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.

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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.

 

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The importance of creating a body of knowledge on female genital cutting

By Cameron Adelman

My ultimate career goal is to work in sexual health with underserved populations. Access to sexual and reproductive health services is incredibly difficult in most states in the United States. It is even more difficult for people living in low-income areas, for the LGBTQIA community, for immigrants, and for people coming from non-Western cultures and perspectives. In designing a research project, these constraints to care services were something I wanted to focus on in some capacity. Genital cutting is a health concern most Western practitioners are unprepared to encounter. Considering the lack of research into psychological and sociocultural relationships to FGC, I felt even the small scale research I would be able to conduct as an undergraduate student could still have an impact by increasing the body of knowledge available.

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Photo by Janko Ferlic on Pexels.com

When I first started working on my project to explore some of the social and cultural factors impacting the quality of life for FGC survivors living in the United States, I was unprepared for the challenges in data collection I would face. I knew that some of the organizations I contacted to recruit participants might decline to participate, but I did not expect so many to not respond at all. The four organizations I originally selected to contact became twelve, and only one yielded any participant data.

My original aim was to collect data from thirty survivors. I figured this was a modest goal, and between the multiple organizations I had contacted that it would not be impossible. I have collected data from eleven survivors. After four months of managing communications between a dozen organizations, I collected just over one third of my initial goal. Even for women who had reached out to support services and organizations, there was still this barrier of stigma and shame preventing the kind of data collection I had hoped for.

The difficulties in data collection lead me to exploring large international databases for information from large scale surveys I could use in addition to my own survey results. I was determined not to let the struggles in data collection stop me from completing this project that had been in the works for over a year. If anything, the barrier in data collection only provided further evidence to the extent of the need for additional research. The taboo nature surrounding FGC and its impact on survivors will never improve if the body of knowledge on the subject remains so limited.

The direction my project has taken has revealed a cycle that keeps this field of research from advancing. The stigma surrounding FGC, the blame and self doubt many women feel about their experience with it, and the difficulties in speaking out against FGC in practicing communities makes collecting data from survivors extremely difficult. The lack of data and research about FGC makes it difficult to reduce the social attitudes and survivor guilt, and support survivors in efforts to speak out. In short, you cannot add to the body of research without data, but you cannot collect sufficient data because of the taboo nature, which an increased body of research could help improve.

From the little data I have been able to collect, there is a clear negative correlation between how supportive someone’s community is of FGC and how that makes women feel – the more supportive a community is of FGC, the more negatively a woman feels about that, and vice versa. Additionally, women in communities that are supportive or very supportive of FGC have had fewer sources of personal support than women in communities that are unsupportive or very unsupportive of FGC. This speaks to the unique challenges in reaching women living in FGC supportive/practicing communities for resources and support, compared to survivors who no longer live in FGC practicing communities. I am still intending to try to address through my research the unique constraints facing survivors in communities and areas supportive of FGC, and the additional social and emotional problems these women may face. I just have to think beyond the scope of the data I have collected through my survey.

As the direction of my research project has morphed and changed over the last few months, it has only served to emphasize the need for this kind of research. The social stigma and shame cannot be addressed if research is not available to speak to the needs and support necessary for survivors. As an undergraduate student, the scope of my research is limited, but I hope even that can be a step along the path to better understanding and support for survivors of FGC.

More on Cameron:

IMG_5046Cameron Adelman is a senior neuroscience major and women and gender studies minor at Wheaton College in Massachusetts. He has been working on his research project about social and emotional effects of FGC since last year. The findings of his research among women who have experienced FGC suggest a number of sociocultural confounds in trying to develop and deliver support systems for women living in practicing communities. Cameron’s hope is to help advise best practices that take these factors, as well as additional risks to wellbeing, into account.

 

Female Genital Cutting (FGC): Is it an Islamic Practice? (Part 2)

By Debangana Chatterjee

Though often being referred to as an Islamic practice, Female Genital Cutting (FGC) precedes both Islam and Christianity. It is believed to have originated in the Pharaonic era of Egypt. Elizabeth Boyle, author of Female Genital Cutting: Cultural Conflict in the Global Community, mentions in the book that before the advent of Islam, Egyptians, who valued FGC (particularly infibulation), introduced a strong slave system and expanded it towards the adjacent geographic region. At the onset of Islam in the Egyptian controlled region, Islam asserted a stringent prohibition towards enslaving other Muslims. Hence, non-Muslim were continued to be used as slaves, and since FGC was done to these non-Muslim women slaves to increase their worth and value as slaves, FGC was by extension spread to other parts of Africa by the slave traders. This remains one of the driving factors behind the spread of FGC in Africa simultaneous to the rise of Islam.

Despite FGC predating Islam, the myth of it being an Islamic practice persists due to the impressions of virginity and purity remaining closely associated with the religion’s values. There are ample reasons to challenge the unnecessary association of the practice with the Islamic culture. First, FGC was common among the Egyptian Coptic Christians and a number of Tanzanian Christian communities. In fact, FGC was also reportedly performed on Western women in the 1950s as a cure to nymphomania and depression according to L. Amede Obiora.

