The Cruelest Cut

Thousands of young London girls may be at risk of a gruesome cultural practice leading to lifelong health problems. Baby London investigates Female Genital Mutilation.

She was about seven years old. They took her to the midwife’s house. They put material in her mouth to stop the screaming and held her legs down.”
A woman describes how her friend was genitally mutilated in East Africa. She goes on to tell how she, too, was ‘cut’ as a child. But this conversation is not taking place in Sudan, Somalia or Eritrea, or any of the 28 African countries where Female Genital Mutilation (FGM) is commonly practised. It’s here in London, for research by a London-based anti-FGM charity called Forward and Options UK, who developed the friend-to-friend research technique. Though it’s phenomenally difficult to get accurate statistics on such a secretive, illegal practice, it’s estimated that anything up to 24,000 British girls are at risk of being genitally mutilated, either in the UK or abroad in the summer holidays, including thousands born in London.

It’s a gruesome subject, wherever it takes place. FGM ranges in severity from a symbolic cut on the clitoris to full ‘infibulation’: the clitoris and most of the labia cut away, then the vagina sewn together so that only a tiny opening is left, sometimes so small that urine can only come out in drops. For those who advocate the practice, the result is considered clean, feminine and a guarantee of virginity until marriage. For the girl, it is usually traumatic, and the start of a lifetime’s painful consequences.

So is this a religious and cultural tradition that Westerners should turn a blind eye to? Not according to Dr Ann-Marie Wilson, founder of 28 Too Many, a new charity that seeks to end the practice in Africa. ‘It’s a social norm for many,’ she says, ‘but so was foot binding in China. Any norms are human constructs that should be re-thought if they cause people harm. And there’s no basis for it in any religion.’

She goes on to tell me exactly how much harm FGM causes. It is rarely carried out by trained, medical practitioners; it’s more likely to be a local grandmother. Occasionally the child dies shortly after being ‘cut’, either from blood loss or infection. It’s commonly done without anaesthetic, so the pain must be unspeakable. There can be great psychological trauma, and permanent damage to the girl’s relationship with whoever is holding her down, often her own mother. Afterwards, periods can be excruciating, caused by a build-up of blood that can’t leave the body. On the wedding night, it’s traditional for an infibulated woman to be ‘opened’ by the groom, with a knife.

It’s in giving birth, though, that female mutilation wreaks the most havoc. In 2006, the World Health Organisation surveyed 28,000 births in clinics across Africa to see how they were affected by FGM. The results were shocking: of those mothers with the worst type, their babies’ death rate during or after birth was 55% higher than for ‘uncut’ mothers. Mothers were also 70% more likely to suffer heavy blood loss. Even milder types of mutilation led to higher rates of heavy bleeding and emergency caesareans.

Statistics from Africa can seem a world away. It’s a shock, then, to hear that in 2004 alone, an estimated 5,980 women with FGM gave birth in London: over five percent of all London births. Though babies are less likely to be stillborn, anecdotal evidence suggests that the mother is more likely to suffer extensive tearing, heavy bleeding, or to need a caesarean section. The women who spoke to Forward’s researchers painted a humiliating picture of antenatal and labour care in London, if their midwives or obstetricians didn’t know about FGM:

‘The midwife took one look at me, and when she saw my circumcision she began screaming, saying ‘Oh My God’. She even pressed the alarm. My mother and family were outside and thought that I was dying.’ Other women described midwives calling others to come and have a look, and one male doctor burst into tears. In the women’s home countries, health professionals are not shocked and know how to ‘deinfibulate’ – ie open up the vagina – before labour. In the UK, women can be faced with a wall of medical ignorance, on a subject they are not exactly willing to explain. However, 11 African Women’s clinics do exist across London for this type of procedure, and efforts are being made to make midwives, gynaecologists and obstetricians aware; midwifery courses now have modules on FGM. So why, despite all the suffering it causes, do London families continue to have their girls ‘circumcised’? According to Forward, it’s often older women who push to continue the practice, with grandmothers and aunts exerting the most pressure. Parents themselves fear that if their daughters are not cut, they may not be able to marry, or will be rejected by their communities.

The Forward report does contain glimmers of hope; the women who took part are clearly against FGM themselves and would not inflict it on their daughters. Some husbands, too, are painfully aware of their wives’ suffering, having seen them in labour, and the effect it has on their sexual relationships.

A few people are working hard to turn the tide. Dr Ann-Marie Wilson’s reaction to meeting her first FGM victim in 2005, a young Sudanese girl, was to close down her lucrative HR consultancy and pour her life savings into studying the issue. The result was the London-based charity 28 Too Many, launched last year, to help anti-FGM organisations network across Africa and end the practice. Here, Forward has just celebrated its 25th anniversary. It lobbies the government and seeks to empower young women at grassroots level, encouraging them to become ‘agents of change’ in their own communities.

Organisations like these need our support. Someone has to take on this hidden violation of millions of young girls, both across the world and right here in our own neighbourhood. Perhaps, then, the thousands of London mothers who have been robbed of their own sexual health can watch their daughters grow up unharmed.

The World Health Organisation classifies FGM into four types:
Type I
 – Partial or total removal of the clitoris, or the fold of skin surrounding it.

Type II
 – Partial or total removal of the clitoris and the inner lips (‘labia minora’), with or without removing the outer lips of the vagina (‘labia majora’).

Type III
 – Narrowing the vaginal opening, by cutting and sewing together the inner, or outer, labia, with or without removal of the clitoris.

Type IV
 – All other harmful procedures for non-medical purposes, eg pricking, piercing, incising, scraping and cauterising the genital area.


London School of Hygiene 
and Tropical Medicine

28 Too Many

World Health Organisation