Female genital mutilation

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"FGM" redirects here. For other uses, see FGM (disambiguation).
photograph
Road sign near Kapchorwa, Uganda, 2004, where FGM is outlawed, but still practised by the Pokot, Sabiny and Tepeth people.[1]
Description Defined by the WHO, UNICEF and UNFPA as the "partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons."[2]
Areas practised Most common in 27 countries in sub-Saharan and north-east Africa, as well as in Yemen and Iraqi Kurdistan[3]
Numbers 125 million in those countries[4]
Age performed

Weeks after birth to puberty and beyond[5]

Female genital mutilation (FGM), also known as female genital cutting and female circumcision, is the ritual removal of the external female genitalia.[2] FGM is practised by ethnic groups in 27 countries in sub-Saharan and north-east Africa, and to a lesser extent in Asia, the Middle East and within immigrant communities elsewhere.[8] It is typically carried out by a traditional circumciser, often with a blade or razor, with or without anaesthesia.[9] The age of the girls varies from weeks after birth to puberty; according to UNICEF, in half the countries for which figures were available in 2013, most girls were cut before the age of five.[5]

The practice is an ethnic marker and varies according to the group. Procedures include removal of the clitoris and clitoral hood, and removal of the clitoris and inner labia. In its most severe form (infibulation), the inner and outer labia are removed and the vulva is closed. In this last procedure, which the WHO calls Type III FGM, a small hole is left for the passage of urine and menstrual blood, and the vagina is opened for intercourse and childbirth.[10] The health effects depend on the procedure, but can include recurrent infections, chronic pain, cysts, an inability to get pregnant, complications during childbirth and fatal bleeding.[11]

Over 125 million women and girls in Africa and the Middle East have undergone FGM.[4] Over eight million have experienced Type III, which is most common in Djibouti, Eritrea, Ethiopia, Somalia and Sudan.[12] The practice is rooted in gender inequality, ideas about purity, modesty and aesthetics, and attempts to control women's sexuality.[13] It is supported by both women and men in countries that practise it, particularly by women, who see it as a source of honour and authority.[14]

FGM has been outlawed or restricted in most of the countries in which it occurs, but the laws are poorly enforced.[15] There has been an international effort since the 1970s to eradicate it, and in 2012 the United Nations General Assembly voted unanimously to take all necessary steps to end it.[16] The opposition is not without its critics, particularly among anthropologists. Eric Silverman writes that FGM is one of anthropology's central moral topics, raising questions about cultural relativism and human rights within a debate framed by colonial and post-colonial history.[17]

Terminology

The practice was widely known as female circumcision until the early 1980s.[18] The Kenya Missionary Council began referring to it as the "sexual mutilation of women" in 1929, following the lead of Marion Scott Stevenson (1871–1930), a Church of Scotland missionary.[19]

photograph
Samburu FGM ceremony in Laikipia plateau, northern Kenya, 2004[20]

Writers in the 1970s began using the term "female genital mutilation."[21] The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children adopted it in 1990, the World Health Organization the following year, and it became the dominant term in the medical literature.[22] Other terms include female genital cutting (FGC) and female genital mutilation/cutting (FGM/C).[23] Terms such as "traditional women's practices" are more likely to be used by advocates.[24]

In countries where FGM is common, the terminology is often associated with hygiene. Arabic terms include tahara in Egypt and tahur in Sudan (purification).[25] In Bambara in Mali it is known as bolokoli ("washing your hands") and in Igbo in Nigeria as isa aru ("having your bath").[26] Procedures other than Type III are known as sunna circumcision; the term sunna means following the tradition of Muhammad, although the procedures are not required by Islam.[27] A sunna kashfa in Sudan involves cutting off half the clitoris.[28] Excision (removal of the clitoris and labia) is known as xalaalays or gudniin in Somalia.[29] Nuss ("half") in Sudan is for anything less than Type III, and al juwaniya ("the inside type") is where only the inner labia are sewn together.[30]

The term infibulation (Type III) derives from the Roman practice of fastening a fibula or brooch across the outer labia of female slaves.[31] Type III is known as pharaonic circumcision in Sudan (tahur faraowniya, or pharaonic purification)[32] – a reference to the practice in Ancient Egypt under the Pharaohs – but as Sudanese circumcision in Egypt.[33] In Somalia it is known simply as qodob ("to sew up").[29]

Procedures and health effects

Circumcisers, methods, age of girls

The procedures are generally performed by a traditional circumciser, with or without anaesthesia, often in the girl's home.[34] The circumciser is usually an older woman who may also be the local midwife; in communities where the male barber has assumed the role of health worker, he will perform FGM too.[35] Medical personnel are usually not involved, although in some countries, particularly Egypt, Sudan and Kenya, it is often carried out by health professionals. In Egypt over 70 percent of FGM is performed by physicians, based on surveys in the period 1997–2011 where women were asked what was done to their daughters, aged 0–17.[36]

When traditional circumcisers are involved, non-sterile cutting devices are likely to be used, including knives, razors, scissors, glass, sharpened rocks and fingernails. Cauterization is used in parts of Ethiopia.[37][38] A nurse in Uganda, quoted in 2007 in The Lancet, said a circumciser would use one knife to cut up to 30 girls at a time.[39] With Type III the wound is closed with surgical thread, thorns, or poultices, and the girls' legs are tied together to aid healing.[37]

Depending on the involvement of healthcare professionals, the procedures may include a local or general anaesthetic, or neither. According to UNICEF in 2013, Egyptian women reported in 1995 that a local anaesthetic was used on their daughters in 60 percent of cases, a general in 13 percent, and neither in 25 percent (two percent were missing/don't know).[34]

