Female genital cutting
Encyclopedia
Female genital mutilation (FGM), also known as female genital cutting and 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 practised in 28 countries in western, eastern, and north-eastern Africa, in parts of Asia and 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 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 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 February 6 since 2003. Sylvia Tamale
, an African 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.
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.
Other terms in use, apart from female circumcision, include female genital cutting (FGC), female genital surgeries, female genital alteration, female genital excision, and female genital modification. Elizabeth Heger Boyle writes that some organizations refer to it as female genital cutting because that is better received in the communities that practise it, who do not see themselves as engaging in mutilation; she writes that state-sponsored groups tend to call it FGM while private groups use FGC. Other groups, such as UNFPA and USAID, use the combined term "female genital mutilation/cutting" (FGM/C).
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
. 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 practise 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 (see below), 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 Pharaoh
s, and "fibula" (in "infibulation") refers to the Roman
practice of piercing the outer labia with a fibula, or brooch. Leonard Kuber and Judith Muascher write that circumcised females have been found among Egyptian mummies
, and that Herodotus
(c. 484 BCE – c. 425 BCE) 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.
Asim Zaki Mustafa argues that the common attribution of the procedure to Islam is unfair because it is a much older phenomenon. While individual Muslims, Christians, and Jews practise FGM, it is not a requirement of any religious observance. 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 circumcision is preferable but 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 gynaecologist 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.
, 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 anaesthesia or sterile equipment, though richer families may pay instead for the services of a nurse, midwife, or doctor using a local anaesthetic. It may also be performed by the mother or grandmother, or in some societies—such as Nigeria and Egypt—by the local male barber.
The WHO divides FGM into four categories (see image right for types I–III). Around 85 percent of women experience Types I and II, and 15 percent Type III, though Martha Nussbaum
writes that Type III nevertheless accounts for 80–90 percent of all such procedures in countries such as Sudan, Somalia, and Dijbouti.
(Type Ia); or the partial or total removal of the clitoris, a clitoridectomy
(Type Ib). Type II, often called excision, is partial or total removal of the clitoris and the inner labia
or outer labia
. Type IIa is removal of the inner labia only; Type IIb, partial or total removal of the clitoris and the inner labia; and Type IIc, partial or total removal of the clitoris, and the inner and outer labia.
or pharaonic circumcision, is the removal of all external genitalia. The inner and outer labia are cut away, with or without excision of the clitoris. The girl's legs are then tied together from hip to ankle for up to 40 days to allow the wound to heal. The immobility causes the labial tissue to bond, forming a wall of flesh and skin across the entire vulva
, apart from a hole the size of a matchstick for the passage of urine and menstrual blood, which is created by inserting a twig or rock salt into the wound. There is another form of Type III called matwasat, where the stitching of the vulva is less extreme and the hole left is bigger. Momoh describes a Type III procedure in Female Genital Mutilation (2005):
The vulva is cut open for sexual intercourse and childbirth. Momoh writes that, in some communities, when a pregnant woman who has not experienced FGM goes into labour, the procedure is performed before she gives birth, because it is believed the baby may be stillborn if it touches her clitoris. The risk of haemorrhage and death from FGM during labour is high, she writes. During three six-month studies in the 1980s, Hanny Lightfoot-Klein interviewed 300 Sudanese women and 100 Sudanese men, and described the penetration by the men of their wives' infibulation:
, the removal of a hymen
regarded as too thick, and gishiri cutting, a practice in which the vagina's anterior wall is cut with a knife to enlarge it.
or acacia
thorns. Affluent people in urban settings may have the procedure done in a safer medical environment.
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". Momoh says the short-term mortality rate is around 10 percent, due to complications such as infection, haemorrhage, and hypovolemic shock
. A film shot in Lunsar
, Sierra Leone, by Mariana van Zeller
in 2007 discusses how girls who bleed excessively are regarded as witches.
Late complications may vary depending on the type of FGM performed. The formation of scars and keloid
s can lead to strictures, obstruction or fistula formation of the urinary and genital tracts. Urinary tract sequalae include damage to urethra and bladder with infections and incontinence
. Genital tract sequelae include vaginal and pelvic infections, dysmenorrhea
, dyspareunia
, and infertility
. Complete obstruction of the vagina results in hematocolpos
and hematometra
. Other complications inlude epidermoid cyst
s that may become infected, neuroma formation, typically involving nerves that supplied the clitoris, and pelvic pain.
FGM may complicate pregnancy and place women at higher risk for obstetrical problems, which are more common with the more extensive FGM procedures. Thus, in women with Type III FGM who have developed vesicovaginal
or rectovaginal fistula
e—holes that allows urine and feces to seep into the vagina—it is difficult to obtain clear urine samples as part of prenatal care making the diagnosis of certain conditions harder, such as preeclampsia. Cervical evaluation during labour may be impeded, and labour prolonged. Third-degree laceration, anal sphincter damage, and emergency caesarean section are more common in FGM women than in controls. Neonatal mortality is increased in women with FGM. The WHO estimated that an additional 10–20 babies die per 1,000 deliveries as a result of FGM; the estimate was based on a 2006 study conducted on 28,393 women attending delivery wards at 28 obstetric centers in Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan. In those settings all types of FGM were found to pose an increased risk of death to the baby: 15 percent higher for Type I, 32 percent for Type II, and 55 percent for Type III.
