Female Genital Mutilation (FGM)

What exactly is meant by the term female genital mutilation (FGM)? Why is it practiced? What are the many documented effects of this tradition on women and girls?

Although female genital mutilation is recognized as a violation of fundamental human rights, the practice is still prevalent in many countries. It is estimated that between 100 and 140 million girls and women worldwide are victims of female genital mutilation, 92 million of them living in Africa…Although women of all ages are at risk for female genital mutilation, it is typically performed on girls between the ages of 4 and 12.[1]

Definition and Prevalence
FGM is the removal of part, or all, of female genitalia and can be divided into four main types.[2] Type I involves the removal of the clitoral foreskin. Type II is the removal of the clitoris as well as partial or complete cutting out of the labia minora. Type III or “infibulation” involves the removal of the clitoris and the labia minora and majora, followed by the sewing up of the orificium vaginae with only a small opening left for urine and menstruation blood to pass through. Type IV includes variations such as pricking, piercing, the stretching of the clitoris or vulva, or the scraping of the vagina.[3] According to recent estimates, around two million girls are circumcised or face the prospect of circumcision every year in at least thirty countries around the world, many of which are located in Africa.[4] In the Sudan, Mali, Djibouti, Egypt, Ethiopia, Somalia and Eritrea about 90% of women experience FGM.[5]

Immediate and Long-Term Effects
Due to the fact that FGM is often performed under unsanitary conditions by practitioners without medical training using instruments such as broken glass, tin can lids, blunt knives, scissors, or razors, girls who undergo this procedure regularly experience severe physical, sexual, and psychological side-effects.[6] These consequences include intense pain and bleeding, including the possibility of severe hemorrhaging causing death; pain during intercourse; and complications including back pain, kidney damage, severe cramping, and infertility due to the build up of scar tissue that blocks the urethral or vaginal opening leading to a buildup of urine and menstrual blood.[7] Women who have been infibulated must also be cut open before each delivery and then sewn up again afterwards, leading to the buildup of thick scar tissue, making childbirth extremely painful and dangerous as it lengthens labor, blocks the birth canal, and often leads to the mother experiencing perianal tears.[8]

According to the World Health Organization, the physical consequences of female genital mutilation may include severe pain, shock, heavy bleeding that may result in death, sepsis, the formation of abscesses, increased susceptibility to HIV/AIDS, pelvic inflammatory disease, infertility, painful periods, infection of the wound, fever, chronic bladder and urinary tract infections, cysts, and increased risk of complications during childbirth including prolonged labor and death of the newborn.

Justifications for FGM
Numerous “reasons” for FGM exist. Many have been passed down from generation to generation, often without practitioners questioning their validity, such as the belief that touching the clitoris during childbirth will result in the death of the baby.[9] In many societies, girls undergo FGM as a rite of passage that also includes the passing down of information on how to be a good wife and mother. Without undergoing this procedure, girls in societies where FGM is prevalent will not be able to get married due to cultural beliefs regarding purity, virginity, and fidelity. Girls who have been circumcised are considered “clean” while those who have not had the procedure performed are considered “unclean.” Most importantly, many of the justifications for FGM have at their root beliefs concerning the inferior status of women and a desire to control a woman’s body and sexuality to ensure submissiveness.[10] For example, as FGM often reduces a woman’s desire for sex, a girl or young woman who has undergone the procedure is less likely to have sex outside of marriage, thereby ensuring her chastity and marriage prospects. The latter is extremely important since in many societies that practice FGM, it is exceedingly difficult for an uncircumcised woman to be married, and in societies where women receive little education or professional opportunities, marriage is often the only means of survival.[11]

Other scholars also highlight the link between FGM and women’s subjugation and devaluation. Favazza asserts that FGM is an attempt to regulate female morality:

…an infibulated woman is a guaranteed virgin most of the time and is therefore marriageable. Excision, by removing the sensitive clitoral area, is thought to attenuate sexual desires in a woman, who, freed from personal lust, can concentrate solely on pleasing her husband.[12]

FGM is used in an attempt to control women’s sexuality and has persisted despite the numerous detrimental side-effects.

Why the Eradication of FGM is Vital to Development
In addition to the fact FGM often leads to so many horrific consequences for women, this practice is a hindrance to long-term development efforts in the Global South. For example, by 2015, many countries have pledged to reach the Millennium Development Goals; three of which are intrinsically hindered by the continuation of FGM. Based on these pledges, the international community has determined that the promotion of gender equality and the empowerment of women, the improvement of maternal health, and the combating of HIV/AIDS and other diseases are necessary for development.[13] It is clear, however, that FGM is linked to the subjugation of women rather than their empowerment, and complications of this practice include many negative ramifications for pregnant women, decreasing rather than improving maternal health. In addition, certain traditional cultural practices such as FGM have been linked to women’s increased susceptibility to HIV/AIDS.[14]

