Cut (22 page)

But if you put aside these variances in custom – the traditional foods, drink, music and clothing that distinguish one FGM-practising community from the next – there is one thing
that all these girls, from Maasai tribes to Manchester daughters, have in common, and that is the pain. These different rituals and rites serve only to normalise FGM within the community, and
validate it as a practice in the eyes of the people who live within it. They are ceremonial smoke and mirrors that have managed to disguise the true nature of the abuse for generation after
generation, so that people both inside and outside the community view the practice as an integral part of that culture’s social life, intrinsic to its structure.

Without the ceremony beforehand, without the party and the presents and all the delicious foods, FGM would be laid bare for what it is – not a rite of passage, but a painful and traumatic
experience forced upon a child, an entirely unnecessary mutilation that is carried out on children to satisfy the belief systems of adults. I don’t doubt that the mothers and fathers of these
children think that cutting them is the right thing to do – no parent would willingly harm their child if there was a choice – but the whole framing of FGM as a cultural tradition
conceals the ugly truth that it is a barbaric and inhumane practice.

And of course, the nature of the area that is cut only adds to the secrecy of the abuse. If a visible part of the body was cut – an ear, an arm – would the practice then be seen
differently? Instead, the pain is hidden between a woman’s legs, buried deep underneath her clothes where no one needs to see it, where no one needs to be confronted by it, or be faced with
the brutality of it. Everyone – the societies that practise it and those in the West who observe it – can turn their eyes away from FGM.

In 2015, a report was released by consultant paediatrician Deborah Hodes and her colleagues from the FGM children’s service, based at University College London
Hospitals.
¹³
It was the first paediatric literature on FGM in the developed world, and a retrospective study of FGM cases seen by Hodes and her colleagues between 2006 and 2014.
Over that time period, forty-seven girls under the age of eighteen were referred to Hodes by health professionals, social workers, teachers and the police, who had suspicions that the girls had
undergone FGM. There were three key findings in the report.

Firstly, there appears to be a move towards what is now being classified as Type 4 FGM. Clear evidence of cutting was found in twenty-seven of the girls: Type 1 FGM (the removal of the clitoris)
was found in two girls; Type 2 (the removal of the clitoris and inner labia) was found in eight girls. No clear evidence of Type 3 (the removal of the clitoris and inner and outer labia and
infibulation) was found in any of the seventeen remaining girls, although there was some evidence of adhesion or sewing together of the front of the genitals in a few cases. This might be
explained, then, by an increasing prevalence of Type 4 FGM, in which the clitoris remains intact and
sunna
(pricking or nicking) takes place – the idea of
sunna
being that
‘letting blood’ from the clitoris lessens its ‘effectiveness’, and will diminish sexual desire in a woman in a similar way to removing it altogether.

The second key finding is one that chimes with the global trend of children being subjected to FGM at an ever-younger age. The majority of the girls were, like me, under the age of ten when the
FGM was performed.

And the third finding is – in my opinion – the most worrying: the increased medicalisation of FGM. According to the report:

The increased medicalisation of FGM might appear at first to be a positive development. Compared to the cutting I and others endured without the use of any anaesthetic and in the most unhygienic
conditions, the thought of a girl being cut under a local or general anaesthetic, in a sterile environment, and being properly cared for afterwards, with the help of pain relief and antibiotics to
combat infection, is obviously appealing. When you consider that in some communities, girls’ labia are held together with thorns and their raw and bloody flesh smeared with mud in the belief
that it has anaesthetic properties, it is not surprising that some might welcome any kind of move towards sanitisation.

In 2001, American anthropologist Bettina Shell-Duncan wrote a paper questioning whether the medicalisation of FGM could be seen as ‘harm reduction’ or as promotion of a dangerous
practice.
¹⁴
In her study, she explored how ‘harm reduction’ had worked in the field of AIDS, where needle-exchange programmes and education on safer drug use had been
adopted in an attempt to minimise the spread of the disease. She asked whether medicalising FGM or promoting
sunna
as an alternative to more invasive forms of the practice could help save
girls from a lifetime of health complications or indeed risk of death. I guess her question was: if it’s going to happen anyway, could we not make sure it happens in a safe environment?

In her report she cited an initiative in both the Netherlands and the US in recent years to aid immigrants who were willing to adapt their rituals to something less invasive. The Dutch
government rejected the proposal in Europe, and the so-called ‘Seattle compromise’, which was based on just nicking the clitoris and allowing one drop of blood to fall, was blocked by
campaigners. Shell-Duncan argued that considering medicalisation as an option for communities unwilling to give up the practice should be explored, saying that if the health of women really was of
paramount importance, then surely this was a worthy alternative in the interim.

But as Hodes states in her report, ‘The “medicalisation” of FGM, although it reduces immediate medical risks, serves only to legitimise and prolong the practice in some
communities.’ In 2010, the WHO issued a report as part of a global strategy designed to stop healthcare providers from performing female genital mutilation. In it, they recognised that 18 per
cent of the girls and women throughout the world who have undergone FGM had it carried out by a healthcare provider, including doctors, nurses and midwives.
¹⁵
This medicalisation
varied greatly, with just 1 per cent reported as medicalised cuttings in some countries, and yet 74 per cent of cuttings were carried out this way in another. The WHO condemned the practice of FGM
by healthcare providers in the strongest possible terms, deeming it to be against the Hippocratic Oath.
¹⁶
They insisted instead that medical professionals should be educated
about FGM so that they are in a position to provide support to those who have undergone it and are able to avoid being pressurised by parents to carry it out, even if they see it as harm
reduction.

