By CHEN YIH WEN and MYRRA BAITY
“If a girl isn’t circumcised, she will be ‘wild’ with sexual desire,” said traditional midwife, Azizah Daud, as she demonstrated her tools of trade – a plastic box cutter, a piece of faded yellow string, a small container of rice grains, and a bottle of antiseptic.
Azizah, better known as Mak Su in her village in Kelantan, is one of the few remaining mak bidan, or traditional midwives, in the country.
While most people opt for the bright lights and antiseptic environs of hospitals for most medical procedures, Mak Su, 65, still circumcises up to three babies a month. By her reckoning, she has performed the procedure on almost a hundred babies.
“In clinics, they don’t recite prayers,” she said. “Parents prefer traditional midwives who know how to recite prayers in case babies are ‘disturbed’ by demons,” she said, unravelling the yellow string, or ‘pelepas’ which she uses to ward off demons.
Her demonstration of the procedure was swift. Pressing a piece of old, faded metal with a tiny hole onto our journalists’ palm, she made a quick slicing action with the box cutter. Used on a baby’s genitals, the tip of the clitoris would be sliced off.
Mak Su disposes the blade after each use, swabs the area with antiseptic, and covers it with cotton. In a matter of minutes, the entire process is over.
But across the country, the procedure is being done with almost zero regulation, even in private clinics, and is said to at least temporarily affect 15% of the girls who undergo it.
“As a medical doctor, when some medical procedure is not standardized, there is no training or SOP, and anybody can just do it according to how they see it – that’s problematic,” said Universiti Kebangsaan Malaysia professor Dr Harlina Halizah Siraj, who specializes in sexual and reproductive health issues relating to adolescents and women.
According to Dr Harlina, while male circumcision procedures are taught in medical school the same cannot be said for female circumcision. And without any form of standardisation, the procedure might cause medical complications and put the child at risk of infection.
There are women like Mak Su scattered throughout the rural villages of Malaysia. Unbound by medical regulation, they use tools ranging from Mak Su’s box cutter, to razor blades and needles.
The procedure itself ranges from slicing a baby’s clitoral hood to a mere prick with a needle.
This looseness in standards extends to hygiene as well. Some midwives religiously adhere to some form of hygiene, like Mak Su’s practice of disposing of blades after each use.
Others don’t. Retired midwife Eshah Mamat, 76, estimated that she used one razor blade per five babies, for the 200-300 babies she circumcised during her career.
“If I circumcised three babies in a week, I’d just use the same blade for all three,” said the sixth-generation midwife.
She’s passed the business on to her daughter, but the latter prefers not to perform circumcision, focusing on child delivery instead.
The procedure is also widely performed in private clinics across the country.
Dr Norliah Mohd Nor has been performing female circumcision in a clinic north of Kuala Lumpur since 1999.
She estimated that she sees about 10 babies a month, but also admitted that there is no formal, standardised procedure, even among professional doctors.
“We only learnt how to perform male circumcision in medical school,” she said. “We usually learn female circumcision from other doctors.”
University of Malaya professor Dr Maznah Dahlui agreed, saying female circumcision wasn’t part of any Malaysian university medical curriculum as far as she knows.
“Most of the general practitioners (GPs) I spoke to said they learnt it from their seniors, and those seniors generally studied in Egypt,” she said.
Without any formal training, professional doctors, like their traditional counterparts in the village, have wildly varying methods of female circumcision.
When R.AGE called a number of private clinics and hospitals to enquire about the procedure, the tools mentioned covered the gamut from needles and scissors, to a “special scalpel”.
The only consistency found across all these answers were that they all prefered to circumcise babies aged under six months – but even then, it wasn’t a rule.
Dr Maznah would prefer to see the practice abolished altogether: she sees regulations as a form of formalising female circumcision and making it a standard medical procedure. However, she also feels that the best short-term solution is standardisation.
“It will make the procedure safer,” she said. “Without it, people will be using all sorts of different tools – it will be difficult to control how much is cut, and that might cause more injury, and result in complications.”
The World Health Organisation (WHO) classifies female circumcision as “Female Genital Mutilation” (FGM), and defines it as “any type of invasive procedure to intentionally alter or injure the female genital organs for non-medical reasons.”