The age at which FGM is performed ranges from shortly after birth to the teenage years.[40] The variation signals that the practice is usually not regarded as a rite of passage between childhood and adulthood.[41] In half the countries for which there are data, most girls are cut before the age of five, including over 80 percent in Nigeria, Mali, Eritrea, Ghana and Mauritania. The percentage is reversed in Somalia, Egypt, Chad and the Central African Republic, where over 80 percent are cut between the ages of five and 14.[42] A 1997 survey found that 76 percent of girls in Yemen were cut within two weeks of birth.[43]

According to British gynecological surgeon Harry Gordon, the extent of excision carried out during infibulation varies considerably. He reported that the clitoris was still intact in 95 percent of "circumcised" Somali women at his reconstructive surgery practice. In addition, some studies indicate that the labia minora and other erogenous zones can become more sensitive in women who have undergone clitoridectomies.[44]

Classification

Overview

diagram
Normal female anatomy and how FGM Types I–III differ from it

The procedures vary according to ethnicity and individual practitioners.[34] The difficulty of collecting accurate data across so many countries means that none of the typologies are entirely accurate. The aid agencies have created them based on household surveys known as Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS); these have been conducted in Africa roughly every five years, since 1984 and 1995 respectively. The questionnaires are completed by women aged 15–49.[45]

In one survey in Niger in 1998, the women responded with 50 different terms when asked to describe what was done to them in their own language.[46] Translation problems are compounded by confusion over which procedure was experienced. In a 2006 study in Sudan, in which over 500 subjects were asked to describe their procedure before being examined, a significant percentage of infibulated subjects reported a lesser procedure.[33]

The WHO divides the main procedures into Types I–III, and Type IV for symbolic circumcision and procedures not related to ritual FGM.[47] UNICEF has four categories: (1) cut, no flesh removed (pricking or symbolic circumcision); (2) cut, some flesh removed; (3) sewn closed; and (4) type not determined/unsure/doesn't know.[48]

WHO Types I and II

The WHO's Type Ia is the removal of the clitoral hood, which is rarely, if ever, performed alone.[49] More common is Type Ib (clitoridectomy), the partial or total removal of the clitoris and clitoral hood.[50] Susan Izett and Nahid Toubia wrote in a 1998 report for the WHO:

[T]he clitoris is held between the thumb and index finger, pulled out and amputated with one stroke of a sharp object. Bleeding is usually stopped by packing the wound with gauzes or other substances and applying a pressure bandage. Modern trained practitioners may insert one or two stitches around the clitoral artery to stop the bleeding."[51]

Type II (excision) is the partial or total removal of the clitoris and inner labia, with or without removal of the outer labia.[52] Most women who undergo FGM experience Types I and II.[12] Ethiopia, Eritrea and Kenya practise mostly Type 1, and Benin, Sierra Leone, Gambia and Guinea in West Africa, Type II.[53]

WHO Type III

External images
Example of Type III FGM,
Swiss Medical Weekly, January 2011.[11]

Type III (infibulation) is the removal of all external genitalia and the fusion of the wound. The inner and outer labia are cut away, with or without removal of the clitoris.[10] A 2–3 mm-hole is created for the passage of urine and menstrual blood by inserting something into the wound before it is closed; a traditional circumciser might insert a twig or rock salt.[54] The wound is closed with surgical thread, agave or acacia thorns; a poultice of raw egg, herbs and sugar might be applied to form a crust. The girl's legs are tied from hip to feet to help the tissue bond; the bindings are loosened after a week and usually removed after two.[55]

About eight million women in Africa, of 15 years and older, have been infibulated, or 10 per cent of the women who have experienced FGM. The procedure is concentrated in Djibouti, Eritrea, Ethiopia, Somalia and Sudan, in northeastern Africa.[12] Comfort Momoh describes an infibulation:

[E]lderly women, relatives and friends secure the girl in the lithotomy position. A deep incision is made rapidly on either side from the root of the clitoris to the fourchette, and a single cut of the razor excises the clitoris and both the labia majora and labia minora.

Bleeding is profuse, but is usually controlled by the application of various poultices, the threading of the edges of the skin with thorns, or clasping them between the edges of a split cane. A piece of twig is inserted between the edges of the skin to ensure a patent foramen for urinary and menstrual flow. The lower limbs are then bound together for 2–6 weeks to promote haemostatis and encourage union of the two sides ... Healing takes place by primary intention, and, as a result, the introitus is obliterated by a drum of skin extending across the orifice except for a small hole. Circumstances at the time may vary; the girl may struggle ferociously, in which case the incisions may become uncontrolled and haphazard. The girl may be pinned down so firmly that bones may fracture.[56]

The woman's vulva is opened with a penis or knife for sexual intercourse.[11] Psychologist Hanny Lightfoot-Klein interviewed 300 Sudanese women and 100 men in the 1980s:

photograph
Road sign in Bakau, Gambia, 2005. FGM is not illegal in Gambia, where 76 percent of women and girls have experienced it.[57]

The penetration of the bride's infibulation takes anywhere from 3 or 4 days to several months. Some men are unable to penetrate their wives at all (in my study over 15%), and the task is often accomplished by a midwife under conditions of great secrecy, since this reflects negatively on the man's potency. Some who are unable to penetrate their wives manage to get them pregnant in spite of the infibulation, and the woman's vaginal passage is then cut open to allow birth to take place. ...

