Female Genital Mutilation

Definition

Female genital mutilation (FGM) is the cutting, or partial or total removal, of the external female genitalia for cultural, religious, or other non-medical reasons. It is usually performed on girls between the ages of four and 10. It is also called female circumcision.

Purpose

FGM results in the cutting or removal of the tissues around the vagina that give women pleasurable sexual feelings. This procedure is used for social and cultural control of women's sexuality. In its most extreme form, infibulation, where the girl's vagina is sewn shut, the procedure ensures virginity. In some cultures where female circumcision has been a tradition for hundreds of years, this procedure is considered a rite of passage for young girls. Families fear that if their daughters are left uncircumcised, they may not be marriageable. As in most cultures, there is also the fear that the girl might bring shame to the family by being sexually active and becoming pregnant before marriage.

Precautions

It is illegal to perform FGM in many countries, including the United States, Canada, France, Great Britain, Sweden, Switzerland, Egypt, Kenya, and Senegal. This procedure is usually done in the home or somewhere other than a medical setting. Often, it is performed by a family member or by a local "circumciser," using knives, razor blades, or other tools that may not be sterilized before use.

Description

Female circumcision includes a wide range of procedures. The simplest form involves a small cut to the clitoris or labial tissue. A Sunna circumcision removes the prepuce (a fold of skin that covers the clitoris) and/or the tip of the clitoris. A clitoridectomy removes the entire clitoris and some or all of the surrounding tissue; this procedure occurs in approximately 80% of cases. The most extreme form of genital mutilation is excision and infibulation, in which the clitoris and all of the surround tissue are cut away and the remaining skin is sewn together. Only a small opening is left for the passage of urine and menstrual blood. Infibulation accounts for approximately 15% of FGM procedures.

The World Health Organization (WHO) estimates that between 100 million and 140 million girls and women have undergone some form of FGM. As a very deeply rooted cultural and religious tradition still practiced in over 28 African and Asian countries, up to two million girls per year are at risk. The following countries have the highest number of occurrences of FGM: Djibouti (98%), Egypt (97%), Eritrea (95%), Guinea (99%), Mali (94%), Sierra Leone (90%), and Somalia (98-100%). As more people move to Western countries from countries where female circumcision is performed, the practice has come to the attention of health professionals in the United States, Canada, Europe, and Australia.

In an effort to integrate old customs with modern medical care, some immigrant families have requested that physicians perform the procedure. While trying to be sensitive to cultural traditions, health care providers are sometimes put in the difficult position of choosing to perform this procedure in a medical facility under sanitary conditions, or refusing the request, knowing that it may be done anyway with no medical supervision. Some families who are intent on having this procedure done will take their daughters back to the country they immigrated from in order to have the girls circumcised.

Many national and international medical organizations including the American Medical Association (AMA), Canadian medical organizations, and WHO oppose the practice of female genital mutilation. The United Nations (UN) considers female genital mutilation a violation of human rights. WHO has undertaken a number of projects aimed at decreasing the incidence of FGM. These include the following activities:

• publishing a statement addressing the regional status of FGM and encouraging the development of national policy against its practice,
• organizing training for regional community workers,
• developing educational materials for local health care workers,
• providing alternative occupations for individuals who perform FGM procedures.

KEY TERMS

Circumcision— A procedure, usually with religious or cultural significance, where the prepuce or skin covering the tip of the penis on a boy, or the clitoris on a girl, is cut away.

Clitoridectomy— A procedure where the clitoris and possibly some of the surrounding labial tissue at the opening of the vagina is cut away.

Infibulation— A procedure where the tissue around the vagina is sewn shut, leaving only a small opening for the passage of urine and menstrual blood.

Aftercare

A girl or young woman who has recently had the procedure performed may require supportive care to control bleeding and antibiotics to prevent infection. Women who were circumcised as children may require medical care to treat complications. Pregnant women who have been infibulated may have to have the labial tissue cut open to allow the baby to be delivered. Aftercare should be provided with a supportive and nonjudgmental approach towards the girls and women who have undergone this procedure.

