Friday, May 23, 2014

"We may be about to see the change we all so much want"


For Hilary Burrage, turning to activism to fight Female Genital Mutilation was a call to action. In her work as an activist and as a researcher, the denouncement of the practice of FGM across the world stands tall. She spoke to The Red Elephant Foundation about her work, her efforts and all the resistance she has met in the course of her activism.
Image (c) Hilary Burrage 

Can you take us through the work you have done, concerning FGM? What got you into activism for the issue?
I have been involved in issues around social policy and action most of my life, having been, among other things, a researcher on teenage pregnancy in a Department of Social Medicine, a Senior Lecturer in Health and Social Care, a Non-Exec Director of a National Health Service Trust and so on. It was my mother (a supporter of Amnesty International) who first alerted me to FGM, in the early 1980s, and I wrote to my then Member of Parliament about it.  He assured me that everything was under control because a new law had been passed to stop ‘female circumcision’. This assurance, and the name, ‘circumcision’ – which I then believed to be a replica ‘only’ of the procedure sadly still done on some boys – misled me into thinking the matter should be left to others more informed than myself. I was therefore horrified to learn almost two decades later that FGM is even more prevalent in the UK than before; so this time I decided that I would not rely on other people.  It was time to do what I could, myself.

For readers that are new to the issue, can you tell us what FGM is?
Female genital mutilation (FGM) is a term covering a range of non-clinical ‘surgical’ alterations to women and girls’ genitalia.  There are four types: 
Ø  Type 1 is the ‘just a nick’ (still a potentially very harmful cut) to the clitoral hood, sometimes performed using, for example, a piece of tin or glass rather than a knife or blade – which means it may be performed crudely, often by someone with no anatomical training.
Ø  Type 2 involves the cutting away of the clitoris and perhaps some surrounding tissue, using the same variety of ‘instruments’. 
Ø  Type 3 is more severe even than Type 2, where the excision is extensive, usually including removal of much of the labia, and the excised remaining skin and tissue are thereafter sewn up using even thorns or other rough material. The girl’s legs are then tied together for some weeks, so when the wound heals (if it ever does) only a small hole in the genital area remains, for the passing of urine and menstrual blood.
Ø  Type 4 is all other forms of non-clinical genital alteration, such as pricking and scarring.

All four types of FGM are traditionally done without anaesthetic or asepsis, with perhaps several women holding the girl (or baby) down so forcibly that bones may be broken, and sometimes also whilst she has cloth stuffed in her mouth to prevent her cries. More recently, significant numbers of FGM procedures are carried out by people with clinical qualifications, sometimes in makeshift clinics or even hospitals.  This is a matter of great concern to the World Health Organisation (WHO) as it is thought this shift to medicalisation may lead those in favour of FGM to think it’s acceptable if done ‘properly’. About 130 million women and girls now living are estimated to have experienced FGM. Roughly five more children undergo it every minute of the day, with some three million more n subjected to it every year in Africa alone. The ‘procedure’ has a probable death rate of between 10 and 30%; haemorrhage, shock, infection and trauma, plus a range of obstetric complications, are frequent, along with many other serious long-term medical and probably also psychiatric complications.  Unsurprisingly, women with FGM, even if they survive initially, are likely to die younger than those without it. FGM occurs because of patriarchy.  It is a brutal form of control of women and is practised by a wide variety of societies. It is known to have occurred even before any of the global religions came into being.

You may have come across scores of stories and narratives in your work: could you weigh in on how FGM can cause or result in Obstetric Fistulae?
There can be few conditions more unendingly unpleasant and isolating than rectal- or vesico (bladder)-vaginal fistulae.  Often it is effectively the end of family and community life for the woman concerned; and even before they had this condition many of these women will have been subject to child ‘marriage’ and sale for bride price. One of the conditions which arises from FGM is scar tissue.  This causes the birth canal to be obstructed and inelastic, which can be very serious obstetrically. Outcomes from that can include baby at severe risk, haemorrhage and tears to maternal tissue, all such that fistulae occur. At the moment views about exactly how fistulae and FGM are connected are still disputed in some quarters, but I simply can’t believe that FGM is not a causal factor, along with the very young age at which some girls are married off after their genital mutilation, and are then forced give birth long before their bodies are ready. Obstetric fistula has been known about for quite a long time now. The British social campaigner Eleanor Rathbone wrote a book (Child Marriage: The Indian Minotaur) about the consequences of child marriage in India, way back in 1934; and this, Obstetric Fistulae: A Review of Available Information by Jane Cottingham and Erica Royston, is a very thorough global report first published in 1991. So it’s good there are now several hospitals in Africa which are seeking to repair obstetric fistulae; but many, many more are needed.

