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Reflection on Addressing FGC in the Clinic: A Dialogue between Survivors and Healthcare Professionals

By Sandra Yu 

On December 8th, 2020, Sahiyo hosted a webinar featuring several health professionals and  survivors of female genital cutting (FGC) to discuss the necessity for trauma-informed care and cultural competency. The event was an eye-opening and invigorating conversation as the panelists discussed the failures of the current medical system and necessary next steps to improve systemic care for survivors of violence. 

Renee Bergstrom and Sarata Kande, two outspoken advocates against FGC, provided unique and moving perspectives about how cultural competency and vulnerability are key to providing better care. The juxtaposition between their Voices to End FGM/C videos and their spoken statements on the panel about their past experiences with healthcare professionals was truly powerful. 

“Once it’s done to you, you are forbidden to ever mention it to anybody,” Kande said. “But when you share your story, it feels good.” 

In response, Deborah Ottenheimer, M.D., detailed how she identifies and speaks with survivors of FGC in an inclusive, vulnerable, and caring manner. Karen McDonnell, Ph.D., a public health specialist and creator of the The George Washington University FGM Toolkit, also addressed the critical need for providers to learn about FGC from a public health perspective, expanding on the treatment of FGC as a subsector of gender-based violence. Mariam Sabir, a Sahiyo volunteer and 4th-year medical student, gave an unsettling glimpse into the current state of medical education surrounding FGC as she described her interactions with peers and faculty on the topic. 

The central theme that arose was the importance of communication, whether it’s between healthcare providers, communities, the general public, or patient-doctor interactions. McDonnell speaks to the creation and normalization of the language used to describe genitalia. Having the right vocabulary to communicate about female genitalia is the first step to having genuine conversations about FGC. Communication between a patient and their doctor is even more crucial for building trust. Knowledge is not enough to make a person feel safe and comfortable.

Bergstrom and Kande alluded to their individual experiences grappling with healthcare providers that fail to embrace vulnerability. Building trust and allowing for vulnerability in the clinic are learned skills that are often overlooked in medical education. The culture of silence surrounding the practice of FGC is pervasive, but we are moving toward a future where silence does not need to be the norm, especially in the clinic where trust is paramount to care. 

Watch the recording of this event here.

Read the transcript here.

 

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Is the United Kingdom backing out of its commitment to end female genital cutting amid the COVID-19 pandemic?

By Olivia Bridge

In the midst of a global pandemic set to the backdrop of Brexit, ending violence against women and girls (VAWG) appears to have slipped down the United Kingdom (U.K.) Government’s priority list. Yet, as campaigners and charities are acutely aware, abuse  thrives in silence behind closed doors – and women and girls disproportionately pay the price. 

One form of abuse that charities fear is on the rise is female genital cutting (FGC), a practice which has affected more than 200 million women and girls worldwide, with a further 68 million more estimated to be at risk in the next ten years. It is said that every seven seconds, a girl somewhere around the world faces the potentially agonizing pain and trauma of being cut.

What is FGC?

The World Health Organisation defines FGC as a procedure which involves the “partial or total removal or the external female genitalia or other injury to the female genital organs for non-medical reasons.” There are four types of FGC that vary in severity, but all types are recognised as child abuse and a violation of women’s and girls’ human rights. In some cases, anaesthetics and antiseptics aren’t used, meaning not only is the initial cutting procedure traumatic, potentially life-threatening and painful, but survivors are at increased risk of blood infections, hemorrhaging and infection throughout their lives, and can face issues with urination, menstruation, pregnancy and penetration.

Communities who practice FGC claim it is linked to tradition, faith and ideas around gender roles, insisting girls must preserve their virginity. Many families believe FGC to be a rite of passage for their daughters, and in some communities, it can go hand-in-hand with other practices, such as breast ironing and forced marriage. 

FGC is a global issue involving at least 92 counties, including the U.K. Despite landmark legislation making those facilitating the practice to be punishable for up to 14 years in prison, girls born to families of these regions in the U.K. are at a heightened risk of being taken abroad under the false pretense of a special ceremony.

How prevalent is FGC in the U.K.?

In the mere five years that the U.K. has been recording data, 24,420 women and girls have been identified by the National Health Service (NHS) as having undergone FGC, with 6,590 being treated in the year up until March of 2020 alone. 205 victims or survivors were U.K.-born.

In total, it is estimated 137,000 women and girls are living with its effects in England and Wales. But many believe the official figure to be the tip of the iceberg considering most survivors (80%) go undetected until they come into contact with midwives or obstetric services. But some women may never come into contact with the NHS at all, including women who don’t have Indefinite Leave to Remain or any form of secure immigration status, in part, either because they are unaware of the support available, or they fear  immigration enforcement.

What is the COVID-19 impact?

