Sav­ing girls from hu­mil­i­a­tion

Same 200 mil­lion women and girls across 30 coun­tries have been af­fected by fe­male gen­i­tal mu­ti­la­tion (FGM). But how do sur­vivors live with the pain of pee­ing, pe­ri­ods and child­birth?

Lesotho Times - - Africa -

LON­DON — ”The first time you no­tice your phys­i­cal­ity has changed is your pee,” says Hibo Wardere.

Hibo, now 46, was sub­jected to what is de­fined by the World Health Or­ga­ni­za­tion ( WHO) as “type three” mu­ti­la­tion when she was six. This means all of her labia were cut off and she was then stitched to­gether, leav­ing a tiny hole she com­pares to the size of a match­stick.

She grew up in So­ma­lia, where 98 per­cent of women and girls be­tween 15 and 49 have had their gen­i­tals forcibly mu­ti­lated.

“An open wound rubbed with salt or hot chilli — it felt like that,” she re­calls.

“And then you re­alise your wee isn’t com­ing out the way it used to come. It’s com­ing out as droplets, and ev­ery drop was worse than the one be­fore. This takes four or five min­utes — and in that four or five min­utes you’re ex­pe­ri­enc­ing hor­rific pain.”

Hibo came to the UK when she was 18, and within months vis­ited a doc­tor to see if they could relieve the pain she ex­pe­ri­enced when she passed urine and dur­ing her pe­ri­ods.

Her trans­la­tor didn’t want to in­ter­pret her re­quest, but the GP man­aged to un­der­stand.

Even­tu­ally Hibo un­der­went a pro­ce­dure called de­fibu­la­tion, when the labia is opened sur­gi­cally. This widened the hole and ex­posed her ure­thra. It is by no means an out­right fix, and can never re­store sen­si­tive tis­sue that was re­moved, but it did make it slightly eas­ier to uri­nate.

Sex, how­ever, pre­sented a new hur­dle. “Even if the doc­tor has opened you up, what they’ve left you with is a very tiny space,” says Hibo.

“Things that were sup­posed to be ex­pand­ing have gone. So the hole that you have is very small and sex is very dif­fi­cult. You do get plea­sures — but it’s once in a blue moon.”

The trauma of the as­sault also had a bear­ing on in­ti­mate sit­u­a­tions with her part­ner.

“First you have a psy­cho­log­i­cal block be­cause the only thing you as­so­ciate with that part of you is pain,” says Hibo.

“The other part is the trauma you ex­pe­ri­enced. So any­thing that’s hap­pen­ing down there, you never see it as a good thing.”

Fig­ures re­leased by Unicef in Fe­bru­ary raised the num­ber of es­ti­mated FGM sur­vivors by around 70 mil­lion to 200 mil­lion world­wide, with In­done­sia, Egypt and Ethiopia ac­count­ing for half of all vic­tims.

In the UK, FGM has been banned since 2003. Last year the gov­ern­ment in­tro­duced a new law re­quir­ing pro­fes­sion­als to re­port known cases of FGM in un­der­18s to the po­lice.ac­tivists and the po­lice have raised aware­ness about the risk of Bri­tish school­girls be­ing flown out of the UK specif­i­cally to be stripped of their gen­i­tals dur­ing what is known as the “cut­ting sea­son” over the sum­mer.

How­ever, lit­tle is known about how the mil­lions of sur­vivors — in­clud­ing at least 137,000 in the UK — cope.

The reper­cus­sions of a pro­ce­dure that ei­ther in­volves re­mov­ing the cli­toris (type one), re­mov­ing the cli­toris and the in­ner smaller labia (type two), a cut and a forced nar­row­ing of the vagi­nal open­ing (type three), or any kind of harm­ful mu­ti­la­tion in the gen­i­tals (some­times re­ferred to as type four), are widerang­ing.

The symp­toms are not nor­mally dis­cussed in the open, partly be­cause FGM is so nor­malised among some com­mu­ni­ties that women don’t think of it as a prob­lem, or even con­nect their myr­iad health prob­lems with their experience of FGM as a child, says Janet Fyle, pro­fes­sional pol­icy ad­vi­sor at the Royal Col­lege of Mid­wives (RCM). Last year, Fyle was awarded an MBE for her work in tack­ling FGM.

The day-to-day re­al­ity for sur­vivors can be bleak. The NHS lists uri­nary tract in­fec­tions, uter­ine in­fec­tions, kid­ney in­fec­tions, cysts, re­pro­duc­tive is­sues and pain dur­ing sex as just some of the con­se­quences. A “re­ver­sal” surgery, as de­fibu­la­tion is some­times termed, can help to relieve some of the symp­toms by open­ing up the lower vagina.