Secondly, the practice is rife only among a limited number of Islamic practitioners of the world. Islam is the world’s second largest religion with approximately 1.6 billion followers of the religion consisting of 23.2 percent of the world population. On the other hand, there are around 200 million reported cases of FGC worldwide which includes non-Islamic people as well. Even if one takes these numbers as absolute, merely 12 percent (approx) of the entire Islamic population is affected by the practice. Thus, FGC does not necessarily qualify as an Islamic practice, considering most of the followers of the religion either nullify FGC or even remain oblivious to it. Third: the Holy Quran altogether stands in opposition to inflicting harm; going by that logic Islam cannot be supportive of FGC inflicting mental/physical harm of any sort onto women/girls. Despite the Prophet being explicit about sunna (tradition) on male genitals, FGC’s existence within Islam remains debatable.

In many countries, Islamic traditions often remain debatable, including discussions on FGC. In the documentary The Cutting Tradition, an imam from the Harar region of Ethiopia is heard explaining how it already existed among various communities and the Prophet merely advised a sunna way of cutting where only the nicking of the clitoral prepuce is permitted. In the same documentary the Grand Mofti of Egypt, Fadilet Al-Mofti Ali Gomma repudiates any religious basis for FGM/C, though in 1994 a religious decree was issued in the country in favour of the practice stating it as an honourable deed for women. In fact, the decree, issued by one of Egypt’s prominent clerics Sheikh Gad el-Haqq, admittedly mentioned that FGC is not obligatory in Islam but should be followed due to the traditional rituals attached to it.

Even in the Afar region of Ethiopia, religious leaders are seen invoking Islamic scripture and text to counter continuation of FGC among practicing community members.

The practice came to South-East Asia in the 13th century, due to the advent of Islam in the region after the change in regime. The Shafi school of Sunni Islam in Indonesia and Malaysia considers FGC an Islamic practice, yet they are culturally influenced by the region where Yemen and Oman are situated, countries that have considerable FGC prevalence.

At a time in the world when right-wing politics riles up with growing Islamophobia, it is important not to straightjacket Islam in order to avoid its unnecessary vilification and mindless demonization. Islam, as it grew, got entangled with cultural traditions in such a manner that it often looks inseparable. But a close and nuanced study of the matter opens it up for further scrutiny and leaves room for potential dialogic engagement with the communities practicing female genital cutting so that in time these communities will come to abandon it.

 Read Part 1 – What Islam says about Female Genital Cutting and how far are these texts invincible?

More about Debangana

Debangana is a doctoral scholar at the Centre for International Politics Organisation and  Disarmament (CIPOD), Jawaharlal Nehru University. Through her research, she is trying to locate the existing Indian discourse surrounding the practices of FGM/C and Hijab into the frame of international politics. If you would like to connect with Debangana, you can reach her at debangana.1992@gmail.com.

What Islam says about Female Genital Cutting and how far are these texts invincible? (Part 1)

By Debangana Chatterjee

A journey through religious texts helps us to validate or disprove the claims that there are religious justifications for traditional cultural practices. A similar logic applies to the claims that Female Genital Cutting (FGC) is an Islamic practice.

The Holy Quran and the hadiths, evolving from the deeds of the Prophet Muhammad, form the basis of Sharia or the Islamic law. Whereas the Quranic scriptures are unquestionable, hadiths require authentication as they are the dynamic source of evolving Islamic practices. Hadiths are the Prophet’s verbal instructions which were documented by various narrators after the Prophet’s death. The actual narration of the text is called the matn and the insad contains the trail of narrators to support the authentic transmission of Prophet’s instructions over generations. Hadiths can be classified as either mutawatir or ahad. Mutawatir hadiths are substantiated and backed up by multiple reporters documenting his guidelines and thus, is adequately acknowledged within the Islamic circle. Praying namaz, donating, fasting and going for Hajj are few of the mutawatir hadiths which are considered fully authentic. On the contrary, although a few ahad hadiths are thought to permit a limited form of female genital cutting, they are deficient of authenticity borne through insad.

According to a Baihaqi hadith, circumcision ennobles women. But many suggest it to be advisory rather than obligatory. One of the Bukhari Sharif hadiths considers circumcision as one of the acts of fitra (human acts inspired by God) like the removal of pubic hair, trimming the moustache, removing armpit hair and shortening nails. In Islam there has been much controversy whether fitra is binding. One Jami at-Trimidhi hadith suggests that there must be an essential bath after sexual intercourse between the two circumcised genitals of opposite gender. Though the supporters here take circumcision as a prerequisite to sexual intercourse and hence to marriage, the commandment of the hadith lies at the fact of taking a shower after sexual intercourse where circumcision may be spoken of as a natural presupposition. Written in Arabic, this hadith may have been toldto a community that was culturally inclined towards FGC at the time it was said. Hadiths by Abu Dawud, Al-Tabrani and Al-Khatib al-Baghdad seem to suggest conducting a plain cut of the clitoral prepuce, as according to them it beautifies a woman’s face and makes her even more desirable to her husband. Primarily even if the hadith  indicates FGC, it eliminates the severe forms of it such as infibulation and only promotes the least severe form.

