On Oct 21st in Berkeley, CA, a team of Sahiyo activists organized the first California Bay Area Thaal Pe Charcha (TPC). This Sahiyo flagship program allows Bohra women to come together in a private, informal setting so that they can bond over food and discuss issues that affect their lives, like Female Genital Cutting or Khatna. The program started in Mumbai, India in 2017 and is being piloted in the United States in 2018 in New York and California. For the organizers of the California Bay Area TPC, the weeks leading up to the event were full of excitement and anticipation for what they hoped would be the start of new friendships in the Bay Area.  

This is what one organizer, Sabiha Basrai, has to say about the program:

“Sharing space with an inter-generational group of Bohra women was healing and inspiring. I was able to embrace my Bohra identity in a new way and celebrate the special bonds that we build in our community, take pride in our cultural and religious history, and of course, enjoy a shared meal around a thaal. It is difficult to talk about the patriarchy that exists within our jamaats and I am grateful that TPC created a safe and confidential space to hear each other’s stories and to remind one another that we are not alone in these struggles.  We are all figuring out how to practice our faith with feminist values. This means challenging certain social norms that are oppressive to women, such as khatna or female genital cutting while recognizing that empowering women is a very Muslim thing to do.

I am grateful for the patient and supportive work of Sahiyo and look forward to the continued work bringing about gender justice in our communities.” 

On October 7, Sahiyo co-founder Aarefa Johari and We Speak Out founder Masooma Ranalvi participated in a panel discussion on Female Genital Cutting in India, at the We the Women summit organised by veteran journalist Barkha Dutt in Bangalore. Prominent human rights activist Srilatha Batliwala moderated the discussion.

The event was attended by more than 200 people in Bangalore and was streamed live on social media. Ranalvi and Johari shared their personal experiences of being subjected to FGC and discussed various aspects of the problem from the need to engage with the community to end the practice and the significance of a law against it.

You can watch the complete video of the discussion here.

The event was a follow up to a similar We the Women summit in Mumbai in December 2017, when Sahiyo co-founder Insia Dariwala spoke about the practice along with Mubaraka and Zohra, two survivors of FGC. You can watch last year’s video here.

A new change.org petition calling for an end to Female Genital Cutting in the Bohra community was started in September by Ranjana Sehgal and Umi Saran.

The petition is addressed to Dr. Syedna Mufaddal Saifuddin, the spiritual leader of the Bohra community, and was started in response to the Syedna’s visit to Indore to give sermons during the first ten holy days of Muharram.

As the petition mentions, “Although the matter is already in the Apex Court if the directive to end FGM comes from the spiritual head of the Bohra community, it will be easier to put an end to this violent practice. The Government of India’s WCD Ministry has said that FGM is in clear contravention of our laws, the Indian Penal Code and Protection of Children from Sexual Offences (POCSO).”

Over 16,000 supporters have already signed, and the campaign’s next goal is reaching 25,000 signatures.  If you would like to support by signing, click here.

By Saleha 

Country of Residence: Canada
Age: 45

Having lived in South-East Asia, and being exposed to multiple races and cultures, I grew up in a very open-minded family. As a child, my family and I occasionally went to the local Bohra mosque to socialize with others in the community. I loved going to the “masjid” – there I got a chance to meet my best friend and also eat delicious Bohri food. It was wonderful to see all the aunties dressed up in “onna ghagra” which are colourful skirts with matching chiffon scarves draped around the head. After the prayers, everyone congregated outside and chatted into the late hours of the night.

Then suddenly in the early 90s it all changed. The upper echelons of the Bohra clergy instated new rules. The progressive Dawoodi Bohras were no more; instead, women were forced to wear a form of hijab called “rida” and men were made to sport a beard, wear a kurta, and “topi” or a cap on their heads. The clergy, headed by the Syedna, began to exert control over everything. Permission from Syedna was required not only for religious matters but in daily life as well. For example, permission was needed to start a business, get married or even to be buried. Female Genital Cutting or khatna was deemed necessary, even though that act of it is not prescribed in the Koran. If any of the rules were not followed, or if you protested and spoke against them, you were excommunicated or threatened to be. You’d lose all your ties to friends and family forever.

I can never forget the awful day, when I was seven, while on a holiday in India, my aunt asked me to go shopping with her. She took me to a dingy place where a Bohri man and woman took me inside. They asked me to undress waist down, and when I protested, the man held my hands while the woman removed my jeans and underwear and forced me to lie down. I saw the man take out a blade and I struggled and screamed for help, while they proceeded to cut me. I lay bleeding on the floor, unable to comprehend what had happened to me. It was horrific, painful, and demeaning. I hated what was done to me. I hated that my mom was not there. I was angry at my aunt for allowing them to hurt me.

