Female Circumcision Comes to America

Performed by new immigrants, veiled in deference to a cultural tradition of the developing world, female circumcision is becoming an American problem

IT is a late-summer night, nearly midnight in Washington, D.C., when the taxicab comes for Mimi Ramsey. She steps into it with a worried look in her eyes and her mouth firmly set. She is on her way to yet another stranger's house, where she will again—for the umpteenth time in the past year—talk about the most personal and most secret of African customs, offering herself as a sort of human roadblock in the traffic of tradition.

At the house Ramsey is kissed on both of her cheeks by her hostess, an Ethiopian immigrant like herself, and ushered into a dimly lit living room decorated with rugs and cloths from their homeland. There she spends the next several hours huddled together with the young mother, Genat, talking in conspiratorial whispers.

"Mother says she will do it anyway, herself—when I'm out of the house—if I don't agree to get it done soon," Genat confides to the woman she hopes will help her. "She says she will take a razor blade and do it." Ramsey nods. She has heard this story many times before, and responds by reciting a long list of reasons why the older woman must be stopped, trying to give Genat the courage to buck tradition and disobey her mother. "You cannot let her do this to your child. Please. It is wrong. You know how painful it is. How damaging. Your daughter may hate you for life for what you allow to happen to her."

Genat shakes her head. She doesn't want her baby girl, just born in this country, to be circumcised, as is customary in her native land, but her mother is adamant.

"She believes in it so strongly," Genat says. "She said if I don't do these things, the girl will grow up horny. She'll be like American girls. And how will I be able to go back to work if my mother is not here to care for my child?"

It is not until many hours later, after a long, sleepless night and a fruitless morning discussion with the older woman, that Ramsey, discouraged, finally ends this peculiar house call. "Please send your mother home," she advises Genat. "Go on welfare if you have to, but don't let your mother stay in the house and do this to your baby."

TO Mimi Ramsey, a forty-three-year-old nurse who lives in San Jose, California, scenes like this one are increasingly familiar. An activist in a growing movement in this country to halt the practice of female circumcision—also called female genital mutilation, or FGM —she, among others, is trying not only to persuade her compatriots to end the practice but also to persuade America to address FGM as a serious health and human-rights issue. It is not an easy task. Even though the details of some of the extreme yet common forms of the practice are as horrifying to most Americans as Nazi human experimentation or brutal child abuse, documentation is hard to come by, and resistance to infringing upon the traditions and mores of another culture is difficult to overcome.

"We don't warn [immigrant] families that we consider this child abuse," says Catherine Hogan, the founder of the Washington Metropolitan Alliance Against Ritualistic FGM. "When you wrap this issue in the cloth of culture, you just can't see what's inside. This is a clear case of child abuse. It's a form of reverse racism not to protect these girls from barbarous practices that rob them for a lifetime of their God-given right to an intact body."

Americans who are aware of the practice, which has been performed on some 100 million to 130 million women and girls worldwide, assume that it is a fact of life only for girls who live in faraway places—a form of barbarism that doesn't touch American homes, schools, or doctor's offices. This is simply not true. As more and more African immigrants move to this country, bringing with them their food, practices, and traditions, perhaps hundreds more daughters of African parents are circumcised in the United States every year.

Many of the immigrant mothers who are making these decisions about their daughters know little or nothing about their own anatomy. They are told that if the clitoris is left alone, it will grow and drag on the ground; that if their daughters are left uncircumcised, they will be wild, and will crave men; that no man from their home country will marry them uncircumcised (although many African men say that they prefer uncircumcised women for sex and marriage); that circumcision aids in menstruation and childbirth (although the opposite is true in both cases); and that it is a religious—usually Islamic—requirement (although none of the major Islamic texts calls directly for FGM). And so these women and their husbands come to the United States filled with misinformation, and remain blindly dedicated to continuing this torturous tradition.

Azza, an Egyptian immigrant who moved to the United States fifteen years ago and now lives in Louisiana, plans to take her ten-year-old American-born daughter back to Egypt in a few months to have her circumcised. "They say it helps us control our emotions," she says. The thirty-three-year-old mother is confused about whether or not she wants to put her daughter through the procedure, first saying that she and her husband are not sure what they are going to do, and finally saying that it is up to him and the Egyptian doctors to decide.

Frequently families will chip in to bring someone from the homeland to the United States to perform circumcisions, because it's cheaper to import a circumciser than it is to send several girls abroad. A taxi driver in Washington, D.C., who hotly defends the practice says that he recently had his daughters circumcised that way. "I stood over her to make sure she cut enough," he says. "I wasn't going to let my daughters have those things!"

