Female Genital Mutilation

Female genital mutilation (FGM), also known as female circumcision, is defined by the World Health Organization (WHO) as ‘all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.’ FGM is typically carried out on girls from a few days old to puberty. It may take place in a hospital, but is usually performed, without anaesthesia, by a traditional circumciser using a knife, razor, or scissors.

According to the WHO, it is practiced in 28 countries in western, eastern, and north-eastern Africa, in parts of the Middle East, and within some immigrant communities in Europe, North America, and Australasia. The WHO estimates that 100–140 million women and girls around the world have experienced the procedure, including 92 million in Africa. The practice is carried out by some communities who believe it reduces a woman’s libido.

The WHO has offered four classifications of FGM. The main three are Type I, removal of the clitoral hood, almost invariably accompanied by removal of the clitoris itself (clitoridectomy); Type II, removal of the clitoris and inner labia; and Type III (infibulation), removal of all or part of the inner and outer labia, and usually the clitoris, and the fusion of the wound, leaving a small hole for the passage of urine and menstrual blood—the fused wound is opened for intercourse and childbirth. Around 85 percent of women who undergo FGM experience Types I and II, and 15 percent Type III, though Type III is the most common procedure in several countries, including Sudan, Somalia, and Djibouti. Several miscellaneous acts are categorized as Type IV. These range from a symbolic pricking or piercing of the clitoris or labia, to cauterization of the clitoris, cutting into the vagina to widen it (gishiri cutting), and introducing corrosive substances to tighten it.

Opposition to FGM focuses on human rights violations, lack of informed consent, and health risks, which include fatal hemorrhaging, epidermoid cysts, recurrent urinary and vaginal infections, chronic pain, and obstetrical complications. Since 1979, there have been concerted efforts by international bodies to end the practice, including sponsorship by the United Nations of an International Day of Zero Tolerance to Female Genital Mutilation, held each 6 February since 2003. Sylvia Tamale, a Ugandan legal scholar, writes that there is a large body of research and activism in Africa itself that strongly opposes FGM, but she cautions that some African feminists object to what she calls the imperialist infantilization of African women, and they reject the idea that FGM is nothing but a barbaric rejection of modernity. Tamale suggests that there are cultural and political aspects to the practice’s continuation that make opposition to it a complex issue.

The procedures known as FGM were referred to as female circumcision until the early 1980s, when the term ‘female genital mutilation’ came into use. The term was adopted at the third conference of the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children in Addis Ababa, Ethiopia, and in 1991 the WHO recommended its use to the United Nations. It has since become the dominant term within the international community and in medical literature. Alexia Lewnes argued in a 2005 report for UNICEF that the word ‘mutilation’ differentiates the procedure from male circumcision and stresses its severity. Local terms for the procedure include ‘tahara’ in Egypt; ‘tahur’ in Sudan; and ‘bolokoli’ in Mali, which Anika Rahman and Nahid Toubia write are words synonymous with ‘purification.’ Several countries refer to Type 1 FGM as ‘sunna circumcision.’ It is also known as ‘kakia,’ and in Sierra Leone as ‘bundu,’ after the Bundu secret society (a women’s association that initiates girls into adulthood). Type III FGM (infibulation) is known as ‘pharaonic circumcision’ in Sudan, and as ‘Sudanese circumcision’ in Egypt. Urologist Jean Fourcroy writes that women in countries that practice FGM call it one of the ‘three feminine sorrows’: the first sorrow is the procedure itself, followed by the wedding night when a woman with Type III has to be cut open, then childbirth when she has to be cut again.

The term FGM is not applied to medical or elective procedures such as labiaplasty and vaginoplasty, or those used in sex reassignment surgery. According to the WHO, some practices regarded as legal in countries that have outlawed FGM do fall under the category of Type IV, but the organization decided to maintain a broad definition to avoid loopholes that could allow FGM to continue.

FGM is considered by its practitioners to be an essential part of raising a girl properly—girls are regarded as having been cleansed by the removal of ‘male’ body parts. It ensures pre-marital virginity and inhibits extra-marital sex, because it reduces women’s libido. Women fear the pain of re-opening the vagina, and are afraid of being discovered if it is opened illicitly. The term ‘pharaonic circumcision’ (Type III) stems from its practice in Ancient Egypt under the Pharaohs, and ‘fibula’ (in ‘infibulation’) refers to the Roman practice of piercing the outer labia with a fibula, or brooch. Leonard Kouba and Judith Muasher write that genitally mutilated females have been found among Egyptian mummies, and that Herodotus referred to the practice when he visited Egypt. There is reference on a Greek papyrus from 163 BCE to the procedure being conducted on girls in Memphis, the ancient Egyptian capital, and Strabo (c. 64 BCE – c. 23 CE), the Greek geographer, reported it when he visited Egypt in 25 BCE.

