Female genital cutting
Table of Contents
- 1.1 Key points
Female genital cutting (FGC), also known as female genital mutilation (FGM) or female circumcision, refers to “all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other non-therapeutic reasons.”World Health Organization. (2010, February). WHO Female Genital Mutilation. Retrieved August 4, 2010, from World Health Organization: http://www.who.int/mediacentre/factsheets/fs241/en/ It is not the same as the procedures used in gender reassignment surgery or the genital modification of intersexuals. FGC is practiced throughout the world, but the practice is concentrated more heavily in AFRICA, Indonesi, and the Middle. The World Health Organization (WHO) separates FGC procedures into four categories: Type I, II, III, and IV. International efforts seek the abandonment of all forms of female genital mutilation, due to an international agreement that the practice violates fundamental human rights and is a risk to health and wellbeing in both short and long-term. However, the practice remains in many societies, as the process of abandonment takes time and needs agreement from a large portion of the community.
The United NationsFPA (UNFPA) recognizes February 6 as the International Day Against Female Genital Mutilation. Charlotte Feldman-Jacobs. “Commemorating International Day of Zero Tolerance to Female Genital Mutilation”. http://www.prb.org/Articles/2009/fgmc.aspx.
Wikigender’s infographic on FGM
FGM includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. The practice has serious and enduring implications for the health and well-being of young women and is rooted in deeply entrenched socio-cultural norms.
FGM is practiced in Africa, Asia, Latin America and the Middle East. This infographic focuses on Africa as this is where there has been the most systematic collection of data on FGM. The infographic was done using data from the 2009 Social Institutions and Gender Index 2012 (SIGI).
- The highest prevalence of FGM in Africa can be found in West and East Africa. Survey data closest to 2012 indicates that Mali , Sierra Leone , Guinea , Sudan , Egypt , Eritrea and Somalia have between 72 and 98 percent of women aged 16-49 who have undergone FGM. Somalia has the highest prevalence at 98 percent and Uganda the lowest (in Africa) at 1 percent.
- There is a downward trend in FGM prevalence in some countries. Available survey data closest to 2012 indicates that 14 countries have reduced the number of women who have undergone FGM. (see the green arrows below).
- Countries are starting to introduce laws to prohibit FGM with Eritrea introducing a law in 2007, Kenya introducing a law in 2001 and Uganda passing a law in 2009. Some countries have introduced campaigns and laws to eradicate female genital mutilation.
- One successful village-level campaign in Senegal run by the Tostan organisation has encouraged whole villages to commit to abandoning the practice (as of 2005, almost 1 700 out of 5 000 communities had formally abandoned the practice).
History of terminology
Different terms are used to describe female genital surgery. The procedures were commonly referred to as female circumcision, but the terms female genital mutilation (FGM) and female genital cutting (FGC) are now dominant throughout the international community. Opponents of the practice often use the term female genital mutilation, whereas groups that oppose the stigma of the word “mutilation” prefer to use the term female genital cutting. A few organizations have started using the combined term female genital mutilation/cutting (FGM/C).
Several dictionaries, including medical dictionaries, define the word circumcision as applicable to procedures performed on females. Morison et al. state that female circumcision is a commonly used term for the procedures.Morison, Linda (2001), The long-term reproductive health consequences of female genital cutting in rural Gambia: a community-based survey, Tropical Medicine and International Health, 6(8),643-653. Cook states that historically, the term female circumcision was used, but that “this procedure in whatever form it is practiced is not at all analogous to male circumcision.”Cook, Rebecca J.; Bernard M. Dickens, Mahmoud F. Fathalla (2003). Reproductive Health and Human Rights: Integrating Medicine, Ethics, and law. Oxford University Press. p. 262. ISBN 0199241333. Shell-Duncan states that the term female circumcision is a euphemism for a variety of procedures for altering the female genitalia.Shell-Duncan, Bettina (April 2001). “The medicalization of female “circumcision”:harm reduction or promotion of a dangerous practice?”. Social Science &amp;amp;amp;amp;amp; Medicine 52 (7): 1013–1028. doi:10.1016/S0277-9536(00)00208-2. Toubia argues that the term female circumcision “implies a fallacious analogy to non-mutilating male circumcision”.Toubia, N (1995). “Female Genital Mutilation”. in Peters, J; Wolper, A. Women’s Rights, Human Rights: International Feminist Perspectives. New York: Routledge. p. 226. ISBN 0415909953.
Female genital mutilation
The term female genital mutilation gained growing support in the late 1970s. The word “mutilation” not only established clear linguistic distinction from male circumcision, but it also emphasized the gravity of the act. In 1990, this term was adopted at the third conference of the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children (IAC) in Addis Ababa. In 1991, the World Category:Health Organization (WHO), a specialized agency of the United Nations (UN), recommended that the UN adopt this terminology; subsequently, it has been widely used in UN documents.World Health Organization. (1996). Female genital mutilation: Report of a WHO Technical Working Group (unpublished document WHO/FRH/WHD/96.10). Geneva: World Health Organization. Retrieved 2007-02-21.