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.
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.
, where Types I and II are more common. It is known to exist in northern Saudi Arabia, southern Jordan, northern Iraq (Kurdistan
), and possibly Syria, western Iran, and southern Turkey. It is also practised in Indonesia, but largely symbolically by pricking the clitoral hood or clitoris until it bleeds.
Several African countries have enacted legislation against it, including Burkina Faso, Central African Republic, Djibouti, Eritrea, Togo, and Uganda. President Daniel Moi of Kenya issued a decree against it in December 2001. In Mauritania, where almost all the girls in minority communities undergo FGM, 34 Islamic scholars signed a fatwa in January 2010 banning the practice.
In Egypt, the health ministry banned FGM in 2007 despite pressure from some (though not all) Islamic groups. Two issues in particular forced the government's hand. A 10-year-old girl was photographed undergoing FGM in a barber's shop in Cairo in 1995 and the images were broadcast by CNN; this triggered a ban on the practice everywhere except in hospitals. Then, in 2007, 12-year-old Badour Shaker died of an overdose of anaesthesia during or after an FGM procedure for which her mother had paid a physician in an illegal clinic the equivalent of $9.00. The Al-Azhar Supreme Council of Islamic Research, the highest religious authority in Egypt, issued a statement that FGM had no basis in core Islamic law, and this enabled the government to outlaw it entirely.
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 practising 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. One American missionary, Hilda Stump, was murdered in January 1930 after speaking out against it. Lynn M. Thomas, the American historian, writes that the period 1929–1931 became what is known in Kenyan historiography as the female circumcision controversy. 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 (c. 1894–1978), who became Kenya's first prime minister in 1963, wrote in 1930:
Support for the practice also came from the women themselves. E. Mary Holding, a Methodist missionary in Meru
, Kenya, wrote in 1942 that the circumcision ritual was an entirely female affair, organized by women's councils known as kiama gia ntonye ("the council of entering"). The ritual not only saw the girls become women, but also allowed their mothers to become members of the council, a position of some authority.
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.
(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 death
s—as a human rights violation, rather than as a health concern, and this encouraged academic interest, including from feminist legal scholars. In June 1993 the Vienna World Conference on Human Rights
agreed that FGM was a violation of human rights.
Some of the international opposition to FGM continues to attract critics. The Hosken Report, in particular, was criticized for its alleged ethnocentrism
, its negative statements about African society, and its insistence on Western intervention. Sylvia Tamale wrote in 2011 that some African feminists interpret traditional practices such as FGM within a post-colonial context that makes opposing them a complex issue. While critical of FGM, they object to what Tamale calls the imperialist infantilization of African women inherent in the idea that FGM is simply a barbaric rejection of enlightenment and modernity.
Lynn Thomas writes that the ritual of FGM has been the primary context in some communities in which the women come together. Because they see it as a way of elevating themselves from girlhood to womanhood, and thereby a way of differentiating between each other, Thomas argues that to remove FGM is to remove that opportunity to gain authority. She writes that the "eradicationists" have responded to these criticisms by reaching out to the African communities and strengthening their relationships with local anti-FGM activists. For example, one of the issues that keeps FGM going in some communities is that the practitioners have no other way to earn a living. Organizations working to end it are therefore offering the women training of some kind; teaching them how to become farmers, for example.
The organization Tostan
provides a basic education program to African communities. Although ending FGM was not one of Tostan's initial objectives, it has become a rallying point for Tostan participants, leading many participants and their communities and social networks to publicly abandon this harmful tradition. As of July 2011, 6,236 communities in seven countries have abandoned female genital mutilation.
. It became illegal in the United States on 30 March 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.
In the UK, the Prohibition of Female Circumcision Act 1985
outlawed the procedure in Britain itself, and the Female Genital Mutilation Act 2003
and Prohibition of Female Genital Mutilation (Scotland) Act 2005
made it an offence for FGM to be performed anywhere in the world on British citizens or permanent residents. The Times reported in 2009 that there are 500 victims of FGM every year in the UK, but there have been no prosecutions. According to the Foundation for Women's Health, Research and Development
, 66,000 women in England and Wales have experienced FGM, with 7,000 girls at risk. Families who have immigrated from practising countries may send their daughters there to undergo FGM, ostensibly to visit a relative, or may fly in circumcisers, known as "house doctors" because they conduct the procedure in people's homes. The Guardian writes that the six-week-long school summer holiday in the UK is the most dangerous time of the year for these girls, a convenient time to carry out the procedure because they need several weeks to heal before returning to school.
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(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 practised in 28 countries in western, eastern, and north-eastern Africa, in parts of Asia and 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 WHO has offered four classifications of FGM. The main three are Type I, removal of the clitoral hood
Clitoral hood
In female human anatomy, the clitoral hood, , is a fold of skin that surrounds and protects the clitoral glans. It develops as part of the labia minora and is homologous with the foreskin in male genitals.-Variation:This is a protective hood of skin that covers the clitoral glans...
