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 the tools of her 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, is a mak bidan, or traditional midwife. Her practice is based in the rural state of Kelantan, northern Malaysia.
While most people opt for the bright lights and antiseptic environs of hospitals to undergo medical procedures, Mak Su, 65, still circumcises up to three babies a month in her kampung home.
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 the babies are ‘disturbed’ by demons,” she added, unravelling a pelepas, a yellow string which she uses to ward off demons.
Her demonstration of the procedure was swift. Pressing a piece of old, faded metal with a tiny cut-out hole onto our journalists’ palm, she made a quick slicing action with a store-bought box cutter. Used on a baby’s genitals, the tip of the clitoris would protrude through the hole in the metal, and 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 reported to result in side effects among 15% of the girls who undergo it.
“As a medical doctor, when some medical procedure is not standardised, 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 Malaysian medical schools, the same cannot be said for female circumcision. And without any form of standardisation, the procedure could 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 the slicing of a baby’s clitoral hood to a mere prick with a needle.
This looseness in standards extends to hygiene as well. Some midwives adhere to certain hygiene standards, like Mak Su’s practice of disposing blades after each use.
Others don’t. Retired midwife Eshah Mamat, 76, said she would use one razor blade for up to five babies before disposing it. She estimates that she has circumcised 200-300 babies throughout her career.
“If I circumcised three babies in a week, I’d use the same blade for all three,” said the sixth-generation midwife.
She has 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 the Malaysian capital city of Kuala Lumpur since 1999.
She sees around 10 babies a month, and 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 preferred to circumcise babies while they were still under six months old.
“Any older, and the baby’s thighs might hurt from being spread apart so wide,” said one doctor.
In the long run, Dr Maznah would prefer to see the practice abolished altogether; but for now, she feels standardisation and regulation is a much-needed stop-gap solution.
“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.”
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 supposedly practised in Malaysia, there really aren’t any guidelines on procedures, or even on the 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 from the Ministry.
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 (to the procedure). 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 only when parents’ ask for it.
“(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, 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 (the Malaysian Islamic Development Department) 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.
Jakim had 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 that 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, widely considered by Malaysian Muslims to be a “liberal” mufti.
“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.
“These 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, in 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.”
Unlikely to change
Despite Shareena and Dr Asri’s views on female circumcision, change of this magnitude needs a shift in mindset at the policy-making level.
If that’s the case, things are unlikely to change anytime soon.
In November, Malaysian delegates to the Universal Periodic Review on human rights in Geneva came under fire for defending infant female circumcision, calling the practice a “cultural obligation” in Malaysia.
This stance was affirmed by Deputy Prime Minister Datuk Seri Dr Wan Azizah Wan Ismail, who is also Women, Family, and Community Development minister, and a medical doctor.
“We are in discussion with the Health Ministry because so far, it is actually something that is cultural, that we have had from before,” she told reporters in Malaysia.
“But we are not the same as Africa, all the mutilation (there).”
Wan Azizah’s comments sparked a firestorm on social media, dividing opinion on whether the practice should be allowed to continue.
The National Human Rights Commission (Suhakam), however, slammed the government for its stance, saying it was making “misleading statements” by calling female circumcision a part of Malaysian culture.
“The inaccuracy of the Ministry’s position in describing female genital mutilation (FGM) as a Malaysian culture has the potential of further damaging Malaysia’s international standing on women’s rights,” said Suhakam chairman Tan Sri Razali Ismail in an interview with The Star.
However, the furore surrounding the issue does not surprise SIS.
“Unfortunately, education in Malaysia, especially in matters of Islam, is controlled and prescriptive,” said SIS communications manager Majidah Hashim.
It makes things harder to change, especially when certain practices are defended as “religious requirements”, as the previous Barisan National administration did when defending female circumcision at the 69th Cedaw session in February 2018.
“While we appreciate that the PH government has moved away from using religion to defend female circumcision, their justification of it being a cultural practice is also problematic and perpetuates violation towards a girl’s body,” said Majidah.
It doesn’t help, she said, that Malaysians are wary of United Nation treaties, thinking that they aim to erode cultural and religious ways of life.
“We need to move away from the propaganda that United Nation treaties are Western or liberal agenda,” she said.
“The issue of female circumcision and how Malaysia is responding to it on the international stage is a stark reminder to the government that we do not and we should not live in our own bubble.”
Given the sensitivities surrounding female circumcision among the Muslim community, Razali is of the opinion that making public statements in the press will not work.
“I sincerely believe the government wants change, but it’s not like they can stand on a roof and shout about it,” he said.
“Instead, we have to operate on a lower level for (change) to be more effective.”
He suggested creating awareness among religious leaders in villages and healthcare practitioners, and using them to disseminate information.
“In certain communities, women are left behind because people operate under the false assumption that to do otherwise would be to break certain aspects of religion,” he said.
“If we want to do the right things and create change, we need to go through the right people.”
At the end of the day, both Razali and Majidah believe education is still possible even without overt political will.
But the best case scenario is for the government to make a stand against female circumcision once and for all.
“The growing access to information is truly reforming how we learn and what we learn – if we want to learn. Even without political will, education and awareness can happen, but it will happen in a much slower pace and will cause unnecessary confusion to many people,” said Majidah.
“And along the way, thousands of girls will continue to get violated in this country until and unless political will ultimately puts a stop to this.”
Watch R.AGE’s original documentary, The Hidden Cut, at fb.com/thestarRAGE.