For International Women’s Day, links and LIKES

Apprised of the suffering inflicted on millions of girls – an estimated 137,000 in the UK – Guardian journalist Maggie O’Kane believes in media’s power to help. With empathy and insight, she approached her editor. Would he agree to feature FGM? She wanted the paper to confront the custom in a way that had not been tried before – in a well-funded, tenacious multi-national campaign. He agreed, stating on camera, ‘We as a paper have committed ourselves to an international campaign to eradicate FGM’.

Launch of the Guardian campaign in the USA

Launch of the Guardian campaign in the USA

Thus, with full support, she and her team have gone on to expose what may be the most widespread crime of which, before The Guardian campaign, few people had heard. Even U.N. Secretary General Ban Ki-moon joined in.Ban Ki-moon 2

Now, for International Women’s Day, a new facebook page is being launched. Your LIKE will ensure the campaign  carries on! Thank you! https://www.facebook.com/gdnendfgm/timeline

Plus, as Maggie writes, “the new and very moving film from Nigeria about one couple,  Abu and Gift Augustine, [who]   fight back.”  http://www.theguardian.com/end-fgm

And last not least, you, too, are certain to appreciate Alice Walker’s gift: http://alicewalkersgarden.com/2015/09/waging-empathy-alice-walker-posessing-the-secret-of-joy-and-the-global-movement-to-ban-fgm/

 

 

 

Breaking the Omerta on FGM. Reflections on Mothers on Mothering Sunday

Mothering Sunday, or Mother’s Day in the UK, falls three weeks before Easter. The tradition dating from the sixteenth century encouraged the dispersed young to return to villages of birth for a family meal that broke the fast for Lent. A simnel cake with marzipan icing often expressed gratitude to women who raised children.

The role of mothers in perpetuating FGM, however, is one of the thorniest aspects of the subject. How are we to understand this particular ‘act of love’, as a Dutch educational film of the early nineties famously called it? The following anecdote meanders toward an answer.

In fall 2004, had you been at Mt. Holyoke College researching FGM, you could hardly have found yourself on more fertile ground. That term prizewinning Senegalese film-maker Ousmane Sembène was on campus, invited to present the first full-length feature film against, in the cineaste’s words, “female genital mutilation,” Moolaadé, introduced by Samba Gadjigo, Sembène’s translator. That same semester, renowned Egyptian physician and novelist Nawal el Saadawi offered a 6-week colloquium at Smith. Twice in South Hadley, these two giants of African resistance to the harmful custom came together. Their message to avid attendees was unequivocal. African leaders and allies alike must break the omerta – the secrecy – that smothers action to end FGM.

Painting and Poem (on FGM)

Godfrey Williams-Okorodus. Painting and Poem (on FGM) Oil on Canvas. 2011

My role as an Associate of the Five Colleges Women’s Studies Research Center included making speeches on FGM. One, on October 7, 2004, early on in the semester, attracted a trio of bright Somali students – let’s call them Amina, Nadija, and Ayan (not their real names). The three, having found my presentation “awesome,” invited me to address the African and Caribbean Students’ Association and to form a study group. Weekly we met to discuss films and readings; we also prepared to spread the word. “What would be better than peer-to-peer encounters,” Amina proposed, “the three of us college students visiting local high schools?” Great idea, I thought. They would bring their cultural sensitivity to the theme. Soon, Northfield Mount Hermon invited us; Amnesty International’s campus group would sponsor.

On December 3, 2004, in Northfield, I gave the speech alone. What had transpired in the meantime? Thanksgiving intervened. The girls, having gone home to Minneapolis, returned with a message from their mothers. “They don’t want us working on this issue,” they told me with considerable regret, “and they forbid us to make any speeches.” “Why?” I asked, though assuring them we wouldn’t – couldn’t – go against their parents’ wishes. “The community is tight-knit,” Nadija explained. “Word would get back and embarrass them.”

Embarrassment is one reason why, in Diaspora, the theme is hushed, though no discomfort accompanies revealing it ‘back home’. In Somalia and other cutting cultures, if performed but NOT disclosed, mortification ensues. Why? For the many reasons the custom prevails. An over-determined behavior, genital ablation is policed by overlapping insistent beliefs, feelings, and fears.

