When do we start demanding immigrants who come to our country assimilate? Why should our doctors be asked to perform a medical procedure that perpetuates a barbaric Muslim act, and is considered illegal in the United States?
Safi Abdulahi’s protruding belly leads the way to the fourth floor of the hulking Hennepin County Medical Center building. The big-eyed 20-year-old shuffles down an echoing hallway, draped in vibrant dresses with a hijab hugging her round cheeks. She passes a framed photo of a sleeping ivory-pale baby and duplicate English and Spanish posters shouting the benefits of breastfeeding. She stops at a corner area labeled in large letters, “BIRTH CENTER.”
Minutes later, Abdulahi lies on a sterile bed in the doctor’s office. A lady spreads cold jelly over her seven-month-pregnant belly. A machine shows a blurry picture of her son curled up inside her. The baby’s heart is beating just fine, the woman tells her.
For a moment, Abdulahi’s mind is at ease. Then just as quickly she is preoccupied with questions about the delivery. Will it hurt badly? Will there be medicine to ease the pain? She doesn’t ask how the birth, or her body, will be affected by what was done to her as a child.
Suffer in Silence
Abdulahi lay on the kitchen floor of her home in Ethiopia, waiting, as her mom handed money over to a stranger. She had never met the old woman now hovering over her armed with a pair of scissors and a razor. Then everything went blurry. All she’d remember was the piercing pain. Sections of her vagina were cut away, the whole of it sewn nearly entirely shut.
The next time she was cut was just after her wedding day. Abdulahi’s new husband surveyed her body to confirm she was pure and untouched. Then she headed to a doctor to open the sutures slightly so she could consummate the marriage.
Now, relaxing on a couch in her south Minneapolis apartment, Abdulahi says she plans to have doctors open her up once more — this time to give birth. The beaming mother-to-be says she wants the doctors to “open everything, bigger!”
But at nearly eight months pregnant, Abdulahi hasn’t yet talked with her doctor about if and when this procedure would be done, and whether her vagina would be sewn again after giving birth.
Back home in Ethiopia, Abdulahi underwent the most severe form of female genital cutting — infibulation, or “fir-oo-ni” as the Twin Cities’ African immigrant community calls it. Though the media and some experts refer to the procedure as “female genital mutilation,” healthcare professionals who work with African immigrants prefer “female genital cutting,” a less offensive term to infibulated women. The procedure, practiced in nearly 30 African countries and a few places in Asia and the Middle East, involves removing all external genitalia, sometimes the clitoris, and then sewing the two sides of the vulva together so the woman is left with a hole about the width of a pencil for urinating and menstruating.
Most of these women come from war-torn areas; some have seen their friends and families brutally murdered, yet still vividly remember the day they were cut. They remember their childhood friends who didn’t make it out alive.
Abdulahi’s 17-year-old neighbor in Ethiopia was one of those friends. Her head sinks to her chest as she remembers how the girl wanted to have only sunnah like the “lucky” girls whose clitorises are removed or only nicked with a small razor. But her friend’s mother forced her to have the full circumcision. The procedure went wrong. The teenage girl bled to death.
Female genital cutting is usually performed when the girl is younger than high school age.
Abdulahi has asked her own mother why she made her undergo the worst form of FGC. “Why did you do this one?'” she’s pleaded. That’s what she had done to her, Abdulahi’s mother says, so she wanted her daughter to have the same.
The mother and daughter are close, and live together along with Abdulahi’s husband in a small, two-bedroom apartment.
She, like many Ethiopian women, is very close with her mother. Matriarchs have a lot of say in their daughters’ life choices — including the style and severity of the genital cutting they undergo.
Traditionally, being cut makes a woman more desirable and gives her the best chance of finding a good husband in countries where the practice is popular. It’s a tradition that’s passed on from generation to generation.
Groups like UNICEF and the World Health Organization have made strides in educating communities about health risks and the long-held misconception that cutting is in the Quran, but experts agree that cultural habits are the hardest to break. Many don’t see the tradition ending soon. With the practice still widely popular, more immigrants will be coming into Minnesota cut.
FGC is illegal in the U.S. But because of the Twin Cities’ large Somali immigrant population, the nonprofit Population Reference Bureau has ranked it one of the top three metropolitan areas in the U.S. where women and girls are at risk for having undergone FGC or having it done to them in the future. More than 37,000 Twin Cities women were at risk in 2013, and that number rises to over 44,000 throughout the state.
Some infibulated expecting mothers might not think to ask what will happen to their unique anatomies before and after they give birth. Even if they did, their doctor might not have an answer for them.
Clinicians should be offering to cut open, or defibulate, a sewn vagina before the woman gives birth, says Jessica Lane, community outreach coordinator for women’s services at Park Nicollet. But Lane, who has spent years researching FGC and working with women affected by it, has found that many providers don’t necessarily know how to do that.
Lane’s research has found that only 12 percent of over 500 women-focused healthcare providers in the country felt comfortable performing defibulation. And though more than half of them had provided care to a patient who had undergone FGC, a majority couldn’t correctly identify the different forms of it.
Lane says she knows a family practitioner for a local hospital who will get paged, even when she’s not on-call, to do the cut because some of her co-workers don’t feel comfortable doing it.
Then there’s the controversial question: Do you re-sew the woman’s vagina after she gives birth? If so, how much?
Abdulahi isn’t sure if or how much she’d like her vagina sewn up after she gives birth, but that might not be up to her anyway. There are no federal policies on whether re-sewing a vagina is considered female genital mutilation. A doctor can choose whether to perform the procedure and how far up to sew, leaving the woman’s body at the mercy of her clinician.
Recently, more African women and their families are opting to keep the vagina completely open, she says. But even then the woman may feel some discomfort with the new opening. It isn’t a custom to repair the vagina in countries where FGC is popular, Malotky says, but for some women closing it is about feeling comfortable in their own skin.
At Everyday Miracles, a 40-year-old Somali woman pregnant with her seventh child, who chose to remain anonymous, said her midwives have sewn her after every child, not for cultural reasons, but because she’s used to her body that way.
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