WATCH | Female genital mutilation (FGM), in which women's reproductive organs are ritually cut, is still taking place in the U.S. and around the world, despite advocacy groups' efforts to end the cultural practice.
At age seven, Zehra Patwa said she was a victim of female genital mutilation (FGM) while vacationing with her parents in India. Patwa, now 46, said it was her aunt who took her to be cut. FGM refers to cutting in the vaginal area, a procedure sometimes referred to as “genital cutting” or “female circumcision.”
In Patwa’s community, it is called khatana, and is carried out on the prepuce, the foreskin over the clitoris. The cut can be as small as a prick, or a larger cut that may scar over. It is believed to maintain the cleanliness of a young girl but doctors say FGM has no medical benefit. Patwa said there are also cultural reasons for cutting. It is also believed that khatana will protect the virtue of a girl or make them more likely to be married.
Patwa is now living in Connecticut, after being raised in England. When she was young, Patwa wasn't aware of what happened to her on the trip to India. She said it wasn't until she watched a TV documentary on FGM four years ago that featured one of her cousins in Australia who spoke up about FGM, did she start questioning what happened to her. Patwa said she questioned her other relatives and learn more about khatana and why it is performed on girls in the community.
“I called everyone and asked them what their experience was like, and I explained that I have no recollection whatsoever, and without fail, every story was painful,” said Patwa. “It was really painful, and these were women 20 years and up, including my mother, including aunts, all the women in my family, who remembered it very distinctively, and it was not a pleasant experience that they remember.”
They take these little girls behind closed doors, they force their knees open, and they cut away their labia and their clitoris.
Female Genital Mutilation
FGM is often performed between birth and the time a girl reaches puberty. Amanda Parker, senior director of The AHA Foundation says it is “child abuse.”
“They take these little girls behind closed doors, they force their knees open, and they cut away their labia and their clitoris,” Parker says.
According to the World Health Organization (WHO) more than 200 million women and girls are living with the effects of FGM. Many of the women affected reside in Africa, Asia, the Middle East, and South America, but according to the Centers for Disease Control (CDC), more than 500,000 girls are at risk of FGM in the United States.
“This is not a very controlled procedure,” said Dr. Ivona Percec, a plastic surgeon who has worked with women suffering from the effects of FGM. “It’s done in relatively poor areas of the world, sometimes with a razor blade, sometimes with a scissor, under very poorly controlled circumstances, so even though we have general categories, no defect is precisely defined during the procedure itself.”
The WHO recognizes four official classifications for FGM, ranging in severity of the cut.
Type I Partial or total removal of the clitoris and/or the prepuce (clitoridectomy).
Type II Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).
Type III Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labiamajora, with or without excision of the clitoris (infibulation).
Type IV All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization.
[FGM] can be very mild in nature, or it can be quite distressing and limiting medically.
“[FGM] can be very mild in nature, or it can be quite distressing and limiting medically,” said Dr. Percec. “Anything that’s just a simple skin webbing that covers the clitoris, to complete closure of the entire vaginal canal where both the urethra, so the urinary opening as well as the vagina can be completely covered.”
FGM in the U.S.
This April, three medical professionals were arrested in Michigan in connection with female genital mutilation operations on multiple girls. FGM has been illegal to perform on women under 18 in the United States since 1997. Dr. Jumana Nagarwala and Dr. Fakhruddin Attar have been charged for performing the procedure. They are members of the Dawoodi Bohra sect of Shia Islam, the same community as Patwa.
“We were actually very shocked. There had been letters sent out from various mosques around the country and in England and Australia, saying that khatana could be considered illegal and shouldn’t be done. We felt those letters were a very strong signal, but it turns out they weren’t,” Patwa says.
The case against Drs. Attar and Nargawala is the first brought under the law criminalizing FGM.
They have also been charged with “conspiracy to transport a minor with intent to engage in sexual activity” because some girls were taken across state lines for operations.
“There’s also a lot of sympathy for the doctors involved, because there is this feeling that maybe they felt pressured into doing it for various reasons,” continued Patwa. “Some people feel the parents should be charged and some people don’t, and the responses run the gamut.”
It’s hard to end a culturally engrained practice
FGM has been outlawed federally and there are 24 states with additional legislation strengthening the punishments. Advocacy groups like The AHA Foundation are working to help develop laws in states that don't have local regulations. “Since the doctors were arrested in Michigan, now Michigan is working toward FGM legislation, which is a great thing,” said Parker.
From The AHA Foundation
But the new laws and prosecution of Drs. Attar and Nargawala may bring another type of FGM into the fold according to Parker.
“There are two ways that we’ve seen FGM presented in the United States. One is girls who are cut here. But we also know that there’s a process called vacation cutting, where little girls are taken over seas to their family’s country of origin to be cut there,” said Parker.
Parker said it is referred to as “vacation cutting” because the procedure happens, as in Patwa’s case, when the family is on summer holiday or Christmas break. She said if the procedure is done then, it gives the girls time to heal.
Groups like "Speak out on FGM," that started in India, who Patwa now advocates for, call for an end of FGM across the world. “I think because I found out about this practice so late in my life, and being a parent, I felt like I couldn’t just do nothing,” said Patwa.
“If it is a wonderful practice, let a woman, as an adult, decide if they want to do it, but do not impose it on all 7-year-old girls because you never know when they’re going to have an issue with it,” Patwa said.
“The psychological downside is so great that it just doesn’t make sense to carry on.”
You can follow Caroline on Twitter @carolinemckee12.