Medical Examiner

Female Genital Mutilation Isn’t a Muslim Issue. It’s a Medical Issue.

Politicization of the topic is masking a bigger problem: Many women in the U.S. need medical care regarding it, and we’re ill-equipped to help them.



Last week, news emerged that an emergency medicine physician from Michigan had been charged with performing female genital mutilation. Dr. Jumana Nagarwala, who practices at the Henry Ford Hospital in Detroit, has been accused of doing the procedure on two 7-year-old girls at a medical clinic in Livonia, Michigan, this past February. The clinic is owned by Dr. Fakhruddin Attar, who has also been charged along with his wife, Farida Attar. Investigators additionally allege that other minors may have been victimized furtively by Nagarwala between 2005 and 2007.

The accused are part of a South Asian Muslim sect known as the Dawoodi Bohras, a Shiite branch of Islam whose adherents number 1.2 million and are dispersed all over the world. Considered mandatory by the sect to curb the sexual promiscuity of Bohra girls, female genital mutilation leaves its victims irrevocably scarred with lurid memories of the experience.

Though performed for nonmedical reasons, its medical consequences (pain, hemorrhage, shock, infection, obstetric complications, death) and costs are jarring. As Tasneem Raja recounts, “We were cut. Some of us bled and ached for days, and some walked away with lifelong physical damage.” A study based on data from six African countries found that female genital mutilation–related obstetric complications accounted for 0.1 to 1 percent of total government spending on women of reproductive age (15-45 years of age). Another study from Nigeria found that the cost of treating post–female genital mutilation complications was $120 per girl in a pediatric clinic.

This was the first arrest related to the practice in the U.S., but it was not an isolated case. Although the practice was outlawed here in 1996, according to the Population Reference Bureau, in 2013 alone, 507,000 women and girls in the United States were either subjected to genital mutilation or were at risk for the procedure.

Considering these numbers, the fact that this was the first arrest is perhaps even more surprising—or perhaps not. As the news began to circulate, it seemed that many were focusing not on the ghastly procedure, but on Nagarwala’s identity as a Muslim. Potentially lost in the periphery were details and actual discussion of the continued prominence of FGM, which is still performed in 30 disparate countries, as documented by the World Health Organization. Instead of lighting a fuse behind the indisputable need to bolster women’s rights and access to proper medical care, the hysteria around Islam’s role is ratcheting up as the story becomes a magnet for Islamophobes looking to buttress their case of why the religion is irreconcilable with American life and values.

Michigan Republican state Rep. Michele Hoitenga used the opportunity to resuscitate talk for the need of an anti-Sharia bill, which is a perpetual bogeyman for those vigilantly guarding against some mythical Islamic law supplanting American law. In an email sent to the Michigan state House, she wrote, “If you have not heard by now, a doctor in Detroit is being charged with operating an underground clinic that actively engaged in genital mutilation on young girls, essentially practicing a fundamentalist version of Sharia Law. I believe we must send a message that these practices shall not be tolerated in the state of Michigan.”

Neil Munro also took up the cause, writing recently in Breitbart of the liberal media’s refusal to mention “Islam” and “Muslim” in their writeups of the story. He quoted a statement from the Media Research Center and ACT for America arguing that such a glaring omission is “guilty of aiding and abetting violence against women out of a politically correct fueled fear of offending Muslims.”   

In a twisted way, Breitbart may sort of have a point here—there was discomfort across the political spectrum at the left’s seeming lack of engagement on the matter. Interviewed for an article in the Chicago Tribune on the silence surrounding the Michigan case, prominent activist and feminist Ayaan Hirsi Ali condemned feminists’ failure to hold Muslims accountable for their misogyny: “In Muslim communities there is the demand that women, girls, should be virgins and a woman’s sexuality is to be controlled and this is an effective and brutal way of doing that.” Ali, like Munro, suggested that part of the silence comes from reticence to condemn men of color and Muslims.

The problem with these criticisms is that female genital mutilation is not a fundamentally Islamic practice. A closer look at maps and numbers debunks these circulating claims: The ancient, barbaric practice originated in pre-Islamic Africa and has endured irrespective of the prevalent religion of the area. Today, it is primarily a cultural problem in central Africa, with Muslim-majority countries such as Egypt and Somalia on the list alongside Christian-majority ones such as Ethiopia and Eritrea. Though much lower in comparison to many African nations, the practice is also seen in Iraq and Yemen.

It is uncommon in some of the largest Muslim countries such as India, Pakistan, and Bangladesh (Bohra communities being the exception) and in the Middle East (Saudi Arabia, Syria, Iran, Jordan, Oman). Further, there is no religious sanction for the procedure found in the Quran. In 2006, the grand sheikh of the deeply venerated Al-Azhar University and other Islamic scholars ruled that female genital mutilation is antithetical to Islam’s teachings. As Kevin Drum of Mother Jones concluded, “The only way to represent [female genital mutilation] as a uniquely Islamic problem is to imply it with a wink and a nudge but without actually producing any evidence.” And yet Nagarwala’s case seems likely to become a tool of the right’s pursuit of a fictional Muslim enemy within that spawns more misguided policies.

It should also be a reminder to physicians that this is a real and serious issue that happens here. As the number of African immigrants to the United States has swelled recently, so has the number of women and girls living here who have undergone mutilation. Given the increasing scale of this practice, the focus must be on establishing a health care system that can cope with and ameliorate its physical and emotional complications.

The data shows that physicians are abysmally prepared to support the needs of survivors, and medical schools, like elsewhere in the world, leave their students woefully equipped to wrestle with the topic. It is a sobering reminder that we will be unable to fully grapple with this burgeoning scourge as long as our doctors and other health care workers are still learning the basic language with which to merely discuss the issue with their patients. A concerted effort aimed at increasing awareness and medical knowledge of female genital mutilation will be necessary to fulfill the rising needs of immigrant women and girls. It is imperative that this begins in the nascent stages of a medical student’s exposure to clinical medicine and persists throughout residency training in relevant subspecialties such as internal medicine, family medicine, obstetrics and gynecology, and urology. These, and not further demonization or disdain for Muslims, should be the enduring lessons from the unfortunate events in Michigan.