"FEMALE GENITAL MUTILATION - A GLOBAL OVERVIEW"

A paper by Linda Williams, London School of Hygiene and Tropical Medicine
                                   at
  Amnesty International UK Section Conference on Women and Human Rights



Female Genital Mutilation: An Overview

Female Genital Mutilation (often abbreviated to FGM) is a more recent name for a practice also
called female circumcision. FGM is a medically unnecessary and harmful operation on the genitalia
of girls, and can even lead to death. There is no doubt that it contravenes a variety of human rights
of both the woman and the child. Many people are shocked and horrified when they first learn
about FGM, and call vociferously for its eradication. However, to women living in communities
where FGM is practised, FGM is a normal way of life, something not to be discussed publicly, and
something that outsiders have no right to interfere in. For this reason there are no easy solutions
when it comes to eradicating FGM.

This paper gives a summary of the practice of FGM and its effects. It then considers why FGM
continues when it is so harmful. Finally, different approaches to eradication are discussed. This
is summarised in the diagram showing "The vicious circle of FGM and how to break it".


The practice of FGM

The vast majority of female genital operations consist of the amputation of all or part of the
clitoris, and/or all part of the labia minora (the intemal vaginal lips). These operations are referred
to as clitoridectomy and excision. The amount of the female genitalia removed in the operation
varies between different countries and ethnic groups. A more extreme operation called
infibulation, consists ofthe removal of the clitoris labia minora as just described, followed by the
stitching together of the labia majora (the outer vaginal lips) to cover the opening to the vagina.
A very small opening is left for urine and menstrual blood.

It is usually the women in a family or village who plan, organise and perform the circumcision
operations. The most common age for girls to be circumcised is probably between 4-8 years old,
although in some groups it happens shortly after birth and in others it is after adolescence. Girls
rarely know exactly what will happen to them during the circumcision but many approach the
operation with a feeling of joy, as well of fear, because at this time they are made to feel special
and are often given gifts and treats. During the operation the girl is held immobile on the ground
with her legs wide open, while the operator cuts the girls genitals with a knife or razor blade.
Traditional medicines are usually applied aflerwards. Some operators manage to acquire antiseptic
powder to use, and some girls from richer, urban families may be operated on by a trained medical
practitioner under aseptic conditions, but the majority have to take their chances with a traditional
operator.

FGM is more widespread than many people imagine. It occurs mainly in Africa in countries north
of the equator, with the more extreme form, infibulation, occurring in Somalia and Sudan (see
diagram). There are no reliable estimates of how common FGM is in each country, but the
evidence available has been compiled by an activist called Fran Hosken who estimates that around
127 million women are affected. In addition to Africa, FGM is also found in Europe, USA and
Australia among people who have migrated from countries where it is practised. In Asia a mild
form of FGM is practised in Indonesia and also possibly in Malaysia. A few ethnic groups in
Yemen and Oman also practise FGM as does a small ethnic group in India.



The Effects of Female Genital Mutilation

The circumcision operation is extremely painful, and bleeding can be severe, sometimes leading
to death. Infections after the operation are common, and can also lead to death. HIV may be
spread by repeated use of the same cutting instrument on several girls. Long-term problems of
FGM include soreness, infections, abscesses and painful nerve tumours. These problems are more
frequent and serious in infibulated women who in addition can suffer from problems associated
with obstructed urinary or menstrual flow because of the small size of the opening left after their
circumcision. This small opening can also make first sexual intercourse extremely painful, with
young women frequently having to be cut before penetration can take place. During childbirth,
the scar tissue of excised women can split, and infibulated women have to be cut open in order
to deliver. The removal of sexually sensitive organs must also affect sexual enjoyment, although
this aspect of the effects of FGM is not well understood, and it has been suggested that
compensatory mechanisms can come into play which mitigate some of the damage. The
psychological eect of having organs surgically removed without anaesthetic, and then suffering
the consequent health problems, is also not well understood, because it is impossible to isolate the
psychological effects of the trauma of circumcision from the psychological benefits of the high
social status that circumcision gives. This leads us to consider the reasons for FGM.


Reasons for FGM

As mentioned previously it is women who, out of love and a sense of responsibility for their
daughters, plan and organise circumcisions. What do they believe that FGM is doing for them?
Many believe that removing the clitoris (male part) makes the girl fully feminine both physically
and in personality. Many believe that having these organs removed brings cleanliness and purity
and is beautiful. Some think that women will be sexually promiscuous and therefore shamed if
they are not circumcised. They also believe that circumcision prepares the girl for the pain of
childbirth and shows that she is strong enough to endure the general hardships of being a woman.
Some believe that circumcision bestows greater fertility on a woman and that it ensures safer
childbirth. Some think that it is a religious requirement. Therefore in such a society a circumcised
woman is seen as feminine, clean, adult and morally upright, a decent member of society and
hence most importantly marriageable. Conversely an uncircumcised woman is seen as unfeminine,
dirty, childish and morally loose. Not only might she not be marriageable, but she may be excluded
from festivities or even simple activities like fetching water. In the face of such overwhelming
social pressure it is perhaps understandable that women opt for circumcision even if they have
worries about the health risks that accompany it.

It is worth giving a more detailed consideration of Islam and FGM. There are many factors which
indicate that FGM is not an Islamic practice. The first is that Christians, Jews and animists practice
female circumcision as well as Moslems. The second is that many Moslems do not practice female
circumcision. The third is that FGM pre-dates Islam, and the fourth is that the Qu'ran forbids
anything that is harmful to health. The Qu'ran does not contain any teaching on FGM but some
hadith (sayings attributed to the Prophet Muhammad) do, and there is a debate amongst Islamic
scholars about how to interpret these. Authorities on Islam agree that infibulation is contrary to
Islarn. However, local religious leaders oen condone it. For excision there is a high level debate


amongst scholars, with confiicting edicts being given by different authorities. This lack of a
definite and authoritative stand against FGM is hampering efforts at eradication. However, it
should be noted that Christian leaders have also, at times, condoned FGM, or turned a blind eye
to it, in order to keep converts.


