March 12, 2003 -- She was the toast of the Sundance Film Festival earlier this year — a 10-year-old who turned into a de facto ambassador-activist, pitching her voice against an excruciatingly inhumane, but ancient, practice that affects millions of women around the world.
When she was barely 8, Fouzia Hassan was pinned down on her living room floor by two local women in her western Kenyan hometown of Eldoret. They tied her legs, clamped her mouth and sat on her chest to prevent the frail schoolgirl from thrashing around, as a third woman circumcised her with a razor blade.
It was just one in an estimated 6,000 cases of female circumcision — or female genital mutilation, as it's commonly called — that occur every day, primarily in 28 countries in North Africa and the Middle East.
But for little Fouzia, the pain, horror and shock of her circumcision left an indelible mark on her psyche. Days after the incident, as she lay recuperating in bed with her legs tightly bound, she asked for a pencil and paper and composed her troubled thoughts into a short, incisive poem, which she titled "The Day I Will Never Forget."
That's also the title of a documentary on female genital mutilation, or FGM, in Kenya by British filmmaker Kim Longinotto that was screened at the Sundance festival in January and will be aired on HBO later this year.
A 92-minute film documenting the experiences of a number of women and girls — including Fouzia — who have been circumcised, The Day I Will Never Forget has been making the rounds on the international film festival circuit, picking up rave reviews and awards along the way.
But it was at Sundance that the documentary created a storm, aided to a considerable extent by the presence of Fouzia and another central character in the film, Fardhosa Ali Mohamed, a health-care provider who works with the Somali immigrant community in the town of Eldoret.
At a packed screening in Park City, Utah, Fouzia stood dignified and composed in her "party frock" as the audience — many of them with tears still streaming down their cheeks — gave the two Kenyans a standing ovation.
"It was verieee nice," she emphasized during a phone interview with ABCNEWS.com days after she got back to Eldoret from her eventful U.S. trip. "I was very surprised how the people liked the film. I didn't think people would like it, but when it was screened, people were very happy."
Controlling Sexuality, Multiplying Health Complications
"Happy" is probably not a term most of the audience would have employed to describe their state of mind after watching the film.
"Appalled" would probably more accurately describe the reactions to the documentary highlighting what the human rights community calls "one of the most extreme forms of violence against women." It's a custom, they say, that is designed to control women's sexuality and "moderate" female sexual desire.
An ancient practice involving the removal of part or all of the female genitalia, FGM is carried out in a number of ways at a variety of ages across parts of Africa and the Middle East.
The most severe form is called infibulation, which involves the removal of the clitoris as well as the labia minora and majora. The World Health Organization estimates that 15 percent of all mutilations are infibulations. The majority, or 85 percent of mutilations, according to the WHO, involve either the removal of the clitoris (clitoridectomy), or the elimination of all or part of the labia minora.
In some parts of the world, girls as young as 3 undergo the process, often under unsanitary conditions where anything from razor blades, shards of glass, scissors or kitchen knives are used without any anesthesia.
Experts say the health consequences of the practice are numerous, from extremely painful menstrual periods and intercourse, to tearing of scar tissue during childbirth, a higher likelihood of stillbirth deliveries, and death due to bleeding and infections.
Keeping Up With the Law
Although FGM today is universally recognized as a violation of human rights, it was not until the 1980s that it made it into international human rights agendas, overcoming barriers against dealing with "private" issues in rights concerns as well as postcolonial concerns that outside intervention would be perceived as cultural imperialism.
Today, a number of African and Middle Eastern countries have outlawed FGM, although there are often gaping lags between the law on paper and its implementation. (See table)
But that does not surprise LaShawn Jefferson, executive director of the Women's Rights Division of New York-based Human Rights Watch. "Legislation has to send a clear signal," said Jefferson. "Law has to lead the way. It's very rarely that people outpace the law."
The fight against FGM could well have remained a non-issue were it not for the work of several African — including Egyptian — women's activists since the 1950s.
And earlier this year, their efforts received a major boost when UNICEF, the United Nations International Children's Emergency Fund, issued a pledge to eliminate FGM by 2010, calling on governments to abide by their commitments in a renewed "zero-tolerance of FGM" policy.
