LONDON (TrustLaw) - As a young trainee nurse back home in Nigeria, Comfort Momoh hadn't heard much about the ancient ritual performed on girls to preserve their chastity -- until her friends' cousins and sisters began dying from it.
Like many other victims of female genital mutilation (FGM), they suffered complications from a practice which dictates that a girl's genitals be cut, stitched, removed or sewn up in the belief it will keep her pure for marriage.
More than 20 years after her student training days, Momoh has made treating the effects of genital cutting her life’s mission.
In 1997, the half-Nigerian, half-Ghanaian midwife established a specialised clinic at London's Guy's and St Thomas's Hospital Trust to help women and girls who have been cut. It was the second clinic of its kind in Britain where Momoh, 48, now lives.
"For some of these women, especially pregnant women, it might be the first time ever that somebody has actually raised the issues around FGM because where they're coming from, it's a hush-hush thing. It's very sensitive, you don't talk about it," says Momoh, who has treated girls as young as seven.
An estimated 92 million girls aged 10 and above have endured some form of cutting in villages and towns across Africa, from Somalia in the east to Senegal in the west.
While the ritual, steeped in centuries of tradition, still flourishes in much of Africa and parts of the Middle East and Asia, it also has spread into Western countries with the arrival of immigrant families reluctant to abandon their customs.
When Momoh opened her African Well Woman's Clinic in London, few doctors, nurses or teachers in the UK knew anything about a practice often carried out by older women with no medical training, no sterile instruments and using no anaesthetic.
"The people that perform the FGM, 99 percent don't have any anatomical knowledge or skill -- (it could be) just anybody from the community, might be a grandmother with very bad eyesight doing more damage to the vulva area," Momoh says
Girls can be cut with anything from a razor blade and broken glass to scissors and tin can lids. The procedure not only robs them of sexual sensation but can lead to life-long problems, including cysts, urinary tract infections, painful intercourse, obstructed labour during childbirth and incontinence.
'AN ACT OF LOVE'
Although Britain made the practice a criminal offence in 1985, some parents circumvented the law by taking their girls abroad to be cut. The Female Genital Mutilation Act of 2003 closed this loophole by making it illegal for UK residents to arrange FGM in Britain or overseas.
However, it will remain difficult to completely stamp out the practice as long as the deeply rooted belief that uncut girls are unclean and promiscuous persists among some groups.
"The parents will argue that although it's seen as child abuse, barbaric in the West, they will argue that it's a rite of passage, that they're preparing their girls for adulthood, they're preparing their girls for marriageability, so it's an act of love to them," Momoh says.
“I do not buy it, but at the same time we have to be realistic. To change people's attitude and mindset, it will take a long time. Even here in this country they used to do cliterodectomy in the 18th century to cure masturbation and hysterical conditions. I always argue why does it (such a procedure) have to be around women? It's about controlling women's sexuality."
The Foundation for Women's Health, Research and Development (FORWARD), a support group working with the African diaspora in the UK, estimates that 6,500 girls are at risk of FGM in Britain every year, and there are now at least 15 specialist clinics like Momoh's dotted around the country.
It's unclear how much FGM is taking place in Britain, but in 1997, Channel 4 television aired a documentary showing secret footage of a British-Indian medical doctor and a Yemeni "circumcisor" willing to perform the procedure for money.
GIVING WOMEN BACK THEIR LIVES
The most severe form of female genital mutilation, infibulation, consists of removal of all or part of the clitoris and labia minora and then cutting and sewing the labia majora together to cover the vagina, in extreme cases with thorns, so that only a tiny hole is left for urine and menstrual blood to pass.
Momoh, who was awarded an MBE (Member of the Order of the British Empire) for services to women's healthcare, reverses the procedure (de-infibulation) at her clinic on average twice or three times a week, a frequency she says is "significant".
Some of the women requesting de-infibulation are getting married and are afraid they will be unable to consummate their relationship without the surgery.
In a consulting room at St Thomas' Hospital, Momoh explains how much of her work is offering advice and information about the effects of the cutting, especially to teenagers.
"They're now in a new country. They're comparing notes with their peers. They might be swimming, and in the changing room they see that they're different. Nobody has explained things to them or talked to them," Momoh says.
Some girls are not even aware they have been cut.
"When you tell them that they have, and there's different types - you show them the diagrams - they get really angry and upset which you can understand," she adds.
Most of her patients are of Somali origin, others come from Nigeria, Sierra Leone, Gambia, Sudan, Eritrea, Mali, Ethiopia, Ghana and she has also helped Kurdish Iraqi women.
In fact, during the interview Momoh takes a call from a pregnant ethnic Somali woman seeking advice on whether she should be de-infibulated before or at labour. With her soothing manner, Momoh suggests the woman come to the clinic to discuss the options.
"I remember, once, one of my students asked me 'do you enjoy delivering babies or do you enjoy doing de-infibulation?' I think both. Obviously in terms of delivering babies, you bring in life to the world, with the de-infibulation you bring women's life back to them," Momoh says.