FGM/C or Khafd: Women suffer in silence owing to the stigma around talking about their sexuality

mutilation1Executive summary of “The Clitoral Hood A Contested Site: Khafd or Female Genital Mutilation/Cutting (FGM/C) in India”, a project by Lakshmi Anantnarayan, Shabana Diler, Natasha Menon in collaboration with WeSpeakOut & Nari Samata Manch, funded by Maharashtra Foundation & Amplify Change:

Female Genital Mutilation/Cutting (FGM/C) amongst Bohras in India has gained systematic public attention since 2012. The issue first rose to prominence because of two international legal cases on FGM/C against practicing Bohras in Australia and the US. We have since seen the rise of a strong survivor-led movement calling for an end to the practice of Khafd amongst Bohras. This anti-FGM/C movement seeks to end the practice through legal reform in India and by raising community awareness about the impact of the harmful traditional practice. Very few national-level field research studies have been published to understand the practice of Khafd in India.

Supporters of Khafd often cite the ‘lack of evidence’ about the impact of FGM/C in India as a justification that it is not harmful and therefore should be continued. The Government of India too has used the lack of ‘official data’ to shirk its responsibility to address or even acknowledge the existence of FGM/C in India. The current study contributes to the small body of existing research studies on FGM/C in India. It not only builds evidence of the existence of the practice in India today, but also seeks to document survivors’ experiences of the harmful impacts of Khafd as practiced by Bohras.

Objectives

The current study seeks to:

  1. Estimate the extent and type of FGM/C practiced in India
  2. Document physical, psychological and sexual impact of FGM/C
  3. Understand the cultural context surrounding the practice
  4. Document the reasons behind Khafd

Methodology

This qualitative study utilized a multi-site case study research design. Purposive maximum variation sampling along with snowball sampling methods were employed to identify participants. This sampling strategy ensured that participants represented:

a) diverse positions on Khafd (those who support and oppose Khafd),

b) varying socioeconomic levels,

c) diverse geographical locations (big city, medium city, small town),

d) different age groups,

e) different religious sub-sect affiliations (Reformist, Conformist, Alvi Bohras, etc.), and

f ) marital status. The study used semi-structured interviews to collect in-depth qualitative data.

Sample

The study included responses from 94 participants of which 83 were women and 11 were men. Data indicated that 81 women in the sample had been subjected to Khafd. A core strength of the sample is the representation of diverse positions on Khafd. Specifically, 43% of participants opposed Khafd and 37% supported Khafd. Additionally, 16% of the participants who previously supported Khafd had since changed their position to oppose it and 4% remained undecided. Indian participants were from thirteen locations across five states in India: Gujarat, Madhya Pradesh, Maharashtra, Rajasthan and Kerala. Additionally, Bohra expats from three countries (Canada, United Arab Emirates, and the United States of America) participated in the study. The sample also included traditional circumcisers, healthcare professionals, and teachers.

Key Findings

Type: A majority of Bohras practice Type 1 FGM/C (partial or total removal of the clitoris and/or clitoral hood/ prepuce). Though supporters of Khafd in India claim Bohras only practice Type 1a (removal of clitoral hood only) and Type 4 FGM/C (pricking, piercing, cauterization), participants in the study (including a medical doctor (OBGYN) who observed Khafd in his Bohra patients) reported that both Types 1a and 1b (partial or total removal of the clitoris and/or clitoral hood) are commonly practiced with very few cases of Type 4 FGM/C.

Prevalence: The data revealed that 75% of daughters (aged seven years and above) of all respondents in the sample were subjected to FGM/C. Girls are usually subjected to Khafd when they are about seven years old.

Impact:

  • Khafd was remembered as a painful experience by 97% (n=62)of women in the study. Women reported painful urination, physical discomfort, difficulty walking, and bleeding immediately following the procedure. Some women suffered from recurrent Urinary Tract Infections (UTIs) and incontinence in the long-term.
  • A key contribution of this study is that it is one of the first studies to document the sexual impact of Type 1 FGM/C. Approximately 33% of women subjected to Khafd in the study believe FGM/C has negatively impacted their sexual life. Low sex drive, inability to feel sexual pleasure, difficulty trusting sexual partners, and over sensitivity in the clitoral area were some of the problems identified by several women.
  • Amongst the psychological consequences of FGM/C, many participants in the study reported feelings of fear, anxiety, shame, anger, depression, low self-esteem, and difficulty trusting people as some of the fallouts of their FGM/C experience.