“But it’s not as simple as car­ry­ing out the phys­i­cal care, which we can carry out as clin­i­cians,” says Fyle, who comes from Sierra Leone, where FGM is wide­spread.

“It’s about the long-term (psy­cho­log­i­cal) con­se­quences — some peo­ple de­scribe it as worse than PTS (post-trau­matic stress), which sol­diers in the bat­tle­field have.”

When Hibo be­came preg­nant for the first time in 1991, aged 22, she says she was tor­tured by the idea of med­i­cal staff look­ing at her gen­i­tals, which had been phys­i­cally al­tered.

“I re­mem­ber tak­ing the pil­low and just putting it on my face be­cause I didn’t want the hu­mil­i­a­tion, the pain,” she says. “Know­ing all those eyes were go­ing to look at me, was too much.”

Dur­ing the birth, she ex­pe­ri­enced flash­backs of be­ing cut — which is a com­mon experience of sur­vivors. At the time, she was the first FGM sur­vivor that staff at the hos­pi­tal in Sur­rey had seen. Nei­ther she, nor they, had any idea how to try to make the birth eas­ier.

“Be­fore they could even think of what was go­ing to hap­pen and how they’re go­ing to de­liver this boy, my son came. They had to cut me. My son ac­tu­ally ripped parts of me as well be­cause he was com­ing with such a force,” Hibo re­calls.

“They were still very shocked and didn’t know what to do with me. It was hor­rific, and I ended up hav­ing a long time to re­cu­per­ate.”

De­spite the experience, Hibo went on to have six more chil­dren, and the sub­se­quent births were much less trau­matic. Her sec­ond child was de­liv­ered via Cae­sarean sec­tion, and she praises the NHS for the in­creased aware­ness and sup­port for FGM vic­tims.in the UK, a de­fibu­la­tion pro­ce­dure is now of­fered as a mat­ter of course be­fore birth, along with psy­cho­log­i­cal sup­port and con­tact with sur­vivor groups.

Mid­wives say this is vi­tal to those women who may have sup­pressed mem­o­ries of the at­tack and find it dif­fi­cult to even recog­nise what was done to them.

Hibo cred­its her hus­band Yusuf, who she met just a few months af­ter hav­ing her med­i­cal pro­ce­dure in the UK, for his un­wa­ver­ing sup­port in her de­ci­sion to have surgery and speak out about a prac­tice that is so com­mon in the com­mu­nity she is from.

De­spite her worst fears, she has found more hap­pi­ness and in­ti­macy than she ever thought pos­si­ble.

But the cou­ple and their fam­ily have not man­aged to es­cape the ex­pec­ta­tions of the cul­ture they are from. Hibo’s de­ci­sion to make a stand against FGM meant con­fronting her mother’s be­liefs and put a huge strain on their re­la­tion­ship.

In her early years, they had “such a close bond”. And yet it was her mother who took Hibo to have her gen­i­tals cut off and sewn up, re­in­forc­ing a wide­spread cul­tural be­lief that such a prac­tice is es­sen­tial for girls’ rep­u­ta­tions and fu­ture mar­riage prospects.

“My mum did love me, and she did this out of love,” says Hibo now.

“She thought this was pro­tec­tion for me. She thought she was pro­tect­ing the fam­ily hon­our. She her­self was a vic­tim — [and] her mother, her grand­mother. Gen­er­a­tions have un­der­gone FGM — they didn’t see any­thing wrong with it.

“They thought if you weren’t cut, you’re go­ing to be talked about, you’re go­ing to be stig­ma­tised, no-one is go­ing to marry you. You’re go­ing to be seen as some­one who sleeps around with other men. For them, it was pro­tec­tion for the fam­ily and pro­tec­tion for you.”

Hibo and her mother man­aged to re­solve any ten­sion be­fore she passed away. But her in-laws have been “up in arms” about the cou­ple’s de­ci­sion not to cut their three girls.

“They be­lieve that I have done some­thing wrong for the kids, they be­lieve that my girls - who’s go­ing to marry them?” says Hibo.

“And here I was think­ing; ‘Do I care about the mar­riage part, or do I care about their health? Do I want them to suf­fer what I’ve suf­fered? Do I want them to go through what I go through?’ No way.” — BBC

A protest against FGM in so­ma­lia.

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