28 August 2013

Questions about FGM

Blog by 28 Too Many volunteer Alison Glennie.

Alice Sheppard is an astronomy enthusiast who has moderated the Galaxy Zoo Forum, a public astronomy project for the last 5 years.  Her latest project, Galactic Orchids, runs a series of astronomy lectures in Newington Green Unitarian Church, London.  Galactic Orchids raise funds for anti female genital mutilation (FGM) organisations, including 28 Too Many.  Guest speakers are invited to talk at each event on different astronomy topics but on the 8th May 2013, Ann-Marie Wilson, founder of 28 Too Many and anti FGM activist gave a rather different talk to Galactic Orchids. I spoke to Ann-Marie about her talk, addressing some of the challenging questions raised afterwards.

Tell me about your evening with Galactic Orchids. 

I explained who I am, what 28 Too Many does, how I came to set up the charity as well as addressing many of the issues and questions that people have about FGM, for example, what is FGM, where does it have an impact, what are the health implications associated with it and what myths are there surrounding the practice.  Although the practice may be shocking and hard to understand for those who were not previously aware of it, FGM has been practised for over 2,000 years and deeply engrained into the way of life for those that continue the practice. FGM is often seen as a rite of passage into womanhood and a prerequisite for marriage. Uncut girls (and their families) often face huge pressure to undergo the procedure and face stigmatisation and exclusion from community life if they resist.  I also talked about more controversial modern issues like labiaplasty and why this is a concern to anti FGM campaigners. 

How did 28 Too Many become involved with Galactic Orchids? 

I came across Galactic Orchids at the end of last year when the BBC TV series Casualty did a double episode on FGM. I responded to some of the people who were tweeting about the episode and one of these was Alice Sheppard, founder of Galactic Orchids, who said she was proud to be supporting the fight against FGM through Galactic Orchids. I hadn’t heard of them before so I contacted her to find out more about what they do. After that initial contact was made I did an introductory talk about FGM.  

The subjects of FGM and Astronomy are worlds apart. How important is it to get involved with projects like Galactic Orchids and inform people about FGM?

I think it’s very important. We are a small charity funded entirely by individual donations so the money raised for 28 Too Many by Galactic Orchids was very much appreciated. Also, through talks and events such as these it increases awareness of the practice. You never know who will become an advocate, fundraiser or who will protect a girl against FGM. 

How does 28 Too Many approach stopping FGM in country and amongst the diaspora?

Our initial strategy was to only to work in country but quickly we decided we had to work in the diaspora communities as well. We have a three part approach.

First, we carry out research benchmarking that allows us to better understand the practice in each country, track future progress and help establish best practices models of change to end FGM.  

Second, networks are set up in countries where FGM is practised including diaspora communities.  28 Too Many released its first country reports in Uganda and Kenya earlier this year. These are being disseminated now in country and we are making network contacts to see how we can give support to local work preventing FGM. 

Third, working with diaspora communities, other anti-FGM organisations and the international development agencies, we advocate locally in country and in the UK as well as internationally.  This creates the environment in which change can happen to end FGM.

If FGM is ended in country then it will stop in the diaspora too?

If we are able to stop FGM happening in the countries where FGM is a long standing practice then this will end most FGM. People leave their country with their own cultural beliefs about FGM so if you stop FGM at source then you are able to stop bringing the practice to other countries. 

However, the problem in the diaspora communities is that they may carry an increased adherence to the cultural practices like FGM to help them feel connected to their country of origin. This can lead to some families continuing practices like FGM after it has been abandoned in their country of origin to preserve and protect their cultural identity. Of course other members of diaspora communities may stop practising FGM once they settle in a new country and they see that girls do not need to be cut. There are no easy answers and to fully end FGM we need planned and sustained work in all countries where it occurs.  

What are the main birthing complications associated with FGM? 

There are many complications that can occur when a woman is giving birth and has undergone FGM. To begin with, depending on the type of FGM there may be no way of checking how far a woman has dilated when she is in labour. Normally, a woman has to have 10cm dilation in order to safely give birth. However, after FGM, the space one needs to check a woman’s dilation can be restricted so there is no way of knowing if she is ready to give birth. This leads to further complications. Often, when women are giving birth in remote locations, the birthing assistant will try to perform an episiotomy. This can lead to the baby’s head being cut and hugely increases the risk of haemorrhaging which a lot of women die from.  Furthermore, it can be difficult to carry out thorough vaginal examinations on women who have undergone FGM and this can compromise foetal health and increase the chance of placenta previa or other complications. FGM increases risks in the birthing process from beginning to end. 

FGM has been carried out for hundreds of years, how would birthing complications normally have been dealt with? Would there have been any protocol in place to deal these complications?

Today, in places like Somalia, Nigeria and Pakistan, if a woman has had Type III FGM (the most severe form) and is coming towards the end of her labour, the focus would be on getting her to a medical facility so that any complications could be dealt with. However, this is not possible for all women especially those living in remote villages. Historically, women who have had FGM could have a labour lasting as long as four days because the baby cannot leave their body and sadly this can still happen. Women can also get incontinence and fistula as a result of FGM and the increased risk of death is often just seen as part of childbirth. It’s all very tragic and unnecessary. Many countries have successfully reduced the rate of FGM and with leadership, funding and support for sustained programmes I believe the practice can be eradicated

What are your views on labiaplasty? 

I am very concerned about the reported increases in labiaplasty operations in the UK and other countries. Whilst there is a need for some procedures to address medical needs there is growing concern that labiaplasty, especially in young girls, is often just a medicalised form of FGM and is an unnecessary operation which can have future health implications. It also highlights an area for confusion in the law.  In essence a 16 year old girl in the UK can pay to have labiaplasty or in some cases get it done for free from the NHS on the basis of her having body dysmorphia.  Legally the plastic surgeon would not be committing FGM. On the other hand if girl from an FGM practicing community who has not been cut, asks for surgery so she can marry within her community, she would legally be unable to receive it because it is FGM. It would not be deemed labiaplasty but FGM. 

Even where there is evidence of body dysmorphic disorder, it may be better to offer non-surgical help such as counselling in the first instance and if surgery is being requested as a medicalised form of FGM then this is illegal and a child protection issue which should be referred appropriately. 

What are the pressures for girls/ women to undergo labiaplasty?

There is increasing pressure on girls and women to conform to prescribed body images and in many societies a growing trend to undergo plastic surgery including labiaplasty for aesthetic rather than medical reasons. Some of this pressure comes from body talk between women but it also comes from men and boys, media images/stories and marketing from cosmetic surgery providers.

A particular concern is that the increased availability of online pornography, especially to young people, is leading to an increase in demand for labiaplasty. Many of the women shown in pornographic material have had labiaplasty and young people seeing this can think it is normal to have very small or no labia and then think that they or their girlfriends are abnormal. Teenagers are often insecure about their bodies and this can lead to girls wanting unnecessary surgery or being pressured into it by their boyfriends.


The unlikely partnership between Galactic Orchids and 28 Too Many is a testament to the far reaching impact that FGM has on society- it affects everyone and that’s is why events organised by campaigners like Alice Sheppard that are so important in raising the issue and bringing awareness to a wider audience. Despite an estimated 30,000 British girls being at risk of FGM many people living in the UK are not aware of the practice. 28 Too Many are also extremely grateful for the donations received from Galactic Orchids, and look forward to their continued support in the future. 


If you would like to support the campaign to end FGM you can donate here, like our Facebook page or follow 28 Too Many on Twitter. You can also keep up to date with Galactic Orchids on Twitter and maybe attend one of their future talks.