A light wind blows in the Midlands and gives way to a hospital scent that I am so familiar with. I sit in the waiting room, fussing over my long skirt and head wrap. I am nervous, with a hunger to learn. I am shadowing Alison, a Specialist Midwife, who runs a Female Genital Mutilation (FGM) Clinic here in the Women’s Wing of the Heartlands Hospital in Birmingham.
‘So why are you interested in FGM?’ she asks
I rumble on about my background and interests in Public Health, African Cultural Practices and my clinical role in a Central London Accident in Emergency and Trauma centre, and for or a moment we are just two frontline clinicians exchanging experiences of working in Nurse/Midwifery led services in the NHS.
Alison explains the four types of FGM, their impact on women sexual, menstrual lives and the medical complications that can arise when a woman has been circumcised. She hovers her hand over the big map of Africa and parts of Asia, and stops over Southern Egypt where the practice is said to have originated from many centuries ago. The practice has historically and culturally been viewed as a good way to preserve young girl’s virginity, control their sexual desires, and prepare them for a good marriage. In some cultures, it was believed that if a baby touched its mother’s clitoris, in childbirth, the baby would be doomed to an unfortunate life.
Historically, circumcised women were viewed as ‘cleaner’ than those uncircumcised. The cutting is traditionally done by older women, who are respected and experienced in cutting girls. In some countries the event is usually ceremonial, festive and celebrative. The girl is flowered with presents, as older women sing and dance around her. When the cutting ceremony begins, the singing and dances increases in volume to drown out the young girls cry.
Alison’s monthly clinic follows up pregnant women who have previously had FGM, or have been ‘cut’ as most in the African community prefer to call it. Her clinic addresses any possible medical complications that might arise at delivery if a woman has had FGM and how these can be managed.
‘In this hospital, we are very much used to looking after women who have been cut’ Alison reassures our first patient.
She engages her patients with deep sense of compassion and cultural competency. She listens and then gracefully addresses the law and options of care for each patient who has been cut.
‘Be careful about the terminology you use when assessing women’ Alison tells me. ‘Use the term that the patient uses’ she concludes. Most women are more comfortable with the word ‘circumcised’ not mutilation.
Those who have been ‘cut’ find the term ‘FGM’ offensive and degrading. Mutilation’ most say is associated with brutality and incomprehensible cruelty. Cutting, they say is best understood in the cultural context in which it occurs. Some will justify it as a means of cleaning and preserving young women for a fruitful marriage, and defend the practice, others accept that the practice of cutting girls is dangerous, harmful and violates their human rights. Peer pressure to undergo circumcision is common, whilst some young girls have died whilst attempting to circumcise themselves. In the some cultures, women who are not circumcised can be denied land ownership and social value within the community.
Women who have been circumcised generally embody a strong sense of social resilience, and most try to get on with their daily lives. Psychological trauma can be difficult to detect and is often managed by an embedded cultural resilience that instills, strength, and an ability to cope.
There are some debates on whether men in practicing communities are prepared to marry women who have not been circumcised, and argue that any level of awareness needs to include men. Activists such as Ayaan Hirsi Ali and Waris Darie argue that we should not dance around razors and culture. FGM is not culture, it is violence’ says Leyla Hussein, a Somalia activist who recently challenged the political correctness around FGM. When we fail to raise these issues within our society due to political correctness, we fail the very vulnerable in our society.
Nurses, midwifes and GP must be therefore be aware of FGM as child abuse, and rise above political correctness in screening and managing young girls at risk of being cut.
Tribal Sands. All rights reserved 2014