Columns

There were two references to female genital mutilation (FGM) in March 6, 2014’s Senior Power column about Women’s History Month and International Women’s Day. Wikipedia online encyclopedia has an excellent article about FGM. Ayaan HirsiAli’s books are in the public library’s collection: The caged virgin :An emancipation proclamation for women and Islam; Infidel; and Nomad: From Islan to America—A personal journey through the clash of civilizations. In 1993 Harcourt Brace published Warrior marks: Female genital mutilation and the sexual blinding of women by Pratibha Parmar and Alice Walker. For a list of publications about FGM, consult the LINK catalog. Many articles about action against FGM are accessible via the public library’s Encore catalog. 

Different societies practice different rituals of so called female circumcision. Female circumcision and female genital mutilation differ. Which of the following do you consider are true and which are false? The practice of mutilation of females’ genital organs is… 

1. acceptable when performed by a certified midwife or rabbi.
2. considered the female counterpart of male circumcision.
3. estimated as having been imposed upon 70+% of the women of Burkina Faso, Djibouti, Eritrea, Ethiopia, Mali, Sierra Leone, Somalia, Sudan.
4. part of the culture.
5. strongly encouraged by many mothers for their daughters’ welfare.

FGM is sometimes incorrectly attributed to cultural or religious practice. It is practiced in 28 African countries, some parts of Asia and the Middle East, and among immigrant communities in Europe, Australia, Canada and the United States. An estimated 100-140 million women and girls have undergone genital mutilation, and each year another 2 million girls are at risk of undergoing some form of this barbarism. 

In some procedures, the foreskin of the clitoris is removed. Others involve "infibulation," in which the clitoris and labia minor are surgically removed and the two sides of the vulva are sewn together. These violent procedures are performed without anesthetic, often with primitive, unsterilized tools.  

Immediate health risks to the girl or woman include hemorrhage, tetanus, blood poisoning, shock, and death. Survivors are left with scarring; sexual relationships are joyless and painful. The surgery leaves openings inadequate for the flow of urine and menstrual blood, which can cause vaginal and urinary tract infections and sometimes sterility, the ultimate disaster for women whose value is based on their ability to reproduce. 

Infibulated women who do give birth must be surgically reopened and re-sewn after each childbirth. Other forms of FGM include cauterization by burning of the clitoris and surrounding tissue; scraping of tissue surrounding the vaginal orifice or cutting of the vagina; and introduction of corrosive substances or herbs into the vagina for the purpose of tightening or narrowing it. 

In Somalia, a study reported by Lori Heise of 33 infibulated women showed that their final labor stage was 5 times longer than normal, 5 babies died, and 29 babies suffered oxygen deprivation from the prolonged, obstructed labor.  

As the U.N. has noted, girls are discriminated against throughout the world, often even before birth in cultures where more value is placed on boys. Some Muslims believe the Koran demands FGM, although, as the World Health Organization points out, the practice predates Islam. Others see women's genitalia as unclean and believe infibulation is a ritual purification. Men in such cultures will not marry unmutilated women, believing them to be unclean, promiscuous, and sexually untrustworthy. Many women do not object to the procedure because they view it as a tradition and natural part of their role in life.  

Victims’ advocate Hirsi Ali reports that "…this cruel ritual does not take place in all Islamic societies. But Islam demands that one enter marriage as a virgin. The virginity dogma is safeguarded by locking girls up in their homes and sewing their outer labia together. Female circumcision serves two purposes: the clitoris is removed in order to reduce the woman's sexuality, and the labia are sewn up in order to guarantee her virginity." … " 'Circumcision' is a term that implies that the practice is acceptable. It is not acceptable. Nor is it culturally 'excusable.' "  

American media coverage of the legal case of Fauziya Kasinga illustrated a range of perceptions within her own family and community in Togo. Kasinga was granted political asylum in the U.S. in 1996, citing fear of forced circumcision. The U.S. Immigration and Naturalization Service recognized for the first time that the fear of genital mutilation was legitimate grounds for asylum. The U.S. Congress outlawed infibulation in the U.S. under the Federal Prohibition of Female Genital Mutilation Act of 1996; in addition, U.S. representatives to the World Bank and other international financial institutions are required to oppose loans to the 28 African nations where the practice exists if those countries fail to conduct educational programs to prevent it.  

