NEW YORK—Don’t call Adama Lee Bah a victim. She is most definitely a survivor. Not only that, she is thriving.
At age 7, in her home country of The Gambia, Bah was subjected to female genital mutilation (FGM), a cultural practice that involves the mutilation or cutting of the female genitalia for nonmedical purposes. It is usually carried out with razors or knives in unsterilized conditions by women who have not been medically trained.
Bah, now 22, was tricked by an aunt, who was in cahoots with Bah’s mother. The aunt invited Bah to stay with her for a vacation, with the promise that she would later support Bah to attend school.
In the early morning after Bah arrived, her aunt took her on an outing “to meet lots of people,” Bah recollects.
“We walked for about two miles. Then all of a sudden I saw a gathering of a lot of people,” she said. “They were speaking Mandinka and I didn’t understand it.”
Bah said an old lady with a red headwrap separated everyone into two groups—those who were going to be mutilated on one side and those who accompanied them on the other—although she didn’t know at the time what the two groups represented.
“There were even children, babies, that were there,” Bah said. She said the women forced the girls to drink hot water, and if they refused, like Bah did, they were slapped and beaten on the head until they complied.
“Up to today, I still don’t know why they forced us to drink that water,” Bah said.
“And then what I remember is, they took me to this place. There’s a lot of women around me. I was laid down. All I could feel at that moment was just pain. I didn’t see my aunt or anybody, I was just surrounded by strangers. I never knew what was happening to me. I didn’t know anything about FGM.”
Bah’s experience is common. More than 200 million women and girls in at least 30 countries have been subjected to FGM, according to the World Health Organization (WHO). Almost one-quarter of the survivors are girls under 15 and more than half live in Indonesia, Egypt, and Ethiopia.
The practice is most common in Somalia and Guinea, where over 97 percent of all women and girls are subjected to FGM. It is also common in other African countries, the Middle East, and Indonesia.
The reasons for why FGM is performed differ depending on the region, but the practice is often associated with cultural traditions around female sexuality and coming of age. Often, FGM is performed to ensure premarital virginity and marital fidelity, according to WHO.
FGM is classified into four major types, ranging from pricking or removing the clitoris, to cutting off part or all of the labia, to stitching closed the remaining labia skin. The last procedure leaves a small hole for urination and menstruation. A woman is often then cut open on her marriage night and again before giving birth.
“FGM is in many communities believed to reduce a woman’s libido and therefore believed to help her resist extramarital sexual acts. When a vaginal opening is covered or narrowed, the fear of the pain of opening it, and the fear that this will be found out, is expected to further discourage extramarital sexual intercourse among women with this type of FGM,” the WHO website states.
After she was mutilated, Bah didn’t sleep for three days and couldn’t urinate for two days, which generated a lot of abdominal pain, she said.
She was forced to stay with the other girls at the place where she was mutilated, ostensibly for a month while she healed, but her father, who had been away on a trip, came and rescued her after a week.
“He picked me up and took me to the hospital. That’s where I actually healed,” Bah said. “I was very sick—and he wasn’t happy with my mum.”
Bah said her father was against FGM after his eldest daughter had been subjected to it at about 1 year old and almost died from complications. He had no idea his wife and his sister were conspiring to subject Bah to the practice while he was away.
FGM is not found in any religious texts and in the countries it is practiced, it crosses belief systems.
“My dad constantly apologized to me, until he died [in 2014], he constantly apologized: ‘I’m very sorry I could not protect you from that,’” Bah said.
It wasn’t until Bah was 11 that she realized that what she'd gone through was FGM. An anti-FGM advocate visited her sixth grade class to talk about it.
“She was teaching it, and as she was explaining, I started having all these flashbacks, like, ‘This is what happened,’” Bah said. “So when I went home, I asked my mom, ‘Why did you take me? Why did you allow my aunt to take me to that lady?’”
“She said, ‘Everybody was doing it.’”
Complications
There are no health benefits to FGM and the risk of complications generally increases with the severity of the procedure.