In this context, the term female circumcision was thus predominantly replaced by the term female genital mutilation: The extensive literature on the subject, the support of international organizations, and the emergence of local groups working against the continued practices appear to suggest that an international consensus has been reached. The terminology used to refer to these surgeries has changed, and the clearly disapproving and powerfully evocative expression of “female genital mutilation” has now all but replaced the possibly inaccurate, but relatively less value laden-term of “female circumcision”. Obermeyer, Carla Makhlouf (March 1999). “Female Genital Surgeries: The Known, the Unknown, and the Unknowable”. Medical Anthropology Quarterly 13 (1): 79–106. doi:10.1525/maq.19220.127.116.11. PMID 10322603. http://links.jstor.org/sici?sici=0745-5194%28199903%292%3A13%3A1%3C79%3AFGSTKT%3E2.0.CO%3B2-3. Retrieved 2007-11-19.
Female genital cutting
Because the term female genital mutilation has been criticized for increasing the stigma associated with female genital surgery, some groups have proposed an alteration, substituting the word “cutting” for “mutilation.” According to a joint World Category:Health Organization/United Nations Children's Fund/United Nations Population Fund statement, the use of the word “mutilation” reinforces the idea that this practice is a violation of the human rights of girls and women, and thereby helps promote national and international advocacy towards its abandonment. They state that, at the community level, however, the term can be problematic; and that local languages generally use the less judgmental “cutting” to describe the practice. They also feel that parents understandably resent the suggestion that they are “mutilating” their daughters. In this spirit, in 1999, the UN Special Rapporteur on Traditional Practices called for tact and patience regarding activities in this area and drew attention to the risk of “demonizing” certain cultures, religions, and communities. As a result, they claim, the term “cutting” has increasingly come to be used to avoid alienating communities. Alexia Lewnes (Ed) (2005). “Changing a Harmful Social Convention: Female Genital Mutilation/Cutting” (pdf). Innocenti Digest. UNICEF. pp. 1–2. ISBN 88-89129-24-7 1028-3528. http://www.unicef-irc.org/publications/pdf/fgm_eng.pdf. Retrieved 2006-09-09.
In 1996, the Uganda-based initiative REACH (Reproductive, Educative, And Community Health) began using the term female genital cutting, observing that female genital mutilation may “imply excessive judgment by outsiders as well as insensitivity toward individuals who have undergone some form of genital excision.”United Nations. (1996, March). 96-03: Dispatches — News from UNFPA, No. 6, March 1996. Retrieved August 4, 2010, from UN: http://www.un.org/popin/unfpa/dispatches/mar96.html While some international organizations, such as the UN and the WHO, continue to use the earlier term of female genital mutilation, a number of agencies, like UNICEF, now use the term female genital mutilation/cutting (FGM/C).
World Health Organization categorization
There are several distinct practices of FGC that range in severity, depending on how much genital tissue is cut away. Four major types have been categorized by the WHOEliminating Female Genital Mutilation – An interagency statement OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO. Department of Reproductive Health and Research (RHR), World Health Organization. 2008. (see Diagram 1), although there is some debate as to whether all common forms of FGC fit into these four categories, as well as issues with the reliability of reported data.S Elmusharaf; N Elhadi, L Almroth (2006-07-15). “Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study”. BMJ 333 (7559): 124. doi:10.1136/bmj.38873.649074.55. PMID 16803943.
The WHO defines Type I FGM as the partial or total removal of the clitoris (clitoridectomy) and/or the prepuce (clitoral hood); see Diagram 1B. When it is important to distinguish between the variations of Type I mutilation, the following subdivisions are proposed: Type Ia, removal of the clitoral hood or prepuce only; Type Ib, removal of the clitoris with the prepuce. In the context of women who seek out labiaplasty, there is disagreement among doctors as to whether to remove the clitoral hood in some cases to enhance sexuality or whether this is too likely to lead to scarring and other problems.Cormier, Zoe (fall 2005). “Making the Cut”. Shameless. http://shamelessmag.com/issues/2005/fall/making-cut/. Retrieved 2008-03-03.
The WHO’s definition of Type II FGM is “partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora. When it is important to distinguish between the major variations that have been documented, the following subdivisions are proposed: Type IIa, removal of the labia minora only; Type IIb, partial or total removal of the clitoris and the labia minora; Type IIc, partial or total removal of the clitoris, the labia minora and the labia majora. This type of FGC is also called khafd, meaning reduction in Arabic.
Type III: Infibulation with excision
The WHO defines Type III FGC as “excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening” (infibulation). It is the most extreme form of FGC, and accounts for about 10% of all FGC procedures.“Female genital mutilation”. World Health Organization. June 2000. http://www.who.int/mediacentre/factsheets/fs241/en/index.html. Retrieved 2008-01-23. Infibulation is also known as “pharaonic circumcision.”
In a study of infibulation in the Horn of Africa, Pieters observed that the procedure involves extensive tissue removal of the external genitalia, including all of the labia minora and the inside of the labia majora. The labia majora are then held together using thorns or stitching. In some cases the girl’s legs have been tied together for two to six weeks, to prevent her from moving and to allow the healing of the two sides of the vulva. Nothing remains but the walls of flesh from the pubis down to the anus, with the exception of an opening at the inferior portion of the vulva to allow urine and Menstruation/menstrual blood to pass through, (see Diagram 1D). Generally, a practitioner deemed to have the necessary skill carries out this procedure, and a local Anesthesia|anestheticis used. However, when carried out “in the bush,” infibulation is often performed by an elderly matron or midwife of the village, with no anesthesia used.