Of the four types of FGM defined by WHO, Malaysian doctors and traditional midwives generally practice Type I(a), where the tip of the clitoral hood or prepuce is removed, and Type IV, where the genitals are pricked, usually with a needle.
Type I(b) is the removal of the clitoris, Type II involves the partial or total removal of the clitoris and labia minora, while Type III (infibulation) is the most severe, where the vaginal opening is narrowed and sewn almost completely shut by cutting or repositioning the labia.
But as demonstrated by Mak Su and Eshah, even for the type of circumcision practised here, there really aren’t any guidelines on procedures, or even tools used.
In 2012, the Health Ministry announced plans to develop guidelines for the procedure, but when contacted by R.AGE, the Ministry revealed that it is still pending review. Several health practitioners R.AGE spoke to said they have yet to receive any guidelines.
In the same year, Dr Maznah was tasked by the Ministry and WHO to conduct a survey on female circumcision, for which she interviewed over 1,000 Malay women from Kedah, Kelantan, Selangor and Johor. She also spoke to 300 health practitioners, including GPs and mak bidans who performed female circumcision.
“There is no medical benefit.In fact, if you perform this procedure, instead of doing good for your child, you’re actually exposing your child to unnecessary risk of infection and other risks,” she said.
“If you use a blade that is not sterile, like what is done by most traditional midwives who reuse blades, this is of course not good.”
Based on her in-depth interviews with GPs, Dr Maznah found that doctors generally perform the procedure upon parents’ request.
“(The doctors) do it because if they don’t, the mothers will take their babies to traditional midwives, who might not perform it in a sterile manner,” she said.
According to her research, which is still unpublished, one of the most cited reasons for female circumcision is religious obligation, followed by hygiene, cultural tradition, curbing women’s sexual desire, and heightening a partner’s sexual desire.
‘It’s to protect our honour’
One woman who sent her daughter to be circumcised is civil servant Nusaybah Che Anuwa.
“My mother circumcised us (daughters) when we were little. Now that I’ve become a mother myself, I will do the same because it protects a girl’s maruah (honour),” said Nusaybah.
While searching for information on female circumcision online, she found a video that advocated the procedure.
“The video said that women out there who aren’t circumcised could end up involved in cases of adultery and ‘free sex’,” she said, adding that the video convinced her to go ahead with the procedure.
In order to reassure other mothers who were planning on circumcising their daughters, she blogged about her experience sending her daughter to undergo the procedure in a private clinic.
“I’m confident (about this procedure) because I’ve done my research, and I’m not sending my child to someone who will harm her,” she said.
However, she also admitted that she didn’t really know exactly what the procedure entailed, as she was holding onto her daughter during the process.
“I believe the doctor removed a bit of skin, that’s all. Because ‘sunat’ (circumcision) means to throw something away, so it couldn’t just be a cut or a prick,” she added.
Another word for “sunat” is the Arabic term “khitan” which means “to cut”. According to JAKIM’s guidelines to circumcision, the practice involves removing some skin from the genital area.
Nusaybah isn’t the only mother to allow her child to undergo the procedure without fully knowing what was about to happen.
According to a 2012 study by the Islamic Science University of Malaysia, only 28% of respondents knew the exact procedure for female circumcision.
And yet, 95% of them said they would circumcise their daughters.
Religion and sex
Most Malaysian Muslims subscribe to the Sunni Syafie madhhab (school of thought), under which female circumcision is compulsory, or wajib.
Malaysia came under fire earlier this year after a Health Ministry representative presented its position on female circumcision to the UN’s Convention on the Elimination of All Forms of Discriminations Against Women (Cedaw) committee, calling the procedure “harmless”.
Fellow Cedaw representatives, including those from Muslim countries, were highly critical.
Ismat Jahan from Bangladesh said FGM is not Islamic, and called for its abolition.
“I come from Bangladesh, a Muslim-majority country, and I find it very disturbing when I find reference that FGM is sanctioned under the religion of Islam,” said Ismat.
The Department of Islamic Development Malaysia (Jakim) previously circulated a fatwa (religious ruling) by the Malaysian Fatwa Committee in 2009 stating that female circumcision is wajib.
“We’ve been practising female circumcision since our ancestors’ time,” said Jakim research fellow Dr Arieff Osman.