Those men who do manage to penetrate their wives do so often, or perhaps always, with the help of the "little knife." This creates a tear which they gradually rip more and more until the opening is sufficient to admit the penis. In some women, the scar tissue is so hardened and overgrown with keloidal formations that it can only be cut with very strong surgical scissors, as is reported by doctors who relate cases where they broke scalpels in the attempt.[58]

The vulva may be opened for childbirth (deinfibulation) for a vaginal delivery, and restored after it (reinfibulation). There is also a process in Sudan known as El Adel, in which the vagina is cut again and tightened to mirror the size of the first infibulation. This may be performed before marriage, after childbirth and divorce, and to prepare elderly women for death.[37]

WHO Type IV

Type IV includes nicking of the clitoris (ritual circumcision), gishiri cutting, angurya cutting, burning or scarring the genitals, and introducing substances into the vagina to tighten it.[59] Gishiri cutting involves cutting the vagina's anterior (front) wall to enlarge it, and angurya cuts involve scraping tissue away from around the vagina. Another procedure is hymenotomy, the removal of a hymen regarded as too thick, which is practised by the Hausa in West Africa.[60] Labia stretching is also categorized as Type IV. In Tanzania and the Congo girls are told to stretch the clitoris and labia minora every day for 2–3 weeks; an older woman uses sticks to hold the stretched parts in place.[61] The WHO does not classify cosmetic procedures, such as labiaplasty, or procedures used in sex reassignment surgery as FGM.[62]

Complications

FGM has no known health benefits.[63] It has immediate and late complications, which depend on several factors: the type of FGM; the conditions in which the procedure took place and whether the practitioner had medical training; whether unsterilized or surgical single-use instruments were used; whether surgical thread was used instead of agave or acacia thorns; the availability of antibiotics; how small a hole was left for the passage of urine and menstrual blood; and whether the procedure was performed more than once (for example, to close an opening regarded as too wide or re-open one too small).[11]

Immediate complications include fatal bleeding, acute urinary retention, urinary infection, wound infection, septicemia, tetanus, and transmission of hepatitis or HIV if instruments are non-sterile or reused.[11] It is not known how many girls and women die; few records are kept, complications may not be recognized, and fatalities are rarely reported.[64]

Short-term complications include necrotizing fasciitis, delay in wound healing due to infection, endometritis and hepatitis.[65] Late complications vary depending on the type of FGM performed.[11] The formation of scars and keloids can lead to strictures, obstruction or fistula formation of the urinary and genital tracts. Urinary tract sequelae include damage to urethra and bladder, with infections and incontinence. Genital tract sequelae include vaginal and pelvic infections, painful periods, pain during sexual intercourse and infertility.[65] Complete obstruction of the vagina results in hematocolpos and hematometra.[11] Other complications include epidermoid cysts that may become infected, neuroma formation, typically involving nerves that supplied the clitoris, and pelvic pain.[66]

FGM may complicate pregnancy and place women at higher risk for obstetrical problems, which are more common with the more extensive FGM procedures.[11] Thus, in women with Type III who have developed vesicovaginal or rectovaginal fistulae (holes that allow urine and faeces to seep into the vagina), it is difficult to obtain clear urine samples as part of prenatal care, making the diagnosis of conditions such as preeclampsia harder.[65] Cervical evaluation during labour may be impeded and labour prolonged. Third-degree laceration, anal sphincter damage and emergency caesarean section are more common in women who have experienced FGM.[11]

Neonatal mortality is also increased. 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.[67]

Psychological complications include depression and post-traumatic stress disorder.[37] In addition, feelings of shame and betrayal can develop when the women move outside their traditional circles and learn that their condition is not the norm.[11] They are more likely to report painful sexual intercourse and reduced sexual feelings.[68] FGM does not necessarily destroy sexual desire in women; according to studies in the 1980s and 1990s, women said they were able to enjoy sex, though the risk of sexual dysfunction was higher with Type III.[69]

Prevalence

map
Prevalence of FGM in Africa. For more detailed maps, see UNICEF 2013, p. 26.

Information about the prevalence of FGM has been collected since 1989 in a series of Demographic and Health Surveys and Multiple Indicator Cluster Surveys funded by the United States Agency for International Development (USAID) and the United Nations Children's Fund (UNICEF). In 2013 UNICEF published a report based on 70 of these surveys, indicating that FGM is concentrated in 27 African countries, as well as in Yemen and Iraqi Kurdistan, and that 125 million women and girls in those countries have been affected.[70]

The practice is mostly found in what political scientist Gerry Mackie describes as an "intriguingly contiguous zone" in Africa, from Senegal in the west to Somalia in the east, and from Egypt in the north to Tanzania in the south, intersecting in Sudan.[71] According to UNICEF, the highest rates are in Somalia (98 percent of women affected), Guinea (96 percent), Djibouti (93 percent), Egypt (91 percent), Eritrea (89 percent), Mali (89 percent), Sierra Leone (88 percent), Sudan (88 percent), Gambia (76 percent), Burkina Faso (76 percent), Ethiopia (74 percent), Mauritania (69 percent), Liberia (66 percent), and Guinea-Bissau (50 percent).[8]

Around one in five cases is in Egypt.[72] Forty-five million women over the age of 15 who had experienced FGM were living in Egypt, Ethiopia and northern Sudan as of 2008, and nine million were in Nigeria.[73]

Outside Africa FGM occurs in Yemen (23 percent prevalence), among the Kurds in Iraq (giving the country an overall prevalence rate of eight percent), Indonesia and Malaysia.[74] It has been documented in India, among the Bedouin in Israel, the United Arab Emirates, and by anecdote in Colombia, Oman, Peru and Sri Lanka.[75] There are indications that it is performed in Jordan and Saudi Arabia, although no nationally representative information is available for those countries.[76] There are also immigrant communities that practise it in Australia and New Zealand, Europe, Scandinavia, the United States and Canada.[11]

