The unspoken practice of female genital mutilation is undermining efforts to create safe motherhood in the developing world.
Amber (not her real name) was officially welcomed into her Ethiopian community at the age of eight, when her mother pinned her down and instructed a professional circumciser to slice off her genitalia. Battling through blurred vision, the elder tacked the remains with thorns, plucked from an acacia tree. The thorns symbolised the straight and proper path Amber would now be able to follow. Two weeks later her flesh fused together, leaving a small hole for urinating and future menstruation. Her family told her she was a lady now; she could hold her head up high.
The World Health Organisation estimates that 140 million women and girls worldwide have been mutilated in this way. The practice of female genital mutilation (FGM) involves removing part, or all, of the clitoris and surrounding labial area. The highest prevalence for FGM is in Northern and Eastern Africa, despite the fact that 18 African countries have criminalised FGM. But increased migration has moved these women – and the practice – all over the world. In the UK, it’s estimated that 66,000 women and girls have undergone FGM. Some experts put the true figure at 280,000.
Twenty year old Amber’s FGM was reversed during labour, using a simple surgical procedure called deinfibulation. It involves slicing open the scar tissue to restore the vaginal opening. Her son Kamal, now 14 months old, is healthy and happy. But Amber’s journey to motherhood has been both painful and humiliating.
Amber moved to London in 2001, aged11 – three years after being mutilated. She first had sex four years later. It was so painful that the neighbours came round to ask why people were screaming and crying. Physically, it took her weeks to recover.
I didn’t know that a girl like me had to be opened up to have sex,” she explains. “I bled for weeks and stayed off school. I had to sit in the bathwater to pee and my mum kept knocking on the bathroom door, asking why I’d been in there for so long.”
Things went from bad to worse three years later when she was raped by a casual acquaintance. The pain was so excruciating that she wanted to die. But a year later she met her baby’s father. She fell pregnant on her 19th birthday but they split up before Kamal was born in 2008.
During Amber’s pregnancy, her GP didn’t know she had been mutilated and nurses only found out when she was due to give birth. Amber was re-opened with a surgical incision, but she felt traumatised and went into shock while giving birth – almost slipping into a coma. She says:
They put me in a different room to my baby. I was shaking and crying so much that the doctors said that they didn’t know what to do. They said, ‘I think we’re losing her’. I felt I was going mad. But I was having flashbacks of the day I was circumcised. Even now my skin goes cold when I think about it. It’s as though I’m there, being held down and cut.”
In Amber’s native Ethiopia, only 6% of births are attended by skilled health workers. For every 100,000 births, 850 women die and many more are seriously and permanently injured. Had Amber had her baby in Ethiopia he may have died or she may have been left incontinent from pushing to give birth through too narrow an opening. But, regardless of location, FGM puts women at a much greater risk of pre and post-natal complications.
The fifth UN Millennium Goal is to reduce maternal mortality by 75% by 2015. Charities such as SafeHands for Mothers have been founded to support this goal. SafeHands provides trained health workers, medical equipment, local infrastructure and emergency transport to make a measurable difference for pregnant women of all ages. At present they are implementing this in 28 villages in Southern Ethiopia.
Yet, FGM is proving to be a persistent risk factor for mothers, both physically and psychologically. Studies have shown that FGM increases the likelihood of foetal asphyxia, excessive bleeding, and the death of both mother and child. And that’s not to mention the diseases (such as Hepatitis B and HIV) that are often transmitted through dirty instruments when the FGM takes place. Building safe birthing centres in the developing world is a positive step, but to be fully successful, this needs to be combined with cultural re-education to eliminate FGM.
Nancy Durrell McKenna, the founder of SafeHands, recognises this. An award winning filmmaker and photographer, she produces educational films. Outreach health workers take these to remote villages in the developing world, armed with solar powered DVD players and a desire to re-educate. Nancy recently produced a documentary about FGM called The Cutting Tradition: Insights into Female Genital Mutilation filmed in Burkina Faso, Djibouti, Egypt, Ethiopia and the UK. She says:
I listened with astonishment to a group of young, educated, men and women in Djibouti express their views. One man responded: ‘When it is cut, her urge will be reduced. This is the main reason the cutting has been done. If she’s left alone without being cut, she will have a high urge, and that’s the problem. That’s why some people call it ‘cutting out the devil’ because that’s the satanic part that has been cut out.’”
Heeding these words, the practice of FGM continues to be passed on from mother to daughter to enhance the child’s marriage prospects. And according to many women, it’s a shedding of blood that links them to their ancestors. Amber admits her own part in the legacy.
I started to believe what my mother had told me, that I was now a proper lady, because of what I’d been through. I started to bully my sister, telling her that she wasn’t a proper lady because she hadn’t been done,”
she admits. Her sister then begged her mother to have her circumcised, and she was cut.
Nancy Durrell McKenna says:
I left Ethiopia haunted by the silent, sad beauty in the faces of those children who had begged their mothers to be circumcised. Why is it that a practice so deeply rooted in tradition, prevented their mothers from telling them the truth?”
FGM is secret, sacred and unsafe. But for many, it’s an integral part of feeling that they truly belong to their community. That need for belonging undermines the need for safe pregnancy and birth practices.
Over the past 14 years, Greta Solomon has worked as a magazine journalist, freelance writer, English tutor and PR account director. She is currently a writing coach – creating and delivering writing skills training courses for corporate clients. She is the author of Just Write It! (McGraw-Hill, 2013) writinglikeaprofessional Tweet her @greta_solomon
- The Cruel Cut (Channel 4 Documentary).
- Stop FGM in the UK now. Petition
- How FGM destroys sexual desire & deepens male domination (justicebrief.com)
- Health bodies draw up joint guidelines to help fight FGM (standard.co.uk)