Which beliefs? One rarely discussed but important motive behind mothers’ actions is aesthetic. “Il faut souffrir pour être belle,” the French contend, and any number of constraining customs, advocated and advanced by women, come to mind. Simply glance out the window at the four to five-inch spikes and think not of footwear embroidered to encase the Chinese lotus, for instance, but of sartorial genres closer to home, like corsets or, though not quite as bad yet not known for comfort, the bindings of my adolescence, girdles.

This is beauty in the service of utility, a means to the end of attracting a spouse.

But beyond utilitarian, the judgement – what is beautiful? — is emotional, not rational; and the difficulty lies in that the lovely is defined by culture.

In Aman. The Story of a Somali Girl, amanuensis Virginia Lee Barnes describes the protagonist having inadvertently observed a white woman giving birth. “When I saw that,” Aman notes, “I thought, they’ve got a lot of cow pussy…” (1)

The notion of scalpels slicing the genitals of children should upset us; but a boom in the services of Harley Street surgeons – or visiting a German sauna – tells us that attractive vulvas are domestic, not foreign, ‘exotic’ desires, and mothers who want them for their girls aren’t unlike us. After all, as Simone de Beauvoir notoriously wrote, women are made, not born, and gender identity includes an ideal beauty.cropped-uncut-logo-godfrey.jpg

Consider the following analogy. Inspired by Kafka’s Gregor Samsa who fell asleep as a human being and awoke to find himself a bug, suppose you slumber through the darkness to awaken – if you had lain down a woman- fully bearded. Think a youthful Santa Claus. The ensuing gender dysphoria would be overwhelming, and before leaving the house, you would shave. … After all, a full-furred face obliterates the gendered self. Whiskers aren’t womanly. Nor in cutting cultures is a clitoris.

As Rogaia Mustafa Abusharaf notes, “As far as adherents of the practice are concerned, an uncircumcised female is not a woman. Because of the nature of this belief, its effects on consciousness cannot be underestimated.” (2) Or as Fadwa El Guindi phrases it in an essay about “Female Circumcision Among Nubians in Egypt”: “’Had This Been Your Face, Would You leave It as It Is?’” (3) Cultures where the contours of private parts are public may be challenging to some of us, but feelings for ugliness or beauty that fuel support for FGM can resonate.

To quote another  French author, Madame de Stael: “Tout comprendre, c’est tout pardonner.” To fully understand is to forgive.

Not quite, but the dilemma of the mothers should be seen for what it is: coercion under patriarchy and emotional attachment to concepts of beauty their cultures gave them in their youth.

Notes

1 Virginia Lee Barnes, Janice Boddy. Aman. The Story of a Somali Girl. NY: Random House, 1995. P. 280.

2 Rogaia Mustafa Abusharaf, ed. Female Circumcision. Multicultural Perspectives. Philadelphia: University of Pennsylvania P., 2006.

3 Fadwa El Guindi. “’Had This Been Your Face, Would You leave It as Is?’ Female Circumcision Among Nubians of Egypt.” In Female Circumcision. Multicultural Perspectives. Ed. Rogaia Mustafa Abusharaf. Philadelphia: University of Pennsylvania P., 2006.

THANKS to Godfrey Williams-Okorodus for the paintings above.

 

Contestation around FGM: Activism and the Academy

Source: Contestation around FGM: Activism and the Academy

Simply click on the link above to the Proceedings of our Workshop on FGM at Lady Margaret Hall, sponsored by the International Gender Studies Centre, LMH at the University of Oxford. The occasion for posting today is this afternoon’s showing of MOOLAADÉ as our contribution to International Zero Tolerance to FGM Day.

TIME: 4 p.m. 4 February 2016

VENUE: The Old Library, Lady Margaret Hall

The film:

For more information on the origin of Zero Tolerance Day, see http://nofgm.org/2014/11/12/the-bamako-declaration-female-genital-mutilation-terminology-mali-2005/

 

On Human Rights Day: Leyla Hussein (on Screen) with WAAF (Women’s Action against FGM – Japan)

“I’m 22 years old, living in Manchester, and I was cut when I was 6 years old.”
“I had my FGM done when I was about four.”
“I had FGM when I was seven …”
“I was only eleven …”
“I thought it was like baptism. …”
“The lady came, the cutter. She told me … to lie down in front of her.”
“They put a big table on the patio and there were a lot of people watching.”
“She took out the razor blade and I started to panic straight away. I started to scream. There was already blood … and little bits of skin…”
“The next thing I knew I was lying on the floor and there’s this HUGE woman, VERY big. She sat on my chest and spread my legs apart.”
“And I remember the first cut of the blade, you know, going through your skin, so sharp.”