In 2013 UNICEF reported a downward trend in some countries. In Kenya and Tanzania women aged 45–49 years were three times more likely to have been cut than girls aged 15–19, and the rate among adolescents in Benin, Central African Republic, Iraq, Liberia and Nigeria had dropped by almost half.[77] In 2005 the organization reported that the median age at which FGM was performed had fallen in Burkina Faso, Côte d'Ivoire, Egypt, Kenya and Mali. Possible explanations include that, in countries clamping down on the practice, it is easier to cut a younger child without being discovered, and that the younger the girls are, the less they can resist.[35]

Reasons

Overview

photograph
Dogon circumcision cave painting in Mali. The Dogon believe that clitoridectomy and male circumcision establish gender.[78]

Practitioners see the rituals as reinforcing community values and ethnic boundaries, and the procedure as an essential element in raising a girl.[79] Mackie compares FGM to footbinding, which was outlawed in China in 1911; he writes that, like FGM, footbinding was an ethnic marker carried out on young girls, was nearly universal where practised, controlled sexual access to women, was tied to ideas about honour, appropriate marriage, health, fertility and aesthetics, was supposed to enhance male sexual pleasure, and was supported by the women themselves.[80]

Among the reasons practitioners cite as benefits of FGM, according to UNICEF, are hygiene, social acceptance, marriageability, preservation of virginity/reduction of female sexual desire, male sexual pleasure, and religious requirement.[81] Infibulation is said by several sources to enhance male sexual pleasure; Gruenbaum writes that men seem to enjoy the effort of penetrating their wife's infibulation.[82]

Most often cited is the promotion of female virginity and fidelity.[83] Uncircumcised women are seen as highly sexualized; philosopher Martha Nussbaum argues that the practice presupposes women to be "whorish and childish."[84] The primary sexual concerns vary between communities, but invariably serve the interests of male sexuality. Anika Rahman and Nahid Toubia write that the focus in Egypt, Sudan and Somalia is on curbing premarital sex, while in Kenya and Uganda the point is to reduce a woman's sexual desire so that her husband can more easily take several wives.[85]

Female genitals are regarded within communities that practise FGM as dirty and ugly; physicians Miriam Martinelli and Jaume Enric Ollé-Goig write that the preference is for women's genitalia to be "flat, rigid and dry."[86] The animist Dogon people of Mali believe that the clitoris confers masculinity on a girl and the foreskin of a boy makes him feminine; they perform FGM to differentiate more clearly between the genders.[87] There are myths that FGM prevents genital discharges and aids conception and birth, and that the clitoris will keep growing, and will harm a baby if it comes into contact with the baby's head. A more practical reason for FGM's continuance is that circumcisers rely on it for their living.[88]

Support from women

In the rural Egyptian hamlet where we have conducted fieldwork some women were not familiar with groups that did not circumcise their girls. When they learned that the female researcher was not circumcised their response was disgust mixed with joking laughter. They wondered how she could have thus gotten married and questioned how her mother could have neglected such an important part of her preparation for womanhood.

— Sandra D. Lane and Robert A. Rubinstein, 1996[89]

A 1988 poem by Dahabo Musa, a Somali woman, described infibulation as the "three feminine sorrows": the procedure itself, the wedding night when the woman is cut open, then childbirth when she is cut again.[90] Despite the evident suffering of women with FGM, particularly infibulation, it is often the women, particularly the grandmothers, who organize the procedure. Anthropologist Rose Oldfield Hayes wrote in 1975 that educated Sudanese men living in cities who did not want their daughters to be infibulated (preferring clitoridectomy) would find the girls had been sewn up after their grandmothers arranged a supposed visit to relatives.[91]

Gerry Mackie and John LeJeune write that women's support for the practice remains one of its "chief puzzles."[92] Mackie explains it with the idea of a "belief trap," a belief that "cannot be revised because the costs of testing [it] are too high." The cost of dissent with FGM is failure to have descendants, because uncircumcised women might not find husbands.[93] Hayes wrote that grandmothers would find they were in a position of authority for the first time in their lives, having spent their youth taking orders from their own family, then from their husband's. When they were finally able to give orders themselves, they were enthusiastic about protecting the male line (their sole source of authority), which meant having their granddaughters infibulated.[94]

Nearly 59 percent of 3,210 Sudanese women in a 1982 study by physician Asma El Dareer said they preferred Types II and III over Type I, and only 17.4 percent said they preferred none.[95] Women in Sudan discussing circumcision with Janice Boddy in 1984 depicted Type I by opening their mouths and Type III by closing them, asking: "Which is better, an ugly opening or a dignified closure?"[96] Attitudes may have changed since then. According to UNICEF in 2013, surveys show that the majority of women in Mali, Guinea, Sierra Leone, Somalia, Gambia and Egypt believe the practice should continue, but elsewhere in Africa, Iraq and Yemen, most think it should end.[97]

Uncut women are regarded as outcasts by some communities. Sociologist Elizabeth Heger Boyle writes that, in Tanzania, the Masai will not call an uncircumcised woman "mother" when she has children, and in several communities uncut women may not be allowed to attend funerals and other public events.[98] Izett and Toubia write that any change to the state of a woman's infibulation can affect her sense of identity and security. They cite the case of a Somali mother of three who was advised to remain defibulated after childbirth to cure her gonorrhoea, but who insisted on being reinfibulated, leading to pain and infection so severe she could hardly walk. They argue that she did this out of "her own sense of impurity."[99]

