Makannera, a U.S. citizen born to Malian parents who relocated to New York City in 1976, had just been genitally mutilated by her maternal grandmother on that same bathroom floor 18 hours earlier.
"I could not sleep, the pain was unbearable. When I peed the first time, I felt fresh pain all over again as my urine touched my wound. I didn't want to suffer that again so I held it for as long as I could," she says.
She was 9 years old and her clitoris was cut off with a razor along with her external genitalia which were subsequently stitched together, leaving only an opening the size of a match stick. She was given no anesthesia.
The Campaign Against Female Genital Mutilation (CAGeM) is an international nonprofit group started by African female physicians in 1998. We are the oldest international organization to work exclusively on the eradication of female genital mutilation, often referred to as FGM. Some who wish to appear neutral on the issue use the phrase female genital cutting. Whatever it is called, we are working hard to eliminate it.
Last year we established an office in New York, for good reason. More than 140 million women around the world have been genitally mutilated and each year families afflict the procedure on 3 million girls and women. The problem is concentrated in Africa, the Middle East and Asia.
Immigrant communities in Europe, Australia and America also sustain it.
In 2000, Boston's Brigham and Women's Hospital reported that 227,887 females in the United States were genitally mutilated or are at risk of it, a 35 percent increase from 1990. The New York metropolitan area has the highest number, at 40,813.
On Sept. 15 our organization will be flagging the risks to inform New Yorkers about FGM in their home town. We will also be raising funds for our program in Egypt, where FGM is nearly universal. Our "Restoring the Rose" walkathon in Riverside Park to promote eradication will also give survivors a chance to speak to the New York City community and describe the horrors that many girls, we must assume, have just endured.
'A Dangerous Time'
"The summer holiday is a dangerous time for girls at risk of FGM in the United States," says Dr. Eno Etuk, a spokesperson for CAGeM. "Tens of thousands of girls in families of immigrant communities are sent out of the country to areas where FGM is ritually practiced to have them genitally mutilated in very unsterile conditions. Many girls facing this run away from home, causing parents to not disclose their intentions to their children."
A bill, The Girl Protection Act of 2011, introduced into Congress in June 2011 and into the Senate as S.1919 in November 2011, would make it illegal to transport a girl out of the country for female genital mutilation.
At the Sept. 15 event, we will be passing out petition cards for participants to mail to federal legislators.
We can also celebrate the fact that in August President Barack Obama issued an executive order that directs U.S. departments and agencies to implement a strategy to prevent and respond to gender-based violence, which includes female genital mutilation.
The practice--also known as female circumcision--is the removal of all or parts of the external female genitalia for non-medical reasons and is often performed without anesthesia. Reasons include preservation of virginity, promotion of faithfulness to husbands, initiations into womanhood because the clitoris is a "male part," avoiding "child death by clitoris" and other superstitious beliefs.
Parents feel their female children would not be able to get married to someone from their home country without being "circumcised" and would resort to the "wayward" ways of the Western world.
Although they have immigrated from practicing countries, they want to stay true to their cultures. Their children are cautioned against speaking about the ordeal and members of the communities who try to speak out receive death threats.
Parents such as Fatima Mohamed, a Somali immigrant who did not want to circumcise her daughter, face community pressure.
"They say they don't want to hear it. Some think I'm disrespecting my own culture. Some will say, 'You act like an American now. You forgot about who you are,'" she says.
New York physicians face the complications arising from FGM in the form of severe infections, increasing neonatal death, painful menstruation and post-traumatic stress disorder. Some patients die.
There is also a very high obstetric cost. A 2006 study by the World Health Organization indicated that deliveries to women who have undergone FGM are significantly more likely to be complicated by Caesarean section, postpartum hemorrhage, episiotomy, extended maternal hospital stay, resuscitation of the infant and inpatient perinatal death than deliveries to women who have not had FGM.
Since a federal law was passed against FGM in 1997, physicians approached to perform FGM face a dilemma. If they refuse it will be done dangerously. Dr. Terry Dunn, a Denver gynecologist, said physicians are often approached by mothers who say "I want to have the procedure that makes my daughter like me."
"When you're dealing with religious or cultural beliefs, saying no sometimes is not sufficient for people and it will not necessarily eliminate the practice," says Dr. Doug Diekema, a pediatrician at Seattle's Children's Hospital.
Better Enforcement Needed
New York is one of 17 states that have outlawed FGM against minors. But we need to press for better enforcement.
"As far as we know, the state is not undertaking activities to address this issue," says Jessica Gormand, legislative director of Assemblywoman Barbara Clark of Queens.
In 2009, Clark introduced a bill that would require the state Department of Health and the Office of Children and Family Services to produce an annual report to the governor and state legislature on their activities addressing FGM. Previous versions of the bill have died in the state Senate since 1995.
"Part of the motivation for putting this bill forward was to bring this to light," says Gormand.
The walkathon comes at a critical time for our organization. We hope to raise funds to ship medical supplies and equipment to the first free hospital providing treatment for victims of FGM in Africa.
We also hope to strengthen our women's economic empowerment program in Egypt where the prevalence of FGM is 97 percent and where some politicians are pushing to legalize FGM. Recently a mobile convoy paraded streets and offered to genitally mutilate women for free.
"If we don't empower these women to stand up now, they could succeed in passing this law with little resistance," says Rehab Mahmoud, chair of our partner organization SAWA, which means "everyone coming together."