A reverse infibulation can be performed to allow for sexual intercourse or when undergoing labor, or by female relatives, whose responsibility it is to inspect the wound every few weeks and open it some more if necessary. During childbirth, the enlargement is too small to allow vaginal delivery, and so the infibulation must be opened completely and restored after delivery. Again, the legs are sometimes tied together to allow the wound to heal. When childbirth takes place in a hospital, the surgeons may preserve the infibulation by enlarging the vagina with deep episiotomies. Afterwards, the patient may insist that her vulva be closed again.Pieters, Guy, M.D.; Albert B. Lowenfels, M.D., F.A.C.S. (April 1977). “Infibulation in the Horn of Africa”. New York State Journal of Medicine 77 (6): 729–731. http://www.cirp.org/pages/female/pieters1.
This practice increases the occurrence of medical complications due to a lack of modern medicine and surgical practices.
A five-year study of 300 women and 100 men in Sudan found that “sexual desire, pleasure, and orgasm are experienced by the majority of women who have been subjected to this extreme sexual mutilation, in spite of their being culturally bound to hide these experiences.” Lightfoot-Klein, Hanny, M.A. (August 1989). “The Sexual Experience and Marital Adjustment of Genitally Circumcised and Infibulated Females in The Sudan”. The Journal of Sex Research (The Society for the Scientific Study of Sexuality) 26 (3): 375–392. doi:10.1080/00224498909551521. http://www.fgmnetwork.org/authors/Lightfoot-klein/sexualexperience.htm.
Most advocates of the practice continue to perform the procedure in adherence to standards of beauty that are very different from those in the west. Many infibulated women will contend that the pleasure their partners receive due to this procedure is a definitive part of a successful marriage and enjoyable sex life.
Type IV: Other types
There are other forms that are collectively referred to as Type IV and may not involve any tissue removal at all. This includes a diverse range of practices, including pricking the clitoris with needles, burning or scarring the genitals as well as ripping or tearing of the vagina or introducing herbs into the vagina to cause bleeding and a narrowed vaginal opening.
PrevalenceWorld Category:Health Organization estimates that over between 100 and 140 million women worldwide have been affected by some form of FGC, with the potential of 3 million procedures being performed every year.
Female genital cutting is mainly practiced in 28 African, some Middle Eastern and a few Asian countries. In Africa, it is practiced in a band that stretches from Senegal in West Africa to Somalia on the East coast, as well as from Egypt in the north to Tanzania in the south. It is also practiced by some groups in the Arabian peninsula. The country where FGC is most prevalent is Somalia, followed by Sierra Leone, Djibouti, Egypt, Eritrea and Mali, all with more than 90% of the women between 15 and 49 having undergone FGM. Egypt recently passed a law banning FGC.“Egypt forbids female circumcision”. BBC News. 2007-06-28. http://news.bbc.co.uk/1/hi/world/middle_east/6251426.stm. Retrieved 2010-05-02.
Whilst FGC in some communities is marked by large public feasts, in some communities it is performed within the family and more secretive. About 90% of all cases of FGM is of Type I and II, among some muslim communities referred to as Sunna circumcision. The remaining 10% is type III. This type is commonly performed in Somalia, Djibouti and Sudan, and in parts of Eritrea. Some west-African countries have reported around 10-15% infibulation, mostly in the form of closure by labia minora, rather than labia majora that is more common in the eastern African countries.
The practice occurs particularly in northern Saudi Arabia, southern Jordan, and Iraq.“Female genital mutilation in Iraqi Kurdistan. Presented at the 1ère Journée Humanitaire sur la Santé des Femmes dans le Monde, Paris, France”. Gynécologie sans Frontières. 27.03.2006. http://www.stopfgmkurdistan.org/html/english/updates/update003e.htm. In the Iraqi village of Hasira, a recent study found that 60 percent of the women and girls reported having had the procedure. Prior to the study, there had been no solid proof of the procedure’s prevalence. There is also circumstantial evidence to suggest that FGC is practiced in Syria, western Iran, and southern Turkey.Birch, Nicholas (August 10, 2005). “Female circumcision surfaces in Iraq”. The Christian Science Monitor. http://www.csmonitor.com/2005/0810/p06s01-woiq.html?s=t5. Retrieved 2006-10-02.
The practice can also be found among a few ethnic groups in South America and very rarely in India.International Campaign for the Abandonment of FGM/C. (2010). A Testimony on Female Genital Mutilation in India. Retrieved August 4, 2010, from STOP FGM/C!: http://www.stopfgmc.org/client/sheet.aspx?root=168&amp;amp;amp;amp;amp;amp;amp;sheet=1951&amp;amp;amp;amp;amp;amp;amp;lang=en-US. In Indonesia, the practice is fairly common among the country’s Muslim women; however, in contrast to Africa, almost all are Type I or Type IV, the latter usually involving the symbolic pricking of blood release.US Department of State (June 1, 2001). “Indonesia: Report on Female Genital Mutilation (FGM) or Female Genital Cutting (FGC)”. Press release. http://www.state.gov/g/wi/rls/rep/crfgm/10102.htm. Retrieved 2006-10-02.
Due to immigration, the practice has also spread to Europe, Australia and the United States. Some tradition-minded families have their daughters undergo FGC whilst on vacation in their home countries. As Western governments become more aware of FGC, legislation has come into effect in many countries to make the practice of FGC a criminal offense. In 2006, Khalid Adem became the first man in the United States to be prosecuted for mutilating his daughter.