, almost invariably accompanied by removal of the clitoris
Clitoris
The clitoris is a sexual organ that is present only in female mammals. In humans, the visible button-like portion is located near the anterior junction of the labia minora, above the opening of the urethra and vagina. Unlike the penis, which is homologous to the clitoris, the clitoris does not...
itself (clitoridectomy
Clitoridectomy
Clitoridectomy is the surgical removal of the clitoris. It is rarely needed as a therapeutic medical procedure, such as when cancer has developed in or spread to the clitoris...
); Type II, removal of the clitoris and inner labia
Labia minora
The labia minora , also known as the inner labia, inner lips, or nymphae, are two flaps of skin on either side of the human vaginal opening, situated between the labia majora...
; and Type III (infibulation
Infibulation
Infibulation is the surgical modification or mutilation of the genitals in males and females, particularly the foreskin, labia minora and labia majora...
), removal of all or part of the inner and outer labia
Labia majora
The labia majora are two prominent longitudinal cutaneous folds that extend downward and backward from the mons pubis to the perineum and form the lateral boundaries of the pudendal cleft, which contains the labia minora, interlabial sulci, clitoral hood, clitoral glans, frenulum clitoridis, the...
, 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 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 February 6 since 2003. Sylvia Tamale
Sylvia Tamale
Sylvia Rosila Tamale was the first woman dean in the Law Faculty at Makerere University, Uganda.-Education:Tamale received her Bachelor of Laws with honors from Makerere University, her Master of Laws from Harvard Law School, and her Doctor of Philosophy , in Sociology and Feminist Studies from...
, an African 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.
Terminology
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 ChildrenInter-African Committee on Traditional Practices Affecting the Health of Women and Children
The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children is a non-governmental organization which seeks to change social values and raise consciousness towards eliminating female genital mutilation and other traditional practices which affect the health of...
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.
Other terms in use, apart from female circumcision, include female genital cutting (FGC), female genital surgeries, female genital alteration, female genital excision, and female genital modification. Elizabeth Heger Boyle writes that some organizations refer to it as female genital cutting because that is better received in the communities that practise it, who do not see themselves as engaging in mutilation; she writes that state-sponsored groups tend to call it FGM while private groups use FGC. Other groups, such as UNFPA and USAID, use the combined term "female genital mutilation/cutting" (FGM/C).
Local terms for the procedure include tahara in Egypt; tahur in Sudan; and bolokoli in Mali, which Anika Rahman and Nahid Toubia
Nahid Toubia
Nahid Toubia, born 1951 in Khartoum, Sudan, is a surgeon and women's health rights activist.Toubia attended medical school in Egypt. In 1981, she completed her surgical training in the United Kingdom, becoming a fellow of the Royal College of Surgeons and the first female surgeon in Sudan...
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
Sande society
Sande, also known as zadεgi, bundu, bundo and bondo, is a women's association found in Liberia, Sierra Leone and Guinea that initiates girls into adulthood, confers fertility, instills notions of morality and proper sexual comportment, and maintains an interest in the well-being of its members...
. 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 practise 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
Labiaplasty
Labiaplasty is a plastic surgery procedure for altering the labia minora and the labia majora, the paired tissue structures bounding the vestibule of the vulva. The indications for the correction of labial hypertrophy are two-fold: the correction of defect and deformity, and the cosmetic...
and vaginoplasty
Vaginoplasty
thumb|right|300px|Vaginoplasty: the pre-operative aspect , and the post-operative aspect of a [[Labiaplasty|labial reduction]].Vaginoplasty is a reconstructive plastic surgery procedure for correcting the defects and deformities of the vaginal canal and its mucous membrane, and of vulvo-vaginal...
, or those used in sex reassignment surgery
Sex reassignment surgery
Sex reassignment surgery is a term for the surgical procedures by which a person's physical appearance and function of their existing sexual characteristics are altered to resemble...
. According to the WHO, some practices regarded as legal in countries that have outlawed FGM do fall under the category of Type IV (see below), but the organization decided to maintain a broad definition to avoid loopholes that could allow FGM to continue.
History and cultural context
Libido
Libido refers to a person's sex drive or desire for sexual activity. The desire for sex is an aspect of a person's sexuality, but varies enormously from one person to another, and it also varies depending on circumstances at a particular time. A person who has extremely frequent or a suddenly...
. 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
Ancient Egypt
Ancient Egypt was an ancient civilization of Northeastern Africa, concentrated along the lower reaches of the Nile River in what is now the modern country of Egypt. Egyptian civilization coalesced around 3150 BC with the political unification of Upper and Lower Egypt under the first pharaoh...
under the Pharaoh
Pharaoh
Pharaoh is a title used in many modern discussions of the ancient Egyptian rulers of all periods. The title originates in the term "pr-aa" which means "great house" and describes the royal palace...
s, and "fibula" (in "infibulation") refers to the Roman
Ancient Rome
Ancient Rome was a thriving civilization that grew on the Italian Peninsula as early as the 8th century BC. Located along the Mediterranean Sea and centered on the city of Rome, it expanded to one of the largest empires in the ancient world....
practice of piercing the outer labia with a fibula, or brooch. Leonard Kuber and Judith Muascher write that circumcised females have been found among Egyptian mummies
Mummy
A mummy is a body, human or animal, whose skin and organs have been preserved by either intentional or incidental exposure to chemicals, extreme coldness , very low humidity, or lack of air when bodies are submerged in bogs, so that the recovered body will not decay further if kept in cool and dry...
