Female genital mutilation: shifting from tradition to education

Often done in unsanitary conditions, the procedure is traditionally performed by an older woman with no medical training.

Girls are held down and, without the use of anaesthetic or antiseptic, the elder partially or completely removes the young girl's external genitalia, using basic tools such as knives, scissors, pieces of glass and razor blades.

Sometimes, infibulation - the surgical closure of the labia - is also carried out.

Then, a mixture of herbs is placed on the wound in order to tighten the vagina and stop the bleeding.

The procedure puts the girl at risk for a number of short-term and long-term complications, including scarring, severe loss of sexual pleasure, difficulty having intercourse, difficulty passing urine, significant psychological problems and a risk of infection (which can lead to death).

The practice is considered to be a violation of the human rights of girls and women by the UN, and yet it is estimated by the European Women's Lobby that around two million girls and women worldwide are affected by FGM, which is usually performed for cultural reasons in Christian and Muslim communities in some African, Middle Eastern and Asian countries.

It is a phenomenon that is also a reality among minority groups in Malta, with a number of female asylum seekers living on the island having undergone FGM in childhood.

A large percentage of migrants living in Malta hail from countries like war-torn Somalia, where FGM, also called female circumcision, is widely practised.

"Many of the women we meet are terrified that their daughters will be sent back to their country of origin and will go through the pain that they went through," says Katrine Camilleri, a human rights lawyer and director of the Jesuit Refugee Service Malta.

She says this raises issues of protection and asserts that FGM should be considered as grounds for asylum.

In countries such as Belgium, France, the Netherlands and Sweden, asylum requests based on FGM have been granted frequently, on the grounds of the medical risks involved in the procedure.

However, in other countries including Italy, Latvia, Lithuania, Malta, Romania and Slovakia, women have been granted asylum on these grounds in only a few cases.

Camilleri claims she is not aware of FGM being carried out in Malta. "However, if it does happen, then it will most likely be young girls who are at risk," she said.

Paediatrician and Labour backbencher Chris Fearne says his worry is for Maltese girls born to African parents.

"Why wait for FGM to start occurring in Malta to do something about it? Surely we should be trying to prevent this from happening in the first place," he says. Fearne will soon table a private members bill which proposing the introduction of a law banning FGM in Malta and also banning it being done to Maltese women abroad.

There are currently no statistics about how many women living in Malta have undergone FGM, since the law does not yet require gynaecologists to report the cases they come across.

"I hope that if the bill is approved, they will become reportable. The Maltese courts will still have no jurisdiction over cases which have occurred overseas, but at least we will be able to gather statistics," says Fearne.

His private members bill is not the first time the law will have been proposed. Family and Social Solidarity Minister Marie Louise Coleiro Preca first floated the idea back in 2006, when she called on the then PN government to outlaw the practice, in a bid to protect migrant women who could be subjected to it.

The bill is currently being drafted by Fearne and representatives of the Attorney General. However, both Katrine Camilleri and Maria Pisani, a sociologist and the co-founder and director of Integra Foundation, emphasise that female migrants in Malta who have undergone the procedure should be involved in the discussions on the matter.

"The experts in genital cutting in Malta are those women and their families who have undergone the practice. I believe they should be involved in a dialogical educational process, on an equal footing," says Pisani, adding that these women would need to understand the implications of such a law and why it is being put in place, and should be educated about why the practice is a harmful one.

"On the other hand, policy makers and practitioners need to understand why this practice is carried out and find the best way of providing information and engaging the communities towards change," says Pisani, whose academic paper 'We Are Going to Fix Your Vagina, Just the Way We Like It', gathered research about instances of FGM in Malta and focused in particular on how "unsure as to how to address the particular post- or antenatal needs of female asylum seekers, the Maltese medical profession has seen fit to - following childbirth - conduct reconstructive surgery on the vaginas of those women who have undergone it".

Her paper claims that "the women were not informed of this decision and the corrective procedure was conducted without their informed consent".

While re-iterating that FGM is not an agreeable practice, Pisani states that this "well-intentioned" surgical re-construction raises another issue altogether - that of the violation of the rights of asylum seekers.

From a medical perspective, there are severe issues which may occur during pregnancy.

"I have seen a few patients with FGM who are pregnant. The mutilation is sometimes such that I am amazed they were able to get pregnant in the first place," says gynaecologist Isabel Saliba, explaining that women who have undergone infibulation are left with an opening which is only big enough to accommodate the passage of menses and which makes intercourse near impossible.

The complications arise when women with FGM have to give birth. Because the women often refuse birth by caesarean section, gynaecologists must open the labia (which have been sewn together) in order to facilitate childbirth. Following the birth of the child, the doctor does not re-sew the woman's genitalia.

Fearne confirms that Maltese doctors never agree to re-sew the genitalia, even if the women ask for it. "The bill will make re-sewing a criminal offence," he says.

Fearne also says that everybody he has consulted - including all Labour MPs and a few Opposition MPs - have unanimously agreed with the bill, but he has yet to ask the Opposition for its official stance on the matter.

Meanwhile, however, Pisani notes that while she welcomes legislation, policy and education on FGM, it is also important to address other, more pressing matters if we want to safeguard human rights.

"In the course of my work with asylum seekers, no woman has approached me and expressed concern regarding the practice of female circumcision. This is not to suggest that female circumcision is celebrated, but rather that it simply has not featured in the women's list of priorities," she says.

Pisani continues on to say that she is generally approached by women regarding what they describe as their "immediate" problems, often related to day-to-day survival, poverty and joblessness, and trying to contact lost relatives who have been caught up in wars and conflict back home.

"I do not at all want to minimise the effects of FGM - I am simply calling for an informed dialogue," she concludes, expressing concern about how the discussion of such topics tends to invite sensationalist headlines and position the victim as "ignorant" - leading to more prejudice in a country where racism and prejudice against minorities is unfortunately a reality.