I remember that experience vividly and to this day I am infuriated that I had to go through this ordeal as a child in the name of religion. While the majority of the Muslim communities around the world have spoken against this, the Dawoodi Bohra religious authorities urge continuing FGC under the guise of cleanliness. The worst part is that some women push this practise on vulnerable children too young to give consent, instead of protecting them as adults should.

It was a difficult time for me. Having grown up with all the freedom in the world, it was  suddenly being taken away from me and I grew cynical of my Bohra culture and wanted no part of it. Today, I am happy I decided to leave the fold. It was not hard to leave. In fact, it was liberating. I was not comfortable with the more rigorous path that my community was taking. I am sure there are many other Bohri people out there who are quietly questioning many of the beliefs handed down to them – some so silly, useless, and others very damaging – Bohris must refrain from using Western toilets; Bohris cannot host or attend wedding functions in secular, non-Bohra venues; brides can apply mehndi only an inch below the wrist and cannot hold the traditional “haldi” functions; and all Bohris must carry a RFID photo ID which will monitor attendance to the mosque.  

Humanity has achieved such remarkable progress. We have ventured into space, developed cloning and gene editing technologies, and most importantly, the Internet has resulted in globalization and interconnection between various cultures and communities. In this light, I wonder why we are still talking about FGC and the right to choose to do it to our daughters in this day and age? I am thankful that organizations like Sahiyo and We Speak Out have become a voice for children who are being hurt in the name of religion.

I look at my children and I see the most informed, connected, and progressive generation. Imposing impractical, harmful religious rules such as continuing FGM on such a generation will only drive them further from our culture. More and more Bohri women and men are speaking out against this harmful practise because whenever religion becomes too rigid, too corrupt, it begins to crack. My hope is that our community can find the strength to break free from all the rigid practices and once again become the most progressive community among the Muslims.

Sahiyo is pleased to introduce our inaugural U.S. Advisory Board. As our U.S. operations and programs have grown, the advisory board will provide strategic advice to the management of our organization, and ensure that we continue fulfilling our mission to empower communities to end Female Genital Cutting and create positive social change through dialogue, education, and collaboration based on community involvement. Advisory board members will be supporting a human rights driven organization dedicated to creating a world without Female Genital Cutting through dialogue, education and direct community involvement.

Join us in welcoming the team: Maria Akhter, Renee Bergstrom, Alisha Bhagat, Insia Dariwala, Dr. Melody Eckardt, Joanne Golden, Priya Goswami, Aarefa Johari, Zehra Patwa, Maryum Saifee, and Joanna Vergoth.

By Brionna Wiggins

Earlier this year I had no idea about female genital cutting (FGC). None whatsoever. I mean, events happen all the time around the world and I’m not aware of the dozens of happenings that occur day-to-day. But for FGC to go on without so much as a whisper of this harmful practice, I thought was rather strange. 

I learned about FGC when I was given an assignment during my junior year in high school. It was a Pre-Senior Project, which was essentially a practice before our year-long project we had to do for our final year of high school. Ideally, we were to choose a topic that pertained to our passions or a problem related to us on some level. I was at a loss for what to choose. Everyone around me jotted down several potential ideas, but my ideas were comparatively vague. By day two or so, I sat with my teacher to make a final decision. My teacher wrenched out my distaste for injustice and helped me narrow the target of people who undergo it. She typed online in the search bar something along the lines of “issues involving women and children” and there it popped up–female genital cutting.

I was appalled when I first learned about it. To reiterate, I had no idea this tradition existed and I wondered how it continued to go on. Why did women and men subject their daughters to this? What was the appeal? I dug deeper, finding out the reasons behind FGC. In some communities, while the intention was to keep daughters clean or marriageable, it was done at the cost of carrying out a potentially traumatic procedure that could leave the woman or girl with a handful of health issues afterward.

However, the concept of cultural relativism impeded criticism and questioning, while justifying the tradition. The idea that because one has not lived in a certain community or society, they can’t truly pass judgment on the cultural practices of others. Two people living in two different places across the world from each other naturally grow up with different experiences. Who is to say that another’s culture and traditional practices are objectively wrong? What is considered wrong when it comes to culture? Outsiders may feel as if they do not have a voice in regard to scrutinizing FGC because it’s an issue beyond their homes. Therefore, proponents of FGC claim that the divide or differences between two groups is too great to judge each other. Admittedly, I initially agreed with the notion of cultural relativism. Who was I to criticize people who carry out FGC in their communities when I knew nothing of their lives? Even so, remaining in place and staying quiet, doesn’t sit well with me, especially if I could be a person who brings awareness to FGC being a human rights violation. The excuse of cultural relativism shouldn’t be used when people are being harmed.

