Chantal (00:00)
Content warning. In this episode, we discuss female genital mutilation and cutting, FGMC, which includes references to physical trauma and violence against women and girls. Some listeners may find this content distressing, so please listen with care and take breaks if needed. If you've been affected by any of the issues raised, please seek professional healthcare support. We will be adding advice for support in the show notes. Joining us today on this wonderful podcast about FGM is Huda. Before we proceed, Huda, could you just give a quick visual

Chantal (00:49)
Joining us today on this wonderful podcast about FGM/C at is Huda. Before we proceed, Huda, could you just give a quick visual description?

Huda (00:59)
so I'm Huda Mohammed and I'm wearing a burgandy scarf today with creamy suit And I'm a woman.

Chantal (01:06)
Thank you. And what experience do you have in terms of working for the charity?

Huda (01:16)
I'm a midwife. I've been a midwife for over 17 years now. So I'm working around women who have had FGM, female genitalia mutilation/circumcision. Physical, if they need mental, physical, whatever emotion they need, will find that for them.

Chantal (01:32)
So you're a healthcare practitioner, you're coming with that expertise. So can we first please, let's understand what is FGM / C. I noticed that you say circumcism, on the website, it says cutting, so I guess that's the same thing. And can you explain what it is and who it happens to?

Huda (01:54)
Okay, so female genital mutilation / cutting / circumcision is a barbaric practice that happens to women. It's global. 230 million or more girls are affected by this. It happens in Africa, in Asia, in America, in Russia. It's very global. It doesn't have a colour. It's in the Middle East. The reason they do it is a cultural belief. Some people do religious belief because of the traditional practice that they have 
for hundreds of years. So it's kind of controlling women, like I say, it's a culture. Sometimes they don't even know why they do this to women because that's what they know is best for the girls. But what we know now is it doesn't have a place in our society, it's inhumane, it affects women. When it happens to them, it affects them in a way that you can never reverse it, no matter what we do. So it's a pain, it's a trauma that women live with, a long life trauma.

on.

Chantal (02:54)
And at what age would these procedures be traditionally or typically carried out?

Huda (03:01)
It carries out from birth, from when they're born, at any point. We heard stories of women, countries who practice cutting, they will cut women even if they're in their deathbed just to make sure that they go through the ritual. So from infancy to some community they do from eight to nine, so women have a vivid experience that they were cut, they were held down. So women don't know that they've been cut because they were cut when they were just a newborn baby. Families share with them and they grow up with that.

Chantal (03:30)
Right.

Huda (03:31)
know, if there's something wrong, then unless they come to healthcare clinician like us, then we identify and we connect the problem they're going on. So it's really hidden, it's a very dark community practice.

They might not share that their daughter's been cut as a baby. So it can happen at any point. Sometimes women, because of peer pressure, culture, if they're into marriage, a community who practice the cutting and her new husband or partner wants that, women might go through that. But it's something that,

Chantal (03:56)
Okay.

Huda (03:58)
like I say, is very hidden. women might not share that with us, but we know it does happen at any point in their lives.

Chantal (04:05)
And I guess if it's happened to you as a baby, you just assume that's just how your body is.

Huda (04:09)
Exactly, exactly. I see that woman every day in my clinic who will come to the clinic because in maternity setting we ask everyone about the question, have you had anything done in your genitalia, have you been circumcised? And this is across the country when we're booking women regardless of their colour, their race. If a woman says yes, I come from a community of practice, maybe, maybe not, then they refer into the clinic.

Chantal (04:31)
Right, okay. So is that across the NHS? Yes. Yeah, okay.

Huda (04:35)
Supposedly, yes.

Not every NHS hospital will have a clinician like myself, but ideally should be someone who will be able to support that woman during their childbirth and during their pregnancy, especially if they have a mother who's having her first baby or having ongoing complication as a result of the cutting.

Chantal (04:53)
There's type one, type two, type three.

