This story was published with the assistance of the Journalism & Women Symposium (JAWS) Health Journalism Fellowship, supported by The Commonwealth Fund.

As soon as she immigrated to Canada in 2011, filmmaker Habibata Ouarme began looking for a doctor who could perform reconstructive surgery to alleviate the consequences of something she endured as a child: genital cutting. 

Now 40, Ouarme was just 6 years old when she experienced female genital mutilation or cutting (FGM/C) as part of what she said is considered a routine tradition in many African and Asian countries. Believed to make girls more suitable for marriage, the procedure instead leaves girls and women with a lifetime of trauma and health problems.

FGM/C is any procedure that involves partial or total removal of the external genitalia, or other injury for non-medical reasons to the genitals of people assigned female at birth. The World Health Organization considers FGM/C a violation of human rights. The immediate consequences of FGM/C are bleeding, severe pain, infection, and even death³. A 1-month-old baby in The Gambia died earlier this year after experiencing excessive bleeding following being cut. The long-term health complications from FGM/C include urinary and vaginal infections, pain, difficult menstruation, scar tissue, increased risk of childbirth complications, and psychological problems such as post-traumatic stress disorder (PTSD), depression, and anxiety. 

Over 230 million women and girls have been subject to FGM/C globally, and over 4 million girls are at risk each year. Ouarme is one of the many survivors who are speaking out against the practice. 

“One of the most traumatic things”

Ouarme can still remember the big house in her home country, the Ivory Coast, where mothers, aunts, and grandmothers brought young girls in their families to be cut. The day she was cut, she was accompanied by her mother, and the cutting was done by a woman from Mali. The woman had a team of four to five people with her, and cutting was her “full-time job,” Ouarme recalled. 

“I didn’t go to school for days,” said Ouarme, noting the pain she endured. FGM/C is usually done without anesthesia or pain medications. 

While Ouarme was cut in her home country, other survivors are often born or live in the West, and as young girls, they are taken back to their family’s home country to be cut in what is often referred to as “vacation cutting.” This was the experience of Somali wellness advocate, Kayowe Mune. 

Without Mune’s parents’ knowledge, at 6 years old, she and her cousins were taken by their grandma to be cut. Mune was in Somalia at the time, visiting family. 

“It wasn’t a decision that my parents wanted, and to this day, it’s one of the most traumatic things to talk about in my family,” Mune said. 

Mune, who is now 41 and living in Toronto, said FGM/C strips girls of their childhood.

“When you’re cut, they don’t want you to learn how to ride a bike because you can open up your stitches,” she said. Once she was older, she signed up for school sports teams, which was her way of rebelling against the culture. “I’m going to learn how to swim, I’m going to learn how to bike, and y’all can’t stop me because I’m Canadian,” she remembered thinking. 

About a decade after its American and European counterparts, in 2023, Canada released data on the number of girls and women in the country at risk of experiencing FGM/C. An estimated 125,000 immigrant girls and women of reproductive age are at risk. This number increases dramatically when including first- and second-generation women and girls of reproductive age whose families come from the 29 countries where FGM/C is documented. When including these populations, the number of girls and women at risk is between 95,000 and 161,000.   

Despite these large numbers, Canada is still behind in providing health care to FGM/C survivors, especially when compared to European countries and the U.S. 

Needed and essential health care

A 2025 report from Islamic Relief Canada found that there is a critical gap in health care practitioners’ knowledge and training regarding FGM/C. The development of culturally sensitive health care protocols and comprehensive systems that include free access to mental health care are some of the main gaps hindering survivor health. These gaps have led to the isolation of many girls and women in Canada. 

The fear of judgment and stigma associated with FGM/C is also so overwhelming that many women refrain from seeking care. Toronto-based anti-oppression activist Rania El Mugammar stressed the importance of training clinicians to be culturally competent in their interactions with survivors. One survivor told El Mugammar that she told her clinician what happened to her, and a look of “horror” appeared on the clinician’s face. The interaction made the survivor so uncomfortable that she never brought up FGM/C again. 