Cultural and religious aspects
The traditional cultural practice of FGC predates both Islam and Christianity. A Greek papyrus from 163 B.C. mentions girls in Ancient Egypt undergoing circumcision and it is widely accepted to have originated in Egypt and the Nile valley at the time of the Pharaohs. Evidence from mummies have shown both Type I and Type III FGC present.Skaine, R (2005). Female genital mutilation: Legal, cultural and medical issues. Jefferson, North Carolina, USA: McFarland. ISBN 0-7864-2167-3.
Although FGC is practiced within particular religious sub-cultures, FGC transcends religion as it is primarily a cultural practice. It is now generally recognized that even though a number of the countries where female genital surgeries are found are predominantly Muslim, the practice is not prescribed by Islam and are, in fact, found among non-Muslim groups such as Coptic Christians of Egypt, several Christian groups in Kenya, and the Falasha Jews of Ethiopia. In CDI, the prevelance is 80 percent among Muslims, 40 percent among those with no religion and 15 percent among Protestants, and in Sudan the prevalence is highest among Muslim women. In Kenya, by contrast, prevalence is highest among Catholics and Protestants compared with other religious groups. Thus, there is no unequivocal link between religion and prevalence. United NationsICEF stated that when “looking at religion independently, it is not possible to establish a general association with FGM/C status.” The arguments used to justify FGC vary; they range from health-related to social benefits:
- maintenance of cleanliness
- maintenance of good health
- preservation of virginity
- enhancement of fertility
- prevention of promiscuity
- increase of matrimonial opportunities
- pursuance of aesthetics
- improvement of male sexual performance and pleasure
- promotion of social and political cohesion
Medical justifications offered by cultural tradition are regarded by scientists and doctors as unsubstantiated. Some African societies consider FGC part of maintaining cleanliness as it removes secreting parts of the genitalia. Vaginal secretions, in reality, play a critical part in maintaining female health. The Mossi of Burkina Faso and the Ibos of Nigeria believe that babies die if they touch the clitoris during birth. In some areas of Africa, there exists the belief that a newborn child has elements of both sexes. In the male body the foreskin of the penis is considered to be the female element. In the female body the clitoris is considered to be the male element. Hence when the adolescent is reaching puberty, these elements are removed to make the indication of sex clearer.
In years past, doctors advocating or performing these procedures sometimes claimed that girls of all ages would otherwise engage in excessive masturbation and be “polluted” by the activity, which was referred to as “self-abuse”.Paige, Karen Ericksen (May 1978). “The Ritual of Circumcision”. Human Nature: 40–48. http://www.noharmm.org/paige.htm.
Social justifications similarly lack scientific evidence. FGC advocates have claimed the practice cures females of a myriad of psychological diseases including clinical depression, hysteria, insanity and kleptomania. FGC is often used as a means of control over female virtue. FGC is often used as a means of preservation and proof of virginity, and is regarded in many societies as a prerequisite for honorable marriage. Type III FGC is often used in these societies, and the husband will sometimes cut his bride’s scar tissue open after marriage to allow for sexual intercourse. Heavy stigma lies on men who marry an uncircumcised woman. Women who have had genital surgeries are often considered to have higher status than those who have not and are entitled to positions of religious, political and cultural power.Post, S., (2004). Encyclopedia of Bioethics. New York: Macmillan Reference USA. Removal of the clitoris is often cited as a means of discouraging promiscuity, as it eliminates the motivating factor of sexual pleasure. Feminists and human rights activists disapprove of this practice because it presupposes that women lack the self control or the right to decide when and with whom they engage in sexual activity.
Aesthetic reasons are also cited. Some societies believe that FGC enhances beauty. This stems from their belief that male foreskin is removed for aesthetic reasons, and that the clitoris thus should be removed for the same reason since it is the counterpart to the penis. In a few communities FGC is believed to prolong sexual pleasure for men, because it is believed that the removal of the clitoris will delay women’s sexual satisfaction, and thereby increase the length of the act . In some communities where infibulation is prevalent, women express belief that FGM increase sexual pleasure in men due to a tighter introitus. However, the men from the same communities refute this, and claim that infibulation causes them physical and emotional pain.
There are no scientific or medical studies that support any of these viewpoints. While there is a correlation between FGC prevalence and religions like Islam and Christianity, prevalence rates vary by culture. These variances preclude an unequivocal link between religion and FGC. However there is debate as to whether or not FGC constitutes a religious practice in particular religious sub-cultures. Obermeyer, Carla Makhlouf (March 1999). Female Genital Surgeries: The Known, the Unknown, and the Unknowable. 13. pp. 79–106. http://links.jstor.org/sici?sici=0745-5194%28199903%292%3A13%3A1%3C79%3AFGSTKT%3E2.0.CO%3B2-3. Retrieved 2007-12-01.
Among practicing cultures, FGC is most commonly performed between the ages of four and eight, but can take place at any age from infancy to adulthood. Prohibition alone does not stop the practice, and some negative consequences has been documented, such as the practice going underground, or moving to other countries. However, when law is combined with community based empowerment programme, the law has proven to increase the abandonement of FGM.
FGM is associated with a series of short and long-term risks for girls and womens physical, psychological and sexual health and well-being. excessive bleeding, pain and infections are among the immediate risks.
Long term health effects include; urinary and reproductive tract infections, caused by obstructed flow of urine and menstrual blood, various forms of scarring and infertility. For women with type II FGM, sexual initiation is usually associated with severe pain for several weeks and even months, because their infibulation has to be opened to facilitate intercourse. This second cut, sometimes performed by the husband with a knife, or the circumciser, cause further suffering and complications.
