Khadija Gbla didn't realise she was a victim of genital mutilation until she was 13.

Khadija Gbla didn’t realise she was a victim of genital mutilation until she was 13.

It had happened years before, in a remote town in the African country of Gambia. But Khadija didn’t know what was done to her until she was standing in a women’s centre in Adelaide, reading a brochure on female genital mutilation (FGM). All at once, she recognised herself.

“I was looking at a brochure and instantly I was drawn to FGM Type II (there are four types),” the now-28-year-old and founder of No FGM Australia told Mamamia. 

“All the memories came back. Until then I had blocked it out.”

FGM Type II involves the removal of the clitoris and the labia minora. It can be done with or without the excision of the labia majora – in Khadija’s case, the labia majora was also excised. The other types range in severity. Some victims have the hood of the clitoris removed; some have their vagina “sealed” with only a small hole left for menstruation; others have their clitoris pricked or sliced to cause nerve damage. According to the World Health Organisation (WHO), at least 200 million women worldwide are affected by FGM. It’s usually done to young, prepubescent girls, with the consent of a family member.

Khadija is one of the 83,000 women living in Australia who have suffered FGM. She immigrated to Australia after the mutilation, but young girls, growing up in Australia, are also having it done today. A report published last week, from the Australian Paediatric Surveillance Unit, found children living in Australia are presenting to paediatricians with FGM.

"We asked 1003 paediatricians about their experience with FGM," Professor of Paediatrics and Child Health at The University of Sydney Elizabeth Elliot, who was involved in the study, told Mamamia. 

"Ten per cent had seen a child with FGM at least once in their career and 2.5 per cent - or 23 doctors - had seen 59 girls with FGM within the last five years."

Three of these 59 girls were born in Australia - two of which had FGM performed in Australia and one in Indonesia. The others were born overseas. The practice is illegal in Australia, but families often take their daughters on 'holidays' in order to have it done.

"We had travelled from Sierra Leone as refugees to Gambia. We were told we would be sent to Australia. My mum said we would take a 'drive' before we left," Khadija said. "We drove in the car for ages. To a remote village. I saw a scary looking woman there, my mother spoke to her. I didn't know why we were there. The old lady went into a hut and came out carrying a orange, rusty knife. We went inside the hut and, quick as a flash, my mother had taken off my clothes. She was holding me to the ground and the lady came in with the knife. I thought she was going to kill me."

"She ran the the knife down my body and grabbed hold of - what I now know was - my clitoris and started cutting at the flesh. I screamed and tried to break free. But nothing was stopping her. It took forever. A blunt, rusty knife. It felt like hours of agony and, no matter how much I screamed, or how many times I passed out, she just kept going."

"Once she was finished she threw away the pieces of flesh like they were disgusting. I didn't know what had happened. We didn't speak about it again."

Female genital mutilation - or "female circumcision" as it's sometimes referred to - is hardy ever acknowledged in the communities it affects. It happens regularly throughout Africa, the Middle East, Central and South East Asia. Now we know girls in Australia are also victims; and No FGM Australia estimates three girls every day are 'at risk' of FGM in Australia. But, despite the numbers, women don't have the language to talk about it.

"There is not even a word for 'clitoris' in my language," Khadija told me. How do you confront something without the words to do it?

"After I saw the brochure, I went home and spoke to my mum - the person who was meant to protect me and love me who also held me down as I screamed and bled everywhere," Khadija said. "I told her 'you performed FGM on me'. 'What's that?' she asked. I explained and she told me she'd been a good mother, that her mother had done the same thing, as had her grandmother. She told me I was lucky, that I needed to 'get over it'."

To Khadija 's mum, FGM is a form of empowerment; that, by removing the clitoris and some of the labia, a woman is 'free' from the urges of sexual pleasure. "You will not get 'itchy' there, you will not want to have sex when you're angry at your husband, you will not be attracted to other men," Khadija's mum told her.

This comes with a life sentence. The immediate pain and trauma and bleeding is followed by weeks of being unable to walk properly, or urinate without pain. There is an enduring risk of urinary tract infections. Menstruation becomes debilitating. Cysts are common. Sex is never pleasurable, it's often painful. Orgasms are, in most cases, impossible. And childbirth becomes life-threateningly dangerous.

"Let's not forget the risk of death," Managing Director of No FGM Australia Paula Ferrari told Mamamia. "Girls die from this. And it's hard to tell how common that is, because many countries do not attribute the death of FGM. It involves cutting major arteries in a major organ. The shock of this can kill. The blood loss can result in death. There is also risk of infection."

