'FGM is practised in 28 African countries, in the southern parts of the Arabian Peninsula and along the Persian Gulf and in India, Indonesia and Malaysia.' Photo: arabianEye
When Susannah* was about seven or eight her family held a party.
Her mother, cousins and aunts came. There were presents and a general air of celebration and festivity.
One by one, Susannah and her cousins lined up to see a local midwife.
No one was sure exactly what was going to happen.
The midwife told Susannah she would make her a "beautiful lady".
One by one Susannah and her cousins were 'circumcised'.
Susannah, from an African country, later moved to Australia with her four children.
She has never enjoyed sex. Childbirth was difficult, as Susannah's vagina had been partially closed. This is often the case for victims of female genital mutilation (FGM) – a practice in which the external genitals are either partially or completely removed.
When Susannah first gave birth, she was attended by a doctor who reopened her vagina.
But not all victims of female genital mutilation have this performed, which means the baby may be unable to pass through the birth canal, possibly resulting in the death of the mother, the baby, or both.
Aside from the risks to a girl at the time, including severe bleeding and trauma, genital mutilation can also cause long-term health problems such as infections, pain and nerve damage.
It occurs in more than 40 countries. It is practised by communities in 28 African countries, in the southern parts of the Arabian Peninsula and along the Persian Gulf and in communities in India, Indonesia and Malaysia.
It is not a religious practice.
It is illegal to perform or assist in arranging the procedure in Australia. It is also illegal to remove a child from the country for the purpose of having it done overseas.
Susannah moved to Australia with her family in 1979.
While working at the district court, she became aware of a program run by NSW Health that focuses on the health of migrant women, including victims of genital mutilation.
It was not until she participated in the program that she realised what had happened to her.
"I didn't hear in my country this was bad," Susannah says.
"When I come here and the lady was explaining what happened to us I was very, very upset. I hate my mother and I really cried."
Susannah was one of the first women to complete the women's health education course.
She became so determined to protect other girls from undergoing the same trauma that she now runs the same workshop she attended for migrant women.
"I fight every family, every woman," she says.
"Sometimes it's not the women, it's the family, it's the husband. The man doesn't know how it affects the woman. Still people are convinced they want it."
The program is based in Sydney at Cumberland Hospital, but educators travel across the state to run the workshops.
Program manager Vivienne Strong says a group of male bilingual workers has just been trained – the first time any health service in the world has employed men to educate their compatriots about genital mutilation.
"Many times the man of the family has the final say about whether a girl is circumcised, so it's really important they understand what's happening," Strong says.
"Most of the men I speak to do not understand. It's a taboo subject for men. It's women's business. Unless a woman has the support of her husband she often can't do anything to prevent the circumcision."
The job of the community educators, Strong says, is to be "the bridge between people who know and understand and the people who have limited understanding of what occurs, and who do not know the legislation in NSW".
Twenty years ago, people who were immigrating or coming as refugees were less likely to know that female genital mutilation is banned in Australia.
Now, people are more likely to know it's illegal here, so there's a push to do it to younger girls before they arrive here, Strong says.
"Sometimes if a woman marries a man from an FGM-practising community and she is not circumcised, the women is forced to be circumcised before the marriage can take place."
The program is so well-regarded internationally that community workers in Egypt, Pakistan and Indonesia have requested copies.
Susannah has now forgiven her mother who, she says, was as much a victim of culture as she was.
She is committed to eradicating the practice and she has worked out a way of reaching women who say they do not want to know about it.
"Some don't want to hear about it, so I say I have a nice program about women's health and in between I tell them about it," she says, laughing.
Today (February 6) is International Day of Zero Tolerance to Female Genital Mutilation.
For more information about female genital mutilation, go here.
* Susannah's name and her country of origin have been changed at her request to protect her identity.