World needs more ‘holistic approach’ in combatting FGM, says leading Geneva expert

Photo of Dr Jasmine Abdulcadir

Dr Jasmine Abdulcadir, a medical expert specialising in genital reconstruction at Geneva University Hospitals, said there needs to be a more holistic approach in combatting female genital mutilation, not divorcing it from other issues that affect girls and women. 

Over the past 10 years Abdulcadir has been working in Geneva University Hospitals specialising in clitoral reconstruction and deinfibulation, a practice to either reduce chronic clitoral pain or improve sexual pleasure, as well as improve one’s  “body image and female identity.”

With reports of the pandemic putting girls increasingly at risk of FGM, Abdulcadir told Geneva Solutions that the focus should be on looking at the holistic impacts of FGM/C, rather than just the impacts of Covid-19 as it will not necessarily help address the issue. With such a complex subject, it is important not to adopt simple fixes and bear in mind several factors.

FGM “should really be understood correctly and should not be separated from all the other issues on girls and women.  For example, FGM is sometimes associated with early marriage or the abandonment of school,” says Abdulcadir.

Her comments echo those of UN secretary-general António Guterres in his statement on the UN’s goal of eliminating FGM by 2030. “Doing so will have a positive ripple effect on the health, education and economic advancement of girls and women,” said Guterres.

More than 200 million girls and women are estimated globally to  have undergone female genital mutilation or cutting (FGM/C). Saturday 6 February marks the United Nations’ International Day of Zero Tolerance for Female Genital Mutilation, bringing attention to the practice that dates back 2,000 years and is still practised in many cultures.

Since the start of the pandemic, it is feared that extended lockdowns and school closures may have caused a rise in FGM cases, with reports by UNFPA, UNICEF and Orchid project citing these increases. UNICEF warned last year that Covid-19 “has negatively and disproportionately affected girls and women, resulting in a shadow pandemic disrupting SDG target 5.3 on the elimination of all harmful practices including, female genital mutilation.”

According to the WHO access to sexual and reproductive health and rights, including FGM prevention and care, may be reduced during national lockdowns, while the UN estimates that Covid-19 will put two million more girls at risk of FGM by 2030.

Governments around the world have expressed these sentiments. The Anti-FGM Board, a semi-autonomous Kenyan government agency, disclosed that more than 110 girls below the age of 18 have been circumcised. In light of the enforcement of stay-at-home measures due to the spread of the coronavirus, thousands of girls are said to be at risk of cutting.

Despite tough penalties outlined in the Kenyan law on the Prohibition of Female Genital Mutilation Act and other robust tools to eliminate sexual and gender-based violence, the practice has unfortunately persisted.

Egypt, which has one of the highest prevalence of the practice, is similarly attempting to clamp down FGM. In 2008, it was made illegal in the country, however, despite the measures, the practice is still carried out. In January last year, 14-year-old Nada Abdel bled to death after forcibly undergoing FGM, which sparked a public outcry online.

On 21 January, the government announced the approval of legal amendments toughening the penalties for FGM. The new amendment to Article 242 increases both the minimum prison sentence from two years to five and maximum from seven years to up to 20 years.

Despite being criminalised in many countries, FGM remains a common practice, and campaigners fear the effects of the pandemic have made it more prevalent. Even scarier, it is believed that the cases of FGM are being underreported. In the UK for example, figures from July to September last year revealed there were 635 cases reported, which represents a fall of more than a third as compared to the same period the previous year.

During the pandemic Dr Abdulcadir found that people were consulting less as in the UK case, however, the number of people accessing the clinic neither increased nor decreased. As “there were altering requests and only needed reorganization (due to the pandemic) for the surgery of deinfibulation” says Abdulcadir.

She compared the impacts of Covid-19 on FGM/C with those of the Ebola outbreak, saying “the number of FGM/C decreased because there was risk of transmission and regulations against FGM/C were implemented”.

Being a scientist, Abdulcadir urges that there should be solid studies with data, which validate the increase in FGM cases to better respond to the practice, rather than focusing on the trending anecdotal reports.

In this pandemic and beyond, the campaigns need to be emboldened to address the issue. In many of the societies that perform FGM/C there are no positive words to describe an uncut girl/woman. “One of the campaigns that UNICEF did in Sudan was to create a word that means uncut and has a positive meaning, (known as the) ‘Saleema’ campaign,” said Abdulcadir.

The FGM/C procedure involves the removal of part or total external female genitalia, or other injury to the female genital organs for non-medical reasons.

According to the WHO, the practice reflects the “deep-rooted inequality between the sexes and constitutes an extreme form of discrimination against women”.

This also links to some of the common misconceptions that explain why the practice is still prevalent. For example, FGM/C is thought to reduce hypersexuality in women and “a girl that is cut will become a more respectful, pure and faithful future wife.” Additionally, some believe that “some kind of cutting will guarantee more beautiful, sexier, cleaner or pure genitals when infibulation is performed,” explained Abdulcadir.

People believe by closing the genitals, this makes “micturition’s lower and less noisy which is considered feminine or polite, or sometimes non-closed genitals are considered ugly and wide or at risk of infections or associated with less sexual pleasure for the future husband” whilst others hold beliefs about the clitoris, “that it might grow, if you don’t cut it, or it might become like a small penis,” Abdulcadir further explained.

Beliefs about the function, appearance, and physiology of women drive the practice but Abdulcadir warned that these reasons and associations should not be painted with broad strokes. There are some common misconceptions, stressing the importance of considering the many different ethnic groups, backgrounds, and cultures when addressing FGM/C.

Growing up in a multicultural and multireligious family, and having parents as gynaecologists, Abdulcadir always wanted to follow in her mother and father’s footsteps. Born to an Italian mother and a  Somali Father, a country (Somalia) with one of the highest rates of FGC, this had a profound impact on Abdulcadir, encouraging her to take a well-rounded approach in addressing the practice.

When working in the care and prevention of FGM/C there are many different subject areas that need to be considered as it “mixes politics, economics, history, human rights, sociology, anthropology, medicine, and so many different subjects.” One must ensure that:

  1. Interventions have to be based on facts and data.

  2. These girls and women who are cut, are not only offered medical health, or surgical health but also social health, so that they’re not discriminated against or stigmatised, but then they’re treated with respect and care.

  3. Their whole psychophysical health is promoted, going beyond their genitals.”

Working in the specialised clinic for the last 10 years, Abdulcadir believes “the key is that girls and women have access to education and independence. Girls and women have to have the tools to earn and choose what to become to counteract the violence and discrimination that is everywhere.”