However, the COVID-19 pandemic appears to have ramped the practice around the globe. A policy briefing by the Orchid Project in September illuminates the extent, noting, “COVID-19 related lockdowns are being seen as an opportunity to carry out FGC undetected,” across East and West Africa; and “economic hardship is driving increased rates of FGC because of parents seeking ‘bride prices.’” 

Other research conducted by UNFPA anticipates that as a result of coronavirus disruptions to FGC prevention programmes, as many as two million more cases could take place in the next ten years that would otherwise have been avoided. As such, it estimates a one-third reduction in the progress toward achieving the Sustainable Development Goal of eradicating the practice by 2030.

Campaigners attribute the rise to mass school closures, a decrease in access to support and health information, and the economic situation forcing girls into marriage for families to secure a dowry. Indeed, as joint research points to prove, whenever girls are stifled from education, they become increasingly more vulnerable to abusive practices.

For this reason, campaigners fear the true scale of gender-based violence is yet to be realised as the U.K. creeps in and out of lockdown and restrictive measures are tweaked every few weeks. Kate Agha, the Chief Executive of Oxford Against Cutting, said, “With the rise in harmful traditions overseas, practicing-communities in the U.K. will come under increased pressure from family abroad to ensure they are part of the group and upholding cultural traditions based on honour.” 

What is the UK doing about it?

The U.K. has remained determined to end FGC, setting a deadline to prevent it from occurring for good by 2030, in line with many other countries. 

Progress has been commendable. FGC has been outlawed in several Western countries including the U.K., Canada, Spain and New Zealand, among others, including 19 African countries. To date, the U.K. remains the largest donor to support the end of FGC globally, helping 10,000 African communities and assisting six African nations with a budget and new laws to criminalize it.

However, amid these trying times, progress seems to be stalling and commitment stuttering behind if the U.K. is to realistically facilitate the end of FGC in the next ten years. For instance, despite being against the law for thirty-five years and a whole host of civil protections and laws being introduced in 2003, there has only been one successful prosecution, which took place in February of 2019. Meanwhile, charities claim social workers and even healthcare practitioners aren’t always trained and equipped to safeguard and handle victims or survivors with there being greater emphasis on support post-procedure than preventing it from happening in the first place. Due to a shocking knowledge gap in Lancashire hospices that emerged in August, medics are now receiving extra training. But how many more remain ill-equipped?

Many believe the U.K. is silently withdrawing from its commitment altogether as it emerges that the Home Office has slashed funding from The National FGM Centre which, since its inception in 2015, has safeguarded 742 girls and supported 341 survivors. The centre reserves the power to issue protection orders for girls at risk, instruct the police on when to intervene and has trained at least 18,000 professionals, including teachers, social workers, police officers, lawyers and doctors. Yet this year, the centre will receive a mere £432,000 in funding – a drop in the ocean compared to the £2.7 million it was awarded five years ago. The Home Secretary is in the midst of attempting to deport an 11-year-old girl to her native country, Sudan, where she is sure to undergo FGC, in a move which lawyers claim mocks domestic FGC laws and protection orders. Fortunately, the girl was spared deportation in the eleventh hour by an FGC protection order, but her future remains uncertain.

As the futures of girls around the world hang on a thread and women become the collateral damage to COVID-19, the government must ensure it does not bulldoze over years of ground-breaking progress toward ending FGC. Without serious, unwavering commitment to ending the practice, women and girls will continue to be violated and stripped of their basic human rights.(Olivia Bridge writes for Immigration News and the Immigration Advice Service.)

 

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Thaal Pe Charcha: February 2020

 On February 8th, as part of our International Zero Tolerance Day for FGM/C, Sahiyo hosted its first Thaal Pe Charcha (TPC) for 2020, with a special private screening of ‘A Girl from Mogadishu’, directed by Mary McGuckain.

 The film is a true story based on the testimony of Ifrah Ahmed, a Somalian whose suffering acted as catalyst for one of the world’s biggest and most successful movements to end gender-based violence and female genital cutting.

 The Sahiyo team and Thaal Pe Charcha participants were deeply moved by the film, and found resonance in Ifrah’s journey on fighting a practice deeply rooted in the culture and tradition of a community constantly seeking ways to establish their identity.

‘Thaal Pe Charcha’, in which a diverse group of participants gather around a meal, and encourage conversations about ending Khatna (FGC) within the community, is currently in its third year and is one of Sahiyo’s more successful ground activities, which provides a safe environment for sharing solutions and stories.

 Read about this ‘TPC’ through the lens of one participant in this thoughtful blog piece.

Sahiyo Volunteer Spotlight: Isabel Panno Shepard

Isabel joined Sahiyo as a Communications Intern. She studied cultural anthropology and human rights at Duke University. She is interested in the use of alternative media for social justice and believes in a multimedia approach to storytelling. Her work aims to center experiences and expressions of girlhood across communities and individuals. She joined Sahiyo to empower those affected by FGC through listening to, elevating, and advocating on behalf of their stories.

