28.4.2015. By Lindsey Stevens

Emirates Woman investigates the culturally sensitive issue of female genital mutilation, and asks what is being done to put an end to this practice in the Middle East.

The preparations have been made. In a makeshift clinic in an old school hall, tables dressed with sheets and pillows serve as hospital beds. This isn’t a blood donation centre, or the latest round of vaccinations for schoolchildren. It’s a clinic in Indonesia where girls are taken to be circumcised. The coming-of-age practice is performed in many countries across the world. For some, it’s perceived as tradition, for others beautification, and many believe it’s intertwined with religious beliefs. According to official bodies such as the United Nations and the World Health Organisation, it’s a human rights violation broadly described as female genital mutilation (FGM), or cutting.

More than 140 million girls worldwide are subjected to FGM, which involves the partial or total removal of external female genitalia. Although many think that this is a practice localised to areas of Africa, it’s actually performed in countries across the Middle East, and Asia, as well as parts of Europe and America. “Cutting is thought to have originated in the Nubia region of the Horn of Africa – now Egypt and Sudan,” explains Chief Executive and Founder of The Orchid Project, Julia Lalla-Maharajh. “Some ancient mummies possess markings that indicate the practice. According to some historical accounts, the practice began when one Pharaoh cut his harem of women in order to control them. When others wanted their daughters to marry into his social group, they cut their daughters too. The practice was passed down into different social strata.”

It’s believed that cutting spread through trade routes, migration and ethnic lines, to become a social norm in certain communities. Although exact figures are hard to come by, it’s estimated that in the likes of Somalia 98 per cent of girls are cut. Outside Africa there has been little research, although experts claim it takes place everywhere from Iraq to Iran, the Philippines and Indonesia.

LIFELONG CONSEQUENCES 

“The type of cutting varies in different communities,” says Julia. “It ranges from cliterodectomy (removal of the clitoris) to infibulation – which can include complete removal of a girls’ external genitals and sewing together to seal the wound that remains, with a small hole left for menstruation and urination. This obviously leads to lifelong consequences for the girl.” One of the most immediate risks of this more severe form of cutting, also known as Type III, is death.

Dr Soraya Farah, Gynaecologist and Obstetrician at Serenity Clinic in Dubai Healthcare City, has seen patients with various levels of cuts. She points out that the majority of Middle Eastern cases involve Type I or Type II.  Women with the most severe form are generally from specific African communities, and in some of these cases the genitalia is left “unrecognisable”. “Trauma from FGM is physical and psychological,” says Dr Soraya. “Circumcised girls are at risk of bleeding, shock, anaemia and infections. In addition [there are] long-term complications such as chronic pain, urine infections and birth complications.”

There’s no doubt that cutting is more common in some Middle Eastern countries than others. But it’s a common misconception that female circumcision only takes place in rural villages at the hands of community leaders, barbers and uncertified midwives. In many cosmopolitan towns and cities it’s practiced by medical professionals in clinics, which creates a belief that it’s safe.

Another common belief is that cutting is exclusive to countries where Islam is the prominent religion. This is something that Julia is keen the address. “Cutting takes place in both non-Islamic and Islamic countries,” she explains. “It’s not correct to say that it’s required by Islam; indeed, in many Islamic countries, cutting doesn’t happen at all.”

Hannah Wettig is the project coordinator for Stop FGM Middle East, a campaign by the Iraq-German non-governmental organisation Wadi and the Dutch Hivos organisation. Hannah feels it’s paramount to do further research, rather than rely on stereotypes or speculative information. She points out that until larger studies are carried out across the region, we don’t know the extent of the problem, or if there is one. “In countries that are rapidly modernising, it could be that the trend is fading out,” she says. “But then the trend could be like it is in Malaysia and Indonesia, where the numbers are actually rising.”

Although it’s clear that there are disparities in how different corners of the world deal with cutting on a legal level, merely drawing up legislation isn’t a comprehensive solution. “Laws are a very supportive element,” says Hannah. “But a law itself is not enough. There must be law enforcement.” This is something that Julia agrees with, pointing out that punishing those who injure girls is actually dealing the problem too late – “By the time someone is prosecuted for cutting, the Government in question has already failed in its duty to protect a girl.”

The problem is much more complex than highlighting medical risks and making FGM illegal. Data from Unicef shows that in Sierra Leone, 66 per cent of women aged between 15 and 49 support cutting. In poorer areas, this figure rises to 77 per cent. There are clearly cultural norms that need to be addressed, many of which dictate that a girl is unclean, or more likely to be promiscuous if she is uncut, but often it’s merely viewed as tradition.

Although legislation provides a useful foundation, nothing will change unless attitudes are reformed. Julia explains that the most rigorously evaluated programme is by the Orchid Project’s partners, Tostan. Their approach in Senegal, in partnership with Unicef and the government of Senegal, has helped 7,500 communities stop cutting young girls. This was achieved through education, and teaching communities more about their human rights.

“As cutting is a social norm, it ends with the entire community declaring that they will end it,” says Julia. “This means that the existing social norm shifts to a new social norm – from cutting their daughters to not cutting their daughters.” It can’t be put more simply than that.

Data and information from The Orchid Project, Stop FGM Middle East, Serenity Clinic, Unicef, the United Nations and the World Health Organisation.

Words: Sarah Garden and Lyndsey Steven

Read full article and account by Orchid Project ambassador Jay Kamara-Frederick