A June 2006 study by the World Category:Health Organization has cast doubt on the safety of genital cutting of any kind. This study was conducted on a cohort of 28,393 women attending delivery wards at 28 obstetric centers in areas of Burkina Faso, Ghana, Nigeria, Kenya, Senegal and The Sudan. A high proportion of these mothers had undergone FGC. According to the WHO criteria, all types of FGC were found to pose an increased risk of death to the baby (15% for Type I, 32% for Type II, and 55% for Type III). Mothers with FGC Type III were also found to be 30% more at risk for cesarean sections and had a 70% increase in postpartum hemorrhage compared to women without FGC. Estimating from these results, and doing a rough population estimate of mothers in Africa with FGC, an additional 10 to 20 per thousand babies in Africa die during delivery as a result of the mothers having undergone genital cutting.
In cases of repairing the damage resulting from FGC, called de-infibulation when reversing Type III FGC, this is usually carried out by a gynecologist or a midwife during childbirth.
The effect of FGC on a woman’s sexual experience varies depending on many factors. FGC does not eliminate sexual pleasure for all women who undergo the procedure. Although sexual excitement and arousal for a woman during intercourse involves a complex series of nerve endings being activated and stimulated in and around her vagina, vulva (labia minora and majora) and clitoris, psychological response and mind-set are also important.Komisaruk, B. et al.: The Science of Orgasm. JHU Press, 2006. For an interview with two of the researchers, see “Exploring the Mind-Body Orgasm”, http://www.wired.com/medtech/health/news/2007/01/72325Mah K, Binik YM: “Are orgasms in the mind of the body? Psychosocial versus physiological correlates of orgasmic pleasure and satisfaction”. Journal of Sex and Marital Therapy 31:187–200, 2005.
In the early 1980s, Hanny Lightfoot-Klein traveled throughout Sudan (where Type III is the prevalent form of FGC, ~90%) asking women who had undergone FGC how often they had experienced orgasm during intercourse. Many of the women had no idea what an orgasm was. Others interviewed (especially if the surgery excised less tissue) not only insisted that they did achieve orgasm, ranging from 90% of the time when they were young to 10% of the time once they had children, but were open to talking about their experiences. The women were able to describe in great detail exactly what an orgasm meant to them. Lightfoot-Klein, Hanny (1989). “The Sexual Experience and Marital Adjustment of Genitally Circumcised and Infibulated Females in The Sudan”. The Journal of Sex Research 26 (3): 375–392. http://www.fgmnetwork.org/authors/Lightfoot-klein/sexualexperience.htm. See also Prisoners of Ritual: An Odyssey into Female Genital Circumcision in Africa, by Hanny Lightfoot-Klein; Harrington Park Press, 1989, ISBN 0-918393-68-X
A study in 2007 found that in some infibulated women, some erectile tissue fundamental to producing pleasure had not been completely excised. Defibulation of subjects revealed that a part of or the whole of the clitoris was underneath the scar of infibulation. The study found that sexual pleasure and orgasm are still possible after infibulation, and that they rely heavily on cultural influences — when mutilation is lived as a positive experience, orgasm is more likely. When FGC is experienced as traumatic, its frequency drops. The study suggested that FGC women who did not suffer from long-term health consequences and are in a good and fulfilling relationship may enjoy sex, and women who suffered from sexual dysfunction as a result of FGC have a right to sex therapy. Catania, Lucrezia; Omar Abdulcadir, Vincenzo Puppo, Jole Baldaro Verde, Jasmine Abdulcadir, Dalmar Abdulcadir (November 2007). “Pleasure and Orgasm in Women with Female Genital Mutilation/Cutting (FGM/C)”. The Journal of Sexual Medicine 4 (6): 1666–1678. doi:10.1111/j.1743-6109.2007.00620.x. PMID 17970975.
A study by Anthropologist Rogaia M. Abusharaf, found that “circumcision is seen as ‘the machinery which liberates the female body from its masculine properties'”.Abusharaf, Rogaia M. (2001). “Virtuous Cuts: Female Genital Circumcision in an African Ontology”. Differences: A Journal of Feminist Cultural Studies 12: 112–140. doi:10.1215/10407391-12-1-112.
Attempts to end the practice of FGC
Despite laws forbidding the practice, FGC remains an enduring tradition in many societies and cultural groups. Political leaders have found FGC difficult to eliminate on the local level because of its cultural and sometimes political importance.Birch/Abril, Nicholas (2008-01-04). “An End to Female Genital Cutting?”. Time Magazine. http://www.time.com/time/world/article/0,8599,1700191,00.html. Retrieved 2008-01-08. For instance, prohibition by the British of the procedure among tribes in Kenya significantly strengthened the tribes’ resistance to British colonial rule in the 1950s and increased support for the Mau Mau guerrilla movement.Birch/Abril, Nicholas. “An End to Female Genital Cutting?”, Time magazine, 2008-01-04. Retrieved on 2008-01-08.
Because the practice holds much cultural and marital significance, FGC opponents recognize that in order to end the practice it is necessary to work closely with local communities.
