BUSPH: ‘Criminalizing FGM Is a Necessary Protective Measure’

Published on: October 3, 2019

Female genital mutilation and cutting (FGM/C) is widely recognized as an act of violence against women, torture, and a violation of human rights. It is defined as the cutting of, injury to, or removal of parts of a girl’s genitalia.

The Massachusetts legislature is currently considering bills that would criminalize FGM/C and provide educational and outreach programs about FGM/C in communities at risk.

On September 24, Sondra Crosby, associate professor of health law, ethics & human rights, provided oral testimony in support of Senate Bill 834, An Act Relative to Female Genital Mutilation, during a Joint Judiciary Committee Hearing at the Massachusetts State House. Crosby is an internal medicine physician at Boston Medical Center and an associate professor of medicine at the School of Medicine, and has treated hundreds of women who have been subjected to this practice.

“FGM/C affects women in all religions and sectors of society, including the US and right here in Massachusetts,” says Crosby. “Some of the patients I’ve seen are asylum seekers fleeing for their safety, or the safety of their daughters who could suffer the same fate.

“Enacting a law against FGMC could serve as a deterrent and provide women with a basis to resist cultural pressure from their families to have their daughters cut,” she says.

In 1996, the United States passed a federal law that ruled FGM/C illegal in this country, but in November 2018, a US district court repealed the law on the grounds that the act should be regulated by the states. Currently, 35 states have enacted such laws. The CDC has estimated that 500,000 young girls and women in the US have been cut or are at risk of having their genitalia cut for non-medical purposes, and Massachusetts ranks 12th in the nation for at-risk populations.

“In my patients, the cutting occurs in many circumstances, but often the cutting is performed with scissors, dirty razor blades or knives, and in unsterile conditions without anesthesia,” says Crosby. “These violent acts result in both short- and long-term physical and psychological health consequences.”

Crosby spoke further about the cultural and religious beliefs associated with FGM/C, and the effects that it has on young women.

Can you explain more about what this bill proposes?

This bill would impose criminal penalties on a person who commits FGM/C or anyone providing parental consent for FGM/C. The bill includes provisions for education about FGM/C to at-risk communities, and enables FGM/C victims to seek civil penalties. We need to provide this support and treatment to FGM/C survivors. We must provide training for clinicians to recognize and treat FGM/C.

We must identify these at-risk populations and create community-based interventions, and we must educate the men and the religious and civil organizations in the communities. Communities practice female genital cutting to enforce virginity and fidelity (sex is painful for the girl who has been cut), secure marriageability (men expect to have sex with a woman who has undergone cutting), increase her future husband’s sexual pleasure, or abide by other religious, cultural, and health beliefs.

Implementation of the law must not prejudicially target immigrant or religious communities, especially given the current hostile political environment toward immigrants in the US. Specifically, criminalizing FGM/C raises awareness and is a necessary protective measure, but we must simultaneously provide support to affected women and communities. We cannot undo the damage for the women who have been cut, but we can facilitate healing, and we are obligated to protect future generations.

What are some of the physical and psychological effects on victims of FGM/C?

Often, both patients and clinicians are reluctant to talk about this painful subject. In our experience, women who have suffered from FGMC often feel stigma and misunderstanding from Western clinicians. Trainings for physicians to screen and treat women whose genitals have been cut, or are at risk of being cut, is not routinely provided in medical education.

The immediate risks include hemorrhage and infection, which can result in death. Long-term medical complications include chronic infections, cysts and abscesses, scar formation, chronic pain, urinary incontinence, and complications with childbirth, including death.

The psychological consequences can last for decades, and include increased risk for PTSD, anxiety, and depression. FGM/C also impacts women’s sexual lives. Sexual intercourse can trigger flashbacks and/or may be painful due to the physical damage. These women may also struggle with sleep disorders, fatigue, generalized body pain, and long-term difficulties in their daily lives and activities.

The story of one patient, who I’ll refer to as Ms. A., is all too common: At eight years old, Ms. A. was taken from her home in an African country to a neighboring village by her grandmother. She was forced to lay on a pile of leaves and restrained by women as her genitals were cut with a knife. No anesthesia was used, and she screamed from the excruciating pain. She had profuse bleeding, and in the following days any movement was painful. For weeks, urination was excruciating. Ms. A. was forced into marriage at 16, and on her wedding day, she said her vagina was cut open by a doctor. She was forced to have sexual intercourse on that same day, an act she described as very painful, and felt she might die. She became pregnant, and her vagina was cut open again for the delivery, and then “sewed closed” after the birth.

Ms. A. fled her country with her daughter to escape the cutting and they were granted political asylum in the US. However, she still suffers from chronic, daily genital pain and avoids sexual relations, and she fears the same fate for her child.

What is the next step of the legislative process for this bill? What can people in the community do to support it?

People should urge their state legislators to pass the House 3332 and Senate 834 bills. Now that the public hearing has taken place, the bill must be reported favorably out of the Judiciary Committee by February 1, 2020 and passed by both the House and the Senate by July 31, 2020.

Written by Jillian McKoy 


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