, and that Herodotus
Herodotus
Herodotus was an ancient Greek historian who was born in Halicarnassus, Caria and lived in the 5th century BC . He has been called the "Father of History", and was the first historian known to collect his materials systematically, test their accuracy to a certain extent and arrange them in a...
(c. 484 BCE – c. 425 BCE) referred to the practice when he visited Egypt. There is reference on a Greek papyrus
Papyrus
Papyrus is a thick paper-like material produced from the pith of the papyrus plant, Cyperus papyrus, a wetland sedge that was once abundant in the Nile Delta of Egypt....
from 163 BCE to the procedure being conducted on girls in Memphis
Memphis, Egypt
Memphis was the ancient capital of Aneb-Hetch, the first nome of Lower Egypt. Its ruins are located near the town of Helwan, south of Cairo.According to legend related by Manetho, the city was founded by the pharaoh Menes around 3000 BC. Capital of Egypt during the Old Kingdom, it remained an...
, the ancient Egyptian capital, and Strabo
Strabo
Strabo, also written Strabon was a Greek historian, geographer and philosopher.-Life:Strabo was born to an affluent family from Amaseia in Pontus , a city which he said was situated the approximate equivalent of 75 km from the Black Sea...
(c. 64 BCE – c. 23 CE), the Greek geographer, reported it when he visited Egypt in 25 BCE.
Asim Zaki Mustafa argues that the common attribution of the procedure to Islam is unfair because it is a much older phenomenon. While individual Muslims, Christians, and Jews practise FGM, it is not a requirement of any religious observance. 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 circumcision is preferable but not required, and several have issued a fatwa against Type III FGM.
Sudanese surgeon Nahid Toubia
Nahid Toubia
Nahid Toubia, born 1951 in Khartoum, Sudan, is a surgeon and women's health rights activist.Toubia attended medical school in Egypt. In 1981, she completed her surgical training in the United Kingdom, becoming a fellow of the Royal College of Surgeons and the first female surgeon in Sudan...
—president of RAINBO
RAINBO
RAINBO - alternatively RAINB♀ - is an international non-governmental organisation working to eliminate female circumcision / female genital mutilation through women’s self-empowerment and social change.-Foundation and initial impact:RAINBO was founded in 1994 by a group of African immigrants...
(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
Imbecile
Imbecile is a term for moderate to severe mental retardation, as well as for a type of criminal. It arises from the Latin word imbecillus, meaning weak, or weak-minded. "Imbecile" was once applied to people with an IQ of 26-50, between "moron" and "idiot" .The term was further refined into mental...
" who was masturbating. Isaac Baker Brown
Isaac Baker Brown
Isaac Baker Brown was a prominent 19th century English gynaecologist and obstetrical surgeon. A specialist in gynaecology and the diseases of women, he was an advocate of the use various surgical procedures including the clitoridectomy as a cure for epilepsy and hysteria...
(1812–1873), an English gynaecologist who was president of the Medical Society of London
Medical Society of London
The Medical Society of London is one of the oldest surviving medical societies in the United Kingdom ....
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.
Classification and health consequences
The age at which the procedure is performed varies. Comfort MomohComfort Momoh
Comfort Iyabo Amah Momoh is a midwife in England who specializes in the study and treatment of female genital mutilation . Originally from Nigeria, she is a public health official at Guy's Hospital in London, where in 1997 she set up the African Well Women's Clinic, dedicated to caring for women...
, a specialist midwife in England, writes that in Ethiopia the Falashas perform it when the child is a few days old, the Amhara
Amhara people
Amhara are a highland people inhabiting the Northwestern highlands of Ethiopia. Numbering about 19.8 million people, they comprise 26% of the country's population, according to the 2007 national census...
on the eighth day of birth, while the Adere and Oromo
Oromo people
The Oromo are an ethnic group found in Ethiopia, northern Kenya, .and parts of Somalia. With 30 million members, they constitute the single largest ethnic group in Ethiopia and approximately 34.49% of the population according to the 2007 census...
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 anaesthesia or sterile equipment, though richer families may pay instead for the services of a nurse, midwife, or doctor using a local anaesthetic. It may also be performed by the mother or grandmother, or in some societies—such as Nigeria and Egypt—by the local male barber.
The WHO divides FGM into four categories (see image right for types I–III). Around 85 percent of women experience Types I and II, and 15 percent Type III, though Martha Nussbaum
Martha Nussbaum
Martha Nussbaum , is an American philosopher with a particular interest in ancient Greek and Roman philosophy, political philosophy and ethics....
writes that Type III nevertheless accounts for 80–90 percent of all such procedures in countries such as Sudan, Somalia, and Dijbouti.
Types I and II
Known in several communities as sunna circumcision, Type I is the removal of the clitoral hoodClitoral hood
In female human anatomy, the clitoral hood, , is a fold of skin that surrounds and protects the clitoral glans. It develops as part of the labia minora and is homologous with the foreskin in male genitals.-Variation:This is a protective hood of skin that covers the clitoral glans...