Despite the close tie between FGC and cultural and, sometimes, religious tradition, there are cases where attempts at ending FGC have been successful.TOSTAN (May 18, 2005). “Ending Female Genital Cutting In Dialacoto – A Celebration Of Life And Culture”. Press release. http://www.tostan.org/news-sept_21_03.htm. Retrieved 2006-10-02. One example is in Senegal, where initiative was taken by native women working at the local level in connection with the Tostan Project. Since 1997, 1,271 villages (600,000 people), some 12% of the practicing population in Senegal, have voluntarily given up FGC and are also working to end early and Forced marriage . This has come about through the voluntary efforts of locals carrying the message out to other villages within their marriage networks in a self-replicating process. By 2003, 563 villages had participated in public declarations, and the number continues to rise.TOSTAN. (2007). Abandoning Female Genital Cutting. Retrieved August 5, 2010, from TOSTAN: http://tostan.org/web/page/586/sectionid/547/parentid/585/pagelevel/3/interior.asp By then, at least 23 villages in Burkina Faso had also held such community wide ceremonies, marking “the first public declaration to end FGC outside of Senegal and showing the replicability of the Tostan program for large-scale abandonment of this practice”. Molly Melching of TOSTAN believes that in Senegal the practice of female genital mutilation could be ended within 2–5 years. She credits education, instead of cultural imperialism, for the rapid and significant changes which have occurred in Senegal.
Some countries which have prohibited FGC still experience the practice in secrecy. In many cases, the enforcement of this prohibition is a low priority for governments. Other countries have tried to educate practitioners in order to make it easier and safer, instead of outlawing the practice entirely. However, with pressure from the WHO and other groups, laws are being passed in regards to FGC. On June 28, 2007 Egypt banned female genital cutting after the death of 12-year old Badour Shaker during a genital circumcision. The Guardian of Britain reported that her death “sparked widespread condemnation” of the practice.“Death of 12-Year-Old Circumcised Girl Shocks Egypt, Prompts Ban on Rite”. Associated Press. 2007-06-27. http://www.foxnews.com/story/0,2933,287393,00.html. Retrieved 2008-01-11. However, Britain has had its own problem confronting cases of FGC, as immigrants from Africa have been known to send their daughters to their home nations to undergo the procedure before returning to Britain.
International Day of Zero Tolerance to Female Genital Mutilation 2013
The International Day of Zero Tolerance to Female Genital Mutilation is observed each year to raise awareness about this practice. Female genital mutilation of any type has been recognized as a harmful practice and violation of the human rights of girls and women. WHO is committed to the elimination of female genital mutilation within a generation and is focusing on advocacy, research and guidance for health professionals and health systems.
Female genital mutilation (FGM) refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. Female genital mutilation has no known health benefits. On the contrary, it is associated with a series of short and long-term risks to both physical, mental and sexual health and well-being.
FGM is affecting about 140 million girls and women, and more than 3 million girls are at risk every year. A special focus for WHO this year, is the troubling trend of health-care providers increasingly being the ones performing female genital mutilation, and thereby contributing to legitimize and maintain the practice.
Laws and prevalence
The following laws are commonly cited in making a legal arguments against FGM:
- Universal Declaration of Human Rights (1948).
- African [Banjul] Charter on Human and Peoples’ Rights (1982).
- The UN Convention on the Elimination of All Forms of Discrimination Against Women ( CEDAW ) (1981).
- Convention on the Rights of the Child (December 1989).
- Declaration on the Elimination of Violence against Women (1993).Circumcision Information Resource Pages. (2003, October 1). Female Genital Mutilation. Retrieved August 5, 2010, from Circumcision Information Resource Pages: http://www.cirp.org/pages/female/
- World Health Assembly resolution (WHA61.16) on the elimination of FGM (2008).
The countries where FGC is commonly practiced were identified by the US State Department.US Department of State. (2001, June 1). FGM Individual Country Reports. Retrieved August 5, 2010, from US Department of State: http://web.archive.org/web/20080306114419/http://www.state.gov/g/wi/rls/rep/crfgm/
- Burkina Faso (71.6% prevalence, Type II)
- A law prohibiting FGC was enacted in 1996 and went into effect in February 1997. Even before this law, however, a presidential decree had set up the National Committee against excision and imposed fines on people guilty of excising girls and women. The new law includes stricter punishment. Several women excising girls have been handed prison sentences. Stolz, Joëlle (September 1998). “Le Burkina Faso fait reculer l’excision” (in French). Le Monde diplomatique: pp. 18. http://www.monde-diplomatique.fr/1998/09/STOLZ/10970. Retrieved 2006-10-02.
- Central African Republic (43.4% prevalence, Type I and II)
- In 1996, the President issued an Ordinance prohibiting FGC throughout the country. It has the force of national law. Any violation of the Ordinance is punishable by imprisonment of from one month and one day to two years and a fine of 5,100 to 100,000 francs (approximately US$8-160). No arrests are known to have been made under the law.
- Côte d’Ivoire ( 44.5% prevalence, Type II)
- A December 18, 1998 law provides that harm to the integrity of the genital organ of a woman by complete or partial removal, excision, desensitization or by any other procedure will, if harmful to a women’s health, be punishable by imprisonment of one to five years and a fine of 360,000 to two million CFA Francs (approximately US$576-3,200). The penalty is five to twenty years incarceration if a death occurrs during the procedure and up to five years’ prohibition of medical practice, if this procedure is carried out by a doctor.
- Djibouti (90-98% prevalence, Type II)
- FGC was outlawed in the country’s revised Penal Code that went into effect in April 1995. Article 333 of the Penal Code provides that persons found guilty of this practice will face a five year prison term and a fine of one million Djibouti francs (approximately US$5,600).