HIV/AIDS is transmitted between individuals through sexual intercourse, the transfer of the disease from mother to baby during childbirth, and the direct transfer of the virus, such as through a blood transfusion or sharing contaminated needles or sharp instruments.[15] Since many instances of FGM are performed by individuals without medical training in unsanitary conditions who reuse razors and other sharp instruments, the risk of transmitting diseases is quite high. This risk is exacerbated by the fact many African women are marginalized and powerless in traditional patriarchal societies, with little support to fight against powerful and deeply entrenched customs.[16] Women are extremely vital contributors to both their families and societies (though many of their contributions are not recognized), but it is illogical to expect women suffering from HIV/AIDS to be able to meaningfully contribute to their communities while battling constant sickness.[17] FGM makes women more vulnerable to HIV/AIDS and is indicative of deep discrimination.[18]

Focusing solely on the negative health effects associated with FGM, however, without a close examination of the root causes of this practice, mainly women’s inequality, is not an effective approach since “underscoring the negative health consequences does not effectively challenge the reasoning behind FGM and thus allows it to continue.”[19]

FGM is also widely considered (especially in Western nations) to be a serious human rights violation and can be understood within the framework of women’s social and economic powerlessness in many societies.[20] In other words, FGM is a “human rights abuse…intimately linked to the unequal position of women in the political, social, and economic structures of societies where it is practiced.”[21] It is also interesting to note that of the 28 countries in Africa that continue to practice FGM, 26 have ratified the UN Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW). This is an international treaty that includes obligations to prevent, investigate, and punish all forms of violence against women, a category which clearly encompasses FGM, despite the labeling of this practice as justified due to tradition, culture or religion.[22]

There are numerous reasons why the eradication of FGM is vital to improving development in the Global South. This practice violates women’s right to have a say in what happens to their own bodies and it involves numerous detrimental health effects for women, thereby severely limiting their ability to contribute meaningfully to their societies. It is also a reflection of the devaluation of women and girls in many cultures, confines a woman’s worth to the domestic sphere, and is a barrier to women’s full participation in society. For these reasons, eradication of FGM is necessary to ensure equality and development.

Efforts by NGOs to Eradicate FGM
Numerous non-governmental organizations (NGOs) throughout Africa have developed strategies for eradicating FGM in a culturally sensitive manner that also links to wider development goals. For example, activists in Sierra Leone have discovered that mass literacy campaigns, education, providing practitioners with alternative forms of income, and raising public awareness concerning the detrimental effects of FGM are effective in the struggle to change people’s thoughts and deeply held traditional and cultural beliefs.[23] One activist underscored this point when she said, “Educating people is empowering them. It is only through their minds that you can change the attitude of people.”[24]

Many NGOs also started seeing increased success in their work at eradicating FGM when they began attempting to understand the practice instead of condemning it, resulting in a more positive response from communities.[25] One of the most important factors that has contributed significantly to various successes of NGOs working towards FGM eradication involve recognizing that indigenous knowledge has value in solving local problems; this results in an increased sense of control and ownership among local populations.[26] A specific project that incorporated many of the above factors is a rural village empowerment program involving formal education and literacy in Senegal.[27] Although FGM was not singled out as a specific topic of discussion during the 18-month curriculum that focused on human rights, women’s health, and sustainable resource management, after women joined the literacy programming, they “never stopped thinking of how to make their lives better.”[28] Ultimately they identified FGM as one of their biggest concerns and then mobilized in order to work towards its elimination. They garnered national media attention, organized international forums, implemented a declaration for entire communities to abandon the practice, and then eventually developed similar programs in other countries.[29] Further, it is generally believed that this project was so successful because “its approach was collective, grounded in the local context, and empowering.”[30]

One of the most important strategies developed by NGOs in their work to eradicate FGM is to question deeply held beliefs and the reasons behind them. In other words, some NGOs attempt to get people thinking about why they believe what they believe and why they do what they do through asking questions involving perceived benefits, traditional gender roles, and religion, always using a frame of reference that is familiar to participants.[31] According to an activist who regularly utilizes this approach:

We may not be able to convince our audiences to stop circumcision with our first conversation, but at least they begin to realize certain contradictions, and they start to rethink the “facts” as they understood them. It is a slow process of change, but arguments supporting FGM can be dismantled with persistent questioning.[32]

In this way, change will not happen quickly, but when it does ultimately occur, the improvements to women’s lives will be tangible and sustainable. Further, instead of focusing on human rights declarations and treaties (which may be of little relevance to local communities), effective approaches to eradicating FGC are informed by local cultural and religious beliefs of common sense, justice and dignity.[33] “Without an understanding of indigenous cultures, and without a deep commitment from within those cultures to end the cutting, eradication efforts imposed from the outside are bound to fail.”[34]

As NGOs work to improve development throughout the Global South, including efforts to increase women’s access to education, opportunities, equality and participation, the likelihood that FGM will be eradicated, thereby removing a major barrier to development, increases as well. Studies have shown that the level of women’s education is directly correlated with their level of willingness to have their daughters circumcised; the more education, the less willing.[35]