Huda (04:55)
Yeah,

so in terms of the cutting, so you have type one, so the removal of the clitoris hood. Type two is partial removal of inner labia, outer labia, and sometimes, because it depends on the age of the cutting, if very young babies, you might see women who's got been cut, their inner labia being removed.

So it varies from age to age, but the standing procedure is time when removal of the clitoris hood. Sometimes some community, they will let it bleed. So they use a small needle. Sometimes they may use salt and water. When we were in they used hot towel. So it depends on the culture and where and how. So in naked eyes, sometimes you can see that's been removed. Sometimes you don't. With type two again, it's removal of the inner labia, outer labia and the clitoris hood. And then you see this scar tissue.

And the complication for women in that sense is they will have some of them will have a nerve damage. So they have ongoing complications as a result of the cutting, hypostimulation of the nerve. So women will complain of a vulvar pain. So unless you put it together, you might not pick it up earlier. Women who's got type 3, it's removal of the inner labia outer labia and the clitoris hood. And what they do, they suture everything together. And you've got tiny, bean hole to pass urine to, to menstruate.

And it's very difficult during childbirth as well. So those kind of women will have problems with intimacy, they'll have problems during childbirth, they have ongoing problem with, you know, urine infections, sometimes the longer they leave it, they may have infertility problems, could never become mothers. So the stories we see varies is really, and each woman will have her own path to follow and pain and experience because everyone's not the same.

Some women would be cut and say, well, that's our culture. And they wouldn't do that. If they were in the West, we're educate them about the law, we're safeguarding the children to be born with it. But if you're coming from a community that was the norm, like that's all I know. But it's important that we support them and 
connect the two together so the ongoing urine infection you're having as a result of that. The ongoing complication, the nerve damage, the hypostimulation and intimacy complications. So once you connect that together, the mindset changes. And then we support them in terms of how do they overcome that. So referring them to the appropriate teams. So if they're having ongoing urine infections, you refer them to your gynaecologist. If they're having, you know, as a result of cutting mental health and stress and

can't go through labour, they need counselling So it's kind of varies how you draw a woman's pathways that depends on their needs and individually assess. Those women who have

Chantal (07:46)
Yes, so everybody's...

Huda (07:49)
got type 1 might think, oh I've got type 1 but they have nerve damage and they will have ongoing complications. We see that in our gynaecology clinics.

Chantal (07:58)
And then it's living with that, isn't it? The procedures, the impact. I mean, giving birth, my head's completely blown right now. Trying to give birth, if you've had a procedure like that, I mean, is it possible to give birth?

Huda (08:13)
So women who are lucky enough to be in settings in our hospitals or departments will plan their care before by having their baby. So they will have the initial assessment and then we'll assess what kind of cutting they have and then we'll be joint care where you include the women in her care. So give them options of something called deinfibulation or reversal, opening the scar tissue. Women in pregnancy, generally we don't examine every woman unless they're required.

But during childbirth, if you're going to have a normal birth, then you need sort of, to be able to examine. That's right. we'll assess the delivery. Then we'll give them the choice to be deinfobulated at the Second trimester. Maybe from 20 weeks on awards we'll offer to them the deinfibulation procedure or the vessel procedure which is done under local anesthesia. It takes maybe 30-40 minutes and it's life changing for them. She will be able to be, she will be able to examine her when she's in labour and obviously it's scar tissue but it's less easier than going into labour when you haven't been and that will risk complications. So woman who doesn't have access to appropriate care.

For example in places they don't have hospital settings, they might even die during a childbirth. For complications,

Chantal (09:27)
Yeah.

Huda (09:30)
they may die, may end up with a fistula or a trauma that will last long.

Chantal (09:37)
So for women who have undergone this procedure, is it a lifelong impacts is it?

Huda (09:46)
Yeah, it's a trauma. Even psychologists say even children who were mutilated when they young, the body remembers the trauma. So they will go into having other complications that everyone might go through, something called vaginousness, so tightening of the phial for when they're having intimacy with the vagina.