“I didn’t stop crying and I did not stop bleeding.”
[Audible sigh] “It’s indescribable”
“… the kind of pain that never leaves you. It doesn’t matter whether you’re having a good day or a bad day. You’ll always have the image popping into your head of you standing over your own pool of blood looking at your flesh…” 1

Among WAAF's services, the group translated the UN's interagency statement on FGM into Japanese.

Among WAAF’s services, the group translated the UN’s interagency statement on FGM into Japanese.

Leyla Hussein’s prize-winning film The Cruel Cut features this powerful symphony of voices,  youthful survivors who decry an act from which they should have been immune. The Universal Declaration of Human Rights, already in place when they were excised, failed to protect them. Yet, on 10 December 1948, the U.N. General Assembly had adopted this key document; 67 years later I made my second visit to WAAF (Women’s Action against FGM – Japan), the unfulfilled promise of human rights protection having brought us together.

Leyla in _The Cruel Cut_ on  screen in Tokyo

Leyla in _The Cruel Cut_ on screen in Tokyo

Welcoming their visitors with sushi, green tea, and a shared concern to live up to safeguarding ideals, Nina Raj, Mitsue Ohi and Yoko Hayashi introduced WAAF’s recent projects in Liberia, Sierra Leone, Tanzania, and Uganda. Ten years ago in Guinea,  WAAF supported a nationwide caravan of parliamentarians who visited their constituencies to speak about FGM, an initiative of Cellule de Coordination sur les Pratiques Traditionnelles Affectant la Santé des Femmes et des Enfants (CPTAFE) in Conakry, Guinea, an IAC affiliate, as you can see on WAAF’s flyer (below left).

Our special guest is the Honorable Sophia Nangombe, Ambassador from Namibia to Japan

Our special guest is the Honorable Sophia Nangombe, Ambassador from Namibia to Japan

WAAF flyer 3

WAAF 2015 Flyer

My task was to outline advances on the left-hand side of the Eurasian landmass. Inspired by the successful reception at our workshop on FGM at the University of Oxford, I carried part of our program to Tokyo. There we screened Maggie O’Kane’s excerpts from the Guardian’s global campaign and Leyla Hussein’s The Cruel Cut. In the UK,  media  has been significant in advancing awareness of FGM while also recording the movement to stop it.

Since its inception, WAAF has been backing grassroots initiatives in Africa. To raise funds, they educate the public. One tool is film, the other simple talk. “Twenty years ago, when we set up information booths, nobody knew what FGM was. At the end of the day we were exhausted,  taking 15 – 20 minutes to describe excision and why we were against it. Today things are different. Five minutes are enough,” Nina explained. “Why?” I asked. “Well, for one thing, books, TV programs and movies. Waris Dirie’s memoirs were translated into Japanese as was Alice Walker’s novel Possessing the Secret of Joy, and the films associated with them – Desert Flower and Warrior Marks – played here. We saw Ousmane Sembène’s Moolaadé as well.”
Interestingly, the translator of Possessing the Secret of Joy, Yumiko Yanagisawa, was the founder of WAAF. Although in a telephone interview on 9 September 2013, Yanagisawa discouraged making any direct link between the African American novelist and WAAF’s birth shortly after the story of Tashi appeared, the book played a major role in awakening its translator’s understanding of the issue, and the group has continued privileging narrative as a teaching tool.
This accounts for  keen interest when I shared another novelty. On 20 October 2015 FORWARD UK premiered the claymation films Needlecraft and My Body My Rules (two versions of the same short, the first for teens, the second for under 12’s) which we watched in Tokyo. The London venue – Porticullis House, the office building for Members of Parliament – underscores the serious concern that the British government now gives FGM.
WAAF admired Needlecraft and My Body My Rules, the first of which shows embroidery as an innocent creative process from which flowers spring and a garden of delight results until the scissors become a weapon that snips appendages off a happy child. Audiences gasp as, wholly unexpectedly, an ear and then a nose are sliced. This dramatic visualization is left out of the film  for younger kids. In its place is the girl pleading “don’t hurt me” and insisting that her body, intact, should be left alone. That is, the cheeky child declares, “My body. My rules.”