In Toronto, Mune has had a general practitioner since the age of 13, and she has routinely gotten check-ups, including Pap smears. Yet, she told Prism that a health care provider never asked her if she’d been cut, “even though … visually [they] can see that,” she explained. After battling severe pain for years, Mune was diagnosed with endometriosis. Only then did health care professionals acknowledge the genital cutting, but only in reference to her pain.

I would be put on Midol. I’d be put on birth control pills. I would be put on everything. But I wasn’t asked about my trauma.

Kayowe Mune, Somali wellness Advocate

“I would be put on Midol. I’d be put on birth control pills. I would be put on everything. But I wasn’t asked about my trauma,” Mune said.

One 2023 Canadian study from the University of Toronto describes the extra emotional labor that survivors perform when attending a doctor’s appointment. The study highlighted how survivors often had to explain the practice of FGM/C to multiple medical personnel. 

“I have to explain my entire story from beginning to end. … It is very emotionally exhausting, because it’s like you are repeating yourself over and over again,” one survivor¹² told the study’s authors. Having to repeatedly share traumatic details can trigger survivors’ PTSD, the study found, making them reluctant to attend follow-up appointments.

These conditions are worsened by Canada’s medical system, which is full of referrals and the separation of care. OB-GYNs in the 2023 study explained that they do not provide mental health care, so a survivor who experiences re-traumatization during an OB-GYN appointment does not get the care they need at that moment. Instead, they get a referral to a psychologist or social worker, often months later. Many survivors don’t follow through on these appointments. 

Mune noted that in the U.S., health care systems—while full of their own serious imperfections—usually have patient portals that allow patients to view their medical records, message their doctor or other health care professionals, or access telehealth options. Whereas in Canada, Mune said patients have to “physically leave the house, wait in the emergency line, go through all these channels.” 

“It makes life so much easier when you can just text somebody,” she said. 

For more serious health care, survivors also turn away from Canada. When Ouarme was looking into reconstructive surgery for FGM/C, she learned the surgery was neither accessible nor recognized in Canada. This led her to look elsewhere. 

“I needed to go to the U.S. to do my surgery,” Ouarme said. But in order to do so, a letter from a Canadian doctor was required stating that she needed to access care abroad. The doctor she asked refused. 

The doctor told Ouarme that Canada doesn’t recognize reconstructive surgery for FGM/C as needed or essential. Without the letter, she decided to write to the U.S. Consulate in Canada and request a U.S. visa—which she needed as a permanent resident—in order to travel for the surgery. Her plan worked, and Ouarme was able to get reconstructive surgery in California.

Upon returning to Canada, Ouarme experienced an infection. She went to the emergency room, and a doctor told her she would need an IV and antibiotics. When the doctor returned to her room, he was with a group of residents. Ouarme said they saw her with her “legs wide open” and at no point was she asked for her consent. 

“I was kind of like a case for him,” she said.

It is often traumatizing for survivors to interact with health care professionals who do not see them as people, but as FGM/C cases—if they can access the health care they need in the first place.  

Care elsewhere 

“I would say easily 10% of our patients are from Canada,” said Dr. Marci Bowers, an OB-GYN specially trained in reconstructive surgery for FGM/C survivors. Based in California, Bowers has performed reconstructive surgery for almost two decades, charging patients only for anesthesia and hospital costs. She told Prism that she sees survivors from across the U.S., and regularly receives patients from Toronto, Edmonton, and Calgary. 

Beyond the lack of surgeons, the primary problem for survivors in Canada is the lack of coverage for reconstructive surgery. Canadian health care is universal and falls under provincial jurisdiction, meaning that patients do not need to pay for third-party insurance and are covered for the vast majority of surgeries, hospital stays, and primary care under provincial health insurance. Provinces provide coverage for surgery following mastectomy or for gender-affirming surgery, but reconstructive surgery for FGM/C is not covered in Ontario, where many survivors reside. 

Ontario’s provincial health authority did not respond to Prism’s request for comment. In Quebec, where a large number of survivors also reside, the health authority told Prism in an emailed statement that “medical care is covered for citizens if that deemed medically and psychosocially necessary, including consultations, examinations, psychiatric treatment, surgeries. Thus, if genital mutilation is observed in a person living in Quebec, appropriate care and services will be provided.” 