Hyper stimulation of the nerve damage, ongoing urine infections, incontinence. Sometimes when they're cutting children who are eight or seven, they're fighting, so they've been held down. And they might also affect the urethra where the urine comes out. that also will have damage

for a time incontinence and also because it's the nerve damage of the muscles also of the vulvar that would be long-term complications also some women will report having intimacy painful intimacy the trauma psychological trauma they live with and like I say it varies from one woman to another.

It varies, the cutting varies and how the women being cut when they were children, the age they were cut, you know every woman, their anatomy is different as well. Yeah so it's complex honestly, it's very complex and each woman will go and have a journey on her own. Yeah. But we're here to support.

Chantal (11:04)
Yeah, everyone.

Huda (11:06)
everyone honestly.

And like I say, doesn't have a race, it doesn't have a colour. As a woman who is coming from an African background, when I came into my health profession I thought it only happens to women who look like me. But now I know it's not. It happens in Middle East. I've seen women from Russia, I've seen women from Malaysia. It doesn't have a colour.

Chantal (11:25)
Okay. it's to that

all. Yeah, and that's why I'm so glad to have been welcomed by the charity to talk about this because we don't talk about women's bodies anyway.

Huda (11:43)
It's really hard to talk about women's body and women in health inequality anyway or women's health. Women generally it's very difficult to talk about women's health because we're unique, we are complex, we're different, we come into different hormonal changes, what have you, different age groups. Women itself is complex. We go through period pains and imagine FGM survivors on top of that, they're going through that. And sometimes women who, especially in England,

accessing healthcare also health inequality for them is also another barrier whereby if you're an FGM survivor you might not get other things. So if you're coming for example of over-reacting bladder and you're a woman who hadn't gone FGM maybe the GP straightaway put you on that pathway. A woman who had FGM might not be putting on that pathway simply because she's gone through that so that also blocks her and accessing that.

Chantal (12:36)
Yeah.

Huda (12:38)
Hence when they come to the FGM clinics, will kind of, okay, you've been through this, but this is actually what's happening in your body now, so this is the pathway you need to be. So you can see how complex it is for

Chantal (12:46)
Right, okay. Yeah.

Huda (12:50)
women, let alone you undergoing FGM as well. It is sad,

Chantal (12:53)
Yeah.

Huda (12:55)
very, it doesn't have no benefit for women, and it should end as soon, no woman should go through what FGM survivors go through.

Chantal (13:04)
and it's illegal in this country.

Huda (13:06)
In this country it is illegal,

it's been illegal since 1985. We've got a law that's strengthened now since 2025. So any healthcare professional who sees it, it, they report it to the police, especially those young children who under 18.

So organisations like yourself as well will make a really awareness for women who will hear this today and say, it's everyone's business.

Chantal (13:30)
Yes. that's right.

Huda (13:32)
Globally the statistics

is 230 million. What makes me sad is the last eight years it's shoot up rather than going down. So

Chantal (13:40)
Yeah.

Huda (13:42)
it is very, like we're doing so much work yet again, it's still the number is increasing. And the latest research done by Birmingham University a year ago, maybe two years ago now, every two minutes a girl would die as a result of cutting.

Chantal (13:56)
I mean, it's just not acceptable.

Huda (13:59)
It's not acceptable and I think the more research they do, we know those girls are not reported, those girls are dying and are not reported. The area is very vascular and if they cut a nerve then that child will die

because they're not done by healthcare professionals or under hospitals or under anesthesia. Again, the pain they go through because they were cut without sometimes any anesthesia.

What I really wish in this country, women to have holistic care.

So work in progress, like I said. And I think we'll get better because we'll keep talking. And for Vavangers, the leading charity in my opinion anyway, who really making some changes. Thank you so much.

Chantal (14:36)
Yeah. Thank you.

I mean, thank you for what you're doing, supporting those young women and girls.