Female Genital Cutting: A Lesson in Cultural Competence

The practice of Female Genital Cutting (FGC) ranks chief among the concerns of many feminists and human rights activists across the globe.  On Thursday, May 30, 2013, Jill Morrison of Georgetown University Law Center’s Women’s Law and Public Policy Fellowship Program (WLPPFP) hosted an intimate gathering of women’s rights advocates to hear from Dr. Fuambai Ahmadu, a post-doctoral fellow at the University of Chicago and Dr. Crista Johnson-Agbakwu, MD, MSc, FACOG, Director of the Refugee Women’s Health Clinic, Maricopa Integrated Health System in Phoenix, Arizona.  Both speakers offered their insight into the medical and cultural implications of FGC.  Dr. Johnson-Agbakwu provides medical care to women who have been cut.  She spearheads a movement toward cultivating cultural competence among healthcare providers.   Dr. Ahmadu is a medical and symbolic anthropologist.  As a senior research scholar and health advisor, she works to build Sierra Leone’s health research capacity and facilitate research collaborations with institutions such as Johns Hopkins Medicine and the National Institutes of Health (NIH) in Maryland.  Importantly, Dr. Ahmadu is a Sierra Leonean woman who returned to her home country to experience FGC, or initiation, in her home community.

Dr. Johnson-Agbakwu shared insight from her experience treating immigrant women who have undergone FGC.  She opened with a primer on the variations of cutting and although the anatomical lesson was fascinating, what was most remarkable about Dr. Johnson-Agbakwu’s presentation was her experience treating immigrant patients who embraced the practice, revered initiation, and in some instances requested re-cutting after their scar had been opened.  For these women, initiation was a sacred rite and their scar represented their womanhood.  Although many will cringe at the thought of undergoing FGC a second time, Dr. Johnson-Agbakwu takes a different approach—she greets her patients with an open mind and her acute awareness of cultural sensitivities enables her to better serve these women.  In explaining her approach, she challenged the audience to take an honest look at our own cultural biases.  For example, she noted that while FGC among African communities is dubbed “mutilation” and considered a human rights violation, vaginal rejuvenation surgery among American women is simply a cosmetic, personal choice and at worst superficial.

Dr. Ahmadu offered a similarly rare insight into the lives of women who have been initiated through FGC.  She shared her own personal experience of returning home to Sierra Leone to participate in the initiation ceremony, undergo FGC, and thereby join a supportive, embracing, and in many respects feminist, society of women from her community.  Dr. Ahmadu also presented a film, produced by her sister who also participated in the ceremony.  The film depicted women and girls being pampered and spoiled prior to the actual cutting; they were powdered and sprayed with perfumes as community members danced and sang around them.  For Dr. Ahmadu, the cutting ritual was an opportunity to join a larger movement of women.  Far from the often decried human rights abuse, Dr. Ahmadu felt empowered by her experience.

Dr. Ahmadu’s perspective, shared by many of Dr. Johnson-Agbakwu’s patients, is one that is rarely, if ever, heard in the human rights dialogue.  Instead, we typically learn only about those women and girls who have been subjected to FGC against their will and who have suffered dire health consequences as a result.

After the presentations, the room was teeming with questions and comments.  Some questioned the appropriate age of consent for FGC.  Others debated whether the choice to be initiated is a genuine choice, or whether it is coerced by cultural expectation and peer pressure.  Although the night closed without a consensus on FGC, what resonated with everyone was the importance of engaging with local communities to understand the cultural nuances of initiation and the role it plays in the lives of women.