Recently, especially with realization of Efua Dorkenoo’s dream of a government sponsored “Girl Generation” to end FGM, youth as a target audience is gaining in popularity among NGOs in the UK, Japan and African nations aiming to end FGM. WAAF for instance supports a long-term project in Liberia that in its first year addressed stakeholders, village elders and religious authorities but in the second generated workshops with young people (and FGM practitioners).
Although UnCUT/VOICES Press hasn’t yet produced materials for the youngest grades, several publications are appropriate for high school students: Khady’s Blood Stains. A Child of Africa Reclaims Her Human Rights (2010), a memoir that catalogs rights violations bracketed by its author’s heroic opposition; Violet Barungi and Hilda Twongyeirwe’s Taboo. Voices of Women in Uganda on Female Genital Mutilation (2015), short stories and poetry that capture the pain and injustice of the injury; and Maria Kiminta and Tobe Levin with photographs by Britta Radike, Kiminta. A Maasai’s Fight against Female Genital Mutilation (2015) which combines memoir and analysis. Designed for classroom use, Kiminta is both a personal narrative and a source book.  Khady herself had been a guest of WAAF when she visited Japan to launch the Japanese edition of her book, but review copies of Taboo, Kiminta and Waging Empathy were offered to the group’s English-speaking members.

You can get in touch with WAAF at waaf@jca.apc.org
URL: http://www.jca.apc.org/~waaf/
Facebook: https://www.facebook.com/womens.action.against.fgm.japan

You can order books at 12€ each plus postage  from me: tobe.levin@uncutvoices.com

Notes and Sources:

1 http://www.channel4.com/programmes/the-cruel-cut/videos/all/stop-fgm Accessed 10 December 2015
CPTAFE: http://www.newfieldfound.org/grants.awarded.php?group=52&action=group

http://leylahussein.com/the-cruel-cut/
http://www.theguardian.com/society/video/2015/feb/06/highlights-of-the-guardians-global-media-campaign-to-help-end-fgm

Rituals of Violence: a Maasai in Germany, Kiminta opposes FGM

Maria Kiminta in northern Germany

Maria Kiminta in northern Germany

With UN backing, November 25 draws attention to violence women endure mainly at the hands of men. Because female genital mutilation,  one form that hostility takes, often suppresses male motives because the ‘ritual’ tends to be carried out by women, Kiminta  illuminates this paradox.

First, she describes how the Maasai do it, complicity among everyone involved born of desire for ‘benefits’ that discursively outweigh harm and, second, after sharing how milk splashed on initiates to numb them doesn’t work; how legs are tied, clitoris and labia shorn, and the desire to pee great but squelched to avoid the excruciating pain of acid on an open wound, Kiminta reflects on men’s proclivities.

“I sometimes suspect that male tastes are behind hygienic and aesthetic arguments for FGM, the belief that female genitalia are ugly, malodorous and in need of enhancement by blade. If I were to take the podium, I imagine myself saying, ‘It’s unethical to think that a girl is born “ugly” and that beauty emerges only when you cut her up. … Please understand that we can clean ourselves down there without your resorting to torture. After all, the scalpel doesn’t work as well as sex education would’.”

Having spoken to peers and elders, Kiminta had already “noted with dismay their inability to explain how FGM qualifies a child to become the wife of some older man. What about maturity, responsibility and love? Shouldn’t a mate exhibit these? Do these qualities count for nothing? They certainly fade to the point of disappearing behind the one criterion that trumps all else: that the new bride must be scarred.”

“If it were up to me,” she goes on, “I’d teach my people about virtues to consider when choosing marriage partners – and the cut would not be one of them! If I were a man, I would want an educated wife, not a subordinate I had bought for dowry. Any man’s refusal to marry an intact girl reflects poorly on him for disrespecting children and their rights. And if he really wants her brutal mutilation, what kind of husband will he be? Will he continue his ruthless demands? Insist she obey? Make her suffer for his ego and his pleasure?