Reasons: The main reasons as stated by participants for the continuation of FGM/C are:

  • To continue with an old traditional practice
  • To adhere to religious edicts (Sunnat/ Shariat)
  • To control women’s sexual behavior and promiscuity and
  • To abide by the rules stated by religious clergy

Circumcisers and Medicalization: Many Bohra women and girls undergo FGM/C which is performed by traditional circumcisers. Study data suggests a trend of increasing medicalization of FGM/C (performance of FGM/C by medical professionals including doctors and nurses) in urban areas in India. While all economic classes practice Khafd, FGM/C in medical facilities is being pursued mainly by upper-class Bohra families.

Men’s Role: Bohra men do participate in Khafd (actively and passively) and have an integral role in its maintenance and/or propagation, both at the personal and the political levels.

Abandoning FGM/C: A variety of factors influence abandonment of FGM/C:

  • Younger women from big cities are more likely to be against FGM/C than those living in less urbanized areas.
  • All mothers who refused to subject their daughters to FGM/C in the study had high education levels (Postgraduates (Master’s degrees) and/or higher).
  • Diverse personal networks and economic independence from the Bohra religious community are key factors in a family’s ability to renounce FGM/C.
  • More Reformists are abandoning the practice compared to Conformist Dawoodi Bohras

Current Trends: Two trends emerged from the analysis:

  • India is viewed as a hub for the performance of FGM/C on Bohra expat/foreign girls. This is primarily due to the recent legal action on FGM/C amongst Bohras in Australia and USA, and the lack of an anti-FGM/C law in India.
  • Increased anti-FGM/C advocacy, media attention, and directives from the religious authority, is forcing the practice underground in India.

Recommendations

  • The Government of India must stop denying the existence of Khafd and act to end it. The harmful traditional practice violates several of India’s obligations under numerous international treaties and violates many rights of women and girls enshrined in the constitution. Anti-FGM/C legislation must primarily target providers of Khafd.
  • A targeted, grassroots level outreach program needs to be implemented reaching younger women (19-30 years) in medium cities and small towns with higher concentrations of Bohras.
  • There was a lack of information and need for education around sexuality and sexual health amongst both young and older women.
  • Many mothers who cut their daughters shared that they were worried for the safety of their daughters in the days after Khafd and worried about how their daughters would handle the immediate pain. It was clear that none of them intended harm. This is a big point of entry for dialogue on the impacts of Khafd with mothers.
  • Several women respondents who did experience challenges in their sexual lives because of Khafd expressed an urgent need for a closed safe group for survivors to share experiences and build a support network.
  • It is important to work with men, especially young men and formalize a space to politicize their role in stopping FGM/C.
  • Economic reasons largely drive traditional circumcisers to perform FGM/C. Traditional circumcisers must be informed about the harms of FGM/C and trained in alternative income generating activities that are more remunerative. They must be encouraged to “lay down the knife” and be fostered to become leaders in the anti- FGM/C movement.
  • Considering the increasing tendency and interest in medicalizing FGM/C in India, the Indian Medical Association needs to be called on to issue a zero tolerance policy on FGM/C. FGM/C violates a fundamental code of medical ethics, which is “First do no harm.”
  • Awareness needs to be raised of medical doctors who serve Bohra patients. Non-Bohra doctors serving Bohras need to be educated about FGM/C as their awareness of the practice is very poor. Anti-FGM/C doctors especially pediatricians must be trained to also counsel Bohra patients (parents of five or six-year old girls) about the health consequences and risks of FGM/C.
  • A multi-disciplinary research study on the psycho-sexual and physical health impacts of Type 1 FGM/C in India is urgently needed.

Conclusion

Khafd in India is risky and harmful. The current research revealed very powerful and moving accounts by over 30% of women who strongly felt that Khafd had affected their sexual life. For all we know, more women suffer in silence owing to the stigma surrounding women talking about their sexuality. In addition, several women shared their painful experiences of long-term psychological and physical harm from FGM/C. Parents who support FGM/C in India need to understand that while they may not intend harm, harm is exactly what they risk when they subject their daughters to Khafd. Therefore, now may be a very good time for us to reimagine ritual purification ceremonies that celebrate Bohra girls, their unique identity, health and well-being, devoid of Khafd.

Download full report HERE

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