(Type Ia); or the partial or total removal of the clitoris, a clitoridectomy
Clitoridectomy
Clitoridectomy is the surgical removal of the clitoris. It is rarely needed as a therapeutic medical procedure, such as when cancer has developed in or spread to the clitoris...
(Type Ib). Type II, often called excision, is partial or total removal of the clitoris and the inner labia
Labia minora
The labia minora , also known as the inner labia, inner lips, or nymphae, are two flaps of skin on either side of the human vaginal opening, situated between the labia majora...
or outer labia
Labia majora
The labia majora are two prominent longitudinal cutaneous folds that extend downward and backward from the mons pubis to the perineum and form the lateral boundaries of the pudendal cleft, which contains the labia minora, interlabial sulci, clitoral hood, clitoral glans, frenulum clitoridis, the...
. Type IIa is removal of the inner labia only; Type IIb, partial or total removal of the clitoris and the inner labia; and Type IIc, partial or total removal of the clitoris, and the inner and outer labia.
Type III
Type III, commonly called infibulationInfibulation
Infibulation is the surgical modification or mutilation of the genitals in males and females, particularly the foreskin, labia minora and labia majora...
or pharaonic circumcision, is the removal of all external genitalia. The inner and outer labia are cut away, with or without excision of the clitoris. The girl's legs are then tied together from hip to ankle for up to 40 days to allow the wound to heal. The immobility causes the labial tissue to bond, forming a wall of flesh and skin across the entire vulva
Vulva
The vulva consists of the external genital organs of the female mammal. This article deals with the vulva of the human being, although the structures are similar for other mammals....
, apart from a hole the size of a matchstick for the passage of urine and menstrual blood, which is created by inserting a twig or rock salt into the wound. There is another form of Type III called matwasat, where the stitching of the vulva is less extreme and the hole left is bigger. Momoh describes a Type III procedure in Female Genital Mutilation (2005):
The vulva is cut open for sexual intercourse and childbirth. Momoh writes that, in some communities, when a pregnant woman who has not experienced FGM goes into labour, the procedure is performed before she gives birth, because it is believed the baby may be stillborn if it touches her clitoris. The risk of haemorrhage and death from FGM during labour is high, she writes. During three six-month studies in the 1980s, Hanny Lightfoot-Klein interviewed 300 Sudanese women and 100 Sudanese men, and described the penetration by the men of their wives' infibulation:
Type IV
A variety of other procedures are collectively known as Type IV, which the WHO defines as "all other harmful procedures to the female genitalia for non-medical purposes, for example, pricking, piercing, incising, scraping and cauterization." This ranges from ritual nicking of the clitoris—the main practice in Indonesia—to stretching the clitoris or labia, burning or scarring the genitals, or introducing harmful substances into the vagina to tighten it. It also includes hymenotomyHymenotomy
A hymenotomy is a minor medical procedure involving the surgical removal or opening of the hymen. It is often performed on patients with imperforate hymens or septate hymens, or other situations where the hymen is unusually thick or rigid. In the case of a female with a hymen without any opening,...
, the removal of a hymen
Hymen
The hymen is a membrane that surrounds or partially covers the external vaginal opening. It forms part of the vulva, or external genitalia. The size of the hymenal opening increases with age. Although an often practiced method, it is not possible to confirm with certainty that a girl or woman is a...
regarded as too thick, and gishiri cutting, a practice in which the vagina's anterior wall is cut with a knife to enlarge it.
Immediate and late complications
FGM is typically carried out by traditional practitioners, without anaesthesia, using unsterile cutting devices such as knives, razors, scissors, cut glass, sharpened rocks, and fingernails, and applying suturing material such as agaveAgave
Agave is a genus of monocots. The plants are perennial, but each rosette flowers once and then dies ; they are commonly known as the century plant....
or acacia
Acacia
Acacia is a genus of shrubs and trees belonging to the subfamily Mimosoideae of the family Fabaceae, first described in Africa by the Swedish botanist Carl Linnaeus in 1773. Many non-Australian species tend to be thorny, whereas the majority of Australian acacias are not...
thorns. Affluent people in urban settings may have the procedure done in a safer medical environment.
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 retention
Urinary retention, also known as ischuria, is a lack of ability to urinate. It is a common complication of benign prostatic hyperplasia , although it can also be caused by nerve dysfunction, constipation, infection, or medications...
, urinary infection, wound infection, septicemia, tetanus
Tetanus
Tetanus is a medical condition characterized by a prolonged contraction of skeletal muscle fibers. The primary symptoms are caused by tetanospasmin, a neurotoxin produced by the Gram-positive, rod-shaped, obligate anaerobic bacterium Clostridium tetani...
, and in case of unsterile and reused instruments, hepatitis
Hepatitis
Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
and HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
. 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". Momoh says the short-term mortality rate is around 10 percent, due to complications such as infection, haemorrhage, and hypovolemic shock
Hypovolemia
In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma...
. A film shot in Lunsar
Lunsar
Lunsar is one of the largest cities of Port Loko District in the Northern Province of Sierra Leone. The population was 16,567 in the 2004 census , but a 2010 estimate is 23,889 . The town lies about 22 miles east of the district capital of Port Loko and 65 miles east of Freetown . The...