“FGM is diabolical in that it causes a child to think like a man. Convinced that he’s right, the best she can imagine is serving him in marriage; persuaded that, when at seven, or ten, or even thirteen, a body part comes off, she’s ready for wifehood. What about making her wholesome instead? Nurturing talent, intellect and skill – all that is left out.”

Academic conference on FGM, in Banjul, the Gambia, May 2009

Academic conference on FGM, in Banjul, the Gambia, May 2009

Yesterday, November 24, the Guardian praised Yahya Jammeh, president of the Gambia, for outlawing FGM. So close to an election, he could be risking votes, some have averred. Or he could be a canary in the mine, sensing that if the percentage of Gambians favoring clitoral ablations has receded, thanks perhaps to Jaha Dukureh’s campaign, he is taking a welcome lead. Good news?

Kiminta, at least, wouldn’t be surprised. Male violence can, after all, be successfully opposed by men.

Sources

Maria Kiminta and Tobe Levin. Kiminta. A Maasai’s Fight against Female Genital Mutilation. Memoir and Sourcebook. Frankfurt am Main: UnCUT/VOICES P. 2015.

Kate Lyons. „The Gambia bans female genital mutilation” http://www.theguardian.com/society/2015/nov/24/the-gambia-bans-female-genital-mutilation

Retrieved 25 November 2015.

Declaration of the Rights of the Child: Lessons from German History for the Fight against FGM

Von Gleichen visit to Sarajevo with Dr. Christian Schwarz-Schilling, June 2007.

Von Gleichen visit to Sarajevo with Dr. Christian Schwarz-Schilling, June 2007.

On 19 November 2015, a family friend, Prof. Dr. Christian Schwarz-Schilling, former Cabinet Minister and High Representative in Bosnia-Herzegovina, celebrated his 85th birthday. Born in 1930, he and his household, we learned, had been marked for life by “frequent visits from the Gestapo” during the years of horror.

It was Claudia Roth (photo below), vice president of the Bundestag and leader of the Green Party, who told us that. Meanwhile, her very presence at the podium was a surprise. Our host’s affiliation with the Christian Democrats (CDU) represents in many ways a contrast. Claudia, however, was amused by the juxtaposition. “You can imagine,” she said, “what he must have thought of me before we met, that is,  if it was a mirror image of my view of him…” As it turned out, they bonded well and only grew in mutual esteem, the cement being a shared regard for human rights. Each cherishes the notion that democracy is meant to uphold the ideals inscribed by the UN in 1948 and again in the Declaration of the Rights of the Child whose anniversary, November 20, is celebrated as the International Day of the Rights of the Child.

Claudia Roth congratulates Christian Schwarz-Schilling on his human rights record

Claudia Roth congratulates Christian Schwarz-Schilling on his human rights record

Christian had in fact been a child when the Gestapo intruded, not an unlikely influence on the principled stance he took in 1992 when, Wikipedia tells us, he “resigned his post in anger at Germany’s inaction over atrocities in the then Yugoslavia — rebuffing Chancellor Kohl’s protestations that Germany’s post-war constitution barred it from stepping in. He told the Chancellor he was ‘ashamed’ to belong to such a government, saying he had entered politics in the first place to ensure that atrocities like those perpetrated by the Nazis ‘never happen again’.”

After we guests, 200 strong, had applauded the stories by the governor of the state (Hesse) and the mayor of Büdingen (Christian’s home town); and enjoyed baritone Florian Dengler with accompanist Marcelo Amaral performing a sonatine and ‘Lieder’ by Reinhard Schwarz-Schilling, Christian’s composer father, our host turned the discourse toward his mother. “You’ll hear a lot about forged passports,” he said, referring to Germany’s present response to refugees, telling us that when they save a life, he advised against harsh critique. “After my father had been dead for twenty years,” he went on, “I finally made two trips to Poland, a nation whose shroud hung mysteriously over us. What did I uncover? That my mother’s passport had not been hers; that she had, in fact, been Jewish but hid her upbringing from the moment revealing it would have meant death.” During her entire lifetime, about the mother he had known, he had never known this, and he wanted us to understand the tragedy of losing that much of who we are …

