"It's like something you have to do to be accepted by your people. I would have my daughter done, because she is always touching herself down below. It would stop her wanting to do that."
"I think they do it so you don't go with other men. We didn't talk about these things. I don't know if it's normal or not...."
"Sometimes we do things for our family's sake. Before you get married, you are circumcised. I know a 19-year-old from my country who hadn't been, but she had to before the wedding because it's the tradition."
"I didn't know that some girls die. Sometimes you hear that someone has died, but not from that... they tell you it was something else."
This is not Africa. These are real comments from women who were born on that continent, but now live in Malaga. Women who have integrated here, who go to our health centres, stop for a chat on the street and take their children to school.
They were noted by the NGO Médicos del Mundo during a training course for African women, covering subjects such as sexuality, gynaecology and reproduction, and also female genital mutilation (FGM), a practice which still continues to different degrees in their countries of origin and which in some cases they bring with them and perpetuate with the new generations.
"It was right here on our doorstep, and we just hadn't seen it," says José Manuel Muñoz Martínez, a doctor at the Regional Hospital in Malaga and member of Médicos del Mundo.
"In Malaga province there are about 500 girls aged between four and 12 who are at risk of ablation; and more than 300 of them live in Malaga city," he says.
He is referring to girls who have come with their families from other countries, not those who were born here and are Spanish, although they may still be affected by genital mutilation.
The alarm was first raised at Médicos del Mundo a few years ago, when the subject came up during a project with migrant women and sex workers on preventing illnesses and improving healthcare.
The NGO has found that in Malaga city there are about 2,500 women whose countries of origin practise FGM (Nigeria, Ivory Coast, Ghana and Senegal, among others), with all the physical and psychological risks that implies, not only for those who have been mutilated before coming here, but for the young girls who grow up with these traditions.
Their call for attention has been heard by the provincial committee against Gender Violence, including Dr Carmen Agüera, who has designed pioneering protocols in Andalucía, such as the detection of chemical submission at hospitals. She has now also participated in another unprecedented protocol from the regional government, designed to detect cases of FGM and take action.
"Female genital mutilation is something absolutely unknown in the health sector, so we need to train professionals to recognise it and, above all, to know how to treat it," she says. "Without the right training, doctors are likely to miss it completely."
Dr Sergio Pérez, another member of Médicos del Mundo, agrees. Since 2017, the NGO has seen about 80 women who were subjected to FGM in their countries of origin, "and others have been notified to us by the health service", he says. Nothing can hide the impact of seeing for the first time how ablation affects women's lives.
"From childhood they have been controlled, first by their father then their husband. They tell you about the aggression they have suffered. Personally, as the father of a young daughter, I find it very hard to hear," he admits.
This is a complex subject and needs to be handled delicately. "It's not something you can talk about on the first visit. But when they have been to see you several times and built up trust, you can approach the subject. The patients don't even know what female genital mutilation is. They have other names for it," says Dr Agüera.
Pediatrician Pedro Navarro, who is also vice-president of the Colegio de Médicos (doctors association) in Malaga, says he has never personally come across a case of ablation, but one mother did come to ask his opinion.
"They were going on a trip to visit relatives and she was afraid they would insist on mutilating her daughter. She said it was customary there, but she didn't like the idea and was scared. I told her that apart from being a form of ill-treatment, it was absolutely barbaric. In the end I convinced her not to allow it," he says.
Another doctor with Médicos del Mundo, pediatrician Mercedes Rivera, says she has seen one case of ablation, an eight-year-old girl who had come to Spain alone. She explains that there are other practices within the same category, carried out at home as something completely normal but still a form of mutilation.
"Some mothers have told me they put coins on their daughter's clitoris, or massage it hard and push it in because they think that will stop it growing," she says.
Monitoring by doctors is essential, but it is only the first step. The aim of the protocol is to widen the networks for detecting cases of FGM.
"Teachers can help us to detect these situations, because they may spot that these girls find it uncomfortable to sit down, or to urinate, or they may seem sad after a trip to their country because of the psychological trauma of their ablation," says Dr Agüera.
It is also important to know in advance if a trip of this type is being planned, whether from a GP, a school or social centre.
"When we know they are planning a trip, the parents have to sign a guarantee that they will not subject their daughter to this practice. It is a legal document and they are warned that if they do not comply then they will be committing a crime, with all the implications that go with it," says Dr Pérez. In these cases, the child is examined before she leaves for the trip and again when she comes back.
Flor de Torres, a prosecutor in cases of violence against women and a member of the working group which drew up the protocol, is adamant: "Mutilation is an attack on physical, social and sexual health, which makes the woman a victim from the moment she is born, but it is also the forerunner to other crimes, such as forced marriage and aggression."
FGM is an "invisible crime" because such practices are considered normal within their communities, she adds.