, Sierra Leone, by Mariana van Zeller
Mariana van Zeller
Mariana van Zeller is a Portuguese journalist and former correspondent for the Vanguard documentary series on Current TV.-Biography:Van Zeller studied International Relations at the Universidade Lusíada de Lisboa...
in 2007 discusses how girls who bleed excessively are regarded as witches.
Late complications may vary depending on the type of FGM performed. The formation of scars and keloid
Keloid
A keloid is a type of scar, which depending on its maturity, is composed mainly of either type III or type I collagen. It is a result of an overgrowth of granulation tissue at the site of a healed skin injury which is then slowly replaced by collagen type 1...
s can lead to strictures, obstruction or fistula formation of the urinary and genital tracts. Urinary tract sequalae include damage to urethra and bladder with infections and incontinence
Incontinence
Incontinence or Incontinent may refer to:*Fecal incontinence, the inability to control one's bowels*Incontinence *Incontinent , a 1981 album by Fad Gadget*Urinary incontinence, the involuntary excretion of urine...
. Genital tract sequelae include vaginal and pelvic infections, dysmenorrhea
Dysmenorrhea
Dysmenorrhea is a gynecological medical condition of pain during menstruation that interferes with daily activities, as defined by ACOG and others. Still, dysmenorrhea is often defined simply as menstrual pain, or at least menstrual pain that is excessive...
, dyspareunia
Dyspareunia
Dyspareunia is painful sexual intercourse, due to medical or psychological causes. The symptom is reported almost exclusively by women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original...
, and infertility
Infertility
Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term...
. Complete obstruction of the vagina results in hematocolpos
Hematocolpos
Hematocolpos is a medical condition in which the vagina fills with menstrual blood. It is often caused by the combination of menstruation with an imperforate hymen....
and hematometra
Hematometra
Hematometra is a medical condition involving collection of blood in the uterus. It can rarely be caused by a proximal transverse vaginal septum, as can hematosalpinx.A collection or retention of blood in the uterine cavity. Also called hemometra....
. Other complications inlude epidermoid cyst
Epidermoid cyst
An epidermoid cyst is a benign cyst usually found on the skin. The cyst develops out of ectodermal tissue. Histologically, it is made of a thin layer of squamous epithelium.-Terminology:...
s that may become infected, neuroma formation, typically involving nerves that supplied the clitoris, and pelvic pain.
FGM may complicate pregnancy and place women at higher risk for obstetrical problems, which are more common with the more extensive FGM procedures. Thus, in women with Type III FGM who have developed vesicovaginal
Vesicovaginal fistula
Vesicovaginal fistula is a subtype of female urogenital fistula .-Presentation:VVF is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault....
or rectovaginal fistula
Rectovaginal fistula
A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina. Rectovaginal fistula may be extremely debilitating. If the opening between the rectum and vagina is wide it will allow both flatulence and feces to escape through the...
e—holes that allows urine and feces to seep into the vagina—it is difficult to obtain clear urine samples as part of prenatal care making the diagnosis of certain conditions harder, such as preeclampsia. Cervical evaluation during labour may be impeded, and labour prolonged. Third-degree laceration, anal sphincter damage, and emergency caesarean section are more common in FGM women than in controls. Neonatal mortality is increased in women with FGM. The WHO estimated that an additional 10–20 babies die per 1,000 deliveries as a result of FGM; the estimate was based on a 2006 study conducted on 28,393 women attending delivery wards at 28 obstetric centers in Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan. In those settings all types of FGM were found to pose an increased risk of death to the baby: 15 percent higher for Type I, 32 percent for Type II, and 55 percent for Type III.
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
Dyspareunia
Dyspareunia is painful sexual intercourse, due to medical or psychological causes. The symptom is reported almost exclusively by women, although the problem can also occur in men. The causes are often reversible, even when long-standing, but self-perpetuating pain is a factor after the original...
(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.
Reinfibulation and defibulation
Women may request reinfibulation (RI)—the restoration of the infibulation—after 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
Pierre Foldes
The French surgeon, of Hungarian origin, Pierre Foldès is the inventor, in collaboration with the urologist Jean-Antoine Robein, of a technique to repair the damage caused by female genital mutilation...
, a French urologist and surgeon, and Marci Bowers
Marci Bowers
Marci L. Bowers is an American gynecologist who operated a surgical practice in Trinidad, Colorado. She has moved her practice to California in December 2010. Bowers is viewed as an innovator in the field of transgender surgery, as well as a pioneer, being the first transsexual woman to be...
, an American surgeon who studied his work; they used intact clitoral tissue from inside women's bodies to form a new clitoris.
Prevalence and attempts to end the practice
Practicing countries
According to the WHO, 100–140 million women and girls are living with FGM, including 92 million girls over the age of 10 in Africa. The practice persists in 28 African countries, as well as in the Arabian PeninsulaArabian Peninsula
The Arabian Peninsula is a land mass situated north-east of Africa. Also known as Arabia or the Arabian subcontinent, it is the world's largest peninsula and covers 3,237,500 km2...