Judaism requires circumcision for boys, but does not allow it for girls. Islamic scholars have said that, while male circumcision is a sunna, or religious obligation, female genital modification is not required, and several have issued a fatwa against Type III FGM. Sudanese surgeon Nahid Toubia—president of RAINBO (Research, Action and Information Network for the Bodily Integrity of Women) —told the BBC in 2002 that campaigning against FGM involved trying to change women’s consciousness: ‘By allowing your genitals to be removed [it is perceived that] you are heightened to another level of pure motherhood—a motherhood not tainted by sexuality and that is why the woman gives it away to become the matron, respected by everyone. By taking on this practice, which is a woman’s domain, it actually empowers them. It is much more difficult to convince the women to give it up, than to convince the men.’ Boyle writes that the Masai of Tanzania will not call a woman ‘mother’ when she has children if she is uncircumcised.

According to Amnesty, in certain societies women who have not had the procedure are regarded as too unclean to handle food and water, and there is a belief that a woman’s genitals might continue to grow without FGM, until they dangle between her legs. Some groups see the clitoris as dangerous, capable of killing a man if his penis touches it, or a baby if the head comes into contact with it during birth, though Amnesty cautions that ideas about the power of the clitoris can be found elsewhere. Gynaecologists in England and the United States would remove it during the 19th century to ‘cure’ insanity, masturbation, and nymphomania. The first reported clitoridectomy in the West was carried out in 1822 by a surgeon in Berlin on a teenage girl regarded as an ‘imbecile’ who was masturbating. Isaac Baker Brown (1812–1873), an English gynecologist who was president of the Medical Society of London in 1865, believed that the ‘unnatural irritation’ of the clitoris caused epilepsy, hysteria, and mania, and would remove it ‘whenever he had the opportunity of doing so,’ according to an obituary. Peter Lewis Allen writes that his views caused outrage—or, rather, his public expression of them did—and Brown died penniless after being expelled from the Obstetrical Society.

The age at which the procedure is performed varies. Comfort Momoh, a specialist midwife in England, writes that in Ethiopia the Falashas perform it when the child is a few days old, the Amhara on the eighth day of birth, while the Adere and Oromo choose between four years and puberty. In Somalia it is done between four and nine years. Other communities may wait until adulthood, she writes, either just before marriage or just after the first pregnancy. The procedure may be carried out on one girl alone, or on a group of girls at the same time. It is generally performed by a traditional circumciser, usually an older woman known as a ‘gedda,’ without anesthesia or sterile equipment, though richer families may pay instead for the services of a nurse, midwife, or doctor using a local anesthetic  It may also be performed by the mother or grandmother, or in some societies—such as Nigeria and Egypt—by the local male barber.

FGM has immediate and late complications. Immediate complications are increased when FGM is performed in traditional ways, and without access to medical resources: the procedure is extremely painful and a bleeding complication can be fatal. Other immediate complications include acute urinary retention, urinary infection, wound infection, septicemia, tetanus, and in case of unsterile and reused instruments, hepatitis and HIV.  According to Lewnes’ UNICEF report, it is unknown how many girls and women die from the procedure because ‘few records are kept’ and fatalities caused by FGM ‘are rarely reported as such.’ A film shot in Lunsar, Sierra Leone, by Mariana van Zeller in 2007 discusses how girls who bleed excessively are regarded as witches. It has been argued that FGM is related to the high incidence of AIDS in some parts of Africa, since intercourse with a circumcised female is conducive to an exchange of blood.

Psychological complications are related to cultural context; damage may occur to women who undergo FGM particularly when they are moving outside their traditional circles and are confronted with a view that mutilation is not the norm. Women with FGM typically report sexual dysfunction and dyspareunia (painful sexual intercourse), but several researchers have written that FGM does not necessarily destroy sexual desire in women. Elizabeth Heger Boyle reported several studies during the 1980s and 1990s where the women said they were able to enjoy sex, though with Type III the risk of sexual dysfunction was higher.