Religion

There is no mention of FGM in the Bible or Quran.[100] Although its origins are pre-Islamic, it became associated with Islam because of that religion's focus on female purity, chastity and seclusion, and family honour, according to Mackie; he writes that it is found "only in or adjacent to Islamic groups."[101] The practice is praised in several hadith (sayings attributed to Muhammad) as noble but not required, along with advice that the milder forms are kinder to women.[102] In 2006 leading Islamic scholars called for an end to the practice, and in 2007 the Al-Azhar Supreme Council of Islamic Research in Cairo ruled that it had no basis in Islamic law.[103]

Mackie writes that FGM is not practised in Mecca and Medina in Saudi Arabia, Islam's holiest cities.[104] There are no nationally representative figures available for that country, according to UNICEF, but there have been reports of it being performed there, perhaps among immigrant communities.[105] Surveys have shown there is a widespread belief in several countries, particularly Eritrea, Egypt, Guinea, Mali and Mauritania, that FGM is a religious requirement.[106] Mackie and LeJeune write that practitioners may not distinguish between religion, tradition and chastity, making it difficult to interpret the data.[107]

FGM has also been practised by Christian groups, including the Copts in Egypt and Sudan; the Coptic Orthodox Church opposes FGM.[108] The only Jewish group known to have practised it are the Beta Israel of Ethiopia; Judaism requires male circumcision, but does not allow FGM.[109]

History and opposition

Origins

Gerry Mackie writes that the origins of the practice are obscure.[110] There is a reference to an uncircumcised girl on the sarcophagus of Sit-hedjhotep, in the Egyptian Museum, dating to Egypt's Middle Kingdom, c. 1991–1786 BCE (see below right).[111] Historian Mary Knight writes that the earliest extant literary reference is to the Greek geographer Strabo (c. 64 BCE–23 CE), who wrote about FGM after visiting Egypt around 25 BCE: "This is one of the customs most zealously pursued by them [the Egyptians]: to raise every child that is born and to circumcise [peritemnein] the males and excise [ektemnein] the females."[112] The philosopher Philo of Alexandria (c. 20 BCE – 50 CE) also wrote about it: "the Egyptians by the custom of their country circumcise the marriageable youth and maid in the fourteenth (year) of their age, when the male begins to get seed, and the female to have a menstrual flow."[113]

But if a man wants to know how to live, he should recite it [a magical spell] every day, after his flesh has been rubbed with the b3d [unknown substance] of an uncircumcised girl and the flakes of skin [šnft] of an uncircumcised bald man.

— Inscription on Egyptian sarcophagus
c. 1991–1786 BCE[111]

According to Knight, a hieroglyph of a woman in labour and the physical examination of mummies in 1906 by Australian pathologist Grafton Elliot Smith (1871–1937) suggest that Type III was not performed in Ancient Egypt. Some mummies had the appearance of Type III because during mummification the skin of the outer labia was pulled toward the anus to cover the pudendal cleft, possibly to prevent sexual violation. Smith wrote that it was not possible to determine from the mummies he examined whether Types I or II had been performed since soft tissues were removed by the embalmers or had deteriorated.[114]

Mackie presents a novel theory on the original purpose of FGM, arguing that infibulation in Africa "originated as paternity-confidence mechanisms under conditions of imperial female slavery." He writes that the "geographic distribution of FGM suggests that it originated on the western coast of the Red Sea, where infibulation is most intense, diminishing to clitoridectomy in westward and southward radiation. Whatever the earliest origins of FGM, there is certainly an association between infibulation and slavery." Mackie notes that Egyptians took captives in the south to be used as slaves, and Sudanic slaves were exported through the Red Sea to the Persian Gulf before the rise of Islam.[115] He also cites the Portuguese missionary João dos Santos (d. 1622), who in 1609 wrote of a group inland from Mogadishu who had a "custome to sew up their Females, especially their slaves being young to make them unable for conception, which makes these slaves sell dearer, both for their chastitie, and for better confidence which their Masters put in them."[116] The English explorer William Browne (1768–1813) wrote in 1799 that the Egyptians practised excision (Type II), and that slaves in that country were infibulated to prevent pregnancy.[117] Mackie thus argues that "[a] practice associated with shameful female slavery came to stand for honor."[118]

Europe and the United States

portrait
Isaac Baker Brown "set to work to remove the clitoris whenever he had the opportunity of doing so."[119]

Gynaecologists in 19th-century Europe and the United States removed the clitoris to treat insanity and masturbation.[120] British doctor Robert Thomas suggested clitoridectomy as a cure for nymphomania in 1813.[121] One of the first reported clitoridectomies in the West was performed in 1822 in Berlin by Karl Ferdinand von Graefe (1787–1840), on a teenage girl regarded as an "imbecile" who was masturbating.[122]

Isaac Baker Brown (1812–1873), an English gynaecologist, president of the Medical Society of London, and co-founder of St. Mary's Hospital in London, believed that masturbation, or "unnatural irritation" of the clitoris, caused epilepsy, hysteria, mania and idiocy, and "set to work to remove [it] whenever he had the opportunity of doing so," according to his obituary in the Medical Times and Gazette.[119] He performed several clitoridectomies between 1859 and 1866. When he published his views in On the Curability of Certain Forms of Insanity, Epilepsy, Catalepsy, and Hysteria in Females (1866), doctors in London accused him of quackery and expelled him from the Obstetrical Society.[123]

In the United States J. Marion Sims (1813–1883) slit the neck of a woman's uterus and amputated her clitoris in 1862, "for the relief of the nervous or hysterical condition as recommended by Baker Brown," after she complained of period pain, convulsions and bladder problems.[124] G. J. Barker-Benfield writes that clitoridectomy continued in the US until at least 1904 and perhaps into the 1920s.[125] According to a 1985 paper in the Obstetrical & Gynecological Survey, it was performed in the US into the 1960s to treat hysteria, erotomania and lesbianism.[126]