AS more and more immigrants from countries that practice FGM come to make their homes in Western countries, these countries are facing the task of confronting a custom that is rigidly adhered to and yet taboo to discuss. The United States has not given FGM the attention or the illegal status that many other nations have given it. The United Kingdom has a full-fledged and longstanding anti-FGM movement that involves the country's social-service agencies. France, Canada, Denmark, Switzerland, Sweden, and Belgium all have outlawed the practice. The first attempt to prohibit FGM here died in the previous Congress. However, the legislation has been reintroduced by its original co-sponsors, Representatives Pat Schroeder, of Colorado, and Barbara-Rose Collins, of Michigan. Senator Harry Reid has proposed similar legislation in the Senate. Three states, New York, Minnesota, and North Dakota, have passed laws making the practice of FGM a felony unless it is medically necessary.

Knowing that federal legislation to deal with FGM is far from a certainty, a growing number of people are joining the battle to stop FGM in America. They want this country to start documenting the extent of the practice here and to use the courts and social services to put an end to it—an aim they're finding it difficult to achieve at a time when so many cities are struggling with other pressing issues.

"It's a serious problem in most urban centers in the United States," Hogan says. "There just hasn't been enough empirical documentation of it. But what we see when we see it, anecdotally or empirically, is just like incest was in its time—or child abuse. It's the tip of the iceberg."

Several recent events have helped to strengthen this movement. Probably the most high-profile of these were the publication of Alice Walker's novel on the subject, Possessing the Secret of Joy, and the production of Walker's documentary film, Warrior Marks, which was shown in cities throughout the United States. Also significant was the well-publicized court case of a Nigerian woman living in Oregon who won asylum in this country by pleading that her daughters would be in grave danger of being forcibly circumcised if they were sent back to their homeland.

Women's-rights groups such as Population Action International, Equality Now, RAINBO, the Washington Metropolitan Alliance Against Ritualistic FGM, and the Program for Appropriate Technology and Health (PATH) and other groups form a loose information-and-activist network on FGM. More important, immigrant women who were circumcised as children have joined forces to fight the tradition among compatriots in this country.

Soraya Mire, a thirty-four-year-old Somali film maker who lives in Los Angeles, has been touring the country with her film Fire Eyes, which shows African children being circumcised. Asha Mohamud, a Somali who has worked as a pediatrician and who lives in Alexandria, Virginia, now directs several FGMprojects in Kenya and the United States for PATH. Mimi Ramsey has made it her avocation to visit African businesses and communities in this country and proselytize against FGM.

Ramsey typifies many who, after hearing about FGM in the media, have finally been able to talk about an experience long suppressed. For years she had gone to doctors for help with the aftereffects of her radical circumcision. For years doctors, either because they were stunned by what they saw or because they were trying to be culturally sensitive, said nothing to Ramsey about what had been done to her and simply prescribed various topical creams and jellies to ease her pain. But in February of last year all that changed.

"I went to a doctor for the problem I have down there," Ramsey says. "He asked me, 'Why did they do this to you? Why did they remove all your genitalia?' He was in shock." After returning to her apartment, depressed and confused, Ramsey, a devout Christian, prayed for some answers. Later that night she saw a television program about FGM and the Nigerian woman's asylum case in Oregon. It answered many of her questions. "I was angry and still am. The morning after the show I got up and called all the African women from my address book who live in the United States. I asked them, 'Are you a victim too?' And they said yes. I said, `Let's talk about it. I'm not going to shut up anymore.'"

MOST of the talk about circumcision in this country has focused on male circumcision, as people have made the case that it causes physical and psychological pain to infant boys. When it comes to women, "circumcision" is at best a misnomer.

"Cutting off the clitoris is equivalent to cutting off much of the penis," Asha Mohamud says.

This is why opponents and medical leaders use the more descriptive and more accurate term "female genital mutilation." Although in a tiny percentage of cases FGM consists of a small cut to the hood of the clitoris, typically it is much more severe. It usually involves the complete removal of the clitoris, and often the removal of some of the inner and outer labia. In its most extreme form—infibulation—almost all the external genitalia are cut away, the remaining flesh from the outer labia is sewn together, or infibulated, and the girl's legs are bound from ankle to waist for several weeks while scar tissue closes up the vagina almost completely. A small hole, typically about the diameter of a pencil, is left for urination and menstruation. The cutting is usually done with a razor, a kitchen knife, or a pair of scissors. It is rare for any anesthesia to be used. The age at which FGMis performed varies among countries and communities. In some countries it is done on infants in the days or weeks after birth; in others, such as Senegal, it is part of an elaborate rite of passage that comes with puberty. In parts of Nigeria and Burkina Faso, FGM is practiced during the seventh month of a woman's first pregnancy, in the belief that if the baby at birth comes in contact with its mother's clitoris, it will die.

