re going through doesn’t matter to us. Sad day to say the least!
~ Aisha Yusuf, United States

“I wasn’t sure what to expect from the  Michigan trial but I never dreamed it would get dismissed on a technicality about federal vs state jurisdiction! I don’t know enough about the law to know if the judge’s ruling was correct but I know I’m not going to let this setback keep me from fighting. Let’s all work together to get legislation passed in the 23 states that don’t yet have a law against FGM so this never has to happen again!”
~ Maryah Haidery, United States

Read more at U.S. Court’s dismissal of FGM/C charge in Michigan case is disappointing but does not condone genital cutting.

Read the Amicus Brief for Dr. Nargawala hearing on November 6, 2018, submitted by Equality Now, WeSpeakOut, Sahiyo, And Safe Hands For Girls in support of the United States.

Read the U.S. End FGM/C Network Statement on Judge’s Decision in Michigan Case.

 

U.S. Court’s dismissal of FGM/C charge in Michigan case is disappointing, but does not condone genital cutting

By Mariya Taher
Co-founder, Sahiyo

I was sitting in my office, reading a blog post submitted to Sahiyo by a woman doing research on Female Genital Cutting in India, when I received a phone call. I answered it, not thinking twice, not knowing that what I was to hear next would leave me dumbstruck.

The call was from a news reporter, who wanted my reactions to the latest news about the United States’ first legal case on Female Genital Cutting (FGC) — the Michigan case involving two doctors and six others brought up on federal charges of performing FGC on nine minor girls in the U.S. I hadn’t heard of the latest news yet. And then, the reporter dropped a bombshell.

It turns out, a U.S. District Judge has dismissed the FGC charges in the case and declared the federal legislation banning and criminalizing Female Genital Cutting in the U.S since 1997 as unconstitutional!

My immediate reaction was, “That’s crazy.” Then my mind shifted to what had happened to me on October 19th, at the inaugural screening of Sahiyo Stories, a collection of digital stories created by U.S. women who have undergone FGC or who have loved ones who have undergone it. After those videos were shown at the screening, a couple walked in, joined the audience, and began to counter the stories of the survivors. They stated that FGC was harmless, that the survivors sharing their stories must only be trying to get attention. I worry that because of what this U.S. District Judge has ruled, what happened at that screening of Sahiyo Stories, might become all too common when survivors share their FGC stories in the hope of preventing harm to future generations of girls.

As stated in the Detroit Free Press by Tresa Baldas

The U.S. District Judge concluded that “as despicable as this practice may be,” Congress did not have the authority to pass the 22-year-old federal law that criminalizes female genital mutilation, and that FGM is for the states to regulate. FGM is banned worldwide and has been outlawed in more than 30 countries, though the U.S. statute had never been tested before this case.

There is no doubt that the decision will be appealed by the government, but this response worries me because without the law, what can we point to, when parents and families are trying to do the right thing and not succumb to the community pressure they face in having their daughter undergo FGC? And at Sahiyo, we do hear from these parents. We hear from parents who tell us they have spared their daughters as well as parents who regret not doing more to protect their daughters, but felt pressured by the community, by members of their families, believing that they had to get it done. That social pressure is real and threatening and at Sahiyo we understand the fear of being ostracised from your family or your community for speaking against what others believe is a religious necessity.

This decision also concerns me because it will be used by proponents of FGC to further suggest that they are justified in pursuing FGC because FGC has been proven harmless. Even though, the fact remains, that this is not at all what the Judge has said in his decision to rule the FGC federal law unconstitutional. To the contrary, the decision made by the Judge clearly recognizes that FGC is a terrible crime.

What the Judge has stated is the following:

“As laudable as the prohibition of a particular type of abuse of girls may be … federalism concerns deprive Congress of the power to enact this statute,” Friedman wrote in his 28-page opinion, noting: “Congress overstepped its bounds by legislating to prohibit FGM … FGM is a ‘local criminal activity’ which, in keeping with long-standing tradition and our federal system of government, is for the states to regulate, not Congress.”

The Judge has ruled that the issue of FGC falls under state law jurisdiction (intrastate) versus federal (interstate). In other words, the judge’s ruling opens up a jurisdiction question and NOT a question on whether FGC is harmful or not.

If “local criminal activity” must be regulated by the state, then it goes to show just how vital it will be for all states in the U.S. to pass laws banning FGC. Currently, only 27 states in the U.S. have such laws. Massachusetts, the state I live in, does not. (See petition ‘Ban FGM/C in MA’).

Even when laws are passed, I believe that it will be important to remember that FGC will most likely still continue just as other forms of gender-based violence such as domestic violence and sexual assault unfortunately continue despite the presence of laws against them. FGC also continues because as a social norm entrenched in the culture, this harmful practice has been touted as a religious or cultural practice that is needed to control women’s sexuality.

This reality points to the importance of education and community engagement to help create social change within communities and amongst groups where FGC might be happening.

To that end, Sahiyo will continue to organize and participate in community events to educate our friends, family and community about the harms of FGC and why it should be abandoned.

Learn more about FGC in the U.S.

If you would like to write about your views on the Judge’s ruling or the Michigan case in general, send a write-up to info@sahiyo.com

 

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.

Read more reflections on the Bay Area TPC here!

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.