This month's column is about female genital mutilation (FGM), an ancient and terrible practice that is still prevalent in many countries. It is also known as "female circumcision" and "female cutting". The World Health Organization (WHO) describes it as follows 1:
Female genital mutilation applies to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons.
The WHO has classified four types of FGM:
Type I- Excision of the prepuce with or without excision of part or all of the clitoris;
Type II- Excision of the clitoris with partial or total excision of the labia minora.
Type III- Excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (also known as infibulation).
Type IV- Unclassified: this includes pricking, piercing or incising of the clitoris and/or labia; stretching of the clitoris and/or labia, cauterization by burning of the clitoris and surrounding tissue.
Over 130 million girls and women have undergone this practice, often seen as a rite of passage from childhood into adulthood. The procedure is often performed on girls between the age of four and twelve years of age. In some countries, it is carried out on infants as young as a few days' old, and in others it is reserved for the time just before marriage or after the first pregnancy.2
In the last couple of decades, there have been significant advances in the campaign to eradicate FGM, led by local non-governmental organizations (NGOS) and groups working at the grassroots level, with increasing support from many governments, and numerous development aid, health and human rights groups.
Before, the practice was shrouded in secrecy and silence, and those who dared to challenge it, were accused of cultural interference or betrayal. More recently, better access to education, the introduction of laws prohibiting FGM, and the work of development, health and human rights groups have started to give some positive results, especially in urban areas. Efforts have concentrated in explaining the harmful health effects of FGM, and encouraging communities to adopt other, non-invasive rites of passage. However, WHO estimates that around 2 million girls still face the risk of being subjected to FGM every year.
In recent years, campaigners have been able to enlist the support of some religious and community leaders to condemn the practice. There is, however, much resistance to change that still remains.
FGM is known to have existed for several thousand years in more than 28 countries in Africa in the Sub-Saharan and Northeast region and parts of the Middle East, although it has been reported to a lesser extent in small Muslim groups in Asia and in some indigenous groups in South America. There have been reports of FGM among African immigrant populations in host countries in Western Europe and North America. Although often perceived as sanctioned by religion, Islam in particular, the practice predates Christianity and Islam in Africa and continues to be practiced by Jew, Muslims, Christians and adherents of indigenous religions throughout the continent.
The exact origin of the practice remains a mystery. However, research indicates that in the 5th Century BC, Egyptians used it as a ritual prior to marriage. Early Romans and Arabs did it for cosmetic reasons or sometimes as an indication of slavery and subordination. It is believed that the practice spread south into Africa through trade and the spread of Islam.
In some communities, FGM is seen as necessary to preserve girls' suitability for marriage and to protect the honor of the family, clan or tribe. FGM is also perpetuated by various myths including beliefs that the woman's clitoris would grow if left uncut potentially harming a baby in childbirth. These beliefs increase the social pressure faced by uncircumcised women, who run the risk of isolation and ridicule in their communities or men's refusal to marry them, in societies where women depend on their husbands for their economic and social status. Families in communities which have practiced FGM for centuries, often lacking access to other points of view, usually believe that circumcision must be carried out for the girl's own good.
The procedure is often carried out by traditional circumcisers, often an older woman. In a large number of cases it is performed in unsterile surroundings with the girl forcibly restrained. Traditional practitioners use razor blades, knives (in some cases specially designed for the practice), and pieces of glass or scissors. There have been reports of sharp stones used as cutting tools, as well as cauterization or burning. In recent years circumcisions have also been carried out in hospitals and clinics, giving rise to much controversy about whether this is a positive measure, or whether it helps to legitimize the practice.
FGM is known to have serious potential health consequences to women and girls, both psychological and physical. Although it has so far been difficult to document its psychological effects, a number of immediate and long-term physical consequences have been identified. Bleeding, post-operative shock, damage to other organs (ureter, bladder, vaginal walls), infection (including tetanus), and risk of inflammation are believed to be some of the immediate effects of FGM. Long-term effects include chronic infections of the bladder, vagina, pain during menstruation, pain during sexual intercourse, higher risk of HIV infection and infertility. The more severe types of circumcision, such as infibulation, carry the higher health risks.
From a human rights perspective, FGM is a violation of women and girls' basic human rights including the right to life, the right to be protected from cruel, inhuman, or degrading treatment or punishment, the right to physical integrity, and the right to health. The work to eradicate FGM has started, but there is an urgent need to step up the campaign, to protect the hundreds of thousands of young girls who are at risk today.
In order to find out more about the practice and what you can do to help in the struggle to eradicate FGM, please contact
1. See WHO document (WHO/FRH/WHD/96.10)
2. See Rahman and Toubia 2000