Women may request reinfibulation (RI) — the restoration of the infibulation — after giving birth, a contentious issue, with surgeons who perform the procedure regarded as behaving unethically and probably illegally. In Sudan, RI is known as ‘El-Adel’ (re-circumcision or, literally, ‘putting right’ or ‘improving’). Two cuts are made around the vagina, then sutures are put in place to tighten it to the size of a pinhole. Vanja Bergrren writes that this in effect mimics virginity. RI may also be carried out just before marriage, after divorce, or even in elderly women to prepare them for death. Defibulation, or deinfibulation, is a surgical technique to reverse the closure of the vaginal opening after a Type III infibulation, and consists of a vertical cut opening up normal access to the vagina. This may be accompanied by removal of scar tissue and labial repair. Procedures have been developed to repair clitoral integrity, such as by Pierre Foldes, a French urologist and surgeon, and Marci Bowers, an American surgeon who studied his work; they used intact clitoral tissue from inside women’s bodies to form a new clitoris.

Anika Rahman and Nahid Toubia write that attempts in the early 20th century by colonial administrators to halt FGM succeeded only in provoking local anger. In Kenya, Christian missionaries in the 1920s and 1930s forbade their adherents from practicing it—in part because of the medical consequences, but also because the accompanying rituals were seen as highly sexualized—and as a result it became a focal point of the independence movement among the Kikuyu, the country’s main ethnic group. Protestant missionaries campaigning against it tried to gain support from humanitarian and women’s rights groups in London, where the issue was raised in the House of Commons, and in Kenya itself a person’s stance toward FGM became a test of loyalty, either to the Christian churches or to the Kikuyu Central Association. Jomo Kenyatta (1894–1978), who became Kenya’s first prime minister in 1963, wrote in 1930: ‘The real argument lies not in the defense of the general surgical operation or its details, but in the understanding of a very important fact in the tribal psychology of the Kikuyu—namely, that this operation is still regarded as the essence of an institution which has enormous educational, social, moral and religious implications, quite apart from the operation itself. For the present it is impossible for a member of the tribe to imagine an initiation without clitoridoctomy [sic]. Therefore the … abolition of the surgical element in this custom means … the abolition of the whole institution.’

Similarly, prohibition strengthened tribal resistance to the British in the 1950s, and increased support for the Mau Mau Uprising (1952–1960). In 1956, under pressure from the British, the council of male elders (the Njuri Nchecke) in Meru, Kenya, announced a ban on clitoridectomy. Over two thousand girls—mostly teenagers but some as young as eight—were charged over the next three years with having circumcised each other with razor blades, a practice that came to be known as ‘Ngaitana’ (‘I will circumcise myself’), so-called because the girls claimed to have cut themselves to avoid naming their friends. Sylvia Tamale argues that this was done not only in defiance of the council’s cooperation with the colonial authorities, but also in protest against its interference with women’s decisions about their own rituals. Thomas describes the episode as significant in the history of FGM because it made clear that its apparent victims were in fact its central actors.

In the 1960s and 1970s, Rahman and Nahid Toubia write, doctors in Sudan, Somalia, and Nigeria began to speak out about the health consequences of FGM, and opposition gathered pace during the United Nations Decade for Women (1975–1985). In 1979 the American feminist writer Fran Hosken (1920–2006) presented research about it—’The Hosken Report: Genital and Sexual Mutilation of Females’—to the first Seminar on Harmful Traditional Practices Affecting the Health of Women and Children, sponsored by the WHO. Rahman and Toubia write that African women from several countries at the conference led a vote to end the practice. In 1980 and 1982 feminist physicians Nawal El Saadawi and Asma El Dareer wrote about FGM as a dangerous practice intended to control women’s sexuality. The decade also saw the framing of FGM—along with other issues in the domestic sphere, such as dowry deaths—as a human rights violation, rather than as a health concern, and this encouraged academic interest, including from feminist legal scholars. In 1993 the Vienna World Conference on Human Rights agreed that FGM was a violation of human rights.

As a result of immigration, FGM eventually spread to Australia, Europe, New Zealand, the United States and Canada. As Western governments became more aware of the practice, legislation was passed to make it a criminal offence, though enforcement may be a low priority. Sweden passed legislation in 1982, the first Western country to do so. It is outlawed in New Zealand and in all Australian states and territories, and is a crime under section 268 of the Criminal Code of Canada. It became illegal in the United States in 1997, though according to a U.S. Centers for Disease Control estimate, 168,000 girls living there as of 1997 had undergone it or are at risk. Nineteen-year-old Fauziya Kasinga, a member of the Tchamba-Kunsuntu tribe of Togo, was granted asylum in 1996 after leaving an arranged marriage to escape FGM, setting a precedent in U.S. immigration law because FGM was for the first time accepted as a form of persecution.

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