Immediate health issues include severe pain, excessive bleeding, shock, urinary retention, and sometimes death.
Dr. Deborah Ottenheimer, gynecologist and associate director of the Mount Sinai human rights program in New York, first learned about FGM when she was in Harlem for her residency in the mid-'90s. During that time, she said there was an influx of Somalis and Sudanese to the area.
“I didn’t know how to talk to the patients, I didn’t know what it meant, I didn’t know why it was happening. ... It just made no sense to me,” Ottenheimer said on June 13. She then spent 8 years at Bronx-Lebanon Hospital Center in the South Bronx, which has a large West African population.
“I’m a native French speaker, so I saw lots of the West African patients,” she said. “We saw women who had been cut every day.”
As she saw more and more women with FGM, delivered their babies, and treated their complications, Ottenheimer realized she needed to get involved.
She now does pro bono forensic evaluations for women who have undergone FGM and are seeking asylum in the United States.
“I’ve done about 50 asylum exams for women ... and every single one of them knows a friend, a sister, a cousin who died as a result of the practice,” she said.
“Some of them died immediately, because of bleeding and infection after the cutting, and some of them died because of later obstetric complications.”
With FGM, women have an increased risk of experiencing an obstructed labor, hemorrhaging, or requiring a C-section. Their newborns are also more likely to die.
A 2006 WHO study that looked at deliveries in hospitals in six African countries found a clear relationship between the extent of the FGM procedure and the potential problems at birth.
Women with the most severe type of FGM, in which their genitals are stitched closed, had a 70 percent higher risk of postpartum hemorrhage than women who had not undergone genital mutilation. And they had a 55 percent higher risk of their baby dying during or immediately after birth, the WHO study found.
In some traditions, a woman is closed back up after every time she has a child, Ottenheimer said.
“If you frame this as an issue of control over women’s bodies, then that is a way to maintain control,” she said. “If being closed is part of the way you control a woman’s sexuality, to leave her open after childbirth would defeat the purpose.”
Other long-term impacts include heavy and painful menstruation, endometriosis, urinary tract infections, sexual problems, and a myriad of psychological issues.
Ottenheimer said much of the difficulty in putting an end to the practice is that it’s so hidden.
“This is not something that people talk about to outsiders,” she said. “The culture of secrecy is so ingrained—women don’t even talk to each other about it. I’ve met women who were cut with their sisters and they don’t ever talk about it together.”
The community backlash can be so severe that women don’t speak out against FGM for fear of being cast out.
“And [being cast out], that’s hard, that’s a really big price and it’s not just them, it’s their children, it’s their husbands if they have one ... and it extends to their extended family sometimes—this is big,” Ottenheimer said.
Mariama Diallo is an African community specialist and adult counselor at Sanctuary for Families, a New York-based nonprofit that works with victims of domestic and gender-based violence. The organization is involved in training doctors in New York about FGM and its complications.
She said 90 percent of her African clients have been subjected to FGM and on top of the myriad physical complications, they carry many psychological scars.
“It’s a lot of feelings of shame, feelings of guilt. Most of the women have been told, ‘You are the elder of the family, you need to protect your siblings,’” Diallo said. So when a girl is unable to protect a sister from FGM, she carries a lot of guilt.
“And feeling less than a woman,” Diallo said. Something essential has been irretrievably removed from them.
Other women have symptoms of post-traumatic stress disorder (PTSD), Diallo said.
Most of the women Ottenheimer has seen have not just suffered FGM but also child marriage, forced marriage, or domestic violence.
So why do women who have suffered FGM put their daughters through it?
“Not every woman who went through FGM wants to subject her daughters,” Diallo said. She said many women come to her organization for help in protecting their daughters.
But some women do subject their children to FGM for fear of being excluded from their own community, “because a girl who is not circumcised may not be able to get a husband, [and] getting married is very, very important,” Diallo said. “So it’s the fear of being ashamed, the fear of being excluded from the community—these are some of the reasons women are taking their children to undergo FGM.”
But, Diallo said, at the end of the day, FGM is child abuse and that’s what she is fighting.
