FGM - ENGENDERED CRUELTY
Mutilation - things can’t get more personal than this. When it’s done to you, it’s an attack. Violent with physical and mental pain, FGM is the harm inflicted on girls and women by which they will suffer for life.
Female Genital Mutilation is often perpetrated in African countries without anaesthetics by older members of a community. Not being medically trained, they use ash and herbs for pain and sometimes egg to encourage wounds to gel. It is believed that removing ‘masculine aspects’ of female genitals brings beautification as well as purity, cleanliness, chastity, modesty, even family honour.
Coming largely from the ranks of an indoctrinated sisterhood, cutters use crude implements such as razors and scissors to slice and scrape away female genitalia, sometimes bashing the area with a stone to purge any potential pleasure forever. Men, perhaps a local barber who has taken on the role of health worker, may also perform this. Struggling while being pinned down can lead to uncontrolled cuts and fractured bones.
This is the hard yet sensitive subject that Dr Phoebe Abe attended the 2014 GMB Women’s Conference for, as part of her determination to engage communities in a real conversation to promote vigilance to protect women and young girls against this act. She presented her talk using an A-Z framework, in which ‘Z ‘stands for creating zero tolerance towards FGM worldwide.
As Dr Abe began to fill us in on some dreadful figures, those of us who thought we knew about FGM were realising we didn’t know as much as we could. Delegates heard that unbearable blood loss and infection means 10% of women and young girls die at the acute stage through shock and fatal bleeding. When cruelly-wielded tools aren’t cleaned and used on as many as 30 at a time, females are at risk of HIV, hepatitis, septicaemia and tetanus. 25% die from complications, others have chronic symptoms for life which many don’t understand stem from what must be called an unbearable crime.
An estimated 140 million girls and women worldwide have undergone FGM, and 3 million young girls are subjected to it each year. It can be done to babies, just days after birth. The commonest age is 4-7 years old, and hearing Dr Abe tell a story of a grandmother being cut, we learned that no age is safe. FGM is concentrated in what political scientist Gerry Mackie describes as an ‘intriguingly contiguous’ zone of 28 African countries - east to west from Somalia to Senegal and north to south from Egypt to Tanzania. It also happens in the Yemen and Iraqi Kurdistan, and to a lesser extent in Indonesia, Malaysia, the UAE and Saudi Arabia. ‘It is terrible to imagine only 2% of women in a country not being cut’, said Dr Abe. FGM incidence is at 98% in Somalia, 97% in Guinea, 91% in Egypt, 90% in Sierra Leone, 89% in Mali, 88% in the Sudan and 74% in Ethiopia.
Immigration means that FGM now happens globally - ‘It has been banned since 1958 in Europe but they are still doing it,’ said Dr Abe. In March this year it was discovered that every single girl in one class at a school in Sweden had been cut. In Scotland, a journalist reported that a cutter was flown in on the evening that a big hall had been hired to cut girls. As of July 2014, an estimated 137,000 women and girls living in the UK have suffered FGM. In March 2014, figures obtained through a BBC Radio London 94.9 Freedom of Information request revealed that 40,000 women and girls had been treated for FGM in London hospitals since 2009. In Dr Abe’s surgery, out of 5,075 female patients, 56 have had FGM and 8 of them are girls.
Phoebe Abe’s power is in the stories she tells, and her determination to combat FGM at grassroots level through a combination of effective information and practical help. In Uganda, her grandfather was head of the chiefs and practiced his belief in the equality of boys and girls, in particular their access to education. She has been a GP for 30 years. Arriving in London as a refugee, she completed her medical studies at Manchester University.
‘Doctor, can I have my clitoris back?’ was the question asked of Dr Abe at her GP Practice 3 years ago which spurred her commitment to stopping FGM. A nice Somali woman of about 22 years old sat in her surgery and said she’d heard there was a doctor who could do this. Resolving to help the woman, Dr Abe discovered that a Parisian Doctor, Pierre Foldes, was a pioneer of clitoral reconstruction who could get women their feelings back. She told us that girls who have been subject to FGM are willing to pay for this.
The 4 types of FGM are graphic facts that must be faced to open this subject up and put an end to it. Type one is mainly the amputation of clitoris and hood. Type II can involve removal of the clitoris and inner labia. Type III is called infibulation, a word that comes from fibula which is Latin for ‘clasp’ - they cut off everything, fuse the wound, stitch it up and leave a little hole where urine can come through. Dr Abe has seen women who thought urine came from the vagina. Infibulated brides may have to endure 3-4 days, sometimes months of her husband’s ‘little knife’ for full penetration to be achieved. It is often closed again and opened up for childbirth. With type IV the vagina can be cut and tightened.