In the UK, in a 2004 academic study, eight young women claimed to have been cut in Britain in what they described as a hospital or clinic, although the health professionals they maintained were
carrying out these procedures were clearly never identified.
¹⁷
Eight years later, in 2012, an undercover reporter working for the
Sunday Times
claimed to have uncovered
three men in Birmingham willing to carry out FGM on her fictional daughters, aged ten and thirteen. The men – a doctor, a dentist and a practitioner of alternative medicine – first
reminded the reporter that the practice was illegal, before then suggesting that she have it done abroad, and eventually agreeing, for a fee, to carry out the procedure here in this country. The
tapes and transcripts of conversations were handed over to the police, but the Crown Prosecution Service decided against prosecuting the three men, claiming that the evidence the reporter had
submitted, including the statement she had for some reason refused to sign despite numerous requests, was unreliable.

FGM survivor, campaigner and former model Waris Dirie told the
Sunday Times
at the time: ‘We are talking here about serious crime committed on innocent baby girls. If a white girl
is abused, the police come and break the door down. If a black girl is mutilated, nobody takes care of her. This is what I call racism.’ These men were willing to cut girls in this country
but they were never prosecuted for this. What kind of evidence do they want? Do we wait for someone to murder a person before we prosecute them? No, we take preventative measures. It should surely
make people wonder what kind of person can call themselves a doctor and yet is willing to cut pieces off children for non-medical reasons. It is worse than an ignorant village woman cutting a
child, because doctors are educated, they know that a procedure like this just causes unnecessary suffering and complications for a female, and yet they are willing to do it for financial gain.

And even medicalisation of FGM doesn’t ensure that girls are safe. In 1959, Egypt banned medical professionals from carrying out Type 3 FGM for fear that it legitimised the practice, but
found that removing girls from clinics only forced the practice underground. As a result, in 1994 they reinstated the right of doctors in selected government hospitals to cut girls in an attempt to
preserve life and lessen complications.
¹⁸
In 2007, however, twelve-year-old Badour Shaker died after being circumcised at a private Egyptian clinic.
¹⁹
Her
mother had paid just $9 for a female physician to perform the procedure on her. To buy her silence after her daughter died, the same doctor offered her $3,000. In 2008, there was an outright and
blanket ban on all FGM, but six years later, the same thing happened again. Thirteen-year-old Suhair al-Bataa died after undergoing FGM at Raslan Fadl’s clinic. At first the doctor denied
carrying out the procedure and said she had died following an allergic reaction to penicillin. At first he was acquitted, but after an appeal he was jailed for two years for manslaughter and
received three months for carrying out FGM. Suhair’s father, who ordered the circumcision, was given a three-month suspended sentence. Fadl’s clinic was also ordered to remain closed
for one year. A pathetic penalty in exchange for this girl’s life.

Even in countries where ‘compromises’ have been made, the practice has not been abandoned. For example, a policy in Sudan permitted the removal of the clitoris but forbade any kind
of infibulation. And yet, it is believed that 88 per cent of women are still sewn up in that country.
²⁰

It seems to me that our fear of overstepping the boundaries, of offending different cultures, means that rather than pursuing a policy of zero tolerance we’re instead more willing to
compromise, and this should never be the case where child protection is concerned. We should adapt our principles and refuse to entertain any form of FGM, all of our energy, efforts and initiatives
should be focused on putting an end to it. In the 2013 report, ‘Uncharted Territory: Violence against migrant, refugee and asylum-seeking women in Wales’, it was revealed that FGM is
happening to children at younger and younger ages; in fact, four out of the twenty-seven cases happened to children under the age of one.
²¹
The report speculates that this might
be done to reduce the psychological impact, but there is nothing to say that cutting girls as babies is less psychologically damaging than when they’re a bit older. In Nigeria twenty or
thirty years ago it was popular to cut girls as babies. These women are only now arriving at British GPs’ surgeries and antenatal clinics, and they have no idea, until they’re told by a
doctor or nurse, that a part of them is missing. Can you imagine the psychological impact this would have on a woman? It is hard to comprehend what these women are going through, but I’m
aware that there is a lot of anger in some of those migrant communities in Britain.

The thought of FGM carried out on any child is, of course, absolutely repugnant, but to think that babies are being subjected to this unbelievable cruelty is sickening. A child’s flesh is
surely not even developed enough – what clitoris is there to take from a tiny baby? When I think back to taking my own babies for their jabs and soothing them as they cried, I wonder how any
mother or father could stand by while their infant child, chubby legs still kicking, is mutilated to stem sexual desire. What happened to me when I was six years old was horrific, but at least I
had a chance to know what was being done to me, at least then I could try to process it. As the report states, performing FGM on infants ‘reduces the chance of the child remembering or being
aware that the practice has taken place, thus reducing the chance of presentation and of a successful prosecution’.
²²

Consultant clinical psychologist Amanda O’Donovan works in a specialist sexual wellbeing clinic at St Bartholomew’s Hospital in London, and often treats women who have been subjected
to FGM. She believes that many societies have been guilty in the past of carrying out procedures on children which were seen as best for the child, but education and evolution have shown us that
they were not.

‘At one conference I went to, one woman said that back in the seventies, lots of kids were having their tonsils out, particularly English, middle-class kids, because it was seen as being
better for children’s health. So everyone went along to have their child undergo a general anaesthetic and a surgical procedure because it was
seen
to be something that was good for
the child; it was culturally sanctioned. I’m not comparing the two, but it’s the idea of having an understanding of why and how something happens within society.’