The Unkindest Cut

Female genital mutilation (FGM) has inflicted pain, illness and death for 2,000 years. Today, nearly 140 million women and girls globally have endured this so-called cultural tradition. The pain lasts, intensifies, recurs: at the cutting, at sexual contact, at childbirth. And that's if the woman doesn't die first, as 35 percent do, from such immediate- or long-term complications as fistulas. Those who survive suffer emotional trauma as drastic as the physical pain.

Sometimes euphemized as "female circumcision," FGM is defined by the World Health Organization as procedures removing the entirety or parts of the external female genitalia. Attributed to various faiths but transcending religious/social/ethnic traditions, FGM is prevalent in Somalia, where approximately 98 percent of women undergo cutting, often by untrained practitioners. It's also common in some other African countries, and sporadically practiced in the Middle East.

Less known is that FGM was common in the United States and United Kingdom until the 1950s, prescribed as a cure for such "female deviancies" as lesbianism, masturbation, nymphomania and even epilepsy. In 1996, after decades of feminist lobbying, Congress passed legislation making it a crime to perform FGM on a minor.

But some immigrant populations are reviving the practice. It's estimated that in one year, nearly 200,000 women in the U.S. will be cut, plus 22,000 in the U.K. Laws must be strengthened, and better enforced (in the U.S., those performing FGM can receive a maximum of five years' imprisonment and/or a fine). Furthermore, women in these communities sometimes defend the procedure, so there is need for support and education about FGM's health-destroying, even fatal, effects.

For decades, Ghanaian activist Efua Dorkenoo, founder of FORWARD (Foundation for Women's Health Research & Development), a London-based NGO, has campaigned to eradicate FGM. Awarded an Order of the British Empire in 1994, her greatest success has been in the U.K., where a law prohibits FGM and has greatly increased awareness among health professionals. Following Dorkenoo's lead, nurse ComfortMomoh -- chair of London's Black Women's Health and Family Support -- counsels survivors.

She warns that it is delicate, yet critical, to address immigrant communities about the procedure, while using language understood in their cultures. Momoh compiled Female Genital Mutilation, a book of information and personal stories. "[M]y friends ... said that they did not want to play with me because I was not done; or that I was unclean," wrote one anonymous Somali woman, "so I put pressure on my mother to have myself done."

Attitudes are changing about FGM, especially on the African continent. But there's a long way to go -- including in the U.S. This past November, Khalid Adem, an Ethiopian immigrant in Lawrenceville, Ga., was convicted of having scissored off his 2-year-old daughter's clitoris in 2001. Although federal law bans FGM, many states lack laws addressing it directly. Georgia legislators, prodded by the girl's mother and women's groups, passed an anti-mutilation law in 2005. But since that law hadn't existed when his daughter was cut, Adem was convicted of aggravated battery and cruelty to children, and sentenced to 10 years' imprisonment. It is believed to be the first such criminal case in the United States.