Outside Paris, a clinic aims to tackle an age-old practice

St.-Denis, France - Miriam clearly remembers the day she was cut, bundled by two village women into a bathroom at the age of 7, where a third performed the procedure. “It was very, very painful,” the young Malian woman says softly, as her two tiny children pinch her cheeks, crying for attention.

She still gets bouts of pain, especially during sex. But she is far more concerned for her 5-month-old daughter and lives in fear that the baby will eventually suffer the same fate.

“All my sisters were cut,” Miriam says. “The same with their children. It’s a practice in my village.”

The 27-year-old mother is not in Bamako, Mali, but at a new women’s center outside Paris that is among the few in France to offer holistic treatment for victims of female genital mutilation, or FGM. Among the clientele, Miriam’s story is chillingly mundane.

Up to 60,000 women in France, and an estimated half-million or more across the European Union, have undergone FGM, the cutting or removal of the labia or clitoris that carries painful and sometimes fatal consequences.

The practice is largely carried out by Muslim and some Christian communities, although it predates both religions and is not sanctioned by the Quran.

Worldwide, where the U.N. estimates about 200 million women and girls have been cut, prevalence rates are shrinking in some places. But in the European Union, the migrant influx is actually increasing FGM numbers, and the same is happening in the U.S., experts say — although patchy reporting and resources make it difficult to gauge the problem, much less find comprehensive solutions.

With one of the EU’s highest counts of FGM victims, mostly within its large, West African community, France has arguably adopted the region’s toughest response, including prison terms of up to 20 years for perpetuating the practice. It is also a top European country of refuge for those at risk of FGM, which can be grounds for asylum claims.

“France is definitely one of the leaders in terms of prosecutions and legal recourse,” says Natalie Kontoulis, communications and advocacy officer for End FGM European Network, a Brussels-based umbrella group. “But evidence shows fear is not a good enough motivator to stop a practice that has been around for hundreds or thousands of years.”

Staff at the women’s center know this firsthand. The brainchild of a French-Lebanese doctor who spent years treating abused immigrant women, the center opened its doors last month in one of France’s poorest and most ethnically mixed regions.

“Many of the women who come here are victims of domestic violence,” including sexual abuse, says the center’s midwife coordinator, Mathilde Delespine. Others come for more mundane sexual issues.

The cheerful, chalet-stye building, where walls are dotted with portraits of female activists, offers an array of specialists under a single roof. It is part of an adjacent public hospital, where some 14 percent of annual births are by women who have undergone FGM.

On a recent afternoon, Delespine ushers Miriam (she asked that her real name be withheld for fear of reprisals) and her children into a small examination room. The young Malian immigrant has traveled from Spain, directed to the center by a French NGO. Her husband cannot find work and wants to return to Mali.

“I told him I won’t go,” she tells Delespine. “I don’t want my girl cut.”

Delespine probes gently. Does she love her husband? She suggests how Miriam might still get sexual pleasure, and makes appointments with the center’s gynecologist and psychologist. Finally she examines Miriam’s tiny daughter and writes out a certificate attesting that she has not been cut. The document is designed to make it more difficult to take the baby from French territory to a country where FGM is practiced.

Many of Europe’s FGM victims were cut before immigrating, experts say, or during holidays back in the “home” country. A small number are cut in Europe, activist Kontoulis says, although evidence is often anecdotal.

“The cutters often come for a short period of time, they cut a load of girls and then they go back to their homelands,” she says. “So they’re hard to find, and the community closes ranks and won’t disclose them.”

FGM is illegal across the EU, where the European Parliament estimates 180,000 women and girls are at risk each year. Yet few countries strictly enforce national laws or establish measures to turn back the tide, activists say.

“Many member states do have the political will, but they’re not putting their resources where their mouth is,” Kontoulis adds.

In some cases, that is changing. Judges in Britain, which has among the highest cutting rates, are beginning to issue FGM protection orders. In Belgium, grass-roots organizations are creating tools to help health care and other professionals detect risks and take preventative action.

France has jailed more than 100 people under a general penal code that sets sentences of up to 10 years for cutting — and up to 20 if the victim is a minor. Both cutters and parents can be sanctioned, even if the cutting takes place overseas.

But cracking down is only part of the answer, activists say. “If we want to eradicate the practice in France, we need to convince the communities to abandon it,” says Marguerite Bannwarth of French NGO Equipop, which fights FGM in France and West Africa.

Equipop trains community activists in France’s immigrant community and works with local NGOs to change mindsets in Mali’s western Kayes region, in which many of these immigrants were born or have ties. In some cases, experts say, home communities have abandoned cutting, while the diaspora continues the practice.

Many French health care and social workers are not trained to detect FGM, activists say, much less track its victims.

“Some women just disappear after visiting a health center,” Bannwarth says. “When they reappear, they are married with babies.”

Back at the women’s center in St.-Denis, Delespine jots down numbers of local NGOs that can help Miriam find a place to stay and eat, at least for now. Her long-term fate, and that of her daughter, is uncertain.

“We see this often,” Delespine says later in her office, referring to the destitute women who knock at the center’s door. “Most have been here just a short time and want to protect their children.

“Of course, education is a better option, but the judicial response can be one answer,” Delespine adds. “It’s important to use the law to say this kind of violence is unacceptable.”