Colonial opposition in Kenya

Protestant missionaries in Kenya, a British colony from 1895 until 1963, began campaigning against FGM in 1906. The practice was known by the Kikuyu, the country's main ethnic group, as irua for both girls and boys: excision (Type II) for girls and removal of the foreskin for boys.[127] Regarded by the Kikuyu as an important ethnic marker, the practice became a focal point of the independence movement from the 1920s onwards. Unexcised women (irugu) were outcasts; there was a fear that Europeans were campaigning against FGM so they could marry uncircumcised girls and acquire more Kenyan land.[128]

Support for the practice came from the women themselves. E. Mary Holding, a Methodist missionary in Meru, described the ritual for girls as an entirely female affair, organized by women's councils known as kiama gia ntonye ("the council of entering"). The girls' mothers were admitted as members of these councils, a position of authority and yet another reason to support the practice.[129]

photograph
Christian missionary Hulda Stumpf was murdered, and possibly mutilated, in Kenya in 1930.

Such was the focus on FGM in Kenya that the 1929–1931 period became known in the country's historiography as the female circumcision controversy. A person's stance toward the practice became a test of loyalty, either to the Christian churches or to the Kikuyu Central Association.[127] The Church Missionary Society led the opposition.[130] Hulda Stumpf (1867–1930), an American missionary who opposed FGM in the girls' school she helped to run, was murdered in 1930 after apparently being circumcised by her attackers.[131]

The general secretary of the Kikuyu Central Association, Jomo Kenyatta (c. 1894–1978), who became Kenya's first prime minister in 1963, wrote in 1930 that, for the Kikuyu, the institution of FGM was the "conditio sine qua non of the whole teaching of tribal law, religion and morality." No Kikuyu man or woman, he said, would marry someone who was not circumcised.[132]

In 1956 the council of male elders (the Njuri Nchecke) in Meru announced a ban on FGM. Over the next three years, as an act of defiance, thousands of girls cut each other with razor blades; medical examinations showed mostly minor cuts to the labia. The movement came to be known in Meru as Ngaitana ("I will circumcise myself"), because the girls said they had cut themselves to avoid naming their friends.[133] Historian Lynn Thomas describes the episode as significant in the history of FGM because it made clear that its apparent victims were in fact its perpetrators.[134]

Growth of opposition

The first known non-colonial campaign against FGM began in Egypt in the 1920s, when the Egyptian Doctors' Society called for it to be banned, as did surgeon Ali Ibrahim Pasha, director of Cairo University, in 1928. An Egyptian medical journal, Al Doktor, and a women's magazine, Hawwaa, criticized the practice in 1951 and 1957, and in 1958 it became illegal to perform FGM in any of Egypt's state-run health facilities.[135] The UN asked the WHO to investigate it that year, but the latter responded that it was a cultural issue, not a medical one.[136] In the 1960s the Central African Republic, Ghana and Guinea became the first countries in Africa to pass legislation against it.[137]

photograph
Nawal El Saadawi, one of the first feminists to write about FGM[138]
photograph
Benoîte Groult became influential in the European campaign against FGM.[139]
photograph
Fran Hosken wrote the first report that estimated numbers.[140]

A few social scientists wrote about FGM from the 1940s to 1970s, including E. Hills Young in 1943, Harold Barclay in Sudan in 1964, and John G. Kennedy in Egyptian Nubia in 1970. Rose Oldfield Hayes began studying infibulation in northern Sudan in 1970, and in 1975 published a detailed paper in the American Ethnologist, calling it "female genital mutilation," and bringing it to wider academic attention.[141]

Interest increased throughout the 1970s. Egyptian physician Nawal El Saadawi criticized it in her book, Women and Sex (1972). The book was banned in Egypt, and El Saadawi lost her job as that country's director general of public health. She followed up with a chapter, "The Circumcision of Girls," in The Hidden Face of Eve (1980).[138] The French writer Benoîte Groult became an influential opponent of FGM in Europe; she called it "the best kept secret in the world" in her book Ainsi soit-elle (1975).[139] American feminist Mary Daly (1928–2010) wrote about it in Gyn/ecology (1978), and Senegalese writer Awa Thiam in La parole aux négresses (1978).[142]

In 1979 Austrian-American feminist Fran Hosken (1920–2006) published The Hosken Report: Genital and Sexual Mutilation of Females, which brought the issue to an international audience. It was the first report that estimated the numbers of women cut around the world.[143] Hosken called FGM a "training ground for male violence," and accused women who facilitated it of "participating in the destruction of their own kind."[144] The language of the report led African women to boycott a session featuring Hosken during the UN's Mid-Decade Conference on Women in Copenhagen in July 1980.[145]

Throughout the 1980s to the 2000s, African and international bodies signalled their opposition.[146] From the 1990s several African governments banned or restricted it. By 2013 legislation had been passed in 22 of the 27 African countries in which it is concentrated, as well as Iraqi Kurdistan and Yemen.[137] Some of the laws reduce it in scope without an outright ban; for example, Mauritania prohibits it in government facilities or by medical personnel. Other countries, such as Kenya, have banned it outright.[147]

From 2003 the United Nations sponsored an International Day of Zero Tolerance to Female Genital Mutilation, held every 6 February, and in July that year the African Union ratified the Maputo Protocol, promising prohibition against FGM.[148] In December 2012 the UN General Assembly voted unanimously to condemn the practice, after the 54 nations of the African Group introduced the text of the resolution.[16]

