Khadija Gbla’s first baby is due in February.
Gbla was delighted to find out she was having a boy. She has bought a pram, but between home renovations and a busy job she has not managed to put together a nursery yet, or even buy a cot. She is also trying to fight off the thought that she and her son could die during the delivery.
When Gbla was nine or 10, as part of the family’s preparation for migrating to Australia from Sierra Leone, her mother took her to a hut where an old woman cut out her clitoris with a rusty knife. “She then threw the piece of flesh across the room like it was the most disgusting thing she’d ever seen,” Gbla recalled in a Tedx Canberra talk.
Now she fears that ignorance about female genital mutilation (FGM) among Australian doctors and midwives could add dangerous pregnancy complications to the long list of traumas inflicted by the practice.
“I kind of feel I will go in and have a baby and [it] will feel like a second FGM procedure. I feel like it could be the second traumatising experience of my life,” she tells Guardian Australia from her Adelaide home.
“I can’t go there and open my eyes and have someone who doesn’t know what they’re doing tell me to push … that could kill my baby. It’s too much, it does my head in. This is just not working out, it’s terrible.”
Despite being told for years that she was infertile, Gbla conceived a child with her husband earlier this year. But her joy was tempered by the terrifying experience still ahead of her, and the failure of medical professionals to recognise its source.
On her first visit to a midwife she was asked the usual questions. Does your family have a history of diabetes? Do you smoke? Do you take any medication?
But Gbla says the midwife showed no interest in whether she had FGM, even though she comes from a country where it is commonly practised.
She says a doctor subsequently told her there was no need to examine the extent of her FGM until further into her pregnancy.
“I asked, don’t you want to check scar tissue?” Gbla says. “[The doctor] basically said, when you get there we’ll open you up, then sew you back up. I walked away pissed and angry. Is this the person who’s going to bring my baby into the world?”
Some doctors who serve FGM-affected communities agree there is an urgent need for more awareness.
Obstetrician Greg Jenkins, who conducts a weekly high-risk antenatal clinic at Auburn Hospital in western Sydney, says discussion about FGM should happen well before an expectant mother reaches the delivery room, and doctors should be more aware of the risks it poses.
“It definitely should happen ... overall increasing awareness is an important thing and then equipping people with information that they need in treating them is important,” he says.
A dearth of data
The World Health Organisation classifies FGM by three types. Type 1 involves cutting out the clitoris. In type 2 the labia minora is also cut out, wholly or partially. Type 3 refers to sewing up the vagina to create a very small hole, which may also include removing the clitoris.
Among the many complications from FGM are pregnancy and birth risks. Some doctors perform a procedure to open up the vagina before the birth, or opt for a caesarean. Even with these precautions the rate of newborn deaths is higher for women with FGM than those without FGM.
Data on FGM survivors and those at risk in Australia is negligible. No official statistics are kept by gynaecologists on women they treat with FGM, and doctors do not report how many babies are delivered to women with FGM.
Nor is there undisputed data on how many girls in Australia are at risk of FGM. Legislation around FGM is the responsibility of the states, but is more or less uniform. In all states and territories it is illegal to carry out FGM, and to take an Australian citizen out of the country to undergo FGM.
There are believed to be 34,000 women in NSW and 83,000 across Australia from countries where FGM is practised to a greater or lesser extent – predominantly Iraq, Pakistan, Indonesia, Egypt and west African countries. An analysis of the data commissioned by No FGM Australia, of which Gbla is a director, estimated there were 5,640 girls under 15 at high risk of FGM in Australia.
She counts herself as one of the “lucky” FGM survivors. At least she was confident enough to raise it with her doctors. Countless other women would not do so, or do not even know they have FGM, she says. As a result, when they give birth their doctors do not know about their FGM until they are in the delivery room.
Views diverge on how best to end the silence and ignorance that surrounds FGM.
Many survivors are reluctant to speak about what they regard as a private matter, and advocates are eager to raise awareness, but wary of making survivors feel their entire culture is being criticised.
Some advocates argue FGM is not a violent practice and, while it needs to be stopped, the debate should be framed thoughtfully, particularly in western countries where women with FGM can end up feeling ashamed of their culture or isolated from the wider community.
Gbla is emphatic in her view that FGM is abuse and will not be stopped with a “softly, softly” approach.
“When I think of FGM I think of someone pinning me down and holding a rusty knife, and cutting away at my flesh, and I’m begging them to stop and they don’t. I would think anyone would call it violence – there’s no way to turn it around, taking a knife to a little girl’s private parts is violence. They’re taking a sharp object, a rusty knife and poor, scared little children then left there to bleed,” she says.
“It’s child abuse, it’s not about culture, there’s no cultural defence for any kind of abuse. Nobody should be able to hide behind culture, this is about patriarchy, gender, this is about trying to control the sexuality of women.”
Vivienne Strong, who manages the NSW education program on FGM, is much less inclined to dismiss the claim that FGM may be viewed by some as a legitimate cultural practice.
In spreading the message that FGM is both illegal and dangerous, she works with facilitators whose background is in each country where FGM is prevalent, so the target groups do not feel they are being singled out by a white society.
