For generations, silence has surrounded female genital mutilation (FGM) in The Gambia. But for women who underwent the practice as children, the experience can remain present long after the physical wound has closed.
Two Gambian women, Njemmeh Jallow and Aminata Cham, said the cutting they experienced as girls continues to affect their lives, including marriage, childbirth and their understanding of motherhood. Their accounts come as The Gambia continues to debate how to confront FGM, a practice prohibited under national law but still practised in some communities.
The World Health Organisation (WHO) says FGM has no health benefits and can cause severe pain, bleeding, infection and problems urinating. Longer-term complications can include chronic pain, menstrual difficulties, sexual problems, psychological distress and complications during childbirth.
On a sunny afternoon in Busura village, Brikama Central, 23-year-old Jallow recalled an experience from childhood that she said has followed her into adulthood and marriage. Like many girls in communities where FGM is practised, she was taken for the procedure when she was too young to understand what was happening or why.
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"We were taken to a bushy area and given fruits and sweets," she recalled. "At first, we thought it was just a gathering. But then the older women started calling the girls one after the other and taking them into the bush."
From where the children waited, Jallow said they could hear other girls crying. Fear spread among them. When her turn came, she was taken into the bush and circumcised. In the days afterwards, she struggled to urinate. The pain was a reminder of what had happened, although she said she did not understand at the time that the effects could continue into adulthood.
The WHO lists painful urination and urinary retention among the immediate complications associated with FGM. It also says scarring and tissue damage can cause chronic pain and other complications later in life.
For Jallow, childbirth brought another painful reminder. She said giving birth was extremely painful and that, for years, she believed the suffering was simply part of being a wife and mother.
"In many communities, women are taught that suffering is part of womanhood," she said. "So many endure it in silence."
Her understanding began to change after she attended an awareness programme about the health risks and human rights implications of FGM. At first, she was sceptical.
"I thought the information was exaggerated," she said. "I did not believe it."
But when she began comparing what she had heard with her own experience, she said she started to see a connection between the pain she had endured and the cutting she underwent as a child.
"All those who promote FGM do not know what women go through," she said.
Aminata Cham, a native of Bakary-Syambuya in Kombo South district, said her experience began at an even younger age.
"At my youngest age I was cut and at the age of seventeen when I was in my senior secondary education I was given a husband who promised to allow me complete my education but that promise never come to pass," Cham says.
She said childbirth brought further complications. When she became a mother, she struggled to give birth to her children. She said health workers at the delivery centre told her that the difficulties were related to the cutting she had undergone. Cham has four daughters. None has undergone FGM.
"I told my husband that none of our children would be cut," she said. Her husband agreed after she explained the risks associated with the practice. Her decision to protect her daughters began before her grandmother died.
Cham recalled taking her daughters to school herself and returning to collect them immediately after classes because she was uncomfortable leaving them alone with her mother. Her fear was rooted in family history. Her grandmother had followed the tradition, and Cham knew that her daughters could be exposed to the same expectations if they were left in circumstances where others could make decisions about them. Her experience as a survivor changed how she understood motherhood.
She could not change what happened to her, but she could decide what would happen to her daughters. Her refusal to continue the practice also brought pressure. Cham said some people in her community resent her decision because families who want their daughters circumcised now have to travel elsewhere. For generations, she said, the expectation had been passed from one woman to another. Her grandmother had left behind a blade. Her mother was expected to pass it to her. Cham chose not to take it.
Fatou Camara, a reproductive health specialist working with the Ministry of Health's Reproductive, Maternal, Neonatal, Child and Adolescent Health programme, said the health consequences of FGM can begin in childhood and continue throughout a woman's life.
"The health implications if the law is repealed are numerous, from childhood up to old age," Camara said. "The part that is removed is a very sensitive part of the woman's body, and it plays an important role in the reproductive system."
Camara said damage to sensitive nerve endings can contribute to long-term pain and other complications.
"A woman may develop a constant pricking sensation around that area. It can become a health issue because even wearing tight clothing can become painful and irritating," she says.
The WHO similarly reports that trapped or damaged nerve endings and scar tissue can cause chronic pain. It also identifies sexual difficulties, painful intercourse and psychological problems among possible long-term consequences.
Camara said the psychological effects can also begin immediately after the procedure.
"When a girl goes through such a traumatic experience, it can have psychological effects that stay with her," she says.
The WHO says FGM can be a traumatic experience because of the pain, shock, physical force and sense of betrayal that can accompany the practice. It has also reported increased risks of anxiety, depression and post-traumatic stress disorder among women who have undergone FGM.
Camara said severe bleeding is one of the immediate dangers. The genital area contains blood vessels and sensitive nerve endings. If a major blood vessel is cut, she said, the consequences can be fatal.