Journalist Giers' photo of Christian Schwarz-Schilling in the Büdingen Kreis-Anzeiger

Journalist Giers’ photo of Christian Schwarz-Schilling in the Büdingen Kreis-Anzeiger

The arc from the Nazis to deletions of identity brings me to the usual theme of this blog, its principled stance against indifference; against inaction; against the tolerance for cultural excuses for FGM which also imposes on children an alteration, dilution or even loss of personality. Time and again we hear and read about the girl, post FGM, now subdued where she had been outspoken; now shrinking where she had been bold; now hesitant where she had been confident. But more important, it was government failure to intervene to stop atrocities that led to Christian’s humble gesture of resigning from complicity – an act that, after all, didn’t become resignation but redoubled action on an even broader scale in defense of human and thereby also children’s rights.

References: https://en.wikipedia.org/wiki/Christian_Schwarz-Schilling#International_political_career  Retrieved 20 November 2015

Portrait of Christian Schwarz-Schilling by Michael Giers in http://www.kreis-anzeiger.de/lokales/wetteraukreis/buedingen/einer-der-sich-noch-immer-einmischt_16391481.htm   Retrieved 20 November 2015

Photo of Claudia Roth by Tobe Levin

The British NHS (National Health Service): “FGM is not the end. There is hope.”

Hoda Ali and friend attend

Hoda Ali and friend attend “FGM is not the end. There is hope” Ealing NHS Symposium.

“No, I’d rather you didn’t take my picture,” the speaker explained. At a Speak-out in St. Germain-en-Laye where Dr. Pierre Foldes gathers his satisfied patients to talk about their experience with others exploring restoration surgery, I had requested the photo to illustrate my report. “I know I’ll be exposed,” she went on, “but hope to mute my family’s embarrassment.” This dilemma confronts  many in the courageous ‘girl generation’ now taking personal risks to uncover FGM, aiming to save others from the blade and to stop the tradition for good.

On 21 October 2015 in Ealing Town Hall, I was privileged to attend another memorable symposium around developments concerning FGM. The  London event had  been organized by Nolan Victory, Equalities, Diversity & Human Rights Manager, London North West Healthcare NHS Trust together with a team of volunteers including FGM Specialist midwife Edon Aissa and her associates Deqa Dirie (Health advocate at Imperial College Hospital/ FGM African Well Women Clinic and London North West Hospital) and Bishara Hassan. (Delegate’s take-away carry-bags were sponsored by the Vavengers community association with support from the FGM Hope Clinic.)

The gathering coincided with the start of mandatory reporting of FGM whenever found by registered professionals, i.e. physicians, educators, social workers and police.

The directive, focused on patients under 18, enters into force on 31 October. The podium informed its audience, more than sixty strong, what this meant.

Nolan Victory opens the Symposium

Nolan Victory opens the Symposium

It also did much more. Given diverse attendees – many  from practicing communities, others represented NGOs engaged in fighting FGM or appeared out of empathy and interest – presentations ranged from straightforward (and broadly available) facts about the practice to ethical and practical dilemmas posed by the new mandate that would directly affect many participants’ work and lives.

Along with Dr. Isaac John, Chair of the Health & Social Care Black and Minority Ethnic Network, I was honoured to welcome participants by introducing the ‘hope’ announced in the symposium title. I had been asked to talk about Dr. Foldes’ success with 80% of roughly 5000 patients.  The physician who invented the procedure, he repairs old wounds but, more important, renews the confidence and sense of wholeness snatched when the blade struck. Hubert Prolongeau’s Undoing FGM: Pierre Foldes, the Surgeon Who Restores the Clitoris contains heartening testimony from survivors enthusiastically grateful for the new lease on life their regained birth anatomy brings them. The British NHS does not cover the costs of the operation, but a Clitoris Restoration Fund is in formation to enable UK residents to benefit from Foldes’ expertise.