In different countries, terms used to describe the process are rooted in local meanings for purification and cleanliness, for ‘washing of hands’ and ‘having a bath’. BMA 2011 guidance on FGM says ‘Risk of FGM should be recognised as legitimate grounds for refugee and asylum status,’ as it is a form of child abuse and against the law. On her website, campaigner Hilary Burrage quotes FGM as being ‘A cruel legacy of patriarchal societies and traditions stretching back over millennia,’ which continues turning mothers into criminals and creating a powerless gendered underclass facing life-threatening consequences.
There is a long historical backdrop to FGM and the campaign against it. Dr Abe told us it was documented by Xanthus of Lydia, happening as far back as 250BCE. In Egypt, they used to get slaves from Sudan and stitch them up. In 1859-66 an English gynaecologist, Isaac Baker Brown - co-founder of St Mary’s Hospital in London, performed ‘cliterodectomy’. He died in poverty after being expelled from the Obstetrical society. In 1930, Christian missionary Hilda Stumpf was murdered for opposing FGM. In 1929 Kenya’s missionary council began referring to it as ‘sexual mutilation of women’. In 1958 the UN asked the World Health Organisation to investigate it, but they refused saying it was nothing to do with them. Then the campaigning started to push perspectives against the practice. Anthropologist Rose Oldfield Hayes used the term FGM in 1975. Dr Abe agrees that the term ‘cutting’ doesn’t encapsulate this horrendous act and we must call it by what it is: ‘mutilation’. The UN calls it mutilation now. In 2003 the wife of the Nigerian president began to campaign to end FGM all over Africa. The UK circumcision act of 1985 was upgraded in 2003 to close a loophole regarding taking girls abroad for FGM.
FGM has no known health benefits. The list of health impacts runs the length from stigma, through abscesses and ulcers, kidney failure, dysmenorrhea, morbidity due to anal intercourse - to anger, confusion, hyper vigilance and sexual pain. Lots of documents are being written, but a major concern of Dr Abe’s is the fact that doctors, midwives and nurses are still not picking up on it. One delegate who works in safeguarding noted that she hadn’t heard of it from a safeguarding perspective. Dr Abe came across a woman with step III who was stitched up, had seen several health professionals, yet none of them had talked about FGM. ‘You have to be suspicious,’ she said. Recently, one of her female patients who had had FGM visited the GP travel clinic. When Dr Abe asked her why she was taking her young baby abroad, she was told it was for ‘cultural reasons’. To protect the baby girl, Dr Abe had to get social services involved.
Currently, Phoebe Abe is carrying out an audit of FGM at her practice and repeatedly comes across a commonality of symptoms and treatments in the medical notes of women who’ve had it – difficulty passing urine, back pain, depression, anxiety, babies being born by caesarean section, multiple examples of endoscopy. Nobody can really measure what is happening to the women’s mental health she said, they are in denial and don’t want to talk about it, some are suffering from PTSD. In birth, risk of death to babies for type III FGM is 55%. Dr Abe saw a woman who had suffered from serious health problems including back pain, incontinence, stabbing period pains and depression. She was misdiagnosed with diabetes, given antibiotics by doctors. Health professionals, including psychiatrists and a counsellor, failed to understand that her problems were caused by FGM. The woman ended up with kidney failure and had to have a transplant. When she met Dr Abe at her practice, this was another instance of being the first time a victim had talked about FGM.
You can never forget the pain of FGM, it stays with you forever and these symptoms all lead to a sufferer’s fear and hatred of having sex. Dr Abe spoke of a man beating his wife because she didn’t want to have it. ‘Men have the good life,’ she said, if the woman is disabled through FGM it suits them to drop her and pick up a younger wife.
Dr Abe asks men in this country, how can they allow this to happen to their daughters? Women who are brainwashed into wanting to have it done are told it is their duty. But she believes the fight against FGM is starting to be won, as even some men are now saying they don’t want it. She cited an example of a woman from a long line of cutters wanting FGM for her daughters but her doctor husband said not to have them cut. Dr Abe is reaching out to men to protect young females, to let them enjoy their childhood, to cherish their girls like ‘honey and bees’.
‘B’ in Dr Abe’s FGM alphabet is for boys and forms the backbone of her campaign. Word coming out from the UK Somali community says that young men don’t want to marry a Somali woman, they want someone who is uncut, she said. In Burkina Faso they are teaching the boys how bad it is and the cutting is coming down.
