There are there are 200,000 survivors of Female Genital Mutilation in Australia, says Khadija Gbla.
Khadija Gbla’s activism against female genital mutilation (FGM) began when they were 13 years old and they told their mother that the practice that women in their family had undergone for generations had to end. “I looked her in the eye and said: ‘No more’.”
Like their mother, as a child Gbla experienced what they call a form of gender-based violence. They told their mother: “I did not consent to this being done. A child cannot consent.”
“I was the circuit breaker,” says Gbla, who identifies as non-binary.
Gbla, who was born in Sierra Leone and fled war as a child before settling in Adelaide, has become one of Australia’s leading voices in the fight to end female genital mutilation (FGM). Earlier this year they spoke to an audience of nurses and midwives at a NSWNMA professional day.
What is FM?
Gbla describes FGM as “a brutal form of discrimination and an attack on autonomy, sexual rights, and so much more”.
According to the World Health Organization (WHO), FGM includes all procedures that involve partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.
There are four main types of FM
Type 1 (Clitoridectomy) – “Type one involves the partial or total removal of the clitoris,” Gbla says. “People use that to liken it to male circumcision. It’s a way to minimise what is a brutal act being done to children.”
Type 2 (Excision) – Partial or total removal of the clitoris and labia minora. This is the type Gbla personally experienced at nine years old in Gambia, when “an old lady was paid money to use a rusty knife to mutilate me.”
Type 3 (Infibulation) – This type involves the removal of external genitalia and sewing the vaginal opening closed. “We have people walking around who are infibulated,”Gbla says. This procedure has serious implications, often causing difficulties urinating.
Type 4 – Includes harmful procedures such as pricking, piercing or cauterising the genital area.
A practice without borders
FGM is often mistakenly seen as an issue confined to regions in Africa or the Middle East, but Gbla says this is not correct. FGM has been documented in “every continent except Antarctica”, and it occurs across communities of different races, religions, and social classes.
“When people think about this, they think of third-world countries. They think of where I was born,” they explain. And yet “labiaplasty for kids under the age of 18, without medical reasons, will fit the definition of FGM if it’s been done for non-medical reasons.”
Gbla says that in Australia “there are 200,000 survivors of FGM”. At last count “11 girls a day were at risk of being mutilated in Australia”.
The immediate risks of FGM include haemorrhage, infection, shock, and death. Long-term complications encompass infertility, fistula, painful periods, sexual dysfunction, and childbirth complications.“
You might not even get to childbirth because one of the health consequences of FGM is infertility,” warns Gbla.
Survivors often experience complex post-traumatic stress disorder, loss of trust in caregivers, and deep emotional trauma. “Remember,” Gbla says, the practice is “predominantly done by caregivers, who you should feel safe with.”
In Australia, FGM is illegal in every state and territory, and it is a criminal offence to perform or assist in performing FGM, to take a child overseas for the procedure, or to fail to protect a child from it.
Gbla reminds healthcare workers of the importance of understanding and communicating the law clearly. “Ensure that girls, women understand the law and how it may help them but understand that people may feel pressured.”
The role of nurses and midwives
For Gbla, health professionals are critical agents of change. “You are at the forefront of the battle to eliminate female genital mutilation,” they say. Nurses and midwives are the frontline workers who provide care to survivors of FGM.
This requires sensitivity, cultural awareness, and a trauma-informed approach, they say. “Sometimes in our battle or fight to eliminate FGM, we sometimes alienate,”Gbla cautions.
“We can come in so strong; we push people back. People can feel ashamed and judged. And you can’t make change where there’s no safety. So, we must make people feel safe.”
Gbla encourages nurses and midwives to ask direct but respectful questions when taking a patient history. For example:
- Have you had the practice of FGM?
- Have you had any gender alterations done to you?
- Have you had any problems passing urine or difficulties during childbirth?
They emphasise the importance of documentation, noting the type of FGM, scar tissue, and any evidence of re-suturing. “Be mindful that dark-skinned people have keloids,” they add.
Gbla advises healthcare providers to approach survivors without judgment. “Be aware of your own feelings and responses. We think we’re poker face, but people watch us. They go, ‘Oh, you’re about to judge me.’ Don’t make assumptions; ‘Oh, you’re African, you must have had FGM.’ Please don’t.”
“You could be the person speaking toa grandma and changing their mind about this. You could be the persons peaking to a mom or a father or a sister. But it will matter how you hold this conversation, which is complex and nuanced.”
Gbla left the audience with a message about why the role of nurses and midwives matters so profoundly to protect children, just as it was their role as a 13-year-old who spoke up to their mother: “Child abuse is my place. Child protection is all our place.”