I have attended several ‘speak-outs’ at the Institut en santé génésique in Paris where gratitude often manifests as a feeling of privilege to educate for prevention and enable others to work toward sparing little girls. Like Valentine Nkoyo (in Maria Kiminta and Tobe Levin. Kiminta. A Maasai’s Fight against FGM. UnCUT/VOICES 2015) who spoke to her father about the pain and complications of which he had been unaware, Foldes’ patients have also convinced their  households to stop excising. They are proud to be the last ones cut.

This is wonderful news. The sad part is, the pace is unacceptable. To accelerate men’s knowledge and commitment as well as to inform healthcare professionals, girls at risk and women suffering the consequences, a series of programmes “aimed at highlighting and educating the [public] on the dangers of the practice” preceded the symposium, as Nolan Victory reminded me in his invitation letter. “The London Boroughs of Ealing, Brent and Harrow have some of the largest communities … affected by … FGM.”

Should anyone doubt the urgency, clinical specialist nurse,  head of the African Well Woman’s Service for Waltham Forest, London, and my decades-long colleague in the EuroNet-FGM, Jennifer Bourne gave details from case studies illustrating long-term harm. One patient, for instance, presented in Jennifer’s practice with recurring panic attacks: suddenly overwhelmed by a sense of asphyxiation, her distress was traced to a flashback of the huge adult who descended upon her, crushing the six-year-old’s chest as her clitoris was cut. Similarly, de-infibulation, a service offered to sewn women by Well Woman Clinics in the UK, either under local anaesthesia or referral to a hospital, is not without its shadow side. “The term ‘reversal’ for opening the scar is incommensurate with the initial abuse,” Jennifer said, “since things will never be the same.”

De-infibulation was, however, the mandate of speaker Juliet Albert’s Acton African Well Woman Centre, the first midwifery-led community based institution outside a hospital setting to offer the service.  Juliet regretted that too many of her colleagues had received insufficient – and in many instances, no – training that would have prepared them for the crisis situations in which professionals often first become aware of FGM.  My friend Comfort I. Ottah, midwife and former managing director of FORWARD, once told a story like theirs. Without prior knowledge of FGM, she found herself facing an infant’s crowning skull impounded against a solid wall of sewn flesh – a life-threatening event – without a clue as to the cause or response. “Cut it! Cut it!” the panicked parturient shrieked, and when Comfort obeyed, the infant was hurled from the womb with such force that the midwife, who caught it, was propelled across the room.

To prevent scenes like the foregoing, reported as occurring with some regularity at Birmingham hospitals when untrained staff encounter excised birthing women, and in response to urging by campaigning groups of FGM survivors, the Department of Health is sponsoring FGM Prevention Programmes. To better assess community needs, however, data is required. To this end, an obligation to contribute to an “FGM Enhanced Dataset,” Juliet Albert informed us, will begin.  According to The Guardian, “Under the new law, health and social-care professionals and teachers in England and Wales will be obliged to report all cases of known FGM in under-18s, whether it is disclosed by the victim or seen by the professional.  Failure to report cases within a month, unless there are ‘exceptional’ safeguarding issues, could result in the professionals facing internal disciplinary action or referral to regulators, which could bar them from practice.” (1)

Though there appears to be little dissent regarding the capture of children’s data, the obligation to report adults’ cases is less clear, although, as Juliet reminds us, for adults “mandatory recording of data” is not the same as “mandatory reporting to police” even if it is, under the “Serious Crime Act” of 2015, for girls. And from the gynaecologist’s perspective, a questionnaire specifically asking about FGM will obviate some abuses in the doctor/patient interview. For instance, a general practitioner failed to ask anything about a woman’s infibulation scar although she suffered from recurrent urinary tract infections – evidence of the medical profession ignoring the issue, likely for being ignorant of it.Jennifer Bourne and Tobe Ealing Town Hall

Left, EuroNet-FGM colleagues’ reunion: Jennifer Bourne and Tobe Levin

Thus, given the mandate to report, education of health professionals will improve. For instance, girls having undergone FGM will be entered in a Risk Indicator System (RIS), an electronic health record, whose notation, however, will be removed when the child turns 18. Health Education England has also made available e-learning modules. (2) And the NHS Choices FGM webpage for professionals is worth consulting [http://www.nhs.uk/NHSEngland/AboutNHSservices/sexual-health-services/Pages/fgm-for-professionals.aspx]. The site is rich in guidance for the consultation that is ethical, frank, and courteous – despite the continuing taboo nature of the topic.