, where Types I and II are more common. It is known to exist in northern Saudi Arabia, southern Jordan, northern Iraq (Kurdistan
Iraqi Kurdistan
Iraqi Kurdistan or Kurdistan Region is an autonomous region of Iraq. It borders Iran to the east, Turkey to the north, Syria to the west and the rest of Iraq to the south. The regional capital is Arbil, known in Kurdish as Hewlêr...
), and possibly Syria, western Iran, and southern Turkey. It is also practised in Indonesia, but largely symbolically by pricking the clitoral hood or clitoris until it bleeds.
Several African countries have enacted legislation against it, including Burkina Faso, Central African Republic, Djibouti, Eritrea, Togo, and Uganda. President Daniel Moi of Kenya issued a decree against it in December 2001. In Mauritania, where almost all the girls in minority communities undergo FGM, 34 Islamic scholars signed a fatwa in January 2010 banning the practice.
In Egypt, the health ministry banned FGM in 2007 despite pressure from some (though not all) Islamic groups. Two issues in particular forced the government's hand. A 10-year-old girl was photographed undergoing FGM in a barber's shop in Cairo in 1995 and the images were broadcast by CNN; this triggered a ban on the practice everywhere except in hospitals. Then, in 2007, 12-year-old Badour Shaker died of an overdose of anaesthesia during or after an FGM procedure for which her mother had paid a physician in an illegal clinic the equivalent of $9.00. The Al-Azhar Supreme Council of Islamic Research, the highest religious authority in Egypt, issued a statement that FGM had no basis in core Islamic law, and this enabled the government to outlaw it entirely.
Colonial opposition
Kikuyu Central Association
The Kikuyu Central Association , led by James Beauttah and Joseph Kang'ethe, was a political organisation in colonial Kenya formed in 1924/5 to act on behalf of the Kĩkũyũ community by presenting their concerns to the British government. One of its greatest grievances was the expropriation of the...
. Jomo Kenyatta (c. 1894–1978), who became Kenya's first prime minister in 1963, wrote in 1930:
Support for the practice also came from the women themselves. E. Mary Holding, a Methodist missionary in Meru
Meru, Kenya
-Transport:The City of Meru is linked to Nairobi by a paved road, whether from the south around the east side of Mount Kenya, via Embu, or from the northwest around the west and north side of Mount Kenya, via Nanyuki and Timau....
, Kenya, wrote in 1942 that the circumcision ritual was an entirely female affair, organized by women's councils known as kiama gia ntonye ("the council of entering"). The ritual not only saw the girls become women, but also allowed their mothers to become members of the council, a position of some authority.
Similarly, prohibition strengthened tribal resistance to the British in the 1950s, and increased support for the Mau Mau Uprising
Mau Mau Uprising
The Mau Mau Uprising was a military conflict that took place in Kenya between 1952 and 1960...
(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
Sylvia Tamale
Sylvia Rosila Tamale was the first woman dean in the Law Faculty at Makerere University, Uganda.-Education:Tamale received her Bachelor of Laws with honors from Makerere University, her Master of Laws from Harvard Law School, and her Doctor of Philosophy , in Sociology and Feminist Studies from...
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.
Since the 1960s
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 HoskenFran Hosken
Fran P. Hosken was an American writer, feminist, and social activist. She founded the Women's International Network in 1975, and published a quarterly journal on women's health issues that became known, in particular, for its research into female genital mutilation...
(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.
Nawal El Saadawi
Nawal El Saadawi , born October 27, 1931, is an Egyptian feminist writer, activist, physician and psychiatrist. She has written many books on the subject of women in Islam, paying particular attention to the practice of female genital mutilation in her society....
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 death
Dowry death
Dowry deaths are the deaths of young women who are murdered or driven to suicide by continuous harassment and torture by husbands and in-laws in an effort to extort an increased dowry. Dowry deaths are reported in various South Asian countries such as India, Pakistan, and Bangladesh. Dowry death...
s—as a human rights violation, rather than as a health concern, and this encouraged academic interest, including from feminist legal scholars. In June 1993 the Vienna World Conference on Human Rights
World Conference on Human Rights
The World Conference on Human Rights was held by the United Nations in Vienna, Austria, on 14 to 25 June 1993. It was the first human rights conference held since the end of the Cold War...
agreed that FGM was a violation of human rights.
Some of the international opposition to FGM continues to attract critics. The Hosken Report, in particular, was criticized for its alleged ethnocentrism
Ethnocentrism
Ethnocentrism is the tendency to believe that one's ethnic or cultural group is centrally important, and that all other groups are measured in relation to one's own. The ethnocentric individual will judge other groups relative to his or her own particular ethnic group or culture, especially with...
, its negative statements about African society, and its insistence on Western intervention. Sylvia Tamale wrote in 2011 that some African feminists interpret traditional practices such as FGM within a post-colonial context that makes opposing them a complex issue. While critical of FGM, they object to what Tamale calls the imperialist infantilization of African women inherent in the idea that FGM is simply a barbaric rejection of enlightenment and modernity.
Lynn Thomas writes that the ritual of FGM has been the primary context in some communities in which the women come together. Because they see it as a way of elevating themselves from girlhood to womanhood, and thereby a way of differentiating between each other, Thomas argues that to remove FGM is to remove that opportunity to gain authority. She writes that the "eradicationists" have responded to these criticisms by reaching out to the African communities and strengthening their relationships with local anti-FGM activists. For example, one of the issues that keeps FGM going in some communities is that the practitioners have no other way to earn a living. Organizations working to end it are therefore offering the women training of some kind; teaching them how to become farmers, for example.