An associate member on the all parliamentary party group on FGM, Dr Abe is concerned that action isn’t taking place at community level - while so many words are being written it’s lamentable that nothing is being done. There is the 2008 multilingual 48-page long Eliminating FGM interagency statement by the World Health Organisation. Together with HM Government’s small booklets in 11 languages, including Swahili and Urdu, there are the 2011 multi-agency practice guidelines on FGM which set out good practice, legal interventions, and guidelines for health professionals, schools and colleges. UK Intercollegiate Recommendations were launched on 4th November 2013. Then there are Jane Ellison’s 2014 parliament recommendations. A parliamentary debate was held in May this year. Dr Abe emphasised the need for health professionals to know these documents exist and where to read them. October 2014 saw the death of Efua Dorkenoo who had done so much work to address the problem of FGM in Britain and Africa.
For all the meetings and work being done by parliamentarians, NGOs, the UN and Amnesty, lessening the incidence of FGM is far too slow. In the UK, FGM has been a criminal offence with a 14 year sentence, for years. Since 2012, parents and girls from communities at risk have been able to carry passports which include a clear government statement that British residents can face this time in prison if they arrange for FGM abroad. Nevertheless, it’s taken until March 2014 for the CPS to announce the first prosecutions. In July 2014, the Home Affairs Select Committee published a report condemning the lack of education, prosecution and action taken with regard to the growing prevalence of FGM within the UK. Committee Chairman Keith Vaz said the failure of the UK to respond adequately was a national scandal. Dr Abe pointed out that perpetrators avoid France because they are strict with the law – all women and girls are checked for FGM, and 100 parents and 2 practitioners have been prosecuted. The NSPCC has a UK helpline. Dr Comfort Momoh leads an FGM campaign in Britain from Guy’s Hospital in London.
It took a British schoolgirl, Fahma Mohamed, the face of the Guardian End FGM initiative, to force Michael Gove via a petition at Change.org to write to schools in England warning them to be alert to the dangers of FGM. Currently Change.org has a petition to enforce the law which forbids FGM and you can also sign a feminist statement against it.
‘It is because of survivors that we know about FGM’, said Dr Abe, urging us to look up the stories they want to be heard on the internet. One girl has no limbs. Dr Abe takes survivors to groups because they are suffering repression. ‘The best thing for us to do is to empower survivors, make them financially sound so that they can work to stop it.’
Sometimes it can be because everybody does it, is the overarching answer to the question why does FGM exist? Happening before the Quran or bible, it is nothing to do with religion. ‘Even Muslim clerics are condemning it,’ said Dr Abe, ‘it is about controlling women, taking away their pleasure and also a form of contraception’. The men want pure women who nobody has touched. Phoebe Abe feels so strong about protecting little girls from this woeful rite of passage to womanhood, where sometimes as young as three they can be dressed up as if they were going to a party but on arrival subjected to horrific child abuse and a shocking legacy of hard lost health. From the age of three, a little girl doesn’t want anybody to touch her and FGM is something that makes women never want to see their country again.
Dr Abe’s foundation webpage for FGM Association Worldwide (FAW) sets out key facts, information on caring for patients and safeguarding children, news updates, links to many articles on the subject, links to hospitals and clinics offering FGM services, and links to organisations such as Daughters of Eve and Equality Now who have been working to eliminate FGM in the UK and globally for 30 years.
GMB National President, Mary Turner, reminded conference that the issue of FGM has been raised again and again by the GMB. It’s been spoken about at the TUC. ‘I call it attempted murder of a girl,’ she said. Like all of us, she finds it difficult to see how a person can damage a child in this manner ‘but we are very observant,’ she added ‘and the GMB has run a heavy campaign on this since 1988’. Dr Abe will credit this in her book, which she intends to give away free as part of her work towards everyone knowing about FGM.
Dr Abe ended her talk with the warning that in the UK there are still communities with a cunning intent to carry it out, ‘Health professionals and all of us must know about Female Genital Mutilation and be vigilant in the prevention of this,’ she said. She is calling for FGM funding initiatives for GP Practices and the GMB was pleased to donate £500 to her foundation.
Written by Caroline Keen a.k.a. Minnie Stacey
Link to Dr Phoebe Abe’s Foundation: www.drabefoundation.com
Link to A Feminist Statement on the Naming and Abolition of FGM: www.statementonfgm.com