The cruel cut

Fatu Sillah was six years old when she had her genitals cut by a group of women from her village. Sillah clearly remembers being held down, the pain of the knife cutting her flesh, and a woman whispering “you’re a woman now and ready to be married.”

Like most women in Africa’s Western region of Sierra Leone, Sillah underwent Female Genital Cutting (FGC), a deeply rooted cultural tradition that has been practiced in her community for centuries.

Sillah now uses her experience to educate teachers, doctors and midwives on how they can help women living in Australia with FGC.

“I had post-traumatic stress and I was aware of everything that happened to me. FGC is child abuse, and there needs to be a better support system,” says Sillah.

Women and girls are increasingly migrating to Australia from countries where FGC is practiced. Sillah believes Australia needs to provide more culturally appropriate health care, community education and safe spaces for women with FGC.

According to the World Health Organisation an estimated 53,000 girls and women born elsewhere but now living in Australia have undergone FGC. FGC is illegal in Australia, but it’s still legal in several regions across the world including some parts of Africa, the Middle East and Asia.

Sillah says medical professionals in Australia need to get more training overseas and listen to FGC survivors. “Sometimes medical professionals don’t even know what FGC is, which can leave survivors feeling embarrassed and confused,” says Sillah.

FGC involves cutting the external parts of the vaginal area and it’s a traditional and cultural practice with no health benefits. It harms women’s sexual and reproductive health.

Special knives, scissors and razor blades are all tools used for Female Genital Cutting. Photo Taylor Padfield.

There are four types of FGC: type 1- the partial or total removal of the clitoris; type 2- the partial or total removal of the clitoris and the labia; type 3 (infibulation)- narrowing of the vaginal orifice with the creation of a covering seal by cutting and stitching the labia; type 4- all other harmful procedures to the female genitalia for non-medical purposes, including pricking, piercing, incising and scraping.

FGC can cause severe pain, shock, bleeding, bacterial infection and longer-term problems including chronical genital infections, pain during sex, complications during childbirth, physiological trauma and even death.

Sillah has type 2 FGC and started realising something was wrong when she became sexually active. “The biggest challenge I have faced with FGC is being open about my sexuality, especially when I am in a relationship. There is a fear that they will judge me or leave me,” says Sillah.

“At first it was scary, but now I have taken control back and I realise it’s my story. Since I have started doing that I feel more powerful and I am not ashamed of what has happened to me.

“Survivors need to be given more of a voice and platform to share their own story.”

Sahiyo is a non-profit organisation that is empowering Asian communities to end FGC and create positive social change. Mariya Taher, co-founder of Sahiyo, says globally we need to have more health professionals trained on how to provide both physical and mental health care for FGC.

In 2018 Sahiyo started the project “Voices to End FGC” which launched a digital storytelling workshop, where nine women created digital stories to elevate the conversation about FGC globally. The stories were distributed online and via media channels, as well as live community screening events.

This November Sahiyo are hosting a digital storytelling workshop specific to capturing stories about how health professionals can provide care for FGC survivors.

“The idea is to create a collection of stories that can be utilised to teach other health professionals the best practices in providing care,” says Taher.

The Family and Reproductive Rights Education Program (FARREP) is a program in Victoria that seeks to prevent FGC and address sexual and reproductive health issues in communities affected by this procedure.

Nigisti Mulholland, FARREP coordinator at the Royal Women’s Hospital, says there are no other FGC health services in Australia like FARREP, and other states often reach out for their help and support.

FARREP works closely with the African Women’s Clinic located at The Royal Women’s Hospital. The clinic is for women all ages who have FGC and want to talk about their circumcision or arrange to re-open their vagina (de-infibulation).

FARREP offers a package of services including sexual counselling, mental health service and physiotherapy. A FARREP worker is also available to support the women during their appointments at the clinic.

“We ask the women a set of culturally appropriate and sensitive questions like ‘what’s your country of birth?’, and ‘have you had FGC done to you?’” These women come to us because they may experience pain during sex, want to give birth, are feeling stigmatised or have mental health issues,” says Mulholland.

Mulholland says it’s common for women with FGC to think the procedure is universal and normal. “That’s why it’s important we educate them in advance and encourage the women to let their community know about our service, so they can seek help earlier and before child birth.”

FARREP educates medical professionals and schools, and Mulholland says she wants to see FGC included in the curriculum for secondary and tertiary education.

Holly Mulder, who is studying midwifery at La Trobe University, says her course “very briefly” taught her how to identify FGC.

“We should definitely learn more about FGC. I wouldn’t even know how common it is and what questions to ask a woman with FGC,” says Mulder.

In February a Somali mother was prosecuted in Queensland for taking her two daughters overseas for FGC. “Now the two girls are left without a mother, and that’s not the outcome we want. We should be providing education instead of imprisonment,” says Mulholland.

Mulholland says when mothers come to Australia as refugees they sometimes feel like they have no sense of belonging here. “Therefore, they will hold on to any kind of tradition which may include sending their children overseas for FGC.”

Mulholland believes that with education and support we can teach them to practice and focus on more important parts of their culture.

According to Mulholland three million girls are cut ever year, and if we don’t continue education and awareness it is estimated to reach four million a year.

“Women with FGC find it hard to discuss the issue amongst themselves. There is a culture of silence, so we need to talk about it and create safer environments where women feel comfortable to speak,” says Mulholland.

UNICEF advocates for a zero-tolerance approach to FGC and campaigns to eliminate it by 2030. Mulholland wants to be optimistic but says that FGC is unlikely to end in 2030. “Foot binding was a tradition that had been going on for centuries, and it took a long time to eradicate the practice,” she says.

“I have seen a massive change in the last 10 years, but this issue is not disappearing tomorrow.”