Cut

by Hibo Wardere

  At first, Pamela travelled to Paris for surgery. When they were unable to reconstruct the clitoral hood, which she dearly wanted, she contacted the Desert Flower Foundation in Berlin. There, a plastic surgeon was able to give her the vagina she wanted.

  Women think that it’s traumatic to have surgery, but . . . when you wake up you feel like a different person. You wake up knowing that something has changed. The experience psychologically for me was completely different. When they carry out FGM, they don’t put you to sleep; you don’t have people around you, talking to you, or counsellors like they had in Berlin. [When you’re having the reconstructive surgery] nobody is pinning you down or cutting you against your will – this is someone trying to help you. You tell them what you want and they do what you ask. I had complete control over the situation. It is very empowering, and there wasn’t any pain when I woke up.

  Pamela had her surgery in July 2015, and she has now set up the Revive Foundation, which aims to fund women travelling to Berlin for reconstructive surgery. She is a strong advocate of women following their hearts, and pursuing reconstructive surgery if they feel that it will help them come to terms with their circumcision. ‘It hasn’t given me complete closure. I don’t think you can ever get closure because mentally you know that you’ve been touched. You still get that flash of anger once in a while. You will always regret that you were made a victim of your parents. But it’s one more step, for me, towards reconciliation with my father, my stepmother and with myself.’

  Aside from the potential psychological benefits of deinfibulation, there is often a very practical need for the procedure. Joy Clarke remembers the first time she came across FGM in her clinical career as a midwife, twenty years ago. A woman turned up on Joy’s ward in the very last stages of labour, having suffered Type 3 FGM. As mentioned, some women fall pregnant without ever having been deinfibulated. Joy’s patient, a dentist from Sudan, was already fully dilated when she arrived. ‘The reason we knew this was because, through the tiny hole that remained of her vagina, the baby’s long black hair was twisting and turning.’ The baby was there, waiting to be delivered, but it couldn’t get out because the woman was still entirely infibulated. The woman was obviously in great distress, and she was not alone.

  The woman was yelling, and you want to be calm and to be able to console her, but everyone was panicking. The room was full of doctors and midwives, and I was so shocked, my back was against the wall. The doctor was frightened, the woman was frightened, and the doctor had no choice but to do an anterior episiotomy – that is, he cut her up the front, upwards of her vagina – and the second he did, the baby just fell out. The baby had been pushing against a closed door, and the minute it was open, it fell out on to the bed.

  It is impossible to imagine the fear that woman must have felt as she tried to give birth to her baby, and this is why clinics like Joy’s and Comfort’s aim to identify women before they get to that stage of pregnancy. If that doctor hadn’t opened the woman there and then, both her life and the baby’s might have been lost. Imagine a similar scenario taking place out in rural communities – it’s no wonder that FGM is linked to both maternal and infant death. Today, the procedure at many antenatal clinics is to identify FGM survivors early on in their pregnancy, so they can be opened between twenty and thirty-two weeks, allowing time for them to heal before the birth. Of course, pregnancy should be a time of happiness, when a woman enjoys the way her body changes and grows as she feels the baby kick inside her, rather than a process that involves undergoing yet more surgery and potentially reliving the initial trauma in the recovery period following the deinfibulation. But at least a partial deinfibulation, like I had, is a necessary thing to do, even if the woman hasn’t had a full Type 3 cutting. If her urethra is covered by scar tissue, this could cause huge complications in an emergency situation, particularly if she needed to undergo a Caesarean and had to be catheterised.

  A 2006 WHO study of more than 28,000 women in obstetric centres across various African countries found that women who had undergone FGM were much more likely to experience serious complications during their labour.28 The report found that those who had been subjected to Type 3 FGM were 30 per cent more likely to require a Caesarean than women who hadn’t had any form of FGM. There was also a 70 per cent increase in the number of women with Type 3 experiencing postpartum haemorrhages. Babies born to mothers with Type 3 FGM also had an 86 per cent higher chance of requiring resuscitation. The death rate among babies during and immediately after birth was also worryingly higher for mothers with FGM – 15 per cent higher in those with Type 1, 32 per cent higher in those with Type 2, and 55 per cent higher in those with Type 3. I’m quite sure that had antenatal care of the kind offered by Joy and Comfort been available to women in these African countries, such desperately sad cases could have been prevented. Babies born in Britain to FGM survivors will be much safer, but any increased risk is always of concern. Of course, no woman knows what she will face when going into labour, but the statistics of how FGM survivors – and their babies – suffer speak for themselves.

  Why this tradition, favoured by generations past, would continue today in the knowledge that it puts future generations at risk is just incomprehensible to me – or perhaps they simply haven’t read the same information as we have. If they don’t have access to all the facts, how will they ever know? It helps to understand the conflicting messages mothers receive, passed down from generation to generation – messages from men, from society, from their peers. I believe the more we strive to understand the context of these women’s actions, the closer we will be to helping mothers – both abroad and in the UK – make an alternative choice, like many others already have. Joy Clarke has had many women confide to her that they, like me, asked to be cut – as if in some way this means they were responsible for what happened to them, when clearly they were coerced or subtly pressured into it, if not by their parents, then by the wider community. Just like the one I heard in the playground, the message from those societies is: be cut and then you will be part of this community.