Arab-American Nonie Darwish recounts how Aunt “Batta once talked about the strange subject of tahara, circumcision of girls. The word tahara literally means cleanliness. In Aunt Batta’s generation, and my mother’s as well, all girls at around age seven had to go through tahara. Batta was laughing while describing how for days young girls could not walk because of the pain between their legs. It did not seem to me like something to laugh about, I noticed that my mother was uncomfortable with the subject and tried to steer the conversation away from it. Fortunately, my mother and much of her generation and class stopped doing this to their daughters. I was relieved that tahara was not something that would be forced on me. However, a large number of the uneducated lower classes still practiced this genital mutilation on their young girls in my generation, and tragically, it is still practiced to this day in many Muslim and African countries.” 

Adult females who have been subjected to FGM as children and who seek repair or reconstructive surgery are unlikely to be successful. There is, however, the possibility of referral to a urogynecologist (there are some practicing in Northern California) for at least a “consult.”  

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This Senior Power column concludes with some other recommended reading and listening:  

“Sequestration, Salary Cap Needed For Nonprofit Housing Developers,” by Lynda Carson (Berkeley Daily Planet, February 28, 2014.) 

“Sherwin B. Nuland, 'How We Die' Author, Dies at 83," by Denise Gellene (New York Times, March 5, 2014.)  

"Fresh Air Remembers Surgeon And 'How We Die' Author Sherwin Nuland," a replay of an interview of Sherwin Nuland by Terry Gross in 1994 (National Public Radio Fresh Air, March 7, 2014.) Print and audio transcripts (running time: 12 minutes, 42 seconds) are available at the site. 

Alone in her rented rooms, my great grandmother, Mary Dodge Wardell, died of “nephritis,” then known as Bright’s disease. She was buried in her GreenWood Cemetery lot in 1911. When I was working on The Truth Must Dazzle Gradually; A Memoir, I hadn’t been able to find much in the literature about Bright’s disease until I read Nuland. In his memoir, Dr. Nuland referred to his aunt's fatal illness as Bright's disease, "at the time a not uncommon process of progressive destruction of the kidneys. It usually was precipitated by an undiagnosed and unremembered streptococcal sore throat, going on to cause renal poisoning and gradual failure. Its relentless advance toward an inevitable death took place over the course of years or even decades."  

"More than 200,000 Los Angeles County residents to be forced into managed health care," by Susan Abram (Los Angeles Daily News, March 16, 2014). Thousands of California residents whose health coverage is provided by Medicare/Medi-Cal (“MediMedi”) are being forced into HMO’s through a state pilot program.  

Abram writes, “Thousands of elderly and disabled Californians will be pushed into managed health care plans soon under a state pilot project, but doctors’ groups and patient advocates have found a number of problems with the program that could threaten care for the most medically fragile. Called Cal MediConnect, the project is touted as a voluntary, three-year pilot. The state’s Department of Health Care Services and the federal Centers for Medicare & Medicaid Services (CMS), described it as a way to ‘help those eligible receive coordinated medical, behavioral health, and long-term institutional, and home-and community-based services through a single organized delivery system.’ … But several groups, including the Los Angeles County Medical Association, the Los Angeles Podiatric Medical Society and at least six other nonprofit organizations, have voiced their concern to the state, saying the notices sent to those who are eligible are inadequate and confusing, and there are no forms that clearly give patients the right to opt out. …” 

“Behold the Ides of March” by Toni Mester. (March 14, 2014, Berkeley Daily Planet. First Person).