The organization Tostan
Tostan
Tostan is a US-registered 501 international nongovernmental organization with operations in over 500 communities in Senegal, Guinea, Guinea-Bissau, The Gambia, Mauritania, Somalia, and Djibouti...
provides a basic education program to African communities. Although ending FGM was not one of Tostan's initial objectives, it has become a rallying point for Tostan participants, leading many participants and their communities and social networks to publicly abandon this harmful tradition. As of July 2011, 6,236 communities in seven countries have abandoned female genital mutilation.
Non-practicing countries
As a result of immigration, FGM 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 CanadaCriminal Code of Canada
The Criminal Code or Code criminel is a law that codifies most criminal offences and procedures in Canada. Its official long title is "An Act respecting the criminal law"...
. It became illegal in the United States on 30 March 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
Matter of Kasinga
The Matter of Kasinga was a legal case decided in June 1996 involving Fauziya Kassindja , a Togolese teenager seeking asylum in the United States in order to escape a tribal practice of female genital mutilation. The Board of Immigration Appeals granted her asylum in June 1996 after an earlier...
, 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.
In the UK, the Prohibition of Female Circumcision Act 1985
Prohibition of Female Circumcision Act 1985
The Prohibition of Female Circumcision Act 1985 is an Act of the Parliament of the United Kingdom. It made female genital mutilation a crime throughout the UK....
outlawed the procedure in Britain itself, and the Female Genital Mutilation Act 2003
Female Genital Mutilation Act 2003
The Female Genital Mutilation Act 2003 is an Act of the Parliament of the United Kingdom. It extended previous legislation by also making it illegal for UK nationals to perform female genital mutilation outside the borders of the UK, and increased the maximum penalty from five to 14 years.The Act...
and Prohibition of Female Genital Mutilation (Scotland) Act 2005
Prohibition of Female Genital Mutilation (Scotland) Act 2005
The Prohibition of Female Genital Mutilation Act 2005 is an Act of the Scottish Parliament. It extended previous legislation by also making it illegal for UK nationals to perform female genital mutilation outside the borders of the UK. There have been no known cases of girls from Scotland being...
made it an offence for FGM to be performed anywhere in the world on British citizens or permanent residents. The Times reported in 2009 that there are 500 victims of FGM every year in the UK, but there have been no prosecutions. According to the Foundation for Women's Health, Research and Development
Foundation for Women's Health, Research and Development
The Foundation for Women's Health, Research and Development is a British charity, founded in 1983 by Efua Dorkenoo, that provides support for women affected by female genital mutilation . It also works to end the practice, and campaigns against child/forced marriage. The organization runs several...
, 66,000 women in England and Wales have experienced FGM, with 7,000 girls at risk. Families who have immigrated from practising countries may send their daughters there to undergo FGM, ostensibly to visit a relative, or may fly in circumcisers, known as "house doctors" because they conduct the procedure in people's homes. The Guardian writes that the six-week-long school summer holiday in the UK is the most dangerous time of the year for these girls, a convenient time to carry out the procedure because they need several weeks to heal before returning to school.
Resources
- FORWARD, The Foundation for Women's Health, Research and Development, accessed 9 September 2011.
- "Hospitals and Clinics in the UK offering Specialist FGM (Female Genital Mutilation) Services", FORWARD, accessed 7 September 2011.
Books
- Abdalla, Raqiya Haji Dualeh. Sisters in Affliction: Circumcision and Infibulation of Women in Africa. Zed Books, 1982.
- Aldeeb, SamiSami A. AldeebSami Awad Aldeeb Abu-Sahlieh, born September 5, 1949 in Zababdeh, near Jenin in West Bank is a lawyer, Christian of Palestinian origin and SwissHe was the head of the Arab and Islamic Law in the Swiss Institute of Comparative Law from 1980 to 2009...
. Male & female circumcision: Among Jews, Christians and Muslims. Shangri-La Publications, 2001. - Dorkenoo, EfuaEfua DorkenooEfua Dorkenoo is a Ghanaian campaigner against female genital mutilation . She was one of the founders in 1983 of the Foundation for Women's Health, Research and Development , a British charity that supports women who have experienced FGM. Dorkenoo is the author of Cutting the Rose: Female Genital...
. Cutting the rose: Female genital mutilation. Minority Rights Publications, Harry Ransom Humanities Research Center, 1996. - Sanderson, Lilian Passmore. Against the Mutilation of Women. Ithaca Press, 1981.
- Skaine, Rosemarie. Female Genital Mutilation. McFarland & Company, 2005.
Background reading
- Dettwyler, Katherine AKathy DettwylerDr. Katherine A. Dettwyler is an anthropology professor at the University of Delaware in Newark, Delaware. She is also a lecturer, author and breastfeeding advocate....
. Dancing Skeletons: Life and Death in West Africa. Waveland Press, 1994. - Mernissi, Fatima. Beyond the Veil: Male-Female Dynamics in a Modern Muslim Society. Indiana University Press, 1987 [first published 1975].