Clitoral Reconstructive Surgery: Hope for Victims of Female Genital Mutilation

Female genital mutilation (FGM) occurs in the US, and unfortunately has been increasing as the immigrant population grows.  In 2000, based on reported cases, it was estimated that 230,000 women and girls had either undergone or where at risk of being genitally mutilated in the United States, a 35% increase from 1990. The New York Metro area has the highest levels of FGM, with 40,813 based on reported cases. The Restoring the Rose Walkathon will occur on September 15, 2012 at Riverside Park, New York City. The event will help to raise awareness on female genital mutilation in the United States and help victims get clitoral reconstructive surgery.

Kadidia Makannera was 9 years old when her clitoris was cut off with a razor along with her external genitalia that were subsequently stitched together, in her Harlem apartment, leaving only an opening the size of a matchstick. She was given no anesthesia. “I could not sleep, the pain was unbearable. When I peed the first time, I felt fresh pain all over again as my urine touched my wound. I didn’t want to suffer that again so I held it for as long as I could”. Kadidia, a US citizen born to Malian parents who relocated to New York in 1976 was genitally mutilated by her maternal grandmother in the bathtub.

Thousands of girls in the United States suffer female genital mutilation in the hands of their immigrant parents. The practice also known as female circumcision is the removal of all or parts of the external female genitalia for non-medical reasons and is often performed without anesthesia. Reasons for the practice include preservation of virginity, faithfulness to husband, initiation into womanhood because the clitoris is a “male part”, avoiding “child death by clitoris”, and other superstitious beliefs.

On August 10, President Obama issued an executive order that directs U.S. departments and agencies to implement the Strategy to Prevent and Respond to Gender-based Violence Globally by cracking down on human trafficking, sexual violence, early and forced marriage, female genital mutilation and so-called honor killings.  CAGeM, an international nonprofit organization working against the practice in the United States has reached out to several government and White House officials to work on eradication of the practice locally.  A federal law was passed against female genital mutilation in the United States in 1997 but as Secretary of State, Hilary Clinton noted on February 6, 2012, the practice still continues.

The practice is prevalent in parts of Africa, the Middle East, and Asia but is also practiced by immigrant communities in Europe, Australia, and America. There are over 140 million genitally mutilated women in the world. Every year, 3 million girls and women will suffer the procedure.

The walkathon comes at a critical time for CAGeM.  As United States survivors gather with supporters to speak out against the practice, the organization hopes to raise funds to ship medical supplies and equipment to the first free hospital providing treatment for victims of FGM in Africa.  The FGM victim restoration hospital established by CAGeM will allow women to receive free clitoral reconstructive surgery, a procedure developed by French surgeon Pierre Foldes that in July was clinically proven to allow women who have undergone female genital mutilation to achieve clitoral orgasms and reduce pain.  The hospital currently has over 500 women on the waiting list for the surgery.  Meanwhile, CAGeM also works with victims in the United States to help them have the reconstructive surgery locally and provides much needed counselling for the trauma associated with FGM. CAGeM is currently advocating for insurance coverage for the surgery using results from the July 2012 study.

Dr. Eno Etuk, a spokesperson for CAGeM stated “The summer holiday is a dangerous time for girls at risk of FGM in the United States.  Tens of thousands of girls in families of immigrant communities send their girls out of the country to areas where FGM is ritually practiced to have them genitally mutilated in very unsterile conditions.  Many girls facing FGM, run away from home causing parents to not disclose their intents to their children.”  A bill, The Girl Protection Act of 2011 (H.R.2221), introduced into congress in June 2011 and into the senate as S.1919 in November 2011, would make illegal, transport out of the country for female genital mutilation. “We hope to encourage congress to pass the Girl Protection Act into law by handing out mass petition cards at the walkathon to participants, which will then be mailed to legislators.”

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Parents feel their children would not be able to get married to someone from their home country without being “circumcised” and would resort to the “wayward” ways of the western world.  Although they have immigrated from practicing countries, they want to stay true to their cultures.  Their children are cautioned against speaking about the ordeal and members of the communities who try to speak out receive death threats. Even when parents do not want to mutilate their girls, they are faced with pressures from their community.  Fatima Mohamed, a Somali immigrant who did not want to circumcise her daughter faces pressures from her US community.  She said “”They say they don’t want to hear it, some think I’m disrespecting my own culture. Some will say, ‘You act like an American now. You forgot about who you are.’ “

New York, physicians are constantly faced with dealing with the complications arising from FGM which include not only physical detrimental health effects, including immediate death but also mental such as post-traumatic stress disorder.  There is also a very high obstetric cost. In addition to severe infections, increasing neonatal death, and painful menstruation, a 2006 study by the World Health Organization showed that deliveries to women who have undergone FGM are significantly more likely to be complicated by caesarean section, postpartum hemorrhage, episiotomy, extended maternal hospital stay, resuscitation of the infant, and inpatient perinatal death, than deliveries to women who have not had FGM.

Since a federal law was passed against FGM in 1997, physicians approached to perform FGM are faced with a dilemma because they know that if they refuse to perform it, it will still be carried out in a very dangerous way at home just like was done to Kadidia. Dr. Terry Dunn, an OB/GYN in Denver said physicians are often approached by mothers saying “I want to have the procedure that makes my daughter like me.”  Dr. Doug Diekema, a pediatrician at Seattle’s Children’s Hospital said “When you’re dealing with religious or cultural beliefs, saying no sometimes is not sufficient for people and it will not necessarily eliminate the practice.”

