03/06/2013 07:36 EST | Updated 05/06/2013 05:12 EDT

Female Genital Mutilation Is a Canadian Issue Too

Some of the blunt and dirty tool used to carry out female genital mutilation (FGM) which were surrendered to Afnet, the anti-female genital mutilation network in Dodoma, Tanzania.

The array of blades in the United Nations photo looks like a museum display of historical weapons: dirty and corroded, and none seem sharp. They don't look like surgical instruments -- unfortunately, that's exactly what they are. These dull, rusty knives are used to ritually slice off the genitalia of young girls in Sierra Leone.

The United Nations World Health Organization estimates that 140-million women and girls around the world have experienced female genital mutilation (FGM). In December the UN unanimously passed a resolution banning the practice.

Although FGM is concentrated in 28 countries in Africa, Asia and the Middle East, the Society of Obstetricians and Gynaecologists of Canada (SOGC) says the problem affects women here, too. We spoke with two Canadian experts on FGM -- Dr. Dorothy Shaw and Dr. Victoria Davis -- about FGM, its impact on Canada, and why ending it takes more than outrage and laws.

Girls forced to undergo FGM, sometimes called female genital cutting, have some or all of their external genitalia -- the labia and clitoris -- cut off. In some cases the vaginal opening is also sewn almost closed. FGM is performed on girls anywhere from infancy to puberty, depending on the culture. FGM can result in life-threatening health complications including infections, bleeding, and problems during childbirth.

The communities where FGM is practiced, explains Dr. Shaw, place high value on virginity, so the custom is seen as protection for young girls from premarital sex. Dr. Shaw has worked for decades on the issue of FGM and in 1989 helped produce a documentary film on the issue.

FGM is deeply rooted in some cultures. Dr. Shaw says when she speaks with women who have been cut, many consider their genitalia to be normal and are actually "puzzled" by cultures that do not engage in the practice. They do not see where the harm lies.

We have spent countless hours in communities around the world where FGM is the norm. We've listened to many women who believe that without FGM their daughters won't get a good husband. Others, who have learned about the health risks, have told us they will never let their daughters be cut.

What shocked us in talking to Drs. Shaw and Davis was discovering FGM is a serious issue in Canada, too.

In 2011, almost 29,000 women from Africa and the Middle East became permanent residents of Canada. Dr. Davis, who has worked with hundreds of immigrant women, says a high percentage of these will have undergone FGM.

In places like Kenya, where FGM is part of the culture, we have invariably found open discussion and debate -- mothers talking to mothers, doctors to parents, or women's groups to school classes. That conversation, more than any law, is helping decrease FGM.

Dr. Davis recalls examining a pregnant immigrant who had undergone FGM in Somalia. In order to have the baby, the woman had to be "defibulated" -- her vagina fully reopened. Dr. Davis saw the woman again when she became pregnant a second time. Performing FGM is illegal in Canada, so Dr. Davis was shocked to discover the woman had been reinfibulated -- sewn up again. The woman admitted she had gone back to Somalia to have it done because, to her, it was normal. Women who undergo this form of FGM often get reinfibulated after intercourse and giving birth.

According to Davis some immigrants even take their pubescent daughters back to their original countries to have FGM performed, often against the will of the girls who have become North Americanized and no longer see the practice as normal.

France has made it illegal for immigrant families to take their French-born daughters out of the country for FGM.

In Kenya, where the government has made FGM illegal, we have seen what can happen when FGM is simply banned: many women just head into the woods to have performed done in secret, usually in highly unhealthy conditions.

If we make it illegal for Canadian immigrants to obtain the procedure abroad, will they stop doing it? Or will they simply keep going, but avoid seeking medical attention when they return?

Kenya taught us that, with FGM, laws are necessary but alone they aren't enough. Canada needs to have the open, public -- and above all respectful and culturally sensitive -- conversation that is already happening in the developing world.

The SOGC says female genital mutilation should be included in the medical school curriculum, teaching doctors and nurses not just about the medical aspects of FGM, but about its cultural roots and how to start a respectful conversation with their patients concerning the serious health risks.

It shouldn't stop there. Education and conversation about FGM must happen among community cultural groups and through targeted outreach, especially for young women and mothers who must be empowered with both health information and to know their rights. Issues of culture always are complex, especially when involve rights of children, so these conversations must include parents, doctors, legislators and community leaders, and most importantly they must give voice to young women and girls themselves.

It will take word of mouth, not just word of law, to end female genital mutilation around the world.

Craig and Marc Kielburger are founders of international charity and educational partner, Free The Children. Its youth empowerment event, We Day, is in eight cities across Canada this year, inspiring more than 100,000 attendees. For more information, visit