- Egypt (78-97% prevalence, Type I, II and III)
- Egypt’s Ministry of Health and Population has banned all forms of female genital cutting since 2007. The ministry’s ban order declared it is ‘prohibited for any doctors, nurses, or any other person to carry out any cut of, flattening or modification of any natural part of the female reproductive system’. Islamic authorities in the nation also stressed that Islam opposes female circumcision. The June 2007 Ministry ban eliminated a loophole that allowed girls to undergo the procedure for health reasons.“Egypt strengthens ban on female genital cutting”. Reuters. 2007-06-28. http://www.reuters.com/article/healthNews/idUSL2801275920070628?feedType=RSS. Retrieved 2008-01-11. There had previously been provisions under the Penal Code involving “wounding” and “intentional infliction of harm leading to death,” as well as a ministerial decree prohibiting FGC. In December 1997, the Court of Cassation (Egypt’s highest appeals court) upheld a government banning of the practice providing that those who did not comply would be subjected to criminal and administrative punishments. This law had proved ineffective and in a survey in 2000, a study found that 97% of the country’s population still practiced FGC. In light of the widespread practice of FGC, even after the ban in 1997, some Egyptian villages decided to voluntarily give up the practice, as was the case with Abou Shawareb, which vowed in July of 2005 to end the practice. However, it remains a culturally accepted practice, and a 2005 study found that over 95% of Egyptian women have undergone some form of FGC. Reuters. (2007, August 20). Egypt Death Sparks Debate on Female Circumcision. Retrieved August 5, 2010, from Reuters: http://www.reuters.com/article/idUSL30168862
- Eritrea (90-95% prevalence, Type I, II and III)
- Eritrea has outlawed all forms of female genital cutting since 2007.BBC News. (2007, April 4). Eritrea Bans Female Circumcision. Retrieved August 5, 2010, from BBC News: http://news.bbc.co.uk/2/hi/africa/6527619.stm
- Ghana (9-15% prevalence, Type I,II and III)
- In 1989, the head of the government of Ghana, President Rawlings, issued a formal declaration against FGC. Article 39 of Ghana’s Constitution also provides in part that traditional practices that are injurious to a person’s health and well being are abolished.
- Guinea (98.6% prevalence, Type I, II and III)
- FGC is illegal in Guinea under Article 265 of the Penal Code. The punishment is hard labor for life and if death results within 40 days after the crime, the perpetrator will be sentenced to death. No cases regarding the practice under the law have ever been brought to trial. Article 6 of the Guinean Constitution, which outlaws cruel and inhumane treatment, could be interpreted to include these practices, should a case be brought to the Supreme Court. A member of the Guinean Supreme Court is working with a local NGO on inserting a clause into the Guinean Constitution specifically prohibiting these practices.
- Indonesia (No national prevalence figures avail., Type I and IV)
- Officials are preparing to release a decree banning doctors and paramedics from performing FGC. FGC is still carried out extensively in Indonesia, the worlds largest Muslim nation. Azrul Azwar, The director general of community health, stated that, “All government health facilities will also be instructed to spread information about the decision as well as the redundancy of female circumcision.” “Indonesia to ban female circumcision”. Stop FGM. June 2, 2005. http://www.cbc.ca/world/story/2005/06/02/circumcision050602.html. Retrieved 2006-10-02.
- Nigeria (25.1% prevalence, Type I, II and III)
- There is no federal law banning the practice of FGC in Nigeria. Opponents of these practices rely on Section 34(1)(a) of the 1999 Constitution of the Federal Republic of Nigeria that states “no person shall be subjected to torture or inhuman or degrading treatment” as the basis for banning the practice nationwide. A member of the House of Representatives has drafted a bill, not yet in committee, to outlaw this practice.
- Senegal (5-20% prevalence, Type II and III)
- A law that was passed in January 1999 makes FGC illegal in Senegal. President Diouf had appealed for an end to this practice and for legislation outlawing it. The law modifies the Penal Code to make this practice a criminal act, punishable by a sentence of one to five years in prison. A spokesperson for the human rights group RADDHO (The African Assembly for the Defense of Human Rights) noted in the local press that “Adopting the law is not the end, as it will still need to be effectively enforced for women to benefit from it.”
- Somalia (90-98% prevalence, Type I and III)
- There is no national law specifically prohibiting FGC in Somalia. There are provisions of the Penal Code of the former government covering “hurt”, “grievous hurt” and “very grievous hurt” that might apply. In November 1999, the Parliament of the Puntland administration unanimously approved legislation making the practice illegal. There is no evidence, however, that this law is being enforced.
- Sudan (91% prevalence, Type I,II and III)
- Currently there is no law forbidding FGC, although Sudan was the first country to outlaw it in 1946, under the British. Type III was prohibited under the 1925 Penal Code, with less severe forms allowed. Outreach groups have been trying to eradicate the practice for 50 years, working with NGO’s, religious groups, the government, the media and medical practitioners. Arrests have been made but no further action seems to have taken place.
- Tanzania (17.6% prevalence, Type II and III)
- Section 169A of the Sexual Offences Special Provisions Act of 1998 prohibits FGC. Punishment is imprisonment of from five to fifteen years or a fine not exceeding 300,000 shillings (approximately US $380) or both. There have been some arrests under this legislation, but no reports of prosecutions yet.
- Togo (12% prevalence, Type II)
- On October 30, 1998, the National Assembly unanimously voted to outlaw the practice of FGC. Penalties under the law can include a prison term of two months to ten years and a fine of 100,000 francs to one million francs (approximately US $160 to 1,600). A person who had knowledge that the procedure was going to take place and failed to inform public authorities can be punished with one month to one year imprisonment or a fine of from 20,000 to 500,000 francs (approximately US $32 to 800).