Other interpretations of this hadith suggest that rather than taking it as the Prophet’s order, one may read this hadith as suggesting it is merely a desirable option. In contradiction, a hadith reported by Abu Sa’id al-Khudri and documented by Ibn Majah and Al-Daraqutni with an authenticated line of insad seems to unequivocally reject any practice amounting to harm.

In Shia Islam, taharat (purity) concerning the notions of hygiene, cleanliness and purity is sometimes put forward to justify FGC. It is believed that due to the clitoral unhooding the excess building up of smegma is addressed. Yet, effective measures of washing and cleanliness are more than adequate to address this issue.Removal of healthy tissues for it does not seem to be credible enough.

In India, Dawoodi Bohras, the largest Bohra sect belonging to the Tayyibi Ism’aili branch of Shia Islam, who practice khatna, consider the Da’i al-Mutlaq, also known as Da’i, to hold an authoritative, infallible status in the community. As the Da’i considers Daim-ul-Islam as the binding religious text for the Bohras, diktats of the text are taken as truth by devout community members. In this text, the Prophet is believed to advise for a simple cut of a woman’s clitoral skin as this, according to certain translations of the text, assigns chastity to a woman and makes her more ‘beloved by their husbands’. Though supporters of FGC cite this as the reason for the continuation of khatna, scholars have shown that da’is have never been as invincible historically, as has occurred in the recent past. In fact, changes in the provision that khatna is required, would add dynamism to the religion.

Islam as a whole neither complies with the practice nor endorses FGC. Despite repeated invocation of religious references as a justification for FGC, considering the myriad number of Islamic texts, the grounds for such justification hold little or almost no merit.

 Read Part 2 – Female Genital Cutting (FGC): Is it an Islamic Practice?

More about Debangana

Debangana is a doctoral scholar at the Centre for International Politics Organisation and  Disarmament (CIPOD), Jawaharlal Nehru University. Through her research, she is trying to locate the existing Indian discourse surrounding the practices of FGM/C and Hijab into the frame of international politics. If you would like to connect with Debangana, you can reach her at debangana.1992@gmail.com.

Why men too must speak out against Khatna

By Priya Ahluwalia

Priya is a 22-year-old clinical psychology student at Tata Institute of Social Sciences – Mumbai. She is passionate about mental health, photography and writing. She is currently conducting a research on the individual experience of Khatna and its effects. Read her other articles in this series – Khatna Research in Mumbai.

Khatna, by virtue of being related to female anatomy, is often categorized as a women’s issue. However, one must also remember that it is a practice performed on uninformed and unconsenting children. We must move beyond defining it as a child or a woman being violated and look at it as a human being who is being wronged, and therefore the most comprehensive way to describe it would be a human rights violation.

Despite it being a human rights issue, it appears as if not many people are willing to speak up against it, even though all people, especially men, need to do so. Within the structure of the Indian patriarchy, men enjoy power not only by virtue of their gender but also by their sheer number in our country. Therefore men can use their position of power to effectively tilt the weights in favor of women who are speaking against Khatna.

Although, ideally we expect all men to support us in the endeavour to end Khatna,  we should also attempt to understand their hesitancy. Within the Indian patriarchal family structure, the woman is seen as the mistress of the house, in charge of children, while men are seen as masters for all things outside the domain of the house. Therefore any attempt by men to venture into the discussion concerning women’s bodies is seen as ill-mannered and a gross violation of clearly demarcated gender roles.

During my research, I met a father who became aware of Khatna and its consequences because he had daughters and therefore vehemently opposed it. He narrated the daily struggle of convincing his own mother against this practice. However, like many other men before and many after him, he was unsuccessful in dissuading the women in his family from continuing it on his daughter. He was blindsided by his mother and given the blanket argument that she knows better for a woman by virtue of herself being a woman.  

Yet research has shown that with increasing education on khatna, more men are willing to campaign against it. Still, the onus of initiating a conversation on khatna among others lies with the women. Communication between men and women, especially husband and wife, is crucial for the discontinuation of Khatna. A woman I interviewed who had undergone Khatna took this initiative and began a conversation with her husband, which gave her immense strength and helped her protect their daughter from falling into the clutches of tradition. Research too corroborates the same: if more men are are part of the decision making process, the less the likelihood that Khatna would be performed on the girl.

The research linked above shows that men who wish to speak up are held back by their limited knowledge on the effects of Khatna.They are unaware of what is removed and what are its ramifications. The primary reason for this ignorance is the lack of conversations about women and their health among family members. This hesitancy to talk about women in front of men comes from the idea that women are equivalent to the family’s honour, therefore talking about aspects of their sexuality may be seen as a violation, thereby a disgrace to the family’s honour.  However, we must move beyond the archaic concept and understand that creating awareness about the ill effects that Khatna has on a woman’s body in no way defiles a family’s honour. After all, what honour can reside in pain?

