AHA Foundation: How did you first become interested in the topic of female genital mutilation/cutting (FGM/C)? Was it discussed when you were in medical school? Do you know if medical students in the U.S. are now learning about FGM/C?
Dr. Ottenheimer: I first encountered FGC as a resident at St. Luke’s Roosevelt Hospital in New York City. I had never heard of the practice before that. At the time, in the 1990’s, there was an influx of women from Somalia in Harlem and I saw one or two women with FGC in our clinic. Later, as an attending physician at Bronx Lebanon Hospital, I saw many women from West Africa in our clinic for obstetric care. I took it upon myself to learn as much as I could about FGC in order to better serve my patients.
Currently, there are medical students who are learning about FGC – I know, because I have taught some of them. It is usually taught as part of a human rights curriculum, not as part of the regular gynecology curriculum. Not all medical schools have a human rights curriculum however.
AHA Foundation: What are some of the physical and psychological effects of female genital mutilation/cutting?
Dr. Ottenheimer: These have been well documented, and well described by the World Health Organization (WHO). Among the issues faced by women who have suffered FGC are sexual dysfunction, chronic vaginal or urinary tract infections, difficulty in labor and delivery, depression, anxiety, and PTSD. There are two critical things that are often overlooked when we talk about women affected by FGC.
First, FGC is often just the tip of the iceberg in terms of the trauma and abuse experienced by a particular woman. A social group that tolerates and encourages FGC is one which is often also permissive for domestic violence, forced marriage, child marriage, honor killing, and disenfranchisement of women generally. Some of the symptoms we ascribe to women who have suffered FGC may stem from these other abuses as well. It’s a difficult thing to untangle, and that is one of the things I focus on in my research.
The other thing that is often overlooked is that the symptoms a woman suffers are not necessarily proportional to the degree of cutting or damage she has suffered. The trauma of the events leading to and surrounding the cutting, in addition to the possible associated abuses, can produce a wide range of physical and emotional symptoms that vary from individual to individual.
AHA Foundation: Can you tell us about the pro-bono work you do across the globe? How did you get involved and where do you mostly volunteer?
Dr. Ottenheimer: Currently, most of my volunteer work is based in NYC. I am a forensic evaluator for asylum seeking women at the Weill Cornell Clinic for Human Rights, at the Mount Sinai Human Rights Program, and at the CUNY School of Medicine Human Rights Collaborative. I also lecture frequently on human rights violations against women, with a focus on FGC, and I teach forensic evaluation and medico-legal collaboration to medical professionals. I am active in the New York Coalition Against FGM, and I am co-director of the US Clinician Network on FGM/C. I also conduct research on various aspects of FGM and human rights violations against women.
Outside of the US, I have spent most of my time working in Haiti. From 2010 – 2018 I worked in a remote community in the South West province under the auspices of a small nonprofit called the Hope for Haiti Foundation. My work there has focused on training our local medical staff so that they would be able to function independently in the care of their female patients. In the past I have also spent time in Rwanda, and I went to DRC with Physicians For Human Rights in 2013.
AHA Foundation: When you have a patient who survived genital cutting, knowing that they have been through a traumatic experience and most likely still suffer physical and psychological consequences, how does your approach to their treatment differ than when you treat other patients who have not gone through this trauma?
Dr. Ottenheimer: Actually, I treat FGC patients the same way I treat any other woman who has experienced sexual or gender-based trauma. The main thing is to listen without judgment or preconceived notions and to move slowly (literally and figuratively). I work to make my office a safe space for any woman, and particularly for a woman who has experienced trauma.
When I have a patient from a country where FGC is practiced, I ask in our initial interview if they have had that experience. I generally ask about the physical symptoms they may suffer first, saving the psychological exploration and the evaluation for other traumas for subsequent visits, when a deeper and more trusting relationship has been established. Of course, I always ask FGC affected women if they have daughters, and I educate them about the laws here in the US.
Every patient is unique in her experience of trauma, in the symptoms she may have, and in the degree to which she is willing to share. I meet women where they are; I do not make them reveal anything they are not ready to share. It is also vital, when treating patients, to put aside my “activist” role. I don’t want any patient to feel judged or ashamed about what they have undergone.
AHA Foundation: For women and girls, it must be very difficult to attend regular gynecological checkups because of the intimate nature of a doctor’s visit. Based on your experience, does this make the survivors more likely to delay seeking regular medical checkups? How can survivors overcome this? Do you advertise in your services that you have experience treating survivors of FGM?
Dr. Ottenheimer: It is hard for every woman to go for gynecology care – it is intimate, invasive, and there is inherent power imbalance in the physician/patient relationship. I think the real issue for survivors of FGC in the U.S. is that medical professionals are not familiar with the practice and its consequences. Women often feel judged and shamed by American practitioners’ reactions to and ignorance about FGC.
AHA Foundation: Last year, a judge ruled that the federal statute making FGM/C a crime in the U.S. was unconstitutional because he feels this should be criminalized on a state-by-state level. Three states have since adopted anti-FGM/C legislation, two using AHA Foundation’s model legislation. How do you see the fight against FGM/C changing in the future?
Dr. Ottenheimer: Unfortunately, I think this will be a state-by-state battle. Our federal government is so dysfunctional right now; I don’t see that there will be national legislation passed. That is a huge change and makes activism difficult as every state operates differently; state legislatures are often not in session all year, or even every day of the week. It will be imperative that activists from different groups collaborate to amplify our message – as has begun to happen with the End FGM Network umbrella organization. The recent decision by the Department of Justice not to appeal the Michigan decision is another blow, but it makes it even more clear that this battle will be fought at the state level now.
The opinions stated above are the participants themselves and do not necessarily represent the views of the AHA Foundation.