I continued researching FGC for my project the next school year, my senior year in high school. This time, the project had to be more extensive, including a longer research paper, another presentation, and some sort of final product. This ranges from documentaries to creating design plans. With all this work I was doing, I thought maybe I could make some sort of difference. I needed a mentor for guidance, one who is an expert on the topic. I sent out an email or two before finding Mariya, a co-founder of Sahiyo. The organization specializes in advocacy regarding FGC, even working with affected communities to diminish the practice. By sharing the stories of women involved with FGC, a wider audience becomes aware of the issue with a deeper understanding. With the combined efforts of multiple organizations and people from different walks of life, the perception of practicing communities will change. Then, I believe, FGC will become part of the past.

Over the course of my project, I hope to improve my advocacy skills and fully understand the issue that I’ve been invested in for the past couple of months. So far, researching FGC and looking into multiple perspectives has encouraged me to consider my own views on the topic. By the end, I will have figured out my ethical priorities. For the rest of my blog posts, I want to look into a handful of countries where FGC is practiced and talk about the circumstances around them. Until next time!

 More on Brionna:

Brionna is currently a high school senior in the District of Columbia. She likes drawing, helping others, and being able to contribute to great causes.

(This article is Part 6 of a seven-part series on trauma related to Female Genital Cutting. To read the complete series, click here. These articles should NOT be used in lieu of seeking professional mental health and counseling services when needed.)

By Julia Geynisman-Tan, MD 

Background 

FGM/C has no known health benefits, but does have many immediate and long-term health risks, such as hemorrhage, local infection, tetanus, sepsis, hematometra, dysmenorrhea, dyspareunia, obstructed labor, severe obstetric lacerations, fistulas, and even death. While the psychological, sexual, and obstetric consequences of FGM/C are well-documented (refer to prior posts in this series), there are few studies on the urogynecologic complications of FGM/C. Urogynecology is the field of women’s pelvic floor disorders including urinary and fecal incontinence, dysfunctional urination, genital prolapse, pelvic pain, vaginal scarring, pain with intercourse, constipation and pain with defecation and many other conditions that affect the vagina, the bladder and the rectum. Urogynecologists are surgeons who can both medically manage and surgically correct many of these issues.

FGM/C and Urinary Tract Symptoms

One recent study from Egypt suggested that FGM/C is associated with long-term urinary retention (sensation that your bladder is not emptying all the way), urinary urgency (the need to rush to the bathroom and feeling that you cannot wait when the urge comes on), urinary hesitancy (the feeling that it takes time for the urine stream to start once you are sitting on the toilet) and incontinence (leakage of urine). However, the women enrolled in this study were all presenting for care to a urogynecology clinic and therefore all of them had some urinary complaints so it is difficult to tell from this study what the true prevalence of lower urinary tract symptoms are in the overall FGM/C population.  

Therefore, given the significant number of women with FGM/C in the United States and the paucity of data on the effects of FGM/C on the urinary system, my research team studied this topic ourselves in order to describe the prevalence of lower urinary tract symptoms in women living with FGM/C in the United States. Publication will be available online in December 2018.  

 We enrolled 30 women with an average age of 29 to complete two questionnaires on their bladder symptoms. Women in the study reported being circumcised between age 1 week and 16 years (median = 6 years).

• 40% reported type I

• 23% type II

• 23% type III

• 13% were unsure

Additionally, 50% had had a vaginal delivery; and 33% of these women reported that they tore into their urethra at delivery.

Findings:

A history of urinary tract infections (UTIs) was common in the cohort:

• 46% reported having at least one infection since being cut 

• 26% in the last year

• 10% reported more than 3 UTIs in last year

• 27% voided ≥ 9 times per day (normal is up to 8 times per day)  

• 60% had to wake up at least twice at night to urinate (once, at most, is normal)

Most of the women (73%) reported at least one bothersome urinary symptom, although many were positive for multiple symptoms:

• urinary hesitancy (40%)

• strained urine flow (30%)

• intermittent urine stream (a stream that starts and stops and starts again) (47%) were often reported

• 53% reported urgency urinary incontinence (leakage of urine when they have a strong urge to go to the bathroom)

• 43% reported stress urinary incontinence (leakage of urine with coughing, sneezing, laughing or jumping)

• 63%reported that their urinary symptoms have “moderate” or “quite a bit” of impact on their activities, relationships or feelings

What’s the Connection Between FGM/C and Urinary Symptoms?

