Pakistan: Low awareness of hidden FGM/C practices

In certain cafés close to medical colleges in Pakistan, and of course within the institutions themselves, students studying gynaecology speak of some unexpected sights they have seen.

"Recently, we examined a woman who complained of pain in her genital region. We were shocked to see when we examined her that she had suffered some mutilation of her private parts. I have read about these practices but I didn't know they took place here," Zeba Khan, a 4th year medical student, told IRIN.

Though female genital mutilation/cutting (FGM/C) takes place, the practice is hidden, hardly ever spoken of, barely known about. The country, for instance, is considered to be "free" of FGM/C, like a number of other Muslim majority countries in the region. Indeed, this view is widely held. "No such thing happens here," Saadia Ahmed, a gynaecologist, told IRIN.

But there is evidence which suggests this widely held view may be inaccurate.

"I can still remember when it happened," Zehra Ali*, 22, told IRIN. She said soon after her eighth birthday, her mother "gave me a big bowl of ice-cream" and then led her to a spare bedroom where an elderly woman spoke to her kindly, had her lie down on the bed and do "a terrible" thing. Zehra says a small part of her clitoris was quickly snipped off, that she felt "some pain" but mainly a strong sense of being "violated". She said the episode, which she "never forgot", causes her problems "now that I am married" and that she needed counselling before she was willing to consent to sex, "for psychological not physical reasons".

Bohra community

Zehra belongs to the Bohra community, a sect of the majority Muslim population which numbers some 100,000, according to official figures, and is based mainly in the southern province of Sindh. The Bohras are among the few communities practising FGM/C in Pakistan.

Other groups which carry out the mutilation are groups with African or Arab origins, such as the ethnic Sheedi community which numbers several thousand, came to the country originally as slaves during the 19th and 20th centuries, and is based primarily in Sindh. There has been little research on the practice among these groups.

Zehra believes that even today at least 50-60 percent of Bohra women undergo circumcision, involving usually a symbolic snipping of the clitoris. "In the past there was more mutilation, and I think 80-90 percent of women suffered it. More awareness has helped reduce the practice," she said.

"I have seen females who have suffered `khatna' as female circumcision is called. Sometimes there is merely a symbolic snipping of some skin, but in some women - especially those who are not so young, there is somewhat more extensive cutting," said a midwife (she preferred anonymity) in the Tando Muhammad Khan District of Sindh, who has attended to Sheedi women. She said she herself did not perform circumcisions.

According to the World Health Organization (WHO), FGM/C "includes procedures that intentionally alter or injure female genital organs for non-medical reasons".  It says an estimated 100-140 million girls and women worldwide are living with FGM/C, 92 million of them in Africa.

"Symbolic" cutting

Shershah Syed, a former president of the Society of Obstetricians and Gynaecologists, who devotes his practice to serving deprived women, told the media he had come across cases in urban Pakistan where women have undergone the procedure.

"In Pakistan, with growing awareness [of the effects of FGM/C], they are now doing it merely symbolically, with only a bit of skin being removed. But even so, I find it to be in clear violation of human rights. There is absolutely no scientific evidence supporting any medical benefit of the procedure. In fact, it can lead to health complications," said Syed.

The WHO lists the string of complications that can arise from the procedure, including repeated infections, cysts, infertility, higher childbirth complications and the need for repeated surgeries.

"In our community, this practice has taken place for generations. The girls nowadays have it done in sterile conditions. It is rarely spoken of. It is just something the women know about and do," said Raazia*, 60, a member of the Bohra community and a grandmother. She says her granddaughters "will be safely circumcized."

"The impact is not just on health, it is psychological too. Such practices leave deep scars, and in our country these have not been studied at all, because so little is known about the mutilation of women in this way," said Aliya Rizvi, a psychologist.

*Not her real name