Comfort Momoh must be the most aptly named midwife in Britain. She was born just days after her mother’s own mother died. As her firstborn child, Momoh helped her mother through her grief. “So I was her Comfort,” she explains.
The pioneering midwife has been living up to the name ever since, treating, supporting and, in many cases, mothering survivors of female genital mutilation in her role as head of the country’s busiest FGM clinic.
She set up the specialist clinic 17 years ago. It’s very much a one-woman affair — for “clinic”, think Momoh, a spare examination room and a very busy diary. She sees pregnant FGM women on Fridays at St Thomas’ Hospital, Central London, and the rest here, at nearby Guy’s Hospital, on Thursdays.
The room is marked as a “minor procedures” room, with a single chair, a bed and a radio playing Aretha Franklin songs, and is unremarkable save for the warm, chuckling presence of the woman in the zebra-print blouse. “I’m expecting three or four women today, maybe a couple of walk-ins,” she explains. Momoh used to get worried about the ones who didn’t turn up. “They might not attend two, three, four times, but I know they will come. They are preparing themselves. They will come when they are ready.”
There are now 15 such walk-in clinics throughout the UK, in Birmingham, Bristol, Nottingham and Liverpool — each of them set up by a midwife trained by Momoh. Still, women come from all over England and Wales to see the agony aunt they know as Comfort.
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Many of the girls are recently engaged and anxious about their wedding night — their fused scar tissue is so smooth from the most severe type of FGM that there is simply no opening to have sex. Others are mothers with myriad complications. Some have simply taken years to pluck up the courage to talk to someone about what their families did to them as children.
Many are from the edges of society — isolated women with little English and asylum seekers who are told by others at their mosques, churches and hostels, who whisper behind hands to “go see Comfort”. “Sometimes a girl who comes to support a sister or a cousin will quietly ask me at the end if I can see her too.” Momoh, 51, carries out around two reversals a week. “Deinfibulations”, as they are known, involve surgically opening up a vagina sewn up often with little more than thorns and thread.
The long wait for somebody to be prosecuted for a crime that has been illegal in this country since 1985 finally came to an end last month, after the Crown Prosecution Service announced that a doctor at the Whittington Hospital in North London — the same hospital where Momoh helped to set up an FGM clinic — had been charged for allegedly repairing FGM that had previously been performed on a patient after she gave birth. Another man has been charged with aiding and abetting the procedure.
While campaigners rejoiced, some experts in maternal health were outraged. Professor Peter Brocklehurst, director of the Institute for Women’s Health at University College London, and Dr Katrina Erskine, consultant gynaecologist and head of obstetrics at Homerton hospital in Hackney, warned that FGM victims could be left bleeding after childbirth because medics would be frightened of being prosecuted if they dared to repair the damage.
However, Momoh welcomed the prosecution. “A crime is a crime, regardless of who has performed it,” she said. “If someone has performed FGM, whether they are a doctor or not, they need to be punished, I’m sorry.”
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No one is really sure of the true scale of FGM in the UK, but conservative estimates indicate that there are about 66,000 women and girls who have already been mutilated and more than 20,000 girls under 15 who are at risk. There are three commonly known types of FGM — the first two involve the removal of the clitoris and labia. The third appears the most extreme — the complete “virginity-preserving” closure of the vagina, leaving just a small hole through which to pass urine and menstrual blood.
But Momoh makes the interesting point that it is the lesser-known fourth type — technically categorised as any harmful, non-medical procedures to the female genitalia, such as piercing — that doctors should be worried about, particularly those who carry out lucrative “designer vagina” surgery privately. “We need to have a closer look at doctors and plastic surgeons who are involved in vulvectomy and other cosmetic surgery on the vagina. We need a clearer pathway for them.
“That can be seen as double standards. African women say to me, ‘Why is it OK for Western women to go to Harley Street to have a piercing or trim her labia, but it’s illegal for me to be circumcised?’” Momoh agrees they have a point. “When is it FGM and when is it a designer vagina?” she asks. “Where do you draw the line?”