Urinary symptoms like the ones described above can be the result of a number of factors. Risk factors for urinary urgency and frequency, incontinence, and strained urine flow include pregnancy and childbirth, severe perineal tears in labor, obesity, diabetes, smoking, genital prolapse and menopause.

However, given the average age of women in our sample and the fact that only half of them had ever had a vaginal birth, the rate of bothersome urinary symptoms are significantly higher than has been previously reported. FGM/C may be a separate risk factor for these symptoms. Interestingly, the prevalence of urinary tract symptoms in our patients closely resembled that of a cohort of healthy young Nigerian women aged 18-30, in which the researchers reported a prevalence of lower urinary tract symptoms of 55% with 15% reporting urinary incontinence and 14% reporting voiding symptoms. The authors do not mention the presence of FGM/C in their study population but the published prevalence of FGM/C in Nigeria is 41%, with some communities reporting rates of 76%. Therefore, it is likely that many of the survey respondents had experienced FGM/C, thereby increasing the prevalence of lower urinary tract symptoms in their cohort. In the study of women in Egypt referenced above, those with FGM/C were two to four times more likely to report urinary symptoms compared to women without FGM/C.

The connection between FGM/C and urinary symptoms can be understood from the literature on childhood sexual assault and urinary symptoms. Most women who experience FGM/C recall fear, pain, and helplessness. Like sexual assault, FGM/C is known to cause post-traumatic stress disorder, somatization, depression, and anxiety. These psychological effects manifest as somatic symptoms. In studies of children not exposed to sexual abuse, the rates of urinary symptoms range from 2-9%. In comparison, children who have experienced sexual assault have a 13-18% prevalence of enuresis (bedwetting) and 38% prevalence of dysuria (pain with urination). The traumatic imprinting acquired in childhood persists into adult years. In a study of adult women with overactive bladder, 30% had experienced childhood trauma, compared to 6% of controls without an overactive bladder. There is a neurobiological basis for this imprinting. Studies in animal models show that stress and anxiety at a young age has a direct chemical effect on the voiding reflex and can cause an increase in pain receptors in the bladder. Additionally, the impact of sexual trauma on pelvic floor musculature has been well described. Women who experience genital trauma often respond with an involuntary contraction of the pelvic floor, which can develop into non-relaxing pelvic floor dysfunction and subsequent urinary hesitancy, strained flow, retention, bladder pain and overflow incontinence.

These Conditions are Treatable

There are treatments for all of the conditions. Urinary hesitancy, strained flow, bladder pain, and urgency are often treated with pelvic floor muscle therapy. That is because many of these symptoms come from an unconscious, constant clenching of the pelvic floor muscles, which then prevents them from using their full range of motion and pinches off the nerves running through the muscles. Pelvic floor therapy focused on lengthening and stretching these muscles can completely change the way that you urinate and the sensation of pain in the pelvis. This kind of physical therapy is done by all female providers in a private room. The therapy consists of a combination of external and internal work on all of the muscles of your core and pelvic floor to release trigger points of tension and teach you how to relax and lengthen these muscles. Sometimes the therapists use biofeedback devices in the vagina to help you to recognize certain muscles groups. The sessions are usually one hour long and last for 6-12 visits. You can obtain a referral to a pelvic floor physical therapist from your local urogynecologist.

If you have urinary leakage throughout the day or nighttime, this can also be treated. Your urogynecologist can help differentiate whether you have stress urinary incontinence (leakage with coughing, laughing, exercise, lifting) or urgency urinary incontinence (leakage that follows the urge to go to the bathroom or sometimes sporadic leakage without any urge). These types of incontinence are treated differently but both can be treated with a combination of medicine, office procedures or surgical treatments. To find a urogynecologist in the Unit, you can go to the website of the American Urogynecologic Society and click on patient services.

About Julia Geynisman-Tan

Julia is a Female Pelvic Medicine and Reconstructive Surgeon in the Department of Obstetrics and Gynecology at Northwestern. During her residency at New York Presbyterian – Weill Cornell, she founded the Survivor Clinic of New York City, a dedicated clinic for women who had experienced sexual violence, including trafficking, female genital mutilation, and torture in war. Now in Chicago, Dr. Geynisman-Tan has founded the Northwestern ERASE Clinic for survivors of human trafficking and is an asylum evaluator for Physicians for Human Rights. She is currently a co-chair of the American Women’s Medical Association Physicians Against Trafficking of Humans Committee, on the board of the America Hospital Association’s Human Trafficking Consortium and serves on the Cook County Human Trafficking Task Force.

