An estimated three million women and girls undergo female genital mutilation each year, according to a 2005 Unicef report. For many Europeans and Americans, these are three million female victims we should feel sorry for or donate to, or perhaps read a book about a girl who survived this practice thousands of miles away from the FGM-free shores of Europe – but not an issue that seems to effect our neighbors down the street, our fellow citizens across town, or even ourselves. But the reality is closer to home than we think.

By Index on Censorship´s M Zapp

Although FGM is mainly practiced in many sub-Saharan countries and parts of the Middle East, an estimated 7,000 females living in the United Kingdom are at risk for FGM, according to the women’s health group Forward. These girls and women might be taken back to their home country which may or may not ban the procedure, or even have the surgery in the UK illegally. At least 74,000 females living in the United Kingdom have already undergone the procedure either before moving to England or while there, and continue to suffer from the long-term health effects, which can include keloid scars, painful sex, sexual dysfunction and increased risk of hemorrhaging and infection during childbirth.

Procedure available in England for £2000
Female genital mutilation was banned in England in 1985, and the criminal penalties were increased in 2003 under the Female Genital Mutilation Act, which also made transporting a female overseas to undergo FGM a crime punishable by up to 14 years in prison. Although at least two doctors have lost their licences for FGM-related offenses, no prosecutions have yet been made under the act.

Moreover, this act has not stopped multiple cosmetic surgery clinics in England from advertising what they called “cosmetic gynaecology” or “female genital surgery,” which some say constitutes FGM. The Hurlingham Clinic and Spa in London advertises “labia reduction,” saying, “During the procedure, the surgeon removes a wedge-shaped piece of tissue and re-attaches the labium in a new position so that the inner lips no longer protrude beyond the outer lips.” The clinic also offers surgical “correction” of the clitoral hood (according to them, for increased sexual pleasure), and clitoral repositioning. Various other cosmetic surgery clinics offer similar procedures, including Transform Medical Group, The Harley Medical Group and London Bridge Plastic Surgery. These surgeries are billed as aesthetic procedures, and a way to make women feel more confident about their bodies. These procedures generally cost over £2000.

Comfort Momoh, a midwife at the African Well Woman clinic, says that so-called labia reduction surgery, or labiaplasty, constitutes FGM. “If you look at the law and the World Health Organization’s classifications, this would definitely be Type IV FGM.” Type IV FGM consists of some form of cutting, burning or otherwise mutilating the labia or clitoris.

No comment from the Department of Health
After repeated phones calls and emails, the Department of Health was not able to offer a stance on the legality of these procedures at the time of publication. Labia reduction is listed as a procedure on the department’s website, where the surgery’s process is described in a similar fashion as the clinics’ descriptions, therefore not condoning the surgery. There was no mention of any of the other procedures on the department’s website.

Nimco Mahamud-Hassan, an ethnically Somali woman who was educated in England, called the labia reduction surgery “outrageous.” “It’s just another way of making women feel more insecure about something else,” she said.

“Women are choosing to have this done.”
Rebecca Johnson from Transform Medical Group said that although not a common procedure, women choose to have labia reduction surgery there not for religious, medical or mental health reasons, but for cosmetic reasons and “self-confidence,” the same reason some people choose to have cosmetic surgery. Johnson says the surgery “includes excision of the labia tissue.”

Under the 2003 Female Genital Mutilation Act, a person is guilty of commiting FGM if she or he “excises, infibulates or otherwise mutilates the whole or any part of a girl´s labia majora, labia minora or clitoris,” making an exception for labour-related procedures and physical and mental health.

Johnson does not believe labia reduction surgery constitutes FGM. “Women are choosing to have this done. I don’t see how in any way it could be considered female genital mutilation, even if the law does say that,” she said. “If it were illegal, we wouldn’t be doing it.”

But Momoh is not convinced. “If we have a law that says this and the World Health Organization is saying Type IV FGM, we need to go by the law,” she said.

FGM on the decrease worldwide
But progress toward ending FGM is happening, both around the world and in the United Kingdom. In their 2005 study, Unicef said that nine out of 16 countries where FGM is commonly practiced surveyed showed a “marked decrease” in the prevalence of FGM among young women. In England, multiple clinics counsel, treat, and offer reversal surgery for women who have already undergone some forms of FGM.

Comfort Momoh helps run such a clinic in London, called the African Well Woman Clinic, which largely assists Somali and other ethnically African women. Momoh estimated that she does two or three FGM reversal surgeries every week. These surgeries are especially important for women who plan to give birth, as the birthing canal is basically sealed over in some forms of FGM.

Ms. Mahamud-Hassan had FGM performed on her when she was nine years old and living in Somalia. Her mother wanted her to have the procedure, while her father objected to the practice – a view she says is shared among some Somali men. At the time, she herself looked forward to the practice as a right of passage. Although Mahamud-Hassan is now very opposed to FGM, she said she harbours “absolutely no resentment” toward her mother.“She thought it was the right thing to do, that nobody would ever marry a woman who wasn’t circumscised,” Mahamud-Hassan said. “It was done out of love.”

About eleven years ago when she was 20, Mahamud-Hassan decided that she wanted to have reversal surgery. Before she had the reversal surgery, it would have been impossible for her to have had sex, as she had undergone infibulation. Infibulation generally consists of the removal of the clitoris and labia and the stitching and narrowing of the vulva, leaving only a small opening to allow out urine and menstrual blood. One month after her surgery, she said that everything was fine. After the reversal surgery, she was able to feel sexual pleasure, which not all women who have the reversal surgery can.

Importance of women talking about FGM in their communities
Although now writing a Somali language textbook in Boston for Harvard University, Mahamud-Hassan has given talks against FGM to other Somali women. Describing herself as a “cultural Muslim, with Somali values,” she told the women, “Allah makes women and creates vaginas in the best way he knows how. By women fiddling with them, you’re just saying you did a better job than he did.” After talking, Mahamud-Hassan said that some women came to her and said they would never allow FGM to happen to their daughters.

Mahamud-Hassan strongly believes that this sort of approach – women talking about stopping FGM with their own communities in their own language, culture and context is what is appropriate and most effective, as opposed to Westerners interfering.

Momoh has a similar stance, and advocates educational opportunities and resources to bring about positive progress toward ending FGM. “Attitudes are changing compared to 10-15 years ago,” said Momoh. “People are mobilising.”

Text of the Female Genital Mutilation Act 2003

 African Well Woman Clinic

Foundation for Women´s Health, Research and Development (FORWARD)