FGM was finally outlawed in Egypt in 2008, where 91 percent of women have experienced it.[149] After the 1959 ban in state-run hospitals, the practice continued elsewhere in the country, and in 1995 CNN broadcast images of a ten-year-old girl undergoing it in a barber's shop in Cairo.[150] The government reversed the 1959 ban so that physicians could carry it out,[151] but in 2007 a 12-year-old girl died during an FGM procedure conducted by a physician. The Al-Azhar Supreme Council of Islamic Research, the country's highest religious authority, ruled in response that FGM had no basis in core Islamic law, and this enabled the government to outlaw it.[152]

In August 2012, Somalia adopted a new Federal Constitution officially banning FGM. The provision was secured by Somali parliamentary consultant Hodan Ahmed, who through her work as Senior Program Officer at the National Democratic Institute, had lobbied for the law.[153] In 2013, UNICEF in conjunction with the Somali authorities reported that the FGM prevalence rate among 1 to 14 year old girls in Somalia's autonomous northern Puntland and Somaliland regions had dropped to 25% following a social and religious awareness campaign.[154][155] In the latter region, awareness raising was led by pioneering campaigner Edna Adan Ismail.[156]

Law in non-practising countries

As a result of immigration, the practice spread to Australia, Europe, North America and Scandinavia.[157] As of 2013 anti-FGM legislation had been passed by 33 countries outside Africa and the Middle East.[7] Sweden banned the practice in 1982, the first Western country to do so.[158] Several former colonial powers, including Belgium, Britain, France and the Netherlands, followed suit, either with new laws or by making clear that FGM was covered by existing legislation.[159] The practice is outlawed in Australia and New Zealand, across the European Union, in the United States, and under section 268 of the Criminal Code of Canada.[160]

Canada was the first to recognize FGM as a form of persecution, when it granted refugee status in 1994 to Khadra Hassan Farah, who had fled Somalia with her 10-year-old daughter to avoid the girl being subjected to it.[161] The law in Canada prohibits FGM against minors only;[162] as of 2012 there had been no prosecutions.[163] There have been over 100 prosecutions in France, where FGM is covered by a provision of the penal code punishing acts of violence against children that result in mutilation or disability. Up to 30,000 women there are thought to have experienced FGM.[164] Colette Gallard, a family-planning counsellor, writes that when it was first encountered in France, the reaction was that Westerners ought not to intervene, and it took the deaths of two girls in 1982, one of them three months old, for that attitude to change.[165]

Nearly 66,000 women in England and Wales were living with FGM in 2001, according to the only national estimate.[166] The Prohibition of Female Circumcision Act 1985 outlawed the procedure in the UK, and the Female Genital Mutilation Act 2003 and Prohibition of Female Genital Mutilation (Scotland) Act 2005 made it an offence to arrange it outside the country for British citizens or permanent residents.[167] The first charges took place in 2014, against a physician and another man, after the physician repaired FGM on a patient in London who had given birth. Another doctor was struck off the medical register that year after discussing how to arrange FGM with an undercover journalist.[168]

In the United States the Centers for Disease Control estimated in 1997 that 168,000 girls living there in 1990 had undergone FGM or were at risk.[169] In 1996 Fauziya Kasinga, a 19-year-old woman from Togo, became the first person to be granted asylum in the US to escape FGM.[170] Several legislative measures were passed that year, including the Federal Prohibition of Female Genital Mutilation Act of 1995, that made it illegal to perform FGM on anyone under the age of 18 for non-medical reasons.[171] An amendment was passed in January 2013, Transport for Female Genital Mutilation, which prohibits knowingly transporting a minor out of the country for the purpose of FGM.[172] The first FGM conviction in the US was in 2006, when Khalid Adem, who had emigrated from Ethiopia, was sentenced to ten years after severing his two-year-old daughter's clitoris with a pair of scissors.[173]

Criticism of the opposition

Challenges to the mainstream position

Anthropologist Eric Silverman wrote in 2004 that FGM was one of the "central moral topics of contemporary anthropology." Anthropologists have been criticized for adopting a position of cultural and moral relativism, rather than defending human rights, while eradicationists stand accused of cultural colonialism.[174]

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FGM eradicationists, including novelist Alice Walker, have been criticized.

Ugandan law professor Sylvia Tamale argued in 2011 that early Western opposition stemmed from a Judeo-Christian judgment that African sexual culture, including not only FGM but also dry sex, polygyny and levirate marriage, was primitive and required correction.[175] She cautioned that African feminists object to the "imperialist, racist and dehumanising infantilization of African women" inherent in the opposition to FGM.[176] African-American feminists have also come into conflict with each other over FGM: Stanlie James criticized anti-FGM campaigner Alice Walker for, as she put it, trying to save African women from themselves.[177]

Anthropologists challenging the opposition to FGM include Richard Shweder, Janice Boddy, Carla Obermeyer, Ellen Gruenbaum and Fuambai Ahmadu, who was cut as an adult during a Sande society initiation in Sierra Leone.[178] Shweder maintains that if a rights perspective is adopted, it must take other rights into account, such as the right to self-determination and freedom of religion.[179] One of the areas of dispute is whether the medical evidence supports that FGM is invariably harmful. Shweder argues that it does not, citing reviews of the medical literature by medical anthropologist Carla Obermeyer of Harvard University, who suggested that the more serious complications are relatively infrequent.[180] Gerry Mackie disputed Obermeyer's findings.[181] Shweder also cites a 2001 study by Linda Morison of the London School of Hygiene and Tropical Medicine that looked at the reproductive health consequences of Type II FGM in the Gambia; Morison concluded that there were few differences between the circumcised and uncircumcised women.[182]