  Ten years ago, a young girl, very close to me, was taken to Tanzania to be cut in the school holidays. Laila had come to this country from Somalia when she was three and had thrived in Britain – she was a bright, outgoing and happy young woman. She was an excellent student and had just sat her GCSE exams, scoring As and Bs across the board, and was due to take up a place in college after the summer break to study chemistry. She remembered nothing of Somalia; Britain was the only home she knew. I had no idea her mother planned to take her away and have her cut until I received a phone call from Tanzania. I begged her mother not to cut Laila, and urged her not to make the same mistake that our mothers had. But her mind was made up; she was adamant and I was thousands of miles away unable to help. Back then I’d heard stories about women taking girls over to places like Tanzania and Dubai in the holidays, how many families paid $200 for a Type 2 procedure under a general anaesthetic in a hospital. Nothing about the sanitised conditions made me feel any better about it.

  The girl who came home from Tanzania was different to the one who’d left six weeks earlier. She was angry, at loggerheads with her mother – and remains so to this day, ten years on. Of course I can see why, but she insists to me that it wasn’t being cut that changed her. Laila has told me: ‘It’s OK, I’m not in any pain. I don’t feel anything. It’s not a big deal.’ I know from my own experience that this is unlikely to be the case, and I can see for myself how much it has changed her. Laila told me that she didn’t want to be cut, but there had been five or six family members – all women – who had coerced her into it. They told her it was a good thing, that it would make her mother happy – who was she to refuse when so many of her cousins seemed convinced that FGM was the right path to choose? And so she said yes, and it destroyed her. She was brainwashed. The girl I knew before was high-achieving; she had great goals and a whole life ahead of her. The girl I know now drifts from job to job; she doesn�
��t know what she wants. All she feels is an anger burning deep inside of her.

  I knew that her mother had broken the law by taking her, but I didn’t have the courage to speak out at the time. If it had happened now, I would move mountains to stop that girl from being cut. But back then I was only just discovering that what had happened to me was child abuse; I certainly wasn’t ready or able to accept that it was happening to others. Today I can see that Laila is still not ready to talk about FGM, but she knows I’ll be here to listen when she is. She is just another example of the girls who are trapped between two cultures, the ones who straddle the void between what their parents want and what they want as a child or teenager growing up in Britain. Can you imagine the pressure that she was put under to agree to be mutilated and the number of lies that she was told to get her to agree? And these lies came from people she knew and trusted.

  This is not a story that is unfamiliar to Dr Comfort Momoh. She sees plenty of women in her London clinic who were taken and cut against their will by parents who wanted to abide by old traditions, and yet wanted their children to be able to have all the very best that a life in the West could afford them.

  ‘We need to empower the young people,’ she says. ‘Young people will say, “I have to follow my culture”, but they get trapped between two cultures – they want to satisfy their parents’ needs but at the same time they want to belong to the West’s community and culture.’

  So many girls must fall into this trap, the space between two cultures, of naturally feeling loyalty towards their family, and yet holding dear the British values that they’ve been brought up with. All children want to please their parents; none of them want to cause disappointment or upset. And yet what is being done to them is totally at odds with Western values, where they may have learned in schools that FGM is wrong. In Britain, we might bring our daughters up to value their bodies, to not become intimate with someone until they are really sure about them. Guidance and information about relationships and sex are gained from within the family; we want our children to be safe. What we don’t do is sew them up from top to bottom to make absolutely sure that they save themselves for their future husbands.

  A 2013 UNICEF report revealed that social acceptance is still the most frequently cited reason for supporting the practice of FGM.29 I can well believe it because I saw it for myself. I wanted to be accepted by my friends, so I asked my mother to cut me. Therefore, I was complicit in my own abuse, just like so many of the other girls I played with, although none of us would have realised that at the time. But it is impossible at four, six, or even sixteen, to know just what FGM is and how it will affect your life. ‘It’s just a little cut,’ they tell you. I often thought about that as I lay recovering from the butchering I received at my own request. Just like most children, we thought we knew everything. We talked about these adult words and phrases as if they meant the same to us as they did to our parents, and yet we had no idea what we were in for.

  In FGM-practising communities, society and family tell girls that it is shameful not to be cut, that’s the lie they spin, or rather that’s the myth they themselves believe. As well as the fact that it’s portrayed as only a tiny cut, you are told that you are ‘brave’ if you are cut, that you are not ‘dirty’, that it will make you a ‘good girl’, a ‘big girl’– who doesn’t want to hear those things as a child? Who wants to be labelled as an unclean coward? Being cut seems like a small price to pay compared to being called that. One FGM survivor explained to the authors of the report, ‘Uncharted Territory: Violence against migrant, refugee and asylum-seeking women in Wales’: ‘Growing up, no one says it’s wrong. At school there was a perception that you are not a woman unless you have been circumcised. Now I am in Wales, I can see it’s wrong.’30