- Uganda (
- Female circumcision was outlawed in Uganda in 2009. Those convicted of the practice receive 10 years in jail. It is said to still be practiced by the Sabiny, some Karamojong sub-groups and the Pokot in eastern Uganda, as well as the Nubi people of West Nile.BBC News. (2009, December 10). Uganda Bans Female Genital Mutilation. Retrieved August 5, 2010, from BBC News: http://news.bbc.co.uk/2/hi/africa/8406940.stm.
- Breast ironing – a practice of flattening the breasts of girls
- Footbinding – an old, primarily Chinese, practice of constricting feet
- Labiaplasty – a recently developed cosmetic practice
- Male Genital Mutilation (MGM)
- See European Union Legislation on Female Genital Mutilation in Europe
- Al-Qaradawi, Y. (2004, December 13). Circumcision: Juristic, medical & social perspectives. Retrieved March 29, 2006.
- Boyle, E. H. (2002). Female genital cutting: Cultural conflict in the global community. Baltimore: Johns Hopkins University Press. [978-0-8018-7063-7].
- Kathy Dettwyler|Dettwyler, Katherine A. (1994). Dancing skeletons: life and death in West Africa. Prospect Heights, Ill.: Waveland Press. [0-88133-748-X].
- Ferguson, I and Ellis, P. (1995). Female Genital Mutilation: a Review of the Current Literature Department of Justice, Canada. Working document
- Gruenbaum, E. (2001). The female circumcision controversy. Philadelphia: University of Pennsylvania Press. [978-0-8122-1746-9].
- Hoffman, B. (2002). Womanhood and Circumcision: Three Maasai women have their say. Berkeley: Berkeley Media.
- Johnson, Michelle C. (2000). Becoming a Muslim, Becoming a person: Female ‘circumcision’, religious identity, and personhood in Guinea-Bissau. In B. Shell-Duncan & Y. Herlund (Eds.), Female circumcision in Africa: Culture, controversy, and change. Boulder: Lynne Rienner Publishers.
- Kandela, P. (1995, January). Egypt sees U turn on female circumcision. British Medical Journal, 310, 12.
- Kassindja, F. (1998). Do they hear you when you cry. New York: Delacorte Press. [0-38531-832-4].
- Obermeyer, Carla Makhlouf (2003). The health consequences of female circumcision: Science, advocacy, and standards of evidence. Medical Anthropology Quarterly, 17(3), 394-412.
- Pieters, G., & Lowenfels A. B. (1977). Infibulation in the horn of Africa. New York State Journal of Medicine, 77(5), 729-31.
- Research papers from medical gynecologists, judges, linguistics, and social scientists on the subject (1994). University of Khartoum, Sudan. Umm Atteya Organization website (Arabic). Retrieved March 29, 2006.
- UNICEF (1999). Consultation on the elimination of female genital mutilation: 14 December-16 December 1998. New York: Author. 40 pp.
- World Health Organization. (1996). Female genital mutilation: Report of a WHO Technical Working Group (unpublished document WHO/FRH/WHD/96.10). Geneva: World Health Organization. Retrieved 2007-02-21.
- Sami A. Aldeeb|Aldeeb, Sami (2000). Male and Female Circumcision in the Jewish, Christian and Muslim Communities, Religious debate. Beirut, .
- Daw, E. (1970). Female circumcision and infibulation complicating delivery. Practitioner, 204(222), 559-63.
- Dewhurst, C.J., & Michelson, A. (1964). Infibulation complicating pregnancy. British Medical Journal, 2(5422), 1442.
- Dirie, Waris (2001). Desert Flower. Autobiography of a Somali woman’s journey from nomadic tribal life to a career as a fashion model in London and to the post of special ambassador at the United Nations. Dirie recounts her personal experience with female genital mutilation that began with circumcision at age five.
- Leonard, Lori (2000). We did it for pleasure only: Hearing alternative tales of female circumcision. Qualitative Inquiry, 6(2), 212-228.
- Mernissi, Fatima. Beyond the veil: Male-female dynamics in a modern Muslim society. Cambridge, MA: Schenkman Pub. Co. [0-470-59613-9].
- Mustafa, Asim Zaki (1966). Female circumcision and infibulation in the Sudan. Journal of Obstetrics and Gynaecology of the British Commonwealth, 73(2), 302–306.
- Robinett, Patricia (2006). The rape of innocence: One woman’s story of female genital mutilation in the USA. N.p.: Aesculapius Press. [1-878411-04-7].
- The Economist Female Genital Cutting: Ending a Brutal Practice
- Ending Female Genital Mutilation: A Strategy for the EU Institutions
- Amnesty International: Women’s Human Rights
- BBC: Female mutilation is ‘birth risk’
- BBC: Kenya shock at mutilation death
- IRIN: In-Depth: Razor’s Edge – The Controversy of Female Genital Mutilation
- Map: Prevalence of Female Genital Mutilation in Africa (“based on very uncertain estimates”)
- ReligiousTolerance.org: Debates about FGM in Africa, the Middle East & Far East
- The Female Genital Cutting Education and Networking Project
- Vibe Review: Clitoral Hood Removal: New Ways of Heightening Arousal
- World Health Organization: Female genital mutilation
- Mauritanian Islamic leaders ban genital mutilation
- A comprehensive research study on female genital mutilation/cutting (FGM/C) in Iran (2015)