"If they cut into the big arteries, repairing that at the community level is almost impossible. Some children can bleed to death, develop severe anaemia, or go into shock before they receive medical attention," she says.
The WHO identifies severe bleeding, shock, infection, urinary problems, impaired wound healing and, in some cases, death among the immediate risks of FGM. Infections are another concern.
"The infections can follow the person into adulthood. Because of the female anatomy, infections can move upwards into the reproductive system, and if they are not treated, they can lead to infertility," Camara says.
The WHO said FGM can be associated with chronic reproductive tract infections, urinary tract infections and other long-term health problems.
Camara said some women who undergo forms of FGM that narrow the vaginal opening can later experience severe menstrual problems.
"When menstruation starts, blood needs to come out. But if there is only a small opening, the blood can become trapped inside the body," she says.
She said some girls experience severe menstrual pain and may miss school or require medical treatment.
"In some cases, when they come to health facilities, they may look like they are pregnant because their abdomen is enlarged, but it is actually blood that has accumulated because it cannot flow out," she says.
The WHO says obstruction of the vaginal opening, particularly in type III FGM, can cause painful menstruation and difficulty passing menstrual blood. Childbirth can bring another set of complications.
Camara said scar tissue does not stretch in the same way as normal tissue during delivery.
"The scar cannot stretch properly, so we have to cut medically to allow the baby to come out. After delivery, some women struggle even to sit because of the pain," she says.
The WHO says FGM is associated with increased risks of difficult or prolonged labour, obstetric tears, episiotomy, caesarean section and postpartum haemorrhage. It also links the practice to increased risks for newborns during delivery.
"When a baby's head is under pressure for a long time during difficult delivery, it can affect parts of the brain responsible for development. Sometimes people may think it is a spiritual problem, but it can be linked to complications during childbirth," Camara said.
A 2025 WHO review of more than 75 studies from about 30 countries found that women who had undergone FGM were more than twice as likely to experience prolonged or obstructed labour or haemorrhage. The review also found substantially higher risks of depression and anxiety and a higher likelihood of post-traumatic stress disorder.
The National Human Rights Commission has described FGM as a harmful traditional practice and a violation of rights including dignity, health, development, protection from torture and bodily integrity.
In The Gambia, FGM is prohibited under the Women's (Amendment) Act 2015. Section 32A makes female circumcision an offence, punishable on conviction by up to three years' imprisonment or a fine of 50,000 dalasis, or the person may face both fine and imprisonment. Where the practice causes death, the law provides for life imprisonment. Section 32B also deals with people who request, incite, promote or assist the practice and with failures to report known cases.
The law has, however, faced political challenges. In 2024, a bill was introduced in the National Assembly seeking to delete sections 32A and 32B of the Women's Act and lift the ban. The proposed amendment argued that the existing prohibition conflicted with citizens' cultural and religious rights. The National Assembly ultimately rejected the proposed repeal in July 2024. The African Commission on Human and Peoples' Rights and the African Committee of Experts on the Rights and Welfare of the Child welcomed the decision and urged The Gambia to maintain legal protection against FGM.
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The Gambia's obligations extend beyond its national law. The country is party to the UN Convention on the Rights of the Child. Article 24 recognises children's right to the highest attainable standard of health and requires states to take effective measures to abolish traditional practices harmful to children's health. The Gambia is also bound by African human rights instruments. Article 5 of the Maputo Protocol requires states parties to prohibit and condemn harmful practices and specifically calls for legislation banning all forms of FGM, including its medicalisation. It also calls for health, legal, psychological and other support for survivors.
In 2024, the African Commission and the African Committee on the Rights and Welfare of the Child said lifting The Gambia's FGM ban would undermine the country's obligations under the African Charter, the Maputo Protocol and the African Children's Charter.
The UN Committee on the Elimination of Discrimination against Women has also addressed FGM through its recommendations, calling for measures including public education, support for women's organisations and health policies aimed at eliminating the practice.
The Gambia is not alone in using criminal law against FGM. Kenya's Prohibition of Female Genital Mutilation Act, enacted in 2011, criminalises the practice and provides for life imprisonment where FGM causes death. The law also establishes mechanisms for prevention and support.
In the United Kingdom, FGM has been a specific criminal offence since 1985. The Female Genital Mutilation Act 2003 strengthened the law and increased the maximum penalty to 14 years' imprisonment. Later measures also introduced protection orders and other safeguards for girls at risk.
These laws reflect a wider international approach that treats FGM as both a public-health concern and a violation of the rights of women and children.
For survivors such as Jallow and Cham, however, the law is only one part of the story. The memories began in childhood. The consequences followed them into adulthood, marriage and motherhood. And the scars remain.