‘I Don’t Know If God Will Forgive Me’
But while most activists and rights groups maintain that legislation is an important tool in eradicating FGM, they insist that nothing can substitute for education and public awareness — especially among women.
Among the more unsettling facets of FGM is the fact that women — including mothers, aunts, grandmothers, circumcisers and community elders — are often the greatest defenders of the practice. "It's another complication," said Jefferson. "The fact that women — and this is all over the world — sometimes commit violence against women."
In Fouzia's case, her father — an Eldoret businessman — was opposed to having his daughters circumcised. It was only while he was away on a business trip that her mother called in the local circumciser and had Fouzia and her younger sister Fardhosa circumcised.
For Fouzia's mother, Fatuma, a Somali immigrant, circumcision was a matter of following tradition, ensuring her daughters' marriage prospects, and adhering — she wrongly believed — to her religion.
Her views were vociferously denounced by her little daughter, who convincingly — and correctly — argued that the practice has never been sanctioned by Islam and several imams (priests) around the world have publicly denounced the custom.
For her transgression against her religion, little Fouzia cleverly argued, she would not forgive her mother unless she promised not to circumcise her youngest sister, 2-year-old Fartun.
Her mother complied.
Today, Fatuma is a changed woman. "When I heard the poem, I regretted that I did that," she told ABCNEWS.com during a phone interview. "She [Fouzia] has forgiven me now. But on the Day of Judgment, I don't know if God will forgive me."
The ‘Soft’ Approach
For Mohamed, a Somali immigrant who deals with the health complications arising from FGM every day at her clinic, Fatuma's about-face is proof of the long-term effectiveness of what she calls "the soft approach" in the fight against FGM.
"I don't hate them for what they are," she said, referring to circumcisers and parents who have their daughters circumcised. "I just hate their actions. I don't feel it's a good way to bring in the police, to go to court. What will happen to the girls at home? How will they be treated?"
It's not just African and Middle Eastern governments that have to negotiate a policy balance between criminalizing the practice and investing in anti-FGM public awareness campaigns. Today, a growing number of Western countries — destinations for immigrants from countries that practice FGM — also have to confront the issue.
And by all accounts, countries such as the United States, Canada, Australia, New Zealand and several European nations have a tricky set of challenges to overcome.
Although FGM is banned in many large Western countries, experts say Western governments have had virtually no success in prosecuting in any case of female circumcision occurring within their borders, despite occasional reports that a circumcision was about to happen in a community.
The failure, experts say, could be due to a variety of reasons, from unsubstantiated reports and rumors reaching the authorities, to silence among immigrant groups.
"A failure to report cases, if any, would be mostly because these are minority communities and people tend to be protective," said Nahid Touima, president of RAINBO, an international women's rights organization led by African women. "Even people who don't like what's happening do not want to blow the lid on the community."
Another challenge facing Western governments is the modern adjustment of an age-old practice, a phenomenon commonly called "holiday circumcisions," when immigrant parents send their daughters back home to be circumcised during the summer holidays.
Experts say that by all accounts, the track record of destination countries having to confront this phenomenon has been disappointing.
"Many countries pass laws criminalizing FGM — largely because of pressure from rights groups and the media — and once the laws are passed, there's a feeling that the job is done," said Touima. "What is needed is the resources and will to reach minority communities at risk, efforts, for instance, that work within school systems so that teachers and fellow students are trained to identify children at risk of FGM."
Activists and experts say it's impossible to overemphasize the power of public awareness in the fight against FGM.
"I saw it on the TV that it was wrong," said Fouzia. "I saw it on the TV that some girls had died because of circumcision and some got very sick. So, I knew it was wrong, but I could not stop my mother."
But while the plucky 10-year-old was unable to save herself from the ghastly practice — the consequences of which she will have to endure her entire life — she takes comfort in the fact that she saved her baby sister. And strength from the fact that she's determined to save many more little girls like her.
"I want to be a doctor like Fardhosa," she said in an acknowledgement of the health-care worker who encouraged her to speak up against the practice. "I want to help girls who are running away from their homes to avoid circumcision. I want to be a doctor and talk to their parents and save them."