There is no doubt within the medical community that FGM is a brutal, harmful practice. A World Health Organization report on FGM says,

The immediate physical effects—acute infection, tetanus, bleeding of adjacent organs, shock resulting from violent pain, and hemorrhage—can even cause death. In fact, many such deaths have occurred and continue to occur as a result of this traditional practice. The lifelong physical and psychological debilities resulting from female genital mutilations are manifold: chronic pelvic infections, keloids, vulval abscesses, sterility, incontinence, depression, anxiety and even psychosis, sexual dysfunction and marital disharmony, and obstetric complications with risk to both the infant or fetus and the mother.

The American and British medical professions have in the past practiced FGM to varying degrees. There are reports of clitoridectomies having been performed as recently as the 1950s, to cure nymphomania and melancholia in girls. In the nineteenth century both clitoridectomies and female castration (removal of the ovaries) were practiced by British and American physicians, as cures for melancholia, masturbation, nymphomania, hysteria, lesbianism, and epilepsy. The American medical profession stopped performing clitoridectomies decades ago, only to find itself today confronting the practice in patients from cultures that perform FGM.

IT is far easier to convince Americans of the horrors of FGM than it is to persuade them that it is enough of a problem here to warrant action. Proving just how widespread the practice is in the United States is a critical step. The legislation proposed in both the House and the Senate calls for the Department of Health and Human Services to gather data on the number of females living in the United States who have been subjected to FGM. However, the current lack of such data means that opponents can only point to anecdotal evidence to estimate the extent of FGM.

"I think some people leave some traditions behind, but some traditions are stronger than others," Mohamud says. "This is one that's very strong. The community here sees explicit sex on television, they hear a lot of alien things, and so it becomes more urgent for mothers to do this to their daughters so the girls don't fall into loose groups. They think if they don't follow the tradition, they don't know what will happen."

It is estimated that at least 7,000 women and girls immigrate to the United States each year from countries where at least a majority of females, if not all of them, are circumcised. Most of these new immigrants live in California, New York, and the Washington, D.C., area. It is difficult to determine the true circumcision rates in their home countries, because in most the practice is not discussed publicly. Nevertheless, rough estimates of what is common in each country suggest that almost half the women of Africa have been circumcised. The rate of FGM in Somalia is nearly 100 percent, in Ethiopia over 90 percent, in Egypt 50 percent. The list of places where it is traditionally practiced includes twenty-six countries in Africa and various areas of the Middle East, Asia, and South America. Even if only a small percentage of newly arrived families from these countries maintain the tradition of FGM, these figures suggest that hundreds of young girls either brought here or born here are in danger each year.

Mimi Ramsey spent part of the past year trying to track down circumcisers rumored to be living in this country. But not all families depend on finding a circumciser. Last September, Ramsey heard about a man in San Jose who had just circumcised his daughter over the objections of his wife. He had waited until his wife left the house and then locked his three-year-old in the bedroom with him and performed the FGM. "He said that she was too wild," Ramsey says. "She liked to play outside too much. She had friends who were boys. He said this will tame her."

If a native-born American father had mutilated his daughter, the action would incontrovertibly constitute child abuse. But this country is at best ambivalent about its role and responsibility in preventing and punishing FGM. In fact, other than in the three states previously mentioned, there is almost no legal protection against FGM for girls in the United States, both because it's difficult to uncover and because, absent a specific law against the practice, courts are unsure about how to punish it. One effort at prosecuting a woman in Georgia who cut off her niece's clitoris failed in part because of the legal confusion surrounding the problem.

"Legislating these issues is going to be really crucial," says Leah Sears, a justice on the Supreme Court of Georgia who has been doing research on FGM and legal questions pertaining to it. "Legal issues concerning FGMare complex. Can an adult woman do this to herself? We American women consent to have our breasts enlarged, which is another bizarre thing women do for the pleasure of men. Is that so different? I think we need comprehensive legislation in this area."

In England and Canada—places where people from FGM-practicing countries have immigrated—laws against FGM and against taking a child out of the country to circumcise her have been passed. France has also made FGM illegal, and in 1993 it sentenced a Gambian woman to five years in prison after she paid $70.00 to have her two daughters circumcised. The medical associations in most of the Canadian provinces have passed prohibitions with strict penalties against circumcision and reinfibulation (sewing the vagina nearly shut again after childbirth). They have also begun educational efforts in those communities where FGM is most likely, preferring to discourage the practice rather than punish a parent after a girl has been circumcised. Unlike the United States, these countries take it for granted that FGM is occurring. Even though most U.S. legal experts interpret child-abuse laws broadly to cover FGM, very few preventive measures, such as education and community outreach, have been implemented in this country.