Throughout the afternoon she attends to her appointments. The first is a girl with Type 2 FGM who is three and a half months pregnant. “She had a miscarriage at four months last time so she is getting anxious,” Momoh says. The second patient brings her six-week-old baby. She also has Type 2 FGM and suffered serious tears after her recent, fourth delivery. “They said I needed to push more, but I don’t know what happened,” she says, apparently unaware of the complications FGM can create.
The third is an asylum seeker from Sierra Leone who claims she is being pressured into taking her two young daughters back home to be cut by her aunt. She needs a medical examination to support her claim.
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Momoh makes sure each has her number and urges them to call her if they have any problems. Patients often phone in the middle of the night after their reversals. “All of a sudden, these girls are passing lots of urine and it’s so shocking for them they get upset.”
Despite working round the clock, Momoh projects a contagious sense of calm. Born in Lagos, she first heard whispers about the secret practice of FGM from friends in other Nigerian tribes, where about 4 in 10 women are affected. It was not until she trained as a midwife in Cambridge, then in London, that she started to specialise in the subject.
She hesitated about applying for this job — her two daughters, Laura and Flora, were still young — so her husband, Robert, a computer analyst, applied for her. Momoh laughs. “He had a good feeling about it,” she says. It gained her an MBE. She began recruiting patients outside Brixton Mosque, inviting women to come for check-ups to “talk about their bodies”.
The first year was slow but word of mouth soon spread. Since 2001, she has seen about 2,500 patients and performed more than 600 FGM reversals. She still goes out, handing out leaflets at African churches and local mosques. This month she will return to Nigeria, on a “scoping” exercise to quantify the scale of the problem. It will be an emotional trip. “It is the first time I will be back since my mother died. I don’t know how I will feel.”
Ever cheerful, she insists that her job brings her up, not down. “I am happy to be supporting these women and seeing the progress.”
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For some women, reversals are impossible. “Last week, I saw a Somalian lady whose scar tissue was completely fused together.” She asked the patient if her legs had been bound up for days after the ceremony. “She said: ‘Yes, how did you know?’”
She still remembers the panic on the labour ward when she was a midwifery student and a woman who could not speak English arrived in established labour, with a baby on the way and no opening through which to push it. “I remember the shock on everyone’s faces. It was fully closed. What do you do?” The consultant had to perform a reversal. Quickly.
Then there was the woman who one of her patients had seen crying in a hostel. She came in with the biggest cyst Momoh had ever seen. “It was like a baby’s head. I had a student with me. She collapsed. I had to resuscitate her.”
People often ask her if she gets angry. “Anger? I don’t think so. Maybe that would cloud you, helping the women.” Only twice did she come close. Once, when two girls aged 9 and 10 were referred by a GP who had discovered the cause of their repeated urine infections. Both had been completely sewn up. Her own daughters were around the same age at the time. “When I saw them, my heart bled.” And again, during a visit to Sierra Leone. “They were preparing all the girls for FGM and I couldn’t do anything to stop it.”
It is clear Momoh is more than a health professional to the women she helps. She scrolls through some of the messages she has received from former patients. One asks her to thank her assistant “for holding my hand” during the operation and for helping her to “face up” to what has happened to her. Another implores Momoh to tell her husband to stop pressurising her into sex while she heals. “Please tell him no. Here is his number,” she says.
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Another begs her advice because her fiancé has just found out about her FGM and has called off the wedding. The message is heart-breaking. “Yes,” Momoh concedes, re-reading the messages, “maybe it does make me feel angry.”
She calls a patient to see how she is recovering after a recent reversal. Content that the girl is doing well, she passes over the phone.
A lilting Welsh voice on the other end of the line describes her gratitude. “I hadn’t really told anybody. It was an awful thing to go through, but she was so kind, so warm, so supportive. I’m so relieved I was brave enough to get [the reversal] done.”
The relieved voice on the end of the line can’t praise Momoh enough. “She is a lifesaver. I wish I could clone her.”