Dr Pere Barri: “Surgery on women subjected to female genital mutilation should include psychological support”

Female genital mutilation (FGM) is a cruel practice that affects millions of women in Africa, the Middle East and Asia. According to the United Nations, 4.1 million girls are at risk of being cut in 2020 alone.

We spoke with Dr Pere Barri, who initiated the Genital Reconstruction Program of the Dexeus Women Foundation in 2007 to operate women living in Spain who had undergone genital mutilation in their home countries.

How did the Genital Reconstruction Program come about?
It emerged as a result of my stay in France. There was a program like this in the hospital where I practised gynaecological surgery and I was excited to apply it here. The aim was not to take African women, operate them and bring them back. We wanted the program to be free of charge and, besides the surgical aspects, to offer a pre and post psychological evaluation. These are the three virtues of this program.

How many patients have you operated?
Over a hundred. This year we will end up with about 125 or 130. The truth is that we visit more women than we operate since many patients come asking for information and we meet with them several times until they make a decision.

Which is the profile of these women?
A girl who is well integrated into our society, who speaks fluent Catalan, who has studied here and is around 25 and 35 years old. A girl born in Catalonia or who has come here being very young. Mutilation is the only thing they lack in order to assert themselves as Western women.

How do they get to you?
At first, it was the most difficult, but thanks to the media we were able to start the project. Then we realized that we had to work it more, so we contacted general immigrant patient associations and associations specifically focused on FGM. Nowadays, word of mouth is working for us: there are still many that come through associations but it is frequent that one patient leads to the other.

Does the surgery change according to the country of origin?
Interestingly, for cultural and geographical reasons, the type of mutilation practised in each place is different, with varying degrees of extremeness. It is usual that those coming from Girona will probably be from the area of Mali, Senegal and Burkina Faso and will have a type one or two FGM. Those coming from Valencia will probably be from Chad or southern Egypt and will have a more extreme type three FGM.

Which are the results?
We are able to return to a normal appearance in more than an 80% of the cases, while we can restore the function, which is also very important, in about a 70% among operated patients. Even though the process is not always 100% satisfactory, from zero to one or two times out of four attempts is already a major change.

How do you assess the results?
The results are encouraging. Given this profile of a young woman who is at the age of knowing people, one of the reconstruction’s biggest goals is to be able to make them to not give any explanation when someone sees them naked. That’s what the psychological evaluations show.

The benefits go beyond visual or physical appearance.
Reconstruction gives them much more confidence in their sexual life, but also the evaluations show that the benefits extend to any type of social interaction, which is one of the most important aspects.

Psychological help is offered.
Being a woman who has undergone FGM in an African country is quite usual because it is very frequent. Even though it is wrong, they feel “normal” because they all suffered the same thing. The psychological problem, even more than the physical one, occurs when they come here and discover that this practice is not as “normal” as they thought. It is not easy, psychologically speaking, to be “not normal” without taking the decision for yourself.

Why is it so important?
Nowadays we are not only measuring, but doing some psychological intervention. These are patients who are affected psychologically, who suffer from loss of self-esteem, depression, maladjustment in the world where they live now and limited knowledge about their sexuality. Working these issues from a psychological perspective makes the process more positive. The surgical part is important but it has to be accompanied by a psychological process.

Is FGM still practised?
FGM is a cultural and ancestral issue. It is persecuted by law in practically all countries, although it is still done illegally and in dangerous conditions for women. It is not carried out in an open hospital environment but in a kind of black market. There is a business behind it and that is why it is so difficult to make it disappear.

How are the surgeries financed?
Thanks to the Dexeus Women’s Health Foundation, which covers the cost of surgical and psychiatric visits. We have always said that women do not have to pay for this.

Are you the only ones who practice this?
Lately, Catalan public health system considers to cover this surgery, however, I do not know if they also include the psychological area. Ideally, this technique should reach all hospitals and the nearer to the patient communities, the better.