“It’s extremely important to communities that they’re treated with respect, that the women are treated with respect. And that we recognise that this is a cultural practice, it’s not a practice of violence, as seen by people in a traditional setting, it’s seen as a practice that makes their daughter acceptable in those societies. Respect for people’s cultural differences while recognising the harm this particular practice can cause [is important], and that of course comes under the banner of the rights of the child, the rights of the adolescent, the rights of girls.”
The legacy of FGM
The effects of FGM ring through a survivor’s life, often interfering with periods, sexual development and fertility, and leaving a lasting psychological legacy. Gbla, one of Australia’s few outspoken FGM survivors, sarcastically refers to FGM as “the gift that keeps on giving”.
Almost crippled by her periods when she was a teenager growing up in Adelaide, she discovered she had FGM when she saw a poster showing the three types and recalled a long buried memory of the woman who cut her.
A long period of fury followed, particularly at her mother, who also had FGM when she was a young girl. “How could you do this to me?” she asked her mother repeatedly. Her mother refuses to apologise.
Gbla’s most enduring grief as an FGM survivor has been for her sexuality.
Flicking through magazines such as Dolly when she was a teenager, she was puzzled by the articles aimed at helping girls come to terms with their raging hormones and questions to Dolly Doctor about the sensations “down there”. Khadija says she felt nothing but “numbness”.
“It’s almost like your vagina is inactive. So really your sexuality is messed up, you don’t feel horny, you don’t have sexual desire, you just feel numb down there, when you touch it there’s just nothing happening,” she says.
“We just have no chance at all in terms of sexual pleasure. It makes you question your sexual orientation – when I was a teenager thought I was asexual. I didn’t feel like sex, ever … I do have sex but have no desire to.”
She says she longs for an orgasm, having often thought of sex as a chore, something in which she is not really a participant.
“I get some sensation with my husband, who’s very wonderful, we talk and experiment … I’m fighting to regain that power and control. So many women don’t think they have alternatives. There’s not much research into this area.
“When I was growing up my mum would say sex is two minutes and then it’s over, you’re not meant to enjoy it ... you do it and you make a baby. As for the pain, she doesn’t care, she doesn’t feel guilty that she did that to me,” she says.
Evidence FGM is declining disputed
Some advocates believe the incidence of FGM in Australia is declining, though again the data is scant.
The executive director of the Women’s Multicultural Centre in Melbourne, Adele Murdolo, refers to a University of Melbourne study, which found the practice was declining in that city.
“There are really clear indications it’s a declining practice, it’s not something the communities, once they’ve arrived in Australia … are holding onto. There are strong indications it’s a less attractive proposition,” Murdolo says.
But the study is viewed warily by No FGM Australia, which argues that it accepted at face value denials from women that they would undertake the practice in Australia.
The group’s director, Paula Ferrari, asks: “Why would they admit to a practice they know is illegal?”
Solid data on prevalence is important for advocates to understand which strategies are most effective in combating FGM.
The NSW education program on FGM has been running for 17 years and Vivienne Strong, with a team of four in her western Sydney office, has a long list of its achievements, including engaging men from FGM-affected communities and an outreach program for rural and regional areas. But she concedes it is challenging getting into schools to educate teachers in the crucial task of identifying girls at risk, because of the many demands on the teachers’ time.
Murdolo’s Melbourne centre uses an international review of best practice and tries to pick up programs that have been evaluated and proved effective. She agrees that building up women in FGM-affected communities to speak out, and involving men, are key planks of the work.
“What you normally get is a divided community – some people think that it’s something that’s needed when others are not so committed to it or strongly opposed to it,” she says. “The idea is getting conversations happening ... It’s about attitudes, not just attitudes to the practice but attitudes to gender equality.”
Two prosecutions for FGM-related offences are making their way through the NSW court system.
A Sydney man has been charged over the genital mutilation of his daughter when she was nine months old. It has been alleged he took her overseas for the procedure, which was discovered when the girl’s mother took her to a doctor. In a separate case a woman, a nurse and a sheikh have been charged over the genital mutilation of two sisters, aged six and seven, in the living room of a western Sydney home.
Both cases have been set down for trial this year. In the second case the court has heard the sheikh told locals to lie to police about the prevalence of FGM in the community.
Last month a Brisbane girl was reportedly taken to a west African country by her father to undergo FGM. Federal police are investigating.
As ever, funding for services is a constant battle. The British government has committed £35m to ending FGM. Murdolo says Australia could do with a commitment that was even a quarter of that.
The money, she says, should be put towards the unglamorous but important job of rationalising resources strewn between states and territories.
“There’s a lot of knowledge accumulated but there hasn’t been enough commitment to coordinating all of that work,” she said. “Every state and territory has resources, but it’s really inconsistent.”
Gbla agrees it is all about education, to break the silence and embarrassment. Educating doctors and nurses, educating child protection officers, educating teachers, educating the girls who are or could be affected by it.
“I don’t like walking around being the face of FGM. I’d rather be the face of lipstick, because I have nice lips, but instead I’m the woman everyone knows has FGM.
“At every stage of your life it impacts you, every woman has her own shame and her own isolation in their own experience. I want people to know how terrible this is, I will stand up and say, ‘I don’t have a clitoris’. There is so much education that needs to be done. Our mothers aren’t going to help us, they’re not going to comfort us. It’s up to us.”