IN this legal vacuum doctors and others who provide social services that could educate and inform communities about FGM and protect uncircumcised girls are caught in the ethical bind of trying to show respect for another culture and at the same time guide people away from a harmful practice that is very much a part of that culture. For instance, in response to growing concern about FGM, the American College of Obstetricians and Gynecologists released a statement opposing all medically unnecessary surgical modification of female genitalia (although doctors here continue to perform cosmetic reduction surgery on both the clitoris and the labia), and declared that FGM should be stopped; but its guidelines end there. Some hospitals and doctors continue to reinfibulate women and to say nothing against parents' plans to circumcise their daughters. An article published in 1993 in the American Journal of Obstetrics and Gynecology clinically details one obstetrician's efforts to deliver a child vaginally from an infibulated woman. The article, written as a guide for dealing with such a situation, ends with a recommendation on how to perform reinfibulation and concludes, "The issue of whether the woman will want her own infant daughter circumcised also needs to be discussed so that she can make an individual, culturally appropriate and educated choice."

"My patients say doctors are often shocked when they see them, and don't know how to help them," says Carol Horowitz, an internist who cares for East African immigrants in Seattle. "I try to deal with them with respect and dignity and try to help them with their problems, surgically or nonsurgically." Horowitz says that she is mindful of the risk of offending her patients when she educates them about the harmful aspects of what was done to them or counsels them against circumcising their children—and that some doctors with whom she has worked will not broach the subject at all. "To many patients, a circumcised vagina is normal. Any change is going to have to come from within that community."

Teachers, nurses, and administrators in elementary schools located in areas with many African students are often ill equipped to detect and help a child at risk for mutilation, or to help a child following this potentially traumatizing experience. "There was a time I got a call from someone in northern Virginia," Asha Mohamud says. "They heard of a girl in a school who was at risk. The teacher was teaching about sex education, and the young girl pointed out the clitoris and said, `That part is really bad, and my mother is taking me back in the summer to have that cut out.'" Mohamud tried to find the girl, but by the time the story had reached her, it was too late. The girl had already graduated and returned from her trip to Africa.

"If that family-life teacher was aware, she could have done something immediately," Mohamud says. "It's something also that made the issue more urgent to us. Things are happening here right under our own noses. Girls are probably being taken back right now."

A DESIRE to educate both the officials in her adopted country and immigrants from her native one drives Mimi Ramsey. The New York-based international women's-rights group Equality Now is raising money to fund Ramsey's efforts so that she will be able to spend more time doing what she does best: taking her message to the streets.

In a dark restaurant in Los Angeles paper place mats are decorated with maps of Ethiopia. Shiny red-vinyl booths are filled with brightly dressed residents of the local immigrant community. Original Ethiopian artwork and African posters cover the walls. The smell of cooked meat and the sound of quiet laughter surround the booth where Ramsey sits, with her just-served lunch. Her own conservative dress is more likely to be found in Orange County than in Addis Ababa. She bows her head and prays aloud: "Please, God, save girls from being tortured. Please, God. Please. Thank you."

Just minutes after she begins her meal of traditional Ethiopian bread dipped in a stew of vegetables and meat, she gets up and approaches a table of four Ethiopian men. She exchanges pleasantries in their native language, Amharic, but quickly the conversation turns tense. A few English words are mixed with the foreign ones. A man says, "Tradition." Ramsey replies, "Let's talk about it," and squeezes in next to the men.

"In this country you see a lot of young women unmarried, pregnant," Yashanu, an Ethiopian taxi driver in his mid-forties, says, leaning back in his chair. "Maybe if American girls were circumcised, this wouldn't happen. When I was growing up, a girl had to stay within the family. She could be home no later than five or six in the afternoon. But in this country there are no rules." He shakes his head. "When you circumcise a woman, they're less active sexually and more interested in their schoolwork."

Mimi describes the physical pain, the burning and irritation, she still feels from what was done to her when she was six years old. She takes a small tube of cream from her purse and shows it to them. The cream is supposed to soothe her damaged nerve endings. "I can't enjoy sex," she tells them. "I feel nothing. I will never forgive my mother for doing this to me. Will you join me in stopping people from doing this to little girls? We have to help them," she says, smiling, touching one of the young men on his arm.