Conversations about Khatna must begin, questions must be asked and collaborative measures between men women must be taken to put an end to this practice. There are several ways to oppose this practice. You may choose to speak out or you may to choose to silently protest;  however, if active measures are not taken to resist it, then there is passive consent for the continuation of khatna, and we must understand that every time such consent is given, it means another child is being harmed. Therefore, let us come together for the children and do whatever we can, wherever we can.

To participate in Priya’s research, contact her on priya.tiss.2018@gmail.com

 

‘Call it by the Name’: A researcher’s dilemma on the FGM-FGC terminology debate

by Debangana Chatterjee

Two years back when I ventured into trying to understand a culturally specific embodied practice pertaining to procedures involving partial or total removal of the external female genitalia ‘for non-medical reasons’ as a researcher, the biggest challenge for me was to ‘call it by the name’.

Disagreements regarding the usage of the term ‘mutilation’ in Female Genital Mutilation (FGM), bearing a negative connotation, have surged. International organisations and agencies commonly term it FGM. The World Health Organization’s (WHO) justifies usage of the term on the basis of its previous reference in 1997 and 2008 by the interagency statements. WHO also acknowledges ‘the importance of using non-judgemental terminology with practising communities’ and some of United Nations agencies prefer adding the word ‘cutting’. Ultimately, both terms underline the violation of women and girls’ rights.

‘Mutilation’ refers to impairing a vital body part by cutting it off with an explicit intent to harm. In this context, a few other terms used to connote FGM require closer attention. Female circumcision and excision are often used identically with FGM, although these do not fully carry the information regarding the practice. Out of the four types of procedures entailing FGM as specified by WHO, female circumcision appears akin to type I and even occasionally type II FGM and appears not as physically severe as the Type III category. Yet, existing research suggests that treating female circumcision as replacements for FGM fails to take the practice into account in its entirety. Using ‘female genital surgeries’ is contested as well, as it appears to validate medicalisation of FGM or in other words implies that FGM is a medical surgery like other standard surgeries.

The term FGM received significant prominence in the 1990s. Fran Hosken coined the term in 1993 to draw international attention to the ill-effects associated with the practice as well as to distinguish it from the widely prevailing male circumcision practices. For Ellen Gruenbaum the term ‘…implies intentional harm and is tantamount to an accusation of evil intent’ and thus, entails greater chances of hurting sentiments. There are scholars like Stanlie M. James and Claire C. Robertson who prefer Female Genital Cutting (FGC) instead of FGM. They consider ‘circumcision’ insufficient as it makes a ‘false analogy’ to male circumcision. At the same time, they disagree with the term FGM as it subsumes that all types of the procedure are an act of ‘mutilation’. Anika Rahman and Nahid Toubia also choose the understanding of FGC and circumcision as to not force women to dwell on their body as mutilated. These scholars understand the sense of trauma that ‘mutilation’ might connote for some women.

In fact, the constant reference of FGM in the existing international human rights (IHR) discourse mostly remains unaware of other forms of bodily mutilation of women. ‘Mutilation’, in this sense, can mean both bodily modifications attempted through cosmetic surgeries and public sexual violence which remains under the sovereign jurisdiction of the states concerned. Needless to say, mutilation of raped bodies is one of the most common occurrences of sexual violence. When FGM as a cultural practice is emphasised over other forms of ‘mutilation’, it indicates the cultural biases of IHR discourse. It is not to dilute the abhorrence that this practice deserves, but to show how little a space it leaves for consciousness building and community learning. For both the activists and researchers alike, extreme caution is required  to not alienate people and to sustain the dialogic engagement with them.

Also, with ‘mutilation’, a popular imagery of infibulation (narrowing of the vaginal orifice)  is attached. It comes more with its representation in popular culture as is the case with the film Desert Flower. Notwithstanding the reality of the incidence shown in the movie, in most of the cases, the type I and II procedures are conducted instead of type III (infibulation). Clubbing all the procedures under the single rubric either exaggerates type I and II FGM or dilutes the gravity of Type III and some forms of Type IV (Type IV includes miscellaneous procedures like piercing, pricking, incising or stretching of the clitoris, burning or scraping of vaginal tissues. Whereas some of the type IV procedures are of greater concern, others may not necessarily appear as severe).

In the light of these debates over terminologies, how does a researcher resolve her dilemma?