When asked for additional data regarding the type of health care provided to individuals with FGM/C, Quebec’s health authority was unable to provide further information because there is no existing medical code used to bill for reconstructive surgery for genital cutting. 

British Columbia’s health authority said in an emailed statement, “[Provincial] legislation stipulates that only those services considered medically necessary may be insured by [provincial coverage]. Surgery to alleviate significant physical symptoms, or to restore or improve function to any area altered by disease, trauma, or congenital deformity is, normally, a benefit of [provincial coverage].” British Columbia’s health authority was also unable to provide additional information about health care options for survivors due to the lack of a medical code. 

“There’s no code for the surgery,” explained Dr. Elise Dubuc, one of the few OB-GYNs in Canada who performs reconstructive surgery for survivors of FGM/C. In order to have a procedure covered under provincial health, a medical code must be used when the provider bills for the procedure. Since no such code exists for reconstructive surgery, doctors such as Dubuc often use alternative codes. The International Classification of Diseases (ICD) is the universal coding standard used in a majority of countries around the world, and the lack of a medical code for FGM/C prevents further documentation on its occurrence, associated procedures, and complications.  

Along with the lack of coverage for clitoral reconstruction, mental health care is also not covered in Canada, despite its particular necessity for FGM/C survivors. Mental health and psychological support are the first steps to recovery, according to experts. Ouarme stressed the importance of psychological healing before making a decision about reconstructive surgery. She often tells other survivors that surgery is just a small percentage of what they need to do to heal. 

A healing process needs to occur first “between you and your family, between you and yourself, between you and your culture,” Ouarme said. But many survivors who want therapy can’t access it due to the out-of-pocket cost, Ouarme told Prism. 

Dr. Angela Deane, a Toronto-based OB-GYN who is offering reconstructive surgery through a newly opened clinic last year, also stressed the importance of mental, psychosocial, and sexual support—and she advocates that these supports should be covered for survivors who want them. 

One survivor from the 2022 University of Toronto study told researchers that while Canada accepts immigrants from around the world, when issues related to FGM/C come up, the county treats it as if it’s “not a Canadian problem.”²¹ 

Canada criminalized the practice of FGM/C in 1997, following the lead of many countries in the West, including the U.S., the U.K., and France. But advocates and survivors say that criminalization, while necessary, does little to solve the issue at its root. 

“People do not want to send their aunties, their uncle, their dad, or whomever to jail,” said El Mugammar, the Toronto activist. Survivors want justice for themselves and for others, but, El Mugammar told Prism, if speaking up means worse consequences or being cast out of their communities, it “becomes way more difficult for survivors to access care and justice.” As one example, Mune said that speaking out and advocating against FGM/C has created tensions within her own family.

Many survivors already struggle to access the support and health care they need, but the conditions they face are now becoming even more challenging. 

An executive order issued by President Donald Trump in January ostracized both transgender people and survivors of FGM/C by classifying gender-affirming surgery as “genital mutilation.” This order was opposed by leading trans and FGM/C advocacy organizations. In a public letter, advocacy organizations condemned Trump’s conflation of a human rights violation with a consensual medical procedure. And in Canada, recent federal funding changes under Prime Minister Mark Carney will slash funding to the ministry of women and gender equality by 80% over the next three years.

Ouarme told Prism that all survivors want is a safe space where they can receive culturally competent care. As an example of what this could look like, she cited Belgium’s Group for the Abolition of Female Genital Mutilation (GAMS), which works to abolish FGM by collaborating with affected communities to carry out prevention, support, professional training, and advocacy work. The organization offers survivors midwife services, therapy, surgery, lawyers, and more—all under one roof and all government-funded. 

Dubuc is working to create a similar multidisciplinary system in Montreal. Her foundation has received some federal funding, but since health care is under provincial jurisdiction, it’s been “difficult to get funding and to get interest from the Quebec government,” Dubuc said. 

“There’s a lot of work to do in Canada,” Ouarme said, noting that she wishes survivors’ journeys didn’t have to be so difficult, especially in a country that considers itself a champion of human rights and universal health care.

Editorial Team:
Tina Vasquez, Lead Editor
Carolyn Copeland, Top Editor
Rashmee Kumar, Copy Editor