As an advocate that denounces FGM and an activist that works hard to stop the practice, what kind of challenges have you encountered?
One frequent challenge is the name.  I insist (in formal discussions at least) that the damage is called for what it is: Mutilation.  Words like ‘cutting’ and ‘circumcision’ (or their translated equivalents) may be required in communities when it is first considered, but once everyone knows what we’re talking about the correct term – the one in fact endorsed by the African women leaders themselves more than a decade ago - is essential.  I actually think that euphemism, the use of words other than ‘mutilation’, is a big part of why FGM has continued to so long in various western societies.  People just didn’t believe it was really so bad…. And then there’s the challenge of excluded communities where they claim that only people like themselves are entitled to tackle FGM (maybe, however mistakenly, they want to keep ‘private’ things private).  I see this as a very dangerous idea, because the whole point is we, the wider society, must keep all children safe.  That won’t happen if professionals in the mainstream are prevented from knowing even that some children in minority communities are at risk.  Of course it would be an excellent development if all parts of the professional world fully reflected diversity – that’s an essential long-term objective – but at the moment it’s not the case; and it’s here and now we must protect little girls at risk of hideous harm. Another frequent problem is the competition quite a lot of men set up between FGM and male circumcision.  I genuinely believe that neither of these ‘customs’ is acceptable (unless medically required), but considerable numbers of men seem to insist that ‘feminists’ want little girls protected, whilst not caring about little boys.   I tell them however that, whilst I personally am concentrating on FGM, I will be happy also to support campaigns to prevent male circumcision.  There is absolutely no reason to compete, but in my judgement the ways we have to lobby to get these things stopped are probably different at this point in time.

Like Child Marriages, it is said that FGM is deeply embedded in a mindset fuelled by cultural norms and ideas. Consequently, it appears that there is no one-size-fits-all approach to bring the issue to an end. How do you view this dilemma? What approaches can we take to deal with it?
Yes, FGM is very complex indeed anthropologically, so the ‘one-size’ approach doesn’t often fit well. I’ve thought about this very carefully, but there’s been so little real progress overall in stopping FGM that I think the end of the ‘softly, softly’ approach is now nigh. But there is one universal value which can increasingly be applied in various ways – which is the horror and shame of child abuse. It is of course true that at least some (I’m not convinced, all) mothers / parents permit or enforce FGM in their daughter’s alleged ‘best interests’.; but tragically most people with this view have themselves experienced FGM in their own childhood, and seem to be oblivious to the likelihood that their (or their wives’) current health has been compromised by this damage. It will be far more difficult in some communities than in others, but we have to find ways to help everyone understand that FGM harms women and often destroys their health.  And we have to try really hard to demonstrate that good health, autonomy (no buying and selling of brides) and socio-economic freedom are the best modes for adult women in the modern world – then it will be easier to see that FGM is child abuse, and that those who continue to inflict it on girls are doing something cruel and criminal. And yes, this is an uphill struggle; but it’s a better way forward in the long-run I am coming to believe than simply showing ‘respect’ for FGM.