  A further aspect of this debate to consider is the women who are forced into work as cutters. A few years ago, the Home Office heard an asylum application from a woman from Sierra Leone, who had inherited the mantle of cutter in the Bondo society. These women-only societies wield great power in Sierra Leone, and cutters are held in very high esteem within their community, which is why their powers are handed down through generations. Here, the women are not cut for men, but as a form of initiation into these societies of women which hold significant political sway. Except this woman didn’t want it, and she knew she wouldn’t be able to continue to survive in that society if she didn’t take over the role, which would also put her own daughters at risk. It was a dilemma that, had she stayed within her community, would have affected her psychologically and, perhaps, physically. What penalties would she have faced for going against her community and tradition? She probably knew that it was not an option she could consider, and so she applied for asylum to this country on the basis that she had the right not to be coerced into becoming a cutter and therefore a perpetrator of FGM. The Supreme Court accepted her argument in principle, yet rejected her claim on the basis that she came from a rural area in Sierra Leone, so she would be able to live peacefully in the capital, Freetown. We can only hope that she did, rather than succumb to the pressure to comply with this age-old custom that she seemed to determined to escape.

  This woman is an example of the next generation desperate to move away from a life they would otherwise have been expected to continue. It is another example of how attitudes are changing between generations, but it feels like frustratingly slow progress. One thing that does seem to speed up the process is migration. A 2004 academic report found that the younger girls and boys are when they come to live in Britain, the more likely they are to abandon these traditions.31 The authors of the report interviewed 200 single male and female Somalians between the ages of sixteen and twenty-two living in Greater London. They found that those who were living in Britain before the age of six (the usual time a girl would be circumcised) were less likely to be circumcised (42 per cent) than those who arrived after the usual age for circumcision (91 per cent). So we could assume that for many, although sadly not all, coming to Britain itself seems a huge reason to abandon the practice. But of course this is dictated by the parents. What of the children, though – how does it affect how they think and feel about FGM?

  In 2013 a report by UNICEF – ‘Female Genital Mutilation/Cutting: A statistical overview and exploration of the dynamics of change’ – revealed some interesting data about the difference between how girls aged fifteen to nineteen viewed the practice as opposed to women aged forty-five to forty-nine.32 In my country, Somalia, for example, 64 per cent of women were in favour of FGM continuing, and 60 per cent of girls. However, in Egypt, the difference of opinion was much greater, with 64 per cent of women being in favour of FGM, as opposed to 34 per cent of girls. In the majority of cases, support for FGM is a lot stronger in the older group of women, and yet in Uganda just 4 per cent of women think the practice should continue and 13 per cent of girls. However, and overwhelmingly, all the evidence seems to indicate that, with each generation that passes, support lessens, which is exactly what we want to hear, and more education on the subject will only decrease the number of supporters in both age ranges.

  I know myself that education plays a huge part in the abandonment of FGM. Many surveys have revealed that girls who are in secondary education are less likely to be cut and more likely to want the practice abolished. In the 2013 UNICEF report, for example, girls and women in Sudan who have had no formal education are nearly four times more likely to support FGM than girls and women with secondary or higher education. Perhaps unsurprisingly, more than 60 per cent of Somalian girls who have received a Koranic education support FGM, compared to almost 50 per cent of those who’ve received a secondary education – despite the fact that it is not a religious practice.

  What of the attitudes of migrants living in Britain, or British girls whose parents were born in practising countries? Can their migration, or that of their parents, be enough to turn them away from FGM? Personally, I don’t believe that migration itself is enough. For example, in some
cultures, migration has proved to be a reason to continue the practice as a way of identifying and reestablishing tribes once they have settled into new countries they plan to call home. Nor do I believe that the law alone is enough to turn people away from this barbaric practice. The most effective way to change attitudes is through education, and not just of children born into migrant communities, but all British children. I’m amazed, when I give talks in secondary schools, just how few hands go up when I ask who has heard of FGM. If white British teenage girls don’t know what FGM is, how can they help their friends who might be at risk?

  That is exactly what Muna Hassan has found. Muna is a twenty-one-year-old FGM campaigner from Bristol. Her Somalian parents came over to Britain when she was three, although Muna was actually born in Sweden. She and her friends co-founded Integrate Bristol four years ago along with teacher, Lisa Zimmerman. The charity was aimed at promoting gender equality among migrant communities, but they quickly made FGM one of their top priorities. Muna is a great example of the changing attitudes of British girls with regard to FGM today. When I spoke to her, she told me she had seen a huge shift in thinking since her campaigning began a few years ago. ‘Attitudes towards FGM have changed so much within the last couple of years. The things I was seeing when I was sixteen and things I’m hearing now are worlds apart,’ she says. Muna started Integrate Bristol with three other girls. When FGM came up in discussion, Muna had never heard of it, even though both her parents are from Somalia. She and her co-campaigners were talking about violence towards women and girls, about rape, forced marriage, child marriage, and when someone mentioned FGM, Muna assumed it was something to do with the economy, or a bank. She was horrified when she later Googled the term and discovered that 98 per cent of Somalian girls are cut. She then came across the word gudnin and realised that over the years she had heard it mentioned in her own community – she just hadn’t known what it was.