My study aims to locate the practices of FGM/C exclusive to the Bohra Muslim community in India in the frame of international politics. Especially keeping in mind my position as a scholar who is outside the purview of the culture, I stand on the edge of being either called a cultural relativist/apologist (a person who believes that people’s cultural traditions can only be judged by the standards of their own culture and thus, cultural practices are to be judged relative to the understanding of its practitioners) or prejudiced against cultural particularities. My study aims to juxtapose international discourses surrounding the practice vis-a-vis its occurrences in India. Hence, while writing my thesis, I shall be using FGM interchangeably with FGM/C to reflect the larger WHO definition and its usage in the international circle. As no term seems perfect in defining the practice, academically FGM/C looks commonly acceptable reflecting the international outlook towards it. Needless to say, the term FGM/C also has received substantial backlash from the communities and Bohras are no exception to it. An objective and unbiased study of the practice seeks the right approach more than an elusive perfection in terminology. Thus, during my interactions with members of the community, while analysing the local Indian discourse, khatna as a term will be given preference respecting the cultural uniqueness that the term bears.

OLYMPUS DIGITAL CAMERAMore about Debangana

Debangana is a doctoral scholar at the Centre for International Politics Organisation and  Disarmament (CIPOD), Jawaharlal Nehru University. Through her research, she is trying to locate the existing Indian discourse surrounding the practices of FGM/C and Hijab into the frame of international politics. If you would like to connect with Debangana, you can reach her at debangana.1992@gmail.com.

Feeling drained after talking about Khatna? Here are some resources that can help

By Priya Ahluwalia

Priya is a 22-year-old clinical psychology student at Tata Institute of Social Sciences – Mumbai. She is passionate about mental health, photography and writing. She is currently conducting a research on the individual experience of Khatna and its effects. Read her other articles in this series – Khatna Research in Mumbai.

As human beings we are trained to react immediately, lessen the magnitude of pain when injured, manage our emotions when overwhelmed. We always initiate a response, however not all actions can be immediately responded to, especially when they are extremely distressing or traumatic. Often they are hidden away by our minds to prevent any major upheaval for us. However, even when hidden, they tend to seep through the cracks, leading to subtle effects such as difficulty falling asleep, distrustfulness, self doubt, among others. But sometimes, a small object, event or even a word can widen the crack, leading to a dam of emotions running out. This process is called re-traumatization. Perhaps the best description of the same would be an object, event or situation which leads to re-experiencing the emotions and physical symptoms that are associated with the initial episode of trauma.

It is essential to acknowledge that all individuals give a similar physical response to trauma, but the psychological response is never the same. For example, we are biologically programmed to give a physical response to pain, such as crying when injured. However, we are culturally conditioned to suppress the psychological pain caused by the injury, which is essentially the case with women who have undergone FGC/Khatna. Although the pain is suppressed, it cannot be avoided because it begins to manifest indirectly. For example, one of the participants, I interviewed for my research reported that although she does not remember anything from the day of her Khatna, she has been terrified of blades ever since then. This is a clear example of unaddressed psychological distress. Thus, irrespective of whether the response to trauma is immediate, delayed, drastic or subtle, all individuals must gain access to resources for assistance.

Therefore, while delving into a topic such as Khatna, which is emotionally charged and traumatic, it is the researcher’s responsibility to ensure that the effect of re-traumatization is minimized. As cliché as it sounds, listening is perhaps the best therapeutic tool to minimize re-traumatization. Case studies have shown that when victims of trauma are unheard they are more likely to indulge in self-destructive behaviour. Besides listening, providing an open and safe environment, choices, lists of resources and being available post the interview are also known to help. However, it is essential that a sense of independence be encouraged. Therefore survivors must be trained to look out for signs on their own and have a some set of immediate resources be available for themselves.

Some of the signs to look out for:

  1. Sudden and recurring thoughts of an unpleasant event, that may be difficult to control.
  2. Change in sleeping habits: an increase or decrease in the need for sleep, as compared to before the interview with the researcher.
  3. Change in eating habits: an increase or decrease in appetite as compared to before the interview with the researcher.
  4. Difficulty paying attention to an activity at hand, inability to remember information.
  5. Easily irritated.
  6. Not interested in participating in activities which were earlier enjoyable.
  7. Frequent crying spells.
  8. Using negative statements (“I am bad”) while addressing oneself.
  9. Having extremely negative view of the world (“everyone in the world is bad”).
  10. Regular thoughts of death or harming oneself.
  11. Distrust and suspiciousness of those around oneself.
  12. Sense of powerlessness
  13. Increased feeling of fear

Things to do:

  1. Seek out a trusted confidante and talk to them, it will allow you an emotional release as well as provide the support to overcome the current distress you feel.
  2. Arrange your day in a way that allows for at least 1 or 2 activities, such as painting or dancing among others, which give you positive emotions such as happiness. These activities could last from anywhere between 30 minutes to an hour, preferably not consecutively organised.
  3. Seek out support in organizations – research has shown that women who choose to speak out about their trauma by joining organizations working against the trauma that they survived are more adept with dealing with their emotions as they are able to gather wider support of individuals with similar experiences.
  4. Perform physical activity which would allow your body to release positive hormones which would assist in overcoming some of the negative emotions you may currently feel.
  5. Progressive Muscle Relaxation:

Progressive muscle relaxation is a two-step process in which you systematically tense and relax different muscle groups in the body. With regular practice, it gives you an intimate familiarity with what tension—as well as complete relaxation—feels like in different parts of the body. This can help you to you react to the first signs of the muscular tension that accompanies stress. And as your body relaxes, so will your mind.

