Maltese doctors facing up to reality of female circumcision in pregnant refugees

Mater Dei hospital hosted Dr Comfort Momoh, a specialist midwife who campaigns for the eradication of female circumcision – which involves the partial or total removal of the external female genitalia – and infibulation, the surgical closure of the vagina’s outer lips, to leave only a small hole for the passage of menstrual blood.

The procedure is traditionally carried out by an older woman with no medical training. Anaesthetic and antiseptic treatment are not generally used and the practice is usually carried out using basic tools such as knives, scissors, scalpels, pieces of glass and razor blades.  Often, a mixture of herbs is placed on the wound to tighten the vagina and stop the bleeding.

Comfort Momoh has performed a number of operations to reverse genital mutilation, the practice of which is widespread in the Horn of Africa, from where many asylum seekers to Malta arrive. FORWARD, the Foundation for Women’s health, Research and Development, estimates that as many as 6,500 girls in the UK are at risk each year. FORWARD also estimates that approximately 100-140 million African women have undergone FGM worldwide and each year, a further 3 million girls are estimated to be at risk of the practice in Africa alone.

So why should it be an issue to Malta? As a result of immigration and refugee movements, FGM is now being practiced by ethnic minority populations in the countries they migrate to. Whether or not this is already the case in Malta is unsure, but doctors have witnessed cases in pregnant asylum seekers arriving to Malta, that required extreme care.

Professor Mark Brincat, director of department of obstetrics and gynaecology, explained that as soon as they hit Maltese shores, pregnant refugee women would go directly to them in labor. Problems arise when some of the women would have had FGM. “Unlike the Royal British College, in Malta we do not have guidelines which we could follow. So we had to follow the Royal British College ones,” he said.

Now the same department is organising modules with Dr Comfort Momoh to teach them how to deliver babies when the mother is circumcised.

“We had problems because some of the women were against having a caesarean section, so we had to be more cautious with them, also not undermining the fact that these women would have gone through horrible experiences,” Brincat said.

With FGM, most women in labor would find it problematic to give birth as the closed vagina would tear up. According to Dr Comfort Momoh, the peak age for FGM is between 5 and 12 years old, whilst some mothers would have had it done on their child as a baby.

Despite the campaigning of organisations such as the World Health Organisation (WHO), Amnesty International, the United Nations Convention, the African Charter, and the passing of the British Female Genital Mutilation Act 2003 which outlaws such practice, it seems as if the numbers won’t go down. In around 28 African countries, FGM is a ritual which all girls forcefully undergo. The roots of FGM have not been exactly possible to determine, however justification for the practice reflect the ideological and historical development of the societies in which it has developed.  Usually, FGM is related to tradition, power inequalities and the ensuing compliance of women to the dictates of their communities.

Back in 2006, Labour MP Marie Louise Coleiro-Preca has called on the government to outlaw the practice of female genital mutilation in Malta, in a bid to protect migrant women who could be subjected to the brutal practice. “We need to protect the rights of migrant women by introducing a legal mechanism to prosecute anyone practising this brutal practice,” Coleiro-Preca had said.

In the past, persons working with immigrants who spoke with MaltaToday said they had not encountered any case of genital mutilation practised in Malta. This can be attributed to the fact that very few young girls actually reach Malta, where men predominate among the immigrant population.

Comfort Momoh is from Africa herself. She is half-Nigerian and half-Ghanaian. Fortunately for her, her tribe does not perform the cutting she says. But her interest to the subject grew during her training as a midwife. Seeing so many of her colleagues’ female relatives die had raised her interest in the matter and she started researching on the subject. “In 1997 I decided to establish a support service for women and children,” Comfort said. And this is the point where her life took her on the journey to start working with other organisations against FGM.  “Each year I see around 400 to 500 cases,” she says.

Momoh said that amongst the many complications which exist, the most “common long-term complications include urinary tract infections, obstruction during labour, pain during sexual intercourse and children who die from immediate complications. Sometimes the mother and/or the unborn child can die as well.”  Circumcised women, for example, have described sexual intercourse as trying to penetrate a brick wall.

And with 99% of the circumcisers having no medical knowledge it can hardly be a surprise that such complications arise. “Circumcisers could be anybody within their community from their grandmother or their mother or their baba (the female elder).” 90% of them do not receive any pain relief for FGM.