By the time Mimi stands up, thirty minutes later, the three younger men, all of whom knew vaguely about FGM because they had had sex with women who were circumcised, are horrified. They each promise earnestly to call their families back in Ethiopia to talk with them about the practice. But the older man remains unconvinced.

Across the street, at another African-owned restaurant, Ramsey speaks to a table of very modern-looking young women. One of them, a beautiful twenty-five-year-old in jeans who works for a Hollywood studio, pulls Ramsey aside and hands her a piece of paper. On it is the name of one of her close friends, a Los Angeles resident, who is planning to take her baby daughter back to Ethiopia for a circumcision in a week's time.

In her own community Ramsey patrols the African shops and restaurants like a diligent security guard. Her golden-brown face lights up whenever she sees a person she recognizes as a fellow Ethiopian, and she immediately engages in traditional greetings before turning the subject to that which is taboo.

"Was this done to you?" she asks the women. "It was done to me. I'm trying to stop this practice. Will you join me?" These encounters, usually the first time these women have ever discussed the issue, often end with tears, an embrace, and an exchange of phone numbers.

Beletu, a thirty-five-year-old Ethiopian immigrant, lives with her husband and their three daughters just outside Washington, D.C., in Maryland. She has had all three of her daughters circumcised—the youngest, two and a half, just last summer, during a short trip back to Ethiopia. "People practice without knowing," Beletu says regretfully, now that she has learned about the harmful aspects of the procedure. "Even though I lived here years, I didn't know. Nobody told me. I wouldn't have put my daughters in this situation if I had known." Five months pregnant with another girl, she vows to leave this one uncircumcised.

"My mother told me it's protection for us—from boys," says Azza, the Egyptian immigrant in Louisiana. "It's very bad pain. I don't want my daughter to have it, but it depends on what the doctor tells us." When told that information exists about the medical effects of the procedure, she begs for it to be sent to her. "The more education the better," she says. "It's done from generation to generation by word of mouth. But why is it done? I'm confused about it."

SORAYA Mire, the Somali film maker, is one of a handful of women trying to find the finances and forums to educate an immigrant population that views FGM as a comforting tie to the morality and traditions of its homeland. She uses screenings of her documentary as opportunities to discuss the issue. Like others, Mire is motivated by her own experience as a mutilated woman.

"They use vegetable thorns to sew because they are very strong," Mire says, describing the process of infibulation that she experienced. "The stitches stay in until marriage. Then three days before the wedding they ask the groom, Do you want to open her or do you want us to open her? A good man will say, You go ahead and do it. Others want to tear the woman open themselves.

"I get calls from people within the community asking me if I know someone who will circumcise their children. I of course say no, and try to talk them out of doing it. I got a call last year from a man in L.A. who said he had just performed a circumcision on a girl. He said, `She had a problem with her clitoris and I corrected it. There's nothing you can do to stop it.'"

Last year Mire went into hiding after receiving death threats from Somalis who were angry about what they saw as her traitorous behavior. She is now cautious when she's out in public and is reluctant to divulge the whereabouts of her secluded Los Angeles-area home.

At the Raleigh Studios, in Los Angeles, she shows her film to an audience of thirty-two people. The viewers cringe as they watch. A young girl is shown being held down. The circumciser reaches for a razor blade. The audience recoils. Mimi Ramsey is part of that audience. She drops her head to her lap and sobs.

After the film is over, Ramsey is asked to speak. She walks to the front of the stage but is still overcome. She simply cries and gasps, unable to talk for several minutes. The theater is perfectly silent except for her crying. Finally she speaks.

"I was struggling and calling my mother," Ramsey says in a hushed and breathless voice, trying not to break down again. "Little did I know that my mother had set me up. She paid for it to be done to me. This is something we all have to struggle with. While we're watching this, more little girls are being cut. My best friend was cut. She was my friend. My buddy. They did her the same day they did me, only she bled to death. What I'm doing now, I'm doing for her. I'm doing it for my buddy. She died for no reason. Please, let's fight it together. Please. Please."

Ramsey is still shaking an hour after the screening. "I need to go home, to face my mother. I need her to say she's sorry. Then I want her to go through Ethiopia with me, talking to women—talking them out of doing this to their daughters. She needs to go ahead of me. I will stand back and let her take the lead. It's only through this that I will forgive her."

Back home in San Jose, some time later, Ramsey hears again from Genat, in Washington. Genat has sent her mother back to Ethiopia. She happily reports that her daughter is safe. Crying, Ramsey thanks her, returns the phone to its cradle, and bows her head in prayer.