This sub rosa feature suggests an additional benefit of mandatory reporting, taking the onus of introducing the topic off of clinicians and passing it on to the government — where it belongs. The symposium revealed, for instance, the extent of secrecy surrounding FGM. Two sisters presented in the clinic, one having undergone clitoridectomy (type 1), the other infibulation (type 3). Even in their sibling intimacy, each remained ignorant of the other’s wound, assuming instead their vulvas were the same.

Difficult to believe, but one mother of eight really did present with an introitus very much the size of the infibulated sister. Because she had laboured outside the country (presumably in Somalia) where re-infibulation is routine, it was strongly recommended to give birth in the UK where this surplus stitching-up would be far less likely. (3)

Hence, to the public and practicing communities must be added the medical profession’s instructional needs. The mandatory reporting questionnaire helps here. Specific questions allow risk assessment. Have you been cut?  Have family members? Do you know about plans to cut others? Naturally children are reluctant to indict their parents because “99% of them,” Joy Clarke tells us, “come from loving families.”

Joy, an FGM specialist midwife who runs the FGM clinic at Whittingdon Hospital notes that all women she examines are asked about FGM, regardless of skin colour or national origin. “Two Portuguese sisters presented with infibulation.” Their mother had been Portuguese, father Somali.

Clearly, the father had it done, but increasing numbers of fathers refuse, as more men – like Pierre Foldes – come on board. In Q and A, one male member of the audience advised, “You should include more men.” “Where have you been?” the podium responded. “I’m here now,” he replied — and hopefully to stay.

Finally, targeting this ephemeral aspect of the fight to end FGM, a Somali filmmaker noted how the movement seemed to proceed “only from project to project, funder to funder, and when the funding ends, so does the project.” Aissa responded: “For me, it’s not a project. It’s my life.” … Just as the symposium foresaw: “FGM is not the end. There is hope.”

Fear, Force, Betrayal and Anguish, Diaspora Hands from Sierra Leone defy group censure to show it as it is ...

Fear, Force, Betrayal and Anguish, Diaspora Hands from Sierra Leone defy group censure to show it as it is …

In gratitude to Nolan and Cheryl-Ann Victory for inviting me to participate in an effective and inspiring event.

1 Karen McVeigh. “FGM. Reporting of Cases among Children becomes Mandatory.” http://www.theguardian.com/society/2015/oct/20/female-genital-mutilation-reporting-cases-children-mandatory Retrieved 25 October 2015.

2 FGM open access presentation now available via the e-lfh.org.uk/FGM programme page. Alternatively please visit http://www.e-lfh.org.uk/programmes/female-genital-mutilation/presentation/ For further information on the programme and how to access the e-learning please visit  http://www.e-lfh.org.uk/programmes/female-genital-mutilation/

3 It is therefore ironic that the first physician formally accused of performing FGM would be an “NHS doctor in a London maternity unit” (Sandra LaVille in The Guardian). Yet, confirming an egregious lack of preparation as the Ealing Symposium pointed out, “until that moment [Dr. Dhanuson] Dharmasena had never seen a woman who had undergone FGM, had never been given training on the subject in his undergraduate or postgraduate studies and had no experience of how to carry out a deinfibulation procedure to help women who have undergone FGM give birth safely. He was handed the mother’s notes, in which midwives had stated she was presenting with type 1 or 2 FGM. Hospital policy dictates that the mother should have been picked up by antenatal teams much earlier in her care, in order to be seen by a specialist team, and referred for a deinfibulation procedure in the months before her due date. But midwives had failed to pick up her condition and instead the doctor had to intervene surgically within minutes, with the birth progressing fast and the baby showing signs of distress.” The single, long figure-eight stitch he then inserted to stop the bleeding also united the labia, an act which, according to Comfort Momoh OBE, is legally FGM although she stresses the need for increased training of medical personnel. See Sandra LaVille, “First FGM Prosecution. How the Case Came to Court.” The Guardian. 4 February 2015. http://www.theguardian.com/society/2015/feb/04/first-female-genital-mutilation-prosecution-dhanuson-dharmasena-fgm accessed 25 October 2015.