Eradication

Given that FGM is so socially and culturally deep-rooted, and given that it is a practice
perpetuated and supported at the grass roots level, how should efforts at eradication be directed?

Specific legislation against FGM is in place in a few African countries. However, the widespread
and popular nature of the practice, combined with the resources of the countries affected, mean
that prosecutions are rare. Similarly, in the UK FGM occurs and is illegal, but there have been no
prosecutions as the governrnent prefers to address the problem under child protection legislation.
Generally then specific legislation against FGM is presently used to symbolise a government's
stance on FGM rather than as a tool for bringing about prosecutions, but even so it is welcomed
by activists. However, in some countries (Ghana, Burkina Faso, France and Australia) there have
been a few widely publicised arrests, court cases and prosecutions involving circumcisers and
parents, either under specific legislation or general assault laws. The effect of these trials on FGM
practice in these countries is not known.

In most countries health workers are not permitted to perform FGM. Another medico-legal
problem is whether health professionals should be permitted to perform FGM, on the grounds that
it would reduce medical complications. Activists are strongly against this on the grounds that it
will legitimise and therefore perpetuate the practice. Other issues, especially in the UK are
whether FGM constitutes child abuse and how it should be handled by health and social workers.

FGM is perpetuated at the community level and therefore the main effort to eradicate it has to be
health-education and consciousness raising to persuade communities to give up the practice or
replace it with something less damaging.

Women' s groups have been found to be one of the most effective means of communicating to
women about FGM. They know the reasons and pressures for FGM in their own community and
they are trusted by the women. It is often taboo to even talk about FGM in public but women's
groups know how to handle talk of"women's matters". They can also provide support for women
who try to go against the norm of circumcision in their society. In addition to discussions by
women's groups, radio can also be used to communicate information about FGM with radio
debates and soaps being paricularly effective.

It is not just the women who need to be persuaded against FGM. Young men and their families
need to be persuaded that uncircumcised women make good wives. The circumcisers need to be
persuaded to give up a profession which is lucrative and gives them a high status in society,
something which perhaps can only be done by actually providing them with an alternative.
Another extremely important group to persuade are the local community and religious leaders
who are oen extremely powerful in African communities.


Always it is a risk to talk to these communities and try to persuade them against this deeply rooted
custom. Many activists against FGM ponder the different approaches they should use to persuade
people. Should they take the safest approach and simply address the health issues? How can they
persuade people that FGM is unnecessary and harmful while at the same time not denigrating
those who have already been circumcised? Should they try and persuade people that it is not a
religious requirement, when local religious leaders explicitly or implicitly condone it? Should they
address the fundamental status of women in these societies? Should they argue that women have
the right to sexual enjoyment? It is perhaps better to just let each group judge how far to go in
their own society.

What can be done at the national and international level? In addition to the introduction of
legislation, the role of national government should be to facilitate the health education and
consciousness raising efforts against FGM in their country. Alongside any statistics on legislation
for each country there should be statistics on how much each effort has actually been put into anti-
FGM activities. Governments should also introduce measures to raise the status of women
generally, for example by encouraging girl's education and making inheritance and ownership laws
fair.

National and international organisations such as the World Health Organisation play an important
role in advocacy, co-ordination and facilitation of health education and consciousness raising
efforts. Many such organisations are currently providing money for research and health education
programmes on FGM. One major research problem is proving that these programmes do actually
have an effect and that fewer girls are circumcised.

To finish with we will examine the progress so far. About 15 years ago it was almost impossible
to even mention FGM publicly in many practising societies. Governments and international
organisations were afraid to take a stand on the topic because it was considered too controversial.
Hardly anyone outside of practising communities knew about FGM. At that time a few pioneering
women were courageous enough to stand up and speak against FGM. They worked with
practising communities encouraging openness and questioning of the practice. Now it is much
easier to actually speak about FGM with these communities. These early activists worked in the
intemational community to educate people about FGM and to motivate them to advocate against
it. This has been very successful and recently FGM was mentioned at both the Cairo conference
on population and development and Beijing. International aid organisations are now giving
reproductive health a high priority, and projects on FGM are being funded in many parts of Africa,
many ofthem in collaboration with women's groups. However, despite this being an optimistic
time for women's reproductive health, FGM is very far from being eradicated. Advocates and
activists have to make sure that the money and effort being put into FGM is not a temporary
fashion. We have to make sure that FGM remains raised as an issue so that the good work that
has been done so far can continue.


Reading for Further Information

D-Ashur, S. (1989) "Silent Tears" London Black Women's Health Action Project, London

Dorkenoo, E (1994) "Cutting the Rose" Minority Rights Publications, 379 Brixton Road, London



Hosken, F.P. (1993) "The Hosken Report: Genital and Sexual Mutilation of Females" Women's
International Network News, 187 Grant Street, Lexington, MA 02173, USA

Toubia, N. (1993) "Female Genital Mutilation: A Call for Action" Women Ink. 777 United
Nations Plaza, New York, NY 10017, USA

Walker, A. (1992) "Possessing the Secret of Joy" Harcourt Brace Jovanovisch, New York, USA

Williams, L.A. (1994) "Female Genital Mutilation: Background Inforrnation" Amnesty
International, 1 Easton Street, London WC1X 8DJ