To address the issue in the United States, last year the international nonprofit organization, Campaign Against Female Genital Mutilation (CAGeM) established a US branch headquartered in New York.  CAGeM was founded in 1998 by African Women Physicians and is the oldest international organization to work exclusively on eradication of female genital mutilation.  It is also the only organization to work exclusively on eradication of the practice in the United States.  On June 16, 2012 they hosted a National Conference “Their Voice” sponsored by the New York Academy of Medicine to raise awareness and promote discussion on FGM in the US and strategies for eradication.  Aberie Ikinko, Director of the US branch of CAGeM), said “It was a very emotional conference because these New Yorkers who had been genitally mutilated spoke out for the first time amidst tears, summing up courage to speak about something the view as very private.  They did this to break the shroud of silence surrounding FGM in the US so that real change can occur.”  One survivor on stage, after telling of her experience of being genitally mutilated, pointed at her father in the audience and said “You did this to me!”  Both father and daughter burst into tears.

Dr. Ousseiny Coulibaly, OB/GYN at Harlem Hospital who is originally from Mali, was a speaker at the conference. Dr, Coulibaly who is currently studying the prevalence of FGM in Harlem to establish a need for comprehensive care and cultural competency for this patient population said “I see victims of FGM all the time.  It is a serious issue that not all physicians are prepared to handle”.

Soraya Mire, a Somali film director who spoke about her experience undergoing FGM on the Oprah show was also a speaker at the conference.  Mire lives in Los Angeles and counsels immigrant parents against the practice.  She addressed the audience at the conference which was largely African, while encouraging survivors to speak out.  “You don’t have a right to do this to your children,” Mire said. “You are continuing the abuse.”  In 2006, Mire helped law enforcement prosecute the first criminal case on female genital mutilation in the U.S.  Khalid Adem of Ethiopia who genitally mutilated his 2-year old daughter in the bathtub of his home in Atlanta was convicted of aggravated battery and cruelty to children.  Mire receives death threats from the immigrant community.  At Their Voice conference, she was awarded the FGM Action Award by CAGeM.

New York is one of 17 states that have outlawed female genital mutilation against minors.  Aberie Ikinko, Director of the US Campaign Against Female Genital Mutilation (CAGeM), stated “The law requires the Office of Children and Family Services to establish education, preventive and outreach activities in high risk communities to inform them of the health consequences of the practice and the provisions of the state law.  However, nothing is being done.  We are trying to fill this void and are hoping that the Office of Children and Family Services and the New York City Health Department will support us in this endeavor”.  In addition to outreach activities, CAGeM provides training workshops for social workers and healthcare providers in the US on the clinical management of FGM as well as child protection issues, and FGM educational tools and resources.

Jessica Gormand, legislative director of Assemblywoman Barbara Clark of Queens said “As far as we know, the state is not undertaking activities to address this issue”.  In 2009, Clark introduced a bill that would require the state Department of Health and the Office of Children and Family Services to produce an annual report to the governor and state legislature on their activities addressing FGM.  Previous versions of the bill have died in senate since 1995.  Gormand said “Part of the motivation for putting this bill forward was to bring this to light.”

Although they were invited, no state officials attended the June16 conference.  Taina Bien-Aimé, the previous Executive Director for Equality Now was a speaker at the conference.  “The United States has fallen behind many European and African countries in addressing female genital mutilation,” she said. “There is a fundamental ignorance on the issue and a limited political will to recognize that girls are at risk here.”

On the International Day of Zero Tolerance Against FGM, on February 6, 2012, Secretary Hilary Clinton stated “Even in the United States we are fighting this practice. FGM/C became a federal crime in the United States in 1997, but the procedure persists in some communities.”  On September 15, 2012, CAGeM will once again give survivors of FGM a chance to speak to the community to promote eradication of the practice.

In addition at the Restoring the Rose Walkathon, CAGeM hopes to strengthen its women’s economic empowerment program in Egypt where the prevalence of FGM is 97%.  In partnership with SAWA association for development in Giza, the program trains women on handcrafts and provides them with microloans to start their own business.  This empowers them to stand up against genital mutilation of their daughters without fear off financial loss from family supports.  It also trains girls on financial independence so that they do not have to succumb to female genital mutilation in order to get married to be financially secure.   The project is especially critical now with the recent threats of legalizing FGM in Egypt.  Recently a mobile convoy paraded streets genitally mutilating women for free.  Rehab Mamoud, CAGeM partner and Chairwoman of SAWA stated “If we don’t empower these women to stand up now, they could succeed in passing this law with little resistance.”  Jewelry and other handcrafts made by these women will be sold at the Walkathon to financially support them and are available at www.sawafordevelopment.org.  Seen from a human rights perspective, FGM reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women.

About CAGeM

Campaign Against Female Genital Mutilation (CAGeM) is an international nonprofit organization made up of mostly volunteer physicians whose primary mission is to eradicate female genital mutilation via health education rather than activism, to protect girls from the procedure, and to provide treatment to victims. CAGeM is the oldest international organization working exclusively on eradication of female genital mutilation and is the only organization working on eradication of the practice in the United States.

Through close collaboration with many different public sector experts, community leaders and local spokespersons, CAGeM links grassroots activism in countries that still practice FGM to foster communication, information and strategy sharing. CAGeM works to ensure that countries practicing FGM adopt a definitive strategy to end FGM and provide protection to women and girls who flee their countries for fear of being mutilated. The campaign focuses on developing and implementing culturally sensitive educational programs to eradicate FGM, assisting victims with medical treatment, and rescuing girls at risk for the procedure and providing them with basic education and care. The campaign also pursues the introduction of legislation banning FGM and is committed to initiating and supporting grassroots anti-FGM campaigns around the world.

CAGeM strongly believes that every woman and young girl has the right to learn, and to enjoy physical, mental and spiritual well-being, and that the health and the well-being of individuals, families and communities as a whole are intertwined.