Waris Dirie, one of the world's most renowned activists against FGM has said: "Women’s loyalty has to be earned with trust and affection, rather than barbaric rituals. The time has come to leave the old ways of suffering behind". Why is there so much attachment to these old ways?
Waris Dirie is of course absolutely right. One of the issues may however be that FGM has passed for millennia from mother to daughter; but now we’re asking girls to accept that what happened to their mothers, and what their mothers may still intend to do to them, is wrong.  However, this also means we’re asking those who have undergone FGM to understand it has only harmful, painful outcomes, and no genuinely positive ones; all that suffering was for nothing.  This is a very tough message for anyone to swallow.  And how, if a woman comes to believe that all this is wrong, is she to forgive the parent/s who inflicted it on her?
Then there’s the issue of personal risk.  In traditional communities, no-one may be willing to refuse FGM, in case, for example, the husband or baby whose body touches the woman’s clitoris really does die; or her clitoris really does grow into a third leg! And, very importantly, there are deeply held, often unarticulated and maybe not even acknowledged, views about women and the ‘need’ to control their (supposedly rampant) sexuality, and keep them ‘pure’ and ‘chaste’.  Observers from the outside may understand that these views are very powerful, patriarchal ways to keep women subjugated to men; but from the inside it probably doesn’t look at all like that. 
We must acknowledge however that even in modern western societies there are still many aspects of our culture which reflect similarly patriarchal perceptions of women – this fear of women, the urge to contain and diminish their ‘power’, may be expressed in different ways in different societies, but it’s usually still there in some form.  It’s important we recognise that western societies are also far from perfect when it comes to treating women and men as equals. We as campaigners need to be humble as we urge everyone, everywhere, to abandon FGM and other cruelties to women and children.

Have you met with resistance or challenges of any kind in your activism against FGM? What keeps you going?
Yes, I’ve met resistance!  And having to think about FGM a lot can be gruelling – but never, ever, remotely as awful as having to undergo it. Concerning challenge, firstly, people in the West genuinely find it very difficult to believe FGM can be as grim as it really is, just as they also seriously doubt that vast numbers of women and girls have experienced it.  And then you get folk (also in the west) who want to espouse ‘cultural relativism’ or, conversely, accuse teachers and others who have in the past not addressed FGM of being outrageously politically correct.  I find both these positions very hard to tolerate.  The former is a totally unacceptable way of shrugging FGM off – it’s somehow OK for little black girls to be tortured – and the latter is just unfair, because until recently only a very few teachers actually knew properly what FGM is, and even now the guidance about how to deal with pupils’ suspected risk of FGM is unclear.  These are not issues which most teachers and other professionals feel able to tackle competently without very clear guidance – hence the Guardian campaign with which I’ve been involved, to persuade the UK Secretary of State for Education, Michael Gove MP, to write to every school on the matter.  (He’s now done that, but there’s still a long way to go…)
Another thing I worry about is the balance which would be best between, especially, medical and legal approaches.  (We all more or less agree that education is critical.)  I increasingly see the clinical aspects as needing to be realigned a little, so that we understand the parameters of each sort of professional input and leadership a bit better. Other challenges include the sheer complexity of FGM as a harmful traditional practice.  You just think you’ve begun to understand it in one context, and it crops up entirely differently somewhere else.  That’s one reason I’ve started to focus on aspects of patriarchy and economics; these themes seem to be universal in one way or another when FGM is considered.
And what keeps me going?  Well, partly I am determined those who have the power and influence to make things happen should be made at last to take the right action.  But mostly, I’m a grandmother.  I couldn’t bear ever to think of any child I know having to undergo this abject cruelty, and I desperately don’t want it to happen to anyone else’s children either. There is surely nothing more precious than the health and happiness of children, and one way towards more of that is to stop FGM.
Can you take us through a few success stories, or achievements that came in through your activism?
I hope I may be having some small success (as a sociologist / researcher) in building interest in the economic and psychological aspects of FGM. Both these factors are surely very relevant to actually eradicating the practice. I’m very pleased too that I have become an Advisory Board member of the European REPLACE2 programme; I’m sure I am learning more from them than they are from me, but it’s fascinating to be able to share views with such a range of colleagues. Likewise, though social media (mainly Twitter and LinkedIn) I’ve also found more amazing colleagues and very special ’FGM friends’, some of whom have been working tirelessly for decades to stop this horror.  It has been a real privilege particularly to collaborate with five other committed women across the globe as we brought to publication in 2013 our Feminist Statement on Female Genital Mutilation
And I am now working with The Guardian newspaper on their UK and global FGM campaigns.  The growth in general public interest and concern about FGM, thanks to media campaigns and the sheer volume of input of knowledge which is now being developed, is incredibly motivating, and also very moving. I really believe we may be about to see the change we all so much want.  It’s not going to happen overnight everywhere - though it really should be possible almost overnight in eg the UK - but there’s now a tangible likelihood that, if everyone continues to push hard enough, the next decade or two will finally make FGM history.

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