“We’re not fighting against anyone else’s culture. We are fighting against gender violence, we are fighting against violence against girls,” she said.
FGM in the States
An estimated 503,000 women and girls are affected by FGM in the United States, according to an estimate by the Centers for Disease Control and Prevention, based on immigration patterns and prevalence of FGM in the home country.
Congress passed a bill in 1996 making it illegal to perform FGM on girls younger than 18 in the United States. The bill was amended in 2013, making it a crime to knowingly transport a girl out of the United States for the purpose of FGM, known as “vacation cutting.”
In the first case to be tried in the United States, two Detroit doctors and one co-conspirator were charged in April for their alleged participation in a scheme to perform FGM on minors, to transport the minors across state lines, and to obstruct justice.
Dr. Jumana Nagarwala, Dr. Fakhruddin Attar, and his wife Farida Attar are charged with performing FGM on minor girls out of Fakrhuddin Attar’s medical office in Livonia, Michigan.
The indictment alleges that Nagarwala performed FGM on two girls from Minnesota who were approximately 6 to 8 years old. The trial is set for Oct. 10 and carries sentences of up to life in prison.
“I think it’s really unconscionable that a doctor would do this,” Ottenheimer said.
She is not surprised that FGM is being performed in the United States, but won’t hazard a guess as to how often.
“I guarantee you that it’s happening all over New York City because it’s a service that is desired, and it’s a service that can be bought, and there are doctors who are from those communities who are going to be willing to do it,” she said.
In New York, it is estimated that 65,000 women and girls are affected by FGM, Ottenheimer said—the same number as in the whole of the United Kingdom.
“But the U.K. is much further along—they’re about 10 years ahead of us in [the prevention of] this,” she said.
Laws play a part, but in most countries where FGM is prevalent, it is already against the law.
In many countries, gains are made in reducing FGM with a combination of outreach education and the law.
“There are some successes in countries that have a very strong grassroots movement. Kenya, for example, Tanzania, and Uganda,” Diallo said. Women of the Maasai tribe in Kenya still conduct a rite of passage celebration for girls but, since 2012, without the cutting.
“It starts with the women, because the women themselves realize that FGM is a problem. And then they start involving the men because they realize we cannot end this type of gender violence if we don’t involve the men. If men can come forward and say, ”I am proud to be married to a woman who is not mutilated,“ that’s very powerful, that will make a difference.”
If Adama Bah’s unstoppable drive is anything to go by, FGM will be wiped out in no time. She works with UNICEF and other NGOs to help educate girls about FGM and empower them to work against it, in particular on social media.
Bah has received mixed reactions to her advocacy work.
“Some said, ‘You should be ashamed of yourself for telling them what we go through,’” she said.
“But I tell them, ‘If we don’t tell them, they can’t help you. Do you think it’s normal that some part of you is gone and you don’t know why?’”
“I am going to portray a face for defiance. Like, yes, I am a survivor of FGM, but look what I have done. Look what we can do if we are subjected to this act,” she said.
“We can be powerful. We need to go out there, look for information, ask questions, understand the laws that actually protect these people, that have the right to suppress us, to victimize us.”
Myths and Facts About FGM
Myth: FGM is a religious practice.
Fact: FGM is a cultural tradition that is not found in any religious texts.
Myth: FGM is no different to male circumcision.
Fact: The purpose of male circumcision is not about the control of men’s bodies and their sexuality.
Myth: FGM is OK to perform on babies because it won’t hurt them as much.
Fact: Babies are just as traumatized and develop just as many complications from FGM as older girls.
Myth: FGM is OK if it is carried out in a medical setting.
Fact: FGM in a sterile setting is still child abuse. In fact, the medicalization of FGM can legitimize and perpetuate it.
Myth: A simple nicking or pricking of the clitoris is a fair alternative.
Fact: It doesn’t solve the ethical problem that FGM is really about the control of women’s bodies. No matter how far the procedure is stepped back, that philosophy is still behind it.
SOURCES: WHO, Dr. Deborah Ottenheimer
