In the global struggle for women's rights, few issues have gone as overlooked and misunderstood as female genital mutilation. Endemic to 29 countries in Africa and the Middle East, the procedure has been performed on at least 130 million girls, and as many as 30 million more under the age of 15 are at risk, according to UNICEF.
The procedure — often euphemized by supporters as "female circumcision" — varies in severity from place to place, but typically involves either infibulation, a deliberate narrowing of the vaginal opening caused by cutting, or partially removing the clitoris.
The procedures have no medical purpose, meaning they're nothing but a threat to women. Dr. Marci Bowers is dedicating herself to reversing that threat.
"I saw these obstructed birth canals, and I thought that would be something that could be corrected," Bowers told Mic.
Bowers first became aware of the issue after treating Somali patients while in residency at the University of Washington. While it's impossible to go back in time, Bowers has become proficient in the next best thing, the rarely performed FGM restorative surgery.
As an ob-gyn, Bowers came to specialize in female-to-male transition surgery, and as a transgender woman herself, made history by being the first such individual to perform the procedure. This specialization and focus has also made her ideally suited to FGM restoration.
"It is not terribly complex," she said. "It is about a one-hour operation."
Resistance. "I think there historically has been a fairly dismissive attitude," Bowers said. The FGM procedure is relatively uncommon, even among experts in the field, and generally overlooked. "Male sexual response is important, but a women's sexual response is largely secondary."
When Bowers first began to explore the possibility of FGM restoration, she faced strong resistance from much of the medical establishment around her.
"I was put down by the more experienced physicians," she said. "'We just deliver the baby, don't worry about that.'"
Undeterred, she did worry about it, and when an opportunity came up to learn the procedure from the organization Clitoraid, Bowers jumped.
Bowers also credited the patronizing attitude to many common misconceptions about FGM, specifically that the entire clitoris was removed, making attempts at repair impossible. Contrary to the World Health Organization's own fact sheet, Bowers was adamant that this was not the case. "There is a large portion of the clitoral body that always remains." she said. "If you remove the entire clitoris, the patient will die. The patient ends up bleeding to death."
Misconceptions. Bowers said there's an unfortunate misconception surrounding the recovery procedure, that it's only about returning sexual pleasure. On the contrary, for many it's a question of restoring an integral part of themselves that had been lost.
"Eighty percent of these women ask for restoration not for sexual purposes, but because they feel their identity has been taken from them," Bowers told Mic. The procedure can happen at almost any age and after any amount of time since FGM. Bowers recalled a woman in her 60s opting for the procedure.
"Eighty percent of these women ask for restoration not for sexual purposes, but because they feel their identity has been taken from them."
While many of the countries where FGM is prevalent, like Eritrea, Mali and Mauritania, are politically and economically dominated by men, the situation on the ground for victims of FGM is considerably more complicated. For one thing, a number of those who perform the procedure are women, according to Bowers.
"This is a deeply ingrained cultural practice," said Bowers. "There is still a lot of resistance, even among women and communities where they would most certainly benefit." Men too, she said, were often opposed, as it made their sexual partners less responsive.
Logistics. Bowers, whose primary practice is located in San Mateo, California, has often confronted the difficult logistics of treating FGM patients. While the problem extends outside the developing world — a report by the nonprofit Population Reference Bureau found there were up to 507,000 women and girls in the U.S. who had undergone FGM or were at risk in 2013 — most of Bowers' clients are in poor countries half a world away.
To better serve vulnerable populations limited by their geography, Bowers teamed up with Clitoraid to launch its so-called "Pleasure Hospital" in Burkina Faso. In March 2014, Bowers traveled to the facility to perform procedures and train local doctors to continue the work after she left. While the hospital was set to open in February, it has been held up by bureaucratic delays.
Bowers estimated she had so far performed around 130 FGM restoration procedures, all of which have been for no charge.
"There's a lot of great mission work around the world," she said, adding that she simply didn't need the money. "All we're doing by making additional money is paying taxes and buying things we really don't need."
The matter of FGM is so extensive that Bowers and all the doctors she trains will only be able to put a small dent in the problem. It is, however, a good start.