And Now, Female Genital Mutilation Comes to America

Last week, a doctor in Michigan was charged with performing genital mutilation on two of her young patients. That’s right—her patients.

via Henry Ford Hospital

I was seeing my own patients in my New York office when I read the news that elsewhere in the United States, another woman physician, Dr. Jumana Nagarwala, was charged in federal court for performing female genital mutilation on two girls as young as 7 in a medical clinic in Livonia, Michigan, outside Detroit. Authorities suspect the Henry Ford Hospital emergency physician had been secretly performing these brutal procedures since 2005, impacting many more children. Henry Ford Hospital has placed the physician on administrative leave while she is on bail. (She is alleged to have performed these procedures at a clinic, not at a Ford facility.)

As a physician in whom my patients place their trust, I am sickened. More importantly, I am enraged, and you should be too.

The United States designates female genital mutilation a federal crime (the literal butchering of a woman or girl’s female genitalia) for good reason. Tragically Michigan is one of 26 states that have failed to enact laws against the practice.

Around the world, more than 200 million infants and girls are mutilated by female genital mutilation/cutting (FGM/C). Most are cut between infancy and age 15, but women up to age 49 have been thus mutilated. The World Health Organization defines four categories of (FGM/C): 1. clitirodectomy alone; 2. excision (of a considerably wide variation of female genital tissue); 3. infibulation—literally a form of “sealing” (excising the entire clitoris and labia and stitching together the edges of the vulva to prevent sexual intercourse).

The fourth category is for those FGM/C victims who are mutilated beyond even the above classifications. Because most Americans reading this will have no knowledge or experience of FGM, let me make it clear: The most severe forms of FGM/C seal shut the introitus. All menstruation, sexual penetration, and childbirth becomes painful and rife with major complications. Women are left with urinary and fecal incontinence, and humiliating fistulas connecting the bowel to the urogenital system. Feces and urine emerge from the vagina, leaving the young woman or girl with a future permanently defined by pain, a sense of being unclean, lethal infections, even death.

It’s all the more shocking that a female doctor would engage in such practices. As an American female physician myself and as a human rights defender, I demand that, if guilty, the doctor be prosecuted to the fullest extent with the harshest punishments, though a federal imprisonment of five years (the current maximum sentence) seems paltry in comparison to the crime.

Without question, if found guilty the doctor in question must be stripped of her license to practice medicine permanently and be rendered a felon. Her alleged longstanding deception of parents (who claim they did not know, some reports suggest) and of the local medical community should also influence the severity of her punishment.

Around the world, FGM/C procedures are universally performed for cultural reasons, and though they predate Islam, they have been tragically adopted by some Muslim communities. FGM/C is seen mostly among ethnic groups in over 30 African nations. Nine out of 10 women in Dijibouti, Egypt, Guinea, Mali, Northern Sudan, Sierra Leone, and Somalia have undergone FGM/C. Recently Indonesia has been found to have high prevalence of FGM despite a 2006 ban.

Diaspora communities migrating to Western nations continue the practice where we encounter it for the first time. FGM/C is rising among migrants of Norway, Australia, Canada, Sweden, Switzerland, Britain, and the United States. Migrants, traveling with daughters on summer vacations to their native countries have the procedure performed at grave risk of infection, bleeding, and death when non-clinicians perform this procedure. School holidays thus become “The Cutting Season.”

Among Muslim diaspora communities here in the U.S.—particularly in the Pacific Northwest among the Somali migrant community—FGM/C is performed “in the name of Islam,” disregarding the complete absence of a Quranic mandate on FGM/C. For the moment it seems the little girls involved in this case were taken from Minnesota to Michigan and therefore may be part of the Somali-American diaspora.

Combating FGM/C in Muslim communities therefore is not an act of anti-Muslim xenophobia or “Islamophobia”: It is a defense of human rights and the duty of every American to stop. The practice of FGM/C is not religious freedom. It is child abuse and criminal physical assault nothing short of dismemberment.

Tragically, these gruesome FGM/C assaults performed at the insistence of culturally indoctrinated mothers and grandmothers on their daughters impacting millions globally. Thus, women (often themselves victims of FGM/C) perpetuate violence on women and girls. Families demand mutilation of girls and women for the preservation of “familial honor.” The 2014 documentary Honor Diaries (for which I was interviewed) examined honor violence directed against women whereby women are maimed and/or killed for the preservation of familial honor in cultures where women are mere empty vessels for containment of familial honor. Female genital mutilation is a form of honor violence.

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These girls can never be made whole again. At age 7, years away from their own sexual knowledge, denied an intact clitoris, they will never experience sexual gratification as consenting women. Yes, they may be able to have babies, but their pregnancies, labor, and deliveries will be high-risk because of the profound anatomic destruction to the birth canal. And this is not even accounting for the incredible psychological injury they will come to experience.

Fortunately, in the United States we have the law on our side. This case is the first of its kind ever prosecuted since FGM/C was first criminalized in 1996 in the United States. In 2013, the Transport for Female Genital Mutilation Act amended this law to forbid “Vacation Cutting,” the practice of taking a girl overseas for FGM/C. We must now modify this to include domestic travel for the same criminal purpose.

Though federal law is overarching, all states must also criminalize this practice and its related activities enabling both state and federal governments to target both medical institutions and practitioners with heavy penalties for such activities including permanent rescinding of any and all medical licenses and, I believe, any access to children. Tell them plainly: When it comes to FGM/C, as Americans we say, “cut it the hell out.”