“(The fatwa) was a response to WHO and Cedaw claiming that our practice is mutilating women and girls, and violating their rights. We wanted to clarify our stance on female circumcision.”
Jakim then consulted with doctors and experts to come up with a manual for female circumcision – the only guideline available on the procedure in Malaysia.
“This was to avoid the cruel practice that FGM is considered to be, as brought up by the WHO, when it comes to female circumcision,” said Dr Arieff, holding up the green booklet titled Circumcision in Islam.
However, the booklet, while containing a list of Hadiths pertaining to female circumcision and conditions under which circumcision cannot be performed, isn’t a strict guide for all practitioners.
While Jakim is the national Islamic body, each state has its own body to deal with Islamic matters. As such, fatwas differ from state to state.
For example, the Perlis State Fatwa Committee issued a fatwa in April 2017 stating the female circumcision is not compulsory.
“In Perlis, we considered the views of various madhhab in Islam, discussed it with doctors and experts, and concluded that it’s not compulsory for Muslim women to be circumcised,” said Perlis mufti Datuk Dr Mohd Asri Zainul Abidin. “There is no medically or scientifically-proven benefits for female circumcision.”
Dr Maznah added that there’s no evidence suggesting that cutting off the tip of the clitoris will reduce sexual desires, calling it “bad science”, but Dr Asri believes that’s beside the point.
“There is nothing wrong with women having sexual desires, even if it’s more than normal, as long as they channel it the right way – to their husbands.”
Whose body is it anyway?
It’s worrying that controlling a woman’s sexual desire without her consent is an accepted cultural norm, said Sisters In Islam programme manager Shareena Sharif.
“Nobody questions it, nobody looks at it from the perspective that it’s a violation of human rights, that it’s trying to control a woman’s independence and bodily integrity,” she said.
People should discuss this issue, instead of merely following tradition, she added. “There should be more public discourse among authorities and policy makers, religious leaders, communities, as well as the mothers and their girls.”
Mothers are especially important, because Dr Maznah’s study found that the decision to circumcise girls usually come from the women in the family.
“It’s a culture that’s been passed down through generations,” she said. “They say it comes from their grandmothers, their aunts, their mothers. This is a female matter, men don’t get involved.
“My own mother and grandmother decided on my first daughter’s circumcision,” she added.
“Thankfully, they didn’t interfere when my second daughter was born, so I made my own decision not to go through with it.”
Other countries are changing the way they look at female circumcision: 31 countries have enacted laws and decrees criminalising the act, including seven Islamic and Muslim-majority countries.
In Egypt, which also subscribes to the Sunni Syafie madhhab, female circumcision was banned in 2007 after a public outcry over the death of a 12-year-old girl who underwent the procedure. The practice was later criminalised in 2016, and religiously forbidden by Egypt’s Islamic ruling body, Dar Al-Iftaa, two years later.
Now, anybody who carries out female circumcision in Egypt faces five to seven years in jail, or 15 years if the procedure results in permanent disability or death.
Shareena looks at Egypt’s move as a possible solution Malaysia could discuss.
“FGM should be banned through legislation,” she said. “It should be a serious offence to mutilate women and girls.”
This, she feels, is the best way to end female circumcision in Malaysia once and for all.
However, a heads-on approach might do more harm than good, cautioned Dr Harlina.
“Parents think they are doing the girls a favour by circumcising them,” she said, adding that criminalising the procedure might cause the practice to go underground instead.
Education, she said, is the key.
“It’s not just about educating the masses – it’s about educating thought leaders like the ulamas (scholars),” she said.
Healthcare professionals also play a very important role, said Dr Harlina, by taking the opportunity to educate parents who request for female circumcisions.
“I would like the medical fraternity to make a decision – ‘Do I want to be involved in this or not?’”
Ultimately, while he disagrees with the practice, Dr Asri said it should be up to the girls to decide.
“The problem is that we are the ones doing this to our daughters, and our daughters should have their rights.
“As such, I don’t think we should continue this practice, unless a girl is grown up and she herself decides to do it. That is up to her.”
R.AGE’s original documentary, The Hidden Cut, premieres today.
Watch it at fb.com/thestarRAGE.