When African women have taken their rightful places in the various spheres of life, when they have gained social equality, political power, economic opportunities, and access to education and health care, genital mutilation will end. Women will make sure of that.[36]

Sources:
[1] “Female Genital Mutilation Fact Sheet.” World Health Organization (Fact sheet no. 241) (February 2010).
[2] “Women’s Human Rights,” Amnesty International, http://www.amnestyusa.org/violence-against-women/female-genital-mutilation--fgm/page.do?id=1108439 (accessed April 8, 2009).
[3] I. Utz-Billing, and H. Kentenich, “Female genital mutilation: an injury, physical and mental harm,” Journal of Psychosomatic Obstetrics and Gynecology vol. 29, no. 4 (2008): 225-229.
[4] Ibid.
[5] Ibid.
[6] “Women’s Human Rights,” Amnesty International, http://www.amnestyusa.org/violence-against-women/female-genital-mutilation--fgm/page.do?id=1108439 (accessed April 8, 2009).
[7] Rogaia Mustafa Abusharaf, "Unmasking tradition: a Sudanese anthropologist confronts female 'circumcision' and its terrible tenacity," The Sciences vol. 38, no. 2 (March-April 1998): 22-27.
[8] “Women’s Human Rights,” Amnesty International, http://www.amnestyusa.org/violence-against-women/female-genital-mutilation--fgm/page.do?id=1108439 (accessed April 8, 2009).
[9] Ibid.
[10] Ibid.
[11] Ibid.
[12] Favazza, Armando R., M.D. Self-Mutilation in Culture and Psychiatry: Bodies Under Siege. (Baltimore: The Johns Hopkins University Press, 1987), 162.
[13] “Millennium Development Goals,” Amnesty International, http://www.amnestyusa.org/demand-dignity/millennium-development goals/page.do?id=1041190 (accessed April 8, 2009).
[14] E.A. Uwe, E.E. Ekuri, and P.N. Asuquo, “African women and vulnerability to HIV/AIDS: Implications for female related cultural practices.” International Quarterly of Community Health Education vol. 27, no. 1 (2006): 87-94.
[15] Ibid.
[16] Ibid.
[17] Ibid.
[18] Ibid.
[19] Nadia Wassef, “Ending Female Genital Mutilation without Human Rights: Two Approaches – Egypt,” Carnegie Council (August 6, 2000).
http://www.cceia.org/resources/publications/dialogue/2_03/articles/631.html (accessed April 8, 2009).
[20] “Women’s Human Rights,” Amnesty International, http://www.amnestyusa.org/violence-against-women/female-genital-mutilation--fgm/page.do?id=1108439 (accessed April 8, 2009).
[21] Ibid.
[22] Ibid.
[23]Liliane Bitong, “Fighting genital mutilation in Sierra Leone,” Bulletin of the World Health Organization vol. 83, no. 11 (November 2005): 806-807.
[24] Ibid.
[25] Asma Mohamed Abdel Halim, “From Bagadadji to Abu Hashim: New Approaches to Combat Female Circumcision,” Review of African Political Economy vol. 34, no. 114 (December 2007): 719-756.
[26] Ibid.
[27] Peter Easton, Karen Monkman and Rebecca Miles, “Social Policy from the Bottom Up: Abandoning FGC in Sub-Saharan Africa,” Gender-Based Violence (2007): 70-85.
[28] Asma Mohamed Abdel Halim, “From Bagadadji to Abu Hashim: New Approaches to Combat Female Circumcision,” Review of African Political Economy vol. 34, no. 114 (December 2007): 719-756. AND Peter Easton, Karen Monkman and Rebecca Miles, “Social Policy from the Bottom Up: Abandoning FGC in Sub-Saharan Africa,” Gender-Based Violence (2007): 70-85.
[29] Peter Easton, Karen Monkman and Rebecca Miles, “Social Policy from the Bottom Up: Abandoning FGC in Sub-Saharan Africa,” Gender-Based Violence (2007): 70-85.
[30] Ibid.
[31] Nadia Wassef, “Ending Female Genital Mutilation without Human Rights: Two Approaches – Egypt,” Carnegie Council (August 6, 2000), http://www.cceia.org/resources/publications/dialogue/2_03/articles/631.html (accessed April 8, 2009).
[32] Ibid.
[33] Ibid.
[34] Rogaia Mustafa Abusharaf, "Unmasking tradition: a Sudanese anthropologist confronts female 'circumcision' and its terrible tenacity," The Sciences vol. 38, no. 2 (March-April 1998): 22-27.
[35] I. Utz-Billing, and H. Kentenich, “Female genital mutilation: an injury, physical and mental harm,” Journal of Psychosomatic Obstetrics and Gynecology vol. 29, no. 4 (2008): 225-229.
[36] Ibid.