1) When and how did you first get involved with Sahiyo?

I joined Sahiyo as a communication intern a couple of months after I graduated from Duke University last spring. When I came across the job listing and read about programs like Voices to End FGM/C, I wanted to be a part of Sahiyo’s mission to end FGC through survivor-centered advocacy and collective storytelling. So, I sat down, wrote my application, interviewed, and here I am!

2) What does your work with Sahiyo involve?

One of my favorite parts of being a Sahiyo intern is that I’ve been able to work on a wide variety of projects that introduced me to a lot of awesome Sahiyo staff, interns, and volunteers. Beyond the intern standard pack of tasks (think MailChimp, Doodle Polls, and Google Calendar), I’ve assisted with and participated in a storytelling workshop on the intersection of FGM/C and global systems of oppression, created storyboards from Voices workshops, and even drafted a few official organization policies.

3) How has your involvement with Sahiyo impacted your life?

Sahiyo has grounded in me such a profound respect for the power of story. It’s an honor to witness the vulnerability and strength of the women (and men) who come together to speak out about FGC through their experiences both shared and not. This community has taught me that stories can unite us, heal us, and empower us – as long as we respect and make space for one another.

4) What words of wisdom would you like to share with others who may be interested in supporting Sahiyo and the movement against FGC?

Slow down and listen.

 

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Dear Maasi: How to address sex-negativity and misogyny in a conservative community

Dear Maasi is a column about everything you wanted to know about sex and relationships but were afraid to ask! It’s a partnership between Sahiyo and WeSpeakOut, and is for all of us who have questions about khatna (female genital mutilation/cutting or FGM/C) and how it impacts our bodies, minds, sexualities and relationships. We welcome you to submit your anonymous questions. 

Dear Maasi,

In many Bohra families, sex is seen as a duty that a woman performs. To even have conversations about your own pleasure is so difficult. When I talked about khatna and its impact on sexuality, my mother asked me, “Why are you the only one who has a problem with this?” My question is how do you articulate this need to not just want to submit? 

—Anonymous

Dear Anonymous,

You’re addressing two powerful taboos—talking about sex and questioning women’s role in sex. Good for you! 

I think that sex-negativity and misogyny are pervasive and global, and not limited to Bohras. In other words, all around the world sex education is dismal or non-existent, and women and non-binary people learn that sex is shameful, not to be discussed, and not for our own pleasure. In a heterosexual context, we learn that sex is to be “given up” for male partners, and only after marriage.

Khatna, a form of female genital cutting and sexual trauma that is secretive and intergenerational, reinforces these ideas. I can see how it would be challenging to talk to your mother, especially if she hasn’t considered and challenged outdated notions about sexuality. 

If I were in your kitchen with you and your mom when she asked this question, I might coach you to say something like this:

“But mom, it’s not just me. I’m not the only one who is questioning this. I know this might be uncomfortable for you, but I encourage you to think more deeply about how khatna impacts us.” 

If she’s open to hearing more, you might share some research: 

—In a Sahiyo survey conducted in 2017, 35% of respondents reported that FGC had affected their sex life, and of those, 87% felt that it had been impacted negatively. 

—In a 2018 WeSpeakOut study, nearly 33% of respondents said the same. 

You might also share your personal experiences with her, but beware that learned sex-negativity can lead people to be judgemental, and Anonymous, you don’t need that. Seek out friends and others who might be supportive. Watch survivor stories.

It’s also good to correct our own sex misconceptions by collecting as much sexual health information as possible. I highly recommend Come As You Are, a book by Emily Nagoski, and Sex With Dr. Jess, a podcast that offers practical sex advice combined with good psychotherapeutic knowledge. In my last column I also recommended the Sex Gets Real podcast episode in which activist and writer Mariya Karimjee discussed her research and personal experiences with sex and dating. My recent novel, Seven, takes up issues of Bohra women’s sexuality, including infidelity, lack of orgasms, and khatna, and there’s even a scene where my protagonist tried to talk to her mother about sex.

Knowledge is power, Anonymous. And with that knowledge, you’ll be able to articulate—to yourself and others—why it’s our birthright to experience sexual pleasure.

Maasi

About Maasi, aka Farzana Doctor:

Farzana is a novelist and psychotherapist in private practice. She’s a founding member of WeSpeakOut and the End FGM/C Canada Network. She loves talking about relationships and sexuality! Find out more about her at http://www.farzanadoctor.com

Disclaimer:

While Farzana is full of good advice, this column won’t address everyone’s individual concerns and should not be used as a substitute for professional medical or psychological care.

 

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