Steps involved:

  • Start at your feet and work your way up to your face, trying to only tense those muscles intended.
  • Loosen clothing, take off your shoes, and get comfortable.
  • Take a few minutes to breathe in and out in slow, deep breaths.
  • When you’re ready, shift your attention to your right foot. Take a moment to focus on the way it feels.
  • Slowly tense the muscles in your right foot, squeezing as tightly as you can. Hold for a count of 10.
  • Relax your foot. Focus on the tension flowing away and how your foot feels as it becomes limp and loose.
  • Stay in this relaxed state for a moment, breathing deeply and slowly.
  • Shift your attention to your left foot. Follow the same sequence of muscle tension and release.
  • Move slowly up through your body, contracting and relaxing the different muscle groups.
  • It may take some practice at first, but try not to tense muscles other than those intended.

6. Mindfulness Meditation:

Rather than worrying about the future or dwelling on the past, mindfulness meditation switches the focus to what’s happening right now, enabling you to be fully engaged in the present moment and thereby reduce our anxiety.

Steps involved:

  • Sit on a straight-backed chair or cross-legged on the floor.
  • Focus on an aspect of your breathing, such as the sensation of air flowing into your nostrils and out of your mouth, or your belly rising and falling.
  • Once you’ve narrowed your concentration in this way, begin to widen your focus. Become aware of sounds, sensations, and thoughts.
  • Embrace and consider each thought or sensation without judging it good or bad. If your mind starts to race, return your focus to your breathing. Then expand your awareness again.

 

Asking more questions is the key to change, and to ending Female Genital Cutting

By Priya Ahluwalia

Priya is a 22-year-old clinical psychology student at Tata Institute of Social Sciences – Mumbai. She is passionate about mental health, photography and writing. She is currently conducting a research on the individual experience of Khatna and its effects. Read her other articles in this series – Khatna Research in Mumbai

Flexibility is a key characteristic of successful research, and it is an extremely essential component of the questions on which the research is based. Although I believe that having an exhaustive list of questions pre-prepared is essential to keep one on track, however as one reads and interacts with others, newer lines of enquiry are generated. It is crucial that all lines of enquiry be amalgamated to allow for a wholesome insight into one individual’s experience.  

Currently my interactions with women allowed me to see connections in their narratives. Accompanied by the literature I read, I found similarities as well as differences in the narratives of women across the world. Researchers have found that Female Genital Cutting (Khatna) leads to urinary problems, menstrual problems, problems in sexual functioning and difficulties during childbirth; some have even found that the psychological distress of the trauma often leads to depression and anxiety among women. A common pattern I found among studies was that all mental distress experienced by women was studied as a didactic relationship, ie, the women in relation to another individual. For example, sexual difficulties leading to marital distress among husband and wife.

However it was intriguing that in my interactions with women I found that Khatna has a great impact on the women’s relationship with themselves. For example, a participant reported that she dealt with self-esteem issues because she felt out of place while growing up, as she did not have the same sexual impulses towards boys as her other friends, the lack of which she attributed to Khatna. My area of interest was always the psycho-social effect of Khatna. However, now I am more curious than ever to explore how Khatna impacts both women’s social relationships as well as their relationship with themselves.

Little research has been done to explore how an individual’s worldview (ie, understanding of the world and how it functions) shifts after their discovery and understanding of Khatna. My curiosity in this area was ignited when one woman reported that following her discovery of Khatna, she was extremely angry with her family and although she has now made peace with her family, her trust in them and her faith in people’s ability to make good decisions has been shattered. I am now fascinated to interview more women and see how their worldview might have shifted after their discovery of Khatna.

Furthermore, research in attitude formation shows that negative experiences with one aspect of a larger domain leads to a negative attitude towards all aspects of the domain. If the same was extended to the practice of Khatna rooted in religious obligation, it would be interesting to explore how attitudes towards Khatna and religion are interlinked.

With each conversation, the questions in my mind multiply and it is often followed by a sense of hesitation of being overambitious. However, I do not let the hesitation pull me back, and the credit for that goes to one research participant who told me that if someone before us had asked these questions, then we wouldn’t have to be here today, and unless we ask these questions, nothing will change and we will still be here five years down the line.

I have made a decision to change, have you?

To participate in Priya’s research, contact her on priya.tiss.2018@gmail.com

Why the new survey on Khafz (Female Genital Cutting) among Bohras is biased and unscientific

By Mariya Taher, MSW, MFA

Last week, many Dawoodi Bohras around the world received the link to an online “research” survey with questions about Khatna/Khafz practiced in the community. Khafz refers to cutting a portion of a girl’s clitoral hood – a type of Female Genital Cutting – and this new online survey by Dr. Tasneem Saify, Dr. Munira Radhanpurwala T and Dr. Rakhee K claims that it aims to get feedback from Dawoodi Bohra women and men about the practice. (Link to survey is here).