(Please note that a version of this article appears on LankaWeb.com. It has been republished here with permission from the author.)

By Fatima Yasmin  

Country: Sri Lanka

Muslim religious organisations in Sri Lanka have called on the government to medicalise female circumcision to ensure the procedure is done under hygienic conditions. In their submission before the Parliamentary Committee on Women and Gender early in September, the Muslim groups stated that the Muslim community was very concerned about moves to ban the procedure on the grounds that it was Female Genital Mutilation (FGM).  

Spokeswoman Noor Hazeema Haris has reportedly said that although Muslims wholeheartedly have supported the abolition of traditional practices harmful to women and children such as Female Genital Mutilation, the Islamic practice of female circumcision was very different.  

She pointed out that the distinction is that female circumcision as practiced by Muslims in Sri Lanka, was a minor procedure, in which only the prepuce or hood of the clitoris was removed.

“It is something that is arranged and done by women. Those who say this is male oppression against women are mistaken. It is we who do it just like our mothers and grandmothers and countless generations of our women have done. We continue to practice it because we know it benefits us. Even educated Muslim women support it wholeheartedly,” she said. “If medical complications have arisen among some women circumcised by Osthamamis (traditional female circumcisors without medical training) as alleged by women’s rights groups, it is all the more reason to medicalise the procedure instead of prohibiting it, which will only drive the procedure underground and put girls and women at unnecessary risk.”

The move is a very dangerous one since it could lead to greater acceptability of FGM. There have been many complaints raised against traditional practitioners including the use of unsterile instruments and harming the clitoris in some cases. However, I believe the solution is to ban it altogether rather than medicalising it.

But analysts warn this could lead to an uproar from religious parties and have political implications since parties that come out against FGM risk losing a large and influential Muslim vote bank. The All Ceylon Jamiyyathul Ulama, an organization of religious scholars in the country issued a fatwa in 2008 stating that female circumcision was obligatory, and was among the parties that made representations to medicalise the practice early in September.

It is also a matter of concern to women’s rights groups that the said Parliamentary committee agreed to accommodate the representations and requested that medical evidence is submitted to prove that female circumcision of the type prescribed in Islam, as stated by these religious groups, causes no harm and benefits women.

A female doctor who performed the procedure before a health ministry circular prohibiting medical professionals from performing it came into effect in the country in October, and whose name has been withheld here by her request, said that she welcomed the move to medicalise it:

“I performed about 25 circumcisions a day in a private clinic, mostly infants. But there were women, too. Some were newly married and wanted to be circumcised at their husbands’ request. All I do is remove a little bit of skin covering the clitoris. I use a very fine instrument for the babies. It takes only a few minutes. In the case of adults, I inject an anesthetic before proceeding to circumcise them. My patients tell me it’s only the injection that hurts a bit and that after that they don’t feel a thing. It’s sore for a few days but heals fast. There is a huge demand for this service. It’s a shame that it’s now going back into the hands of untrained women who have no proper medical knowledge and who use unsterilized instruments for the purpose.”

A young mother who had her infant daughter cut by a traditional practitioner also agreed.

“Doctors refuse to do this now, and I was forced to get it done by an Osthamami. She took out a blade which looked as if it had been used many times and made a cut to my daughter’s genitals. Some blood came out. I could not bear to look. Later I checked it and noticed a cut had been made in the skin over the clitoris but the foreskin had not been removed. This is an improper circumcision according to my sister who is an Aalimah (religious scholar) and so I will have to get her circumcised again. Why are these so-called women’s groups against doctors doing it? We will practice it whether they ban it or not.”

However, a member of a prominent women’s organization said that prohibiting the practice is the right thing to do.

“FGM has been condemned as a violation of the rights of women and girl children by the World Health Organisation. WHO makes no distinction between FGM and the type of circumcision practiced here. It’s all the same. How can you cut these girls and call it a religious obligation? I understand there is a strong religious argument for the practice, but we cannot let religion affect the health of girls and women.”

And so the debate goes on – to ban or medicalise. One thing is for sure. It won’t be easy. Not only does the religious establishment in Sri Lanka, unfortunately, support the practice, but many local women are for continuing it, meaning the government and activists working to end FGM will face many challenges ahead before FGM can be abandoned in Sri Lanka.