Risks

The immediate risks after the procedure are hemorrhage (excessive bleeding), severe pain, and infection (including abscesses, tetanus, and gangrene ). The most severe consequence is death due to excessive blood loss. Long term complications include scarring, interference with the drainage of urine and menstrual blood, chronic urinary tract infections, pelvic and back pain, and infertility. Sexual intercourse can be painful. Complications of childbirth are also a risk. It is unclear whether it is related to the procedure itself, or related to the general condition of medical practice, but infant and maternal death rates are generally higher in those communities where female circumcision is practiced.

Resources

OTHER

The Female Genital Mutilation Research Homepage. 〈http://www.hollyfeld.org/fgm〉.

"Female Genital Mutilation." The World Health Organization. 〈http://www.who.int/frh-whd/FGM/index.htm〉.

FEMALE GENITAL MUTILATION

Surgical operation performed on girls in the Nile Valley, northeast Africa, and parts of West Africa

Female circumcision has been the subject of fascination, horror, and feminist agitation in the West. There is little doubt that circumcising women is linked to control of female sexuality. In the feminist literature, the term female genital mutilation (FGM) has tended to replace female circumcision as a more accurate description of the operation performed upon young African girls in the Nile Valley, northeast Africa, and parts of West Africa.

There is no reference to female circumcision in the Qurʾan, and it is only mentioned in the hadith where Muhammad is said to have advised the use of the sunna (customary) method, not to destroy or mutilate, for this is better for the man and would make the woman's face glow. The right of a woman to sexual satisfaction in marriage is upheld in Muslim interpretations. There is general agreement that female circumcision was already customary in societies where Islam spread, and that since it was not prohibited by Islam its continued practice was permitted.

The greatest prevalence of female circumcision is in the African continent—especially in northeast and eastern Africa and across the Sahel to West Africa—where it is also practiced by some Christian groups in Ethiopia and Egypt. The Islamic faith enjoins modesty and proper sexual conduct for both males and females, but as is true for other faiths originating in the Middle East, the sexual double standard demands more protection and greater monitoring of women to guard their chastity. Female circumcision is a powerful ally, but it is neither the only approach nor is it commanded by Islam. The religious scholars (ulama) in different Muslim countries have at different times interpreted the shariʿa as either being neutral to the practice (Sudan during colonial times) or in favor of female circumcision (Egypt under recent Islamist pressure). The grand shaykh of Al-Azhar University, Gad al-Haq Ali Gad al-Haq, ruled in a 1995 fatwa that "female circumcision is a noble practice that does honor to a woman," and that medieval scholars had ruled that both male and female circumcision is mandated by Islamic law. However, Egypt's grand mufti Sayyid Tantawi argued that circumcising women is not part of Islamic teaching and is a matter best evaluated by medical professionals.

Three different forms of circumcision are recognized: (1) clitoridectomy, or the excision of the tip of the clitoris only; (2) modified excision, or the removal of the clitoris and parts of the labia majora and minora; (3) infibulation, or excision of the clitoris and all of the labia majora and minora, leaving a smooth vulva and a small opening for the common flow of urine and menses. The latter (called Pharaonic circumcision in Sudan) is most widely practiced in Somalia and parts of East Africa. The less severe forms of the operation are more commonly found in West Africa. Female circumcision is not practiced in some of the most patriarchal of Muslim countries, such as Saudi Arabia or Afghanistan, or in Jordan, where killings of allegedly un-chaste women are believed to protect family honor.

The global women's rights movement has asserted that female circumcision is in a category with other human rights violations, such as domestic abuse and honor killings. An international human rights campaign against FGM has advocated banning it, or at least some amelioration of the practice, as a violation of girls' and women's rights. The Vienna Human Rights Conference in 1993 and the Beijing International Women's Conference in 1995 passed resolutions against FGM and called for state-supported and international educational and public health campaigns to end or ameliorate the various practices associated with it.

See also Circumcision; Hadith; Shariʿa.

Bibliography

Gruenbaum, Ellen. The Female Circumcision Controversy. Philadelphia: University of Pennsylvania Press, 2000.

Sanderson, Lilian Passmore. Against the Mutilation of Women. London: Ithaca Press, 1981.

Toubia, Nahid. Female Genital Mutiliation: A Call for Global Action. New York: Women Ink, 1995.

carolyn fluehr-lobban

female genital mutilation see circumcision .