As someone who has gone through the process of designing multiple research studies, I can confidently say that this latest survey on Khatna/Khafz in the Bohra community is neither a safe nor an unbiased tool for conducting proper research on female genital cutting. Other academic researchers who reviewed the Khafz survey have also pointed this out. For example, Usha Tummala-Narra, Ph.D., an associate Professor in the Department of Counseling, Developmental and Educational Psychology at Boston College, states:

The questions are strangely worded, and implicitly and explicitly suggest that the practice is not mutilation or traumatic. There are also no questions related to girls’ or women’s experiences of the practice. We can’t really know much about the definition of khatna/khafz without asking about the experience and its effects over time.”

While Karen A. McDonnell, an Associate Professor and Vice-Chair in the Department of Prevention and Community Health at Milken Institute School of Public Health at the George Washington University, states:

“Overall this survey presents itself as a feedback mechanism from Dawoodi Bohras about female circumcision. Taking the perspective of someone trained in objective survey development in psychology and public health, the survey actually reads in its entirety, not as a feedback, but rather as a tool for marketing a perspective. As the survey proceeds, the tenor of the questions increase in a lack of objectivity and a central cause/message is quite clear and the respondent is made to feel manipulated.” 

While all research has its limitations, the design of this questionnaire suggests that it clearly was NOT created and sent out into the world to collect empirical unbiased research on the practice FGC/Khatna/Khafz. Instead, the bias and manner of wording of this survey tool express that the authors (Dr. Tasneem Saify, Dr. Munira Radhanpurwala T & Dr. Rakhee K) are seeking responses that will justify their motives to prove that Female Genital Cutting (FGC) does not harm girls.

Which makes me wonder, was this research tool (the survey) even vetted before the study’s implementation?

In 2008, because of my increasing passion to end violence against women, I choose to craft and carry out research for my Master of Social Work thesis on “Understanding the Continuation of Female Genital Cutting Amongst the Dawoodi Bohras in the United States.” The issue had been in the recesses of my mind for years and I wanted to learn how a practice that involves cutting the sexual organs of a young girl could ever have been deemed a religious or cultural practice. I wanted to understand how the issue of Female Genital Cutting (FGC) could continue generation after generation without question, because if I could understand this reasoning, then I could better understand why FGC had been done to me at the age of seven.

As a graduate student, my thesis advisors walked me through every step of the research process, from consulting references and existing studies, to contacting other academics and experts who had studied FGC. In the end, I carried out an exploratory study and crafted questions that could be used to conduct ethnographic interviews. Ethnographic interviewing is a type of qualitative research that combines immersive observation and directed one-on-one interviews. In order to draft the questions, I consulted questions used in previous studies by other researchers. My thesis advisors reviewed the questions, and the San Francisco State University’s Institutional Review Board examined my question to ensure there was no hidden bias in the wording of my questions that could lead participants to answer one way or the other.

Having been through the process once, and understanding the importance of having multiple individuals review your questions for hidden biases, years later, I went through a similar process when Sahiyo designed its study on Khatna among Dawoodi Bohra women. Prior to engaging Bohra women for the study, our research tool (the survey) was vetted by many NGOs and expert researchers.  

If this newest Khafz questionnaire by Dr. Tasneem Saify, Dr. Munira Radhanpurwala T & Dr. Rakhee K had been vetted by other individuals and institutions, it would have recognized the following problems well before releasing the study to the public.

intro.JPG1) Participant consent

Prior to filling out a study, it is important that participants are informed of the study’s intention and are able to sign a consent form acknowledging that they understand the study’s purpose and are giving their permission for the findings to be used in a study’s report. The new Khafz -survey does not have a consent form that does such. [See Screenshot to the left]. In fact, the purpose of this survey is misleading to the reader. There is no mention of how the respondents are being recruited and if their responses will be anonymous or even held in confidence and in essence violates a respondents rights as a participant.

2) Confidentiality

The new Khafz survey form requires participants to provide information that will NOT allow their information to remain private. The study requires that participants add their Community ID (ITS52/Ejamaat) Number. As reported in Mumbai Mirror, the ITS number keeps track of a Dawoodi Bohra’s personal details, including the number of times a person visits the mosque. By requiring an individual to enter this information, already the researchers have directly violated a person’s right to privacy. The question also limits respondents to only those who have signed up for such an ITS number. This, therefore, rules out the participation of many individuals born into the Bohra community or to a Bohra parent who may not have signed up for the ITS card for a variety of reasons, but who have had to undergo FGC as children because of a decision made by a family member or community member.

The mandatory requirement of disclosing one’s ITS number can also discourage an individual from filling out the survey for fear of backlash from the religious community for disagreeing with the practice of Khafz Such backlash occurs on a regular basis against advocates speaking against FGC as can be viewed on Sahiyo’s social media accounts. (See Sahiyo Activist Needs Assessment to learn more about the challenges individuals face when they speak in opposition to FGC).

