Low awareness of hidden FGM/C practices

In certain cafés close to medical colleges in Pakistan and, of course, within the institutions themselves, students studying gynaecology speak of some unexpected sights they have seen.
“Recently, we examined a woman who complained of pain in her genital region. We were shocked to see when we examined her that she had suffered some mutilation of her private parts. I have read about these practices, but I didn’t know they took place here,” said Zeba Khan, a fourth year medical student.
Though female genital mutilation/cutting (FGM/C) takes place, the practice is hidden, hardly ever spoken of, barely known about. The country, for instance, is considered to be “free” of FGM/C, like a number of other Muslim majority countries in the region. Indeed, this view is widely held. “No such thing happens here,” said Saadia Ahmed, a gynaecologist.
But there is evidence that suggests this widely held view may be inaccurate.
“I can still remember when it happened,” said 22-year-old Zehra Ali*. She said soon after her eighth birthday, her mother “gave me a big bowl of ice-cream” and then led her to a spare bedroom where an elderly woman spoke to her kindly, had her lie down on the bed and do “a terrible” thing. Zehra says a small part of her clitoris was quickly snipped off, that she felt “some pain”, but mainly a strong sense of being “violated”. She said the episode, which she “never forgot”, causes her problems “now that I am married” and that she needed counselling before she was willing to consent to sex, “for psychological not physical reasons”.
BOHRA COMMUNITY: Zehra belongs to the Bohra community, a sect of the majority Muslim population that numbers some 100,000, according to official figures, and is based mainly in Sindh. The Bohras are among the few communities practising FGM/C in Pakistan.
Other groups that carry out the mutilation are groups with African or Arab origins, such as the ethnic Sheedi community that numbers several thousand, which came to the country originally as slaves during the 19th and 20th centuries and are based primarily in Sindh. There has been little research on the practice among these groups, though.
Zehra believes that, even today, at least 50 percent to 60 percent of Bohra women undergo circumcision, involving usually a symbolic snipping of the clitoris. “In the past, there was more mutilation, and I think 80 percent to 90 percent of women suffered it. More awareness has helped reduce the practice,” she said.
“I have seen females who have suffered ‘khatna’, as female circumcision is called. Sometimes, there is merely a symbolic snipping of some skin, but in some women, especially those who are not so young, there is somewhat more extensive cutting,” said a midwife, preferring anonymity, based in the Tando Muhammad Khan district of Sindh, who attends to Sheedi women. She said she herself did not perform circumcisions.
According to the World Health Organisation (WHO), FGM/C “includes procedures that intentionally alter or injure female genital organs for non-medical reasons”. It says an estimated 100 million to 140 million girls and women worldwide are living with FGM/C, 92 million of them in Africa.
“SYMBOLIC” CUTTING: Shershah Syed, a former president of the Society of Obstetricians and Gynaecologists who devotes his practice to serving deprived women, said he had come across cases in urban Pakistan where women have undergone the procedure.
“In Pakistan, with growing awareness [of the effects of FGM/C], they are now doing it merely symbolically, with only a bit of skin being removed. But even so, I find it to be in clear violation of human rights. There is absolutely no scientific evidence supporting any medical benefit of the procedure. In fact, it can lead to health complications,” said Syed.
WHO lists the string of complications that can arise from the procedure, including repeated infections, cysts, infertility, higher childbirth complications and the need for repeated surgeries.
“In our community, this practice has taken place for generations. The girls nowadays have it done in sterile conditions. It is rarely spoken of. It is just something the women know about and do,” said 60-year-old Raazia*, a member of the Bohra community and a grandmother. She says her granddaughters “will be safely circumcised.”
“The impact is not just on health, it is psychological, too. Such practices leave deep scars, and in our country these have not been studied at all, because so little is known about the mutilation of women in this way,” said Aliya Rizvi, a psychologist.

*Name changed to protect privacy