"But FGM is not always done with a rusty knife in a small village. It is also performed in clinical settings and this is one of the most dangerous myths - that the 'medicalisation' of FGM somehow makes it 'safer'," Ferrari continued. "In some countries, such as Singapore and Indonesia, the clinical practice of FGM is legal. It can even be booked in as part of a 'birth package'. Sure, FGM at the hands of a 'professional' might result in less immediate trauma. But, if a medial professional wants to remove the clitoris, they're going to do a brutally accurate job."

Elliott said that myth - alongside many others - was also reflected in the research findings.

"Many of the paediatricians surveyed thought FGM was a religious practice; that it was only seen in Africa; and that, if it was performed by a doctor, it was more 'okay'," she said.

These insights reflect the glaring need for further education on FGM in Australia. They also raise the question: why?

The motivation for removing a woman's clitoris, so she may never feel sexual pleasure, has nothing to do with religion.

In fact, the practice pre-dates religion and is not dictated in any religious dogma. "Some misinformed scholars believe FGM is an Islamic practice. It is highly un-Islamic, as many of the Muslim supporters of No FGM Australia will tell you," Ferrari said.

Its roots lie in ancient, ancient culture. And, Khadija says, it has everything to do with control.

"Make no mistake, FGM is the result of the patriarchy," she said. "Yes, it is often the women initiating it, doing the cutting, mothers and aunts planning FGM, but it is because of the patriarchy. It is violence against women and girls. It is child abuse and sexual abuse all at once."

"It's all about control," she continued. "It comes from the belief that a woman's body should be controlled; that her sexuality should be controlled; that woman's only purpose it to have children; and that she should remain a virgin until she is married. The system has been created so mothers know that if their daughters don't receive FGM, they won't be married, and they will be ostracised from society."

What can be done?

"There are global goals - both WHO and UNICEF have 'zero tolerance' policy against FGM. That, no matter what type of FGM, or who it's performed by, the practice is always considered harmful," Elliott said. "The challenge is to empower women and men to stand up against it. We have seen progress in many communities around the world. But it won't change overnight; to fix the problem, we need a change in attitude."

With the bravery of women like Khadija, attitudes are slowly changing. By speaking out against her community, her family, she is informing the world of one, vital truth: FGM is harmful to women and girls and, in no instance, should it be accepted.

With social pressure building, we also need education in government and changes in policy. From this, training programs for professionals might be implemented. Programs designed to help teachers and medical staff better assist victims of FGM; provide support to survivors to recover psychologically and physically; and, hopefully, help professionals identify the risk factors and prevent FGM in young girls.

"All studies show children at most risk are those whose sisters or mothers also had FGM," Elliott continued. "Doctors at refugee clinics need to be able to recognise this and ask about FGM. They need to able to know how to open the discussion in a culturally and medically sensitive way."

"FGM is common practice in Indonesia, and they're our neighbours," she continued. "There is increasing global travel, increasing immigration, more people seeking asylum. We need to talk about FGM."

And it's not just the job of general practitioners.

"I was a teacher, and it makes me shudder how many children might have been at risk of FGM under my care and I didn't know anything about it," Ferrari said. "Teachers need to know how to look for the signs. That, if one of the girls in their class is going on a 'holiday' to visit family in Africa or Indonesia, they might be at risk of FGM."

Then there's breaking the cycle.

"When I had my baby - if it had been a girl - I would have loved if the midwife had come to me and asked about FGM," Khadija said. "My history with FGM should be a flag in the system, telling doctors and teachers to take extra precautions. The same way midwives and child services talk about domestic violence to new mothers and fathers, they also need to talk about FGM."

For too long, FGM has been under-reported, brushed aside, mentioned but never really understood. Elliott is right - it is a time of widespread global travel, huge immigration, and we need to know the facts. We need education, awareness, conversations around the harm caused by FGM. But, most importantly, we need to remember that this is nothing to do with religion, that it's bigger than a cultural issue. That, with one single act, young girls are losing their sexuality. And, because of that, they will live a lifetime of pain and complications.

"If these kids were blonde, with blue eyes, we would be having a very different conversation right now," Khadija said. "Not all children are being treated equally or treated as priorities. We is the government? Where is the training? Where is the education?"

"This is not a cultural issue, it is a human right issue. Every child has the right to safety, every women has the right to sexuality. We have failed these little girls. No child, no child, deserves to be mutilated."