3) Biased questions Khafz survey Q2

Besides the problematic ITS number, the wording of subsequent questions on the new Khafz survey is biased and considered to be leading questions that prompt survey respondents to answer in a specific manner.  Khafz survey Q5

For instance, Questions 2, 5, 9, and 10 make assumptions about religious freedom, media, and activists, rather than posing the questions and response choices in a more neutral, open-ended form.

Khafz survey Q9n10

Questions 12 and 13 are perfect examples of problematic, leading questions: Question 12 Khafz survey Q1213offers a definition of the word “mutilation” without any context to why the word is being asked. Question #13 then frames the question in a manner that can minimize or under report a participant’s level of distress associated with khatna/khafz, and also automatically suggests to the participant that the practice is not mutilation. 

Question 14 is confusing for another reason. The introductory paragraph by the researchers suggests that male participants can take part in the study, however, Question 14 is written and geared towards female participants who undergo Khatna/khafz. Khafz survey Q14Yet, because of the asterisk (*), the question is mandatory for all respondents, meaning men would have to submit a response to Question #14. This inclusion of information would automatically invalidate the data collected as men have NOT gone through khafz. The wording of the question also infers that all Dawoodi Bohra women have undergone khatna/khafz, which, from anecdotal reports and previous research on FGC in the Bohra community, we recognize is not the case. In fact, we do see a trend in the Bohra community of people wanting to give up the practice on future generations of girls. Yet, the survey makes no mention of this trend or suggests that it is even an option amongst survey respondents.

Overall, the Khafz/Khatna study is problematic for an entire milieu of reasons, not only the ones I have listed here. However, as a researcher, a social worker, and a woman who has undergone FGC because I was born into the Bohra community, what saddens me the most about this survey is that it is yet another attempt to discredit and disbelieve the numerous women and girls who have spoken up and stated that FGC was harmful to them. These women have spoken up for no other reason than to be believed, and instead of comforting them, the researchers of this new Khfaz/Khatna questionnaire are trying to silence them.

How I found out Khatna exists and why I choose to speak out

By Priya Ahluwalia

Snugly sitting on my bed on the wintry night of December, a cold chill ran down my spine as I read through the Change.Org petition against Female Genital Mutilation also known as Female Genital Cutting or Khafz.  I failed to recognize the magnitude of this practice because of the lack of knowledge of my own genitalia, but reading the petition created dread in my mind. The dread transformed into anger, anger towards the society that violated its own daughters, anger towards all those who let the practice continue and anger towards the ignorance of my own immunity. In anger I signed the petition but it was the vicarious traumatisation I went through while reading the petition in the first place that made me speak out.

An implicit responsibility of those choosing to speak out is to create more awareness. However, to my amazement I found that despite the multitudes of women affected by it, the information on FGC was little. Therefore I never understood the true roots of the practice and its implications on the community until this February at Sahiyo’s activists retreat in Mumbai. The retreat was perhaps the most comprehensive and genuine source of information about the Bohra community, the practice of Khafz and its implications. The retreat was also responsible for breaking one of the biggest barriers I had while talking about this practice: intellectualization. I had honed the tendency to talk about FGC mechanically, removing all speck of emotion from my voice as a way of protecting myself from further distress and also to prevent any secondary opinions or personal bias colouring my narrative. However emotions are fundamental to those who choose to speak out including myself, and therefore ignoring them would be a grave injustice to us all. A one-toned discussion has never led to any change, therefore it is integral that while holding a discourse on Khatna, the emotions be incorporated within the facts.

While presenting FGC as a topic in my school and college years, I often noticed the discomfort that many people feel as soon as the term genitalia was introduced. I couldn’t help but wonder that if verbalizing the word caused so much distress to an adult, then imagine the fear felt by the seven-year-old girl whose legs were held apart and her rights stolen away. I can feel the anguish, I can feel the anger and I can feel the betrayal she must have felt, because I could have easily been that girl, but here is where my immunity lies; I come from a community where this form of gender violence does not exist. However, the immune must support raising those who have undergone FGC which is why I chose this as a topic for my master’s thesis.

This was not a decision I took lightly or quickly, because I know the responsibility that lies with me. I had felt reluctance because I wondered if I, an outsider with little understanding of the community and the practice, would be able to do justice to the women and their stories. I do not know how the thesis will turn out but I know that I will do my best to do right by the women who choose to speak to me. They will not be just data but people with stories to tell that need to be protected and preserved. My aim is to understand the practice as a whole and therefore, I do not want to have a hypothesis of the results I will get, rather I wish to incorporate in my research as many voices as I can, both those who are pro-khatna and those who oppose it.

My job as a researcher will be to be open to all narratives and record them as authentically as I can.

All of us have a voice and therefore have the responsibility to use it wisely. Thus, I choose to use my voice for myself and all those women who have been silenced under the burden of tradition.

(Priya Ahluwalia is a 22-year-old clinical psychology student at Tata Institute of Social Sciences – Mumbai. She is passionate about mental health, photography and writing. To participate in her research, contact her on priya.tiss.2018@gmail.com )