Comparison with other procedures

Obermeyer argues that FGM may be conducive to women's well-being within their communities in the same way that procedures such as breast implants, rhinoplasty and male circumcision may help people elsewhere.[183] The WHO does not include cosmetic procedures such as labiaplasty (reduction of the inner labia), vaginoplasty (tightening of the vaginal muscles) and clitoral hood reduction as examples of FGM; some elective practices do fall within its categories, but its broad definition aims to avoid loopholes.[62] Gynaecologist Birgitta Essén and anthropologist Sara Johnsdotter argue that this is a double standard, with adult African women (for example, those seeking reinfibulation after childbirth) viewed as mutilators trapped in a primitive culture, while other women seeking cosmetic genital surgery are viewed as exercising their right to control their own bodies.[184]

Essén and Johnsdotter write that several doctors have drawn a parallel between cosmetic procedures and FGM.[185] Benoîte Groult made the same point in 1975, citing both FGM and elective corrective surgery as sexist and patriarchal.[186] Ronán Conroy of the Royal College of Surgeons in Ireland argued in 2006 that cosmetic genital procedures were "driving the advance of female genital mutilation by promoting the fear in women that what is natural biological variation is a defect, a problem requiring the knife."[187]

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Martha Nussbaum argues that the key moral and legal issue with FGM is that it is conducted on children using physical force.

Some of the legislation banning FGM would seem to cover cosmetic genital alteration. The law in Sweden, for example, bans operations "on the external female genital organs which are designed to mutilate them or produce other permanent changes in them" regardless of consent.[188] Because anti-FGM laws are not used to stop cosmetic genital procedures, Essén and Johnsdotter argue that it seems the law distinguishes between Western and African female genitals, and deems only African women unfit to make their own decisions. Where FGM is banned even if consent is given, physicians may end up having to ask of prospective patients whether they appear to be victims of African patriarchy before deciding whether to offer them genital alteration.[185]

Arguing against these parallels, philosopher Martha Nussbaum writes that the key issue with FGM is that it is mostly conducted on children using physical force. She argues that the distinction between social pressure, which might reduce autonomy, and physical force is always morally and legally salient, and is arguably comparable to the distinction between seduction and rape. She also argues that the literacy of women in practising countries is generally poorer than that of women in the Western world, which reduces their ability to make informed choices.[189]

Several commentators argue that children's rights are being violated in the West too, with the genital alteration of intersex children born with genital anomalies that physicians regard as in need of correction. Legal scholars Nancy Ehrenreich and Mark Barr write that thousands of these procedures take place every year in the United States, and argue that they are medically unnecessary, more extensive than FGM, and have more serious physical and mental consequences. They attribute the silence of anti-FGM campaigners about intersex procedures to white privilege and North American exceptionalism, a refusal to acknowledge that "similar and harmful genital cutting occurs in their own backyards."[190]

Sources

Notes

  1. ^ Masinde, Andrew. "FGM: Despite the ban, the monster still rears its ugly head in Uganda", New Vision, Uganda, 5 February 2013.
  2. ^ a b "Classification of female genital mutilation", World Health Organization, 2013.
  3. ^ a b "Female Genital Mutilation/Cutting: A Statistical Overview and Exploration of the Dynamics of Change", United Nations Children's Fund, July 2013, p. 2.
  4. ^ a b UNICEF 2013, p. 22. See footnote 62: the estimate uses data from 1997 to 2012 for the 27 countries in Africa where FGM is concentrated, as well as Yemen and Iraqi Kurdistan.
  5. ^ a b UNICEF 2013, p. 50.
  6. ^ UNICEF 2013, p. 9.
  7. ^ a b UNICEF 2013, p. 8.
  8. ^ a b UNICEF 2013, p. 2. The countries where it is concentrated and the percentage of women affected:

    Somalia (98 percent), Guinea (96 percent), Djibouti (93 percent), Egypt (91 percent), Eritrea (89 percent), Mali (89 percent), Sierra Leone (88 percent), Sudan (88 percent), Gambia (76 percent), Burkina Faso (76 percent), Ethiopia (74 percent), Mauritania (69 percent), Liberia (66 percent), Guinea-Bissau (50 percent), Chad (44 percent), Côte d'Ivoire (38 percent), Kenya (27 percent), Nigeria (27 percent), Senegal (26 percent), Central African Republic (24 percent), Yemen (23 percent), United Republic of Tanzania (15 percent), Benin (13 percent), Iraq (8 percent), Ghana (4 percent), Togo (4 percent), Niger (2 percent), Cameroon (1 percent), and Uganda (1 percent).

    Because FGM is practised by different ethnic groups within these countries, a country's overall rate can be affected by a high or low rate within any of these groups; see UNICEF 2013, p. 28.

  9. ^ UNICEF 2013, p. 43: "In the majority of countries, FGM/C is usually performed by traditional practitioners and, more specifically, by traditional circumcisers"; p. 45: "In most cases, a blade or razor was used for cutting in Egypt, and one in four daughters underwent the procedure without an anaesthetic of any kind. It is plausible to expect this proportion to be much higher in countries where the practice is mostly performed by traditional circumcisers rather than medical personnel."
  10. ^ a b WHO 2013; WHO 2008, p. 4: "Narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation)."
  11. ^ a b c d e f g h i j k Jasmine Abdulcadira, C. Margairaz, M. Boulvain, O. Irion, "Care of women with female genital mutilation/cutting", Swiss Medical Weekly, 6(14), January 2011 (review). doi:10.4414/smw.2011.13137
  12. ^ a b c P. Stanley Yoder, Shane Khan, "Numbers of women circumcised in Africa", United States Agency for International Development, March 2008, pp. 13–14.

    Also see P. Stanley Yoder, Shanxiao Wang, Elise Johansen, "Estimates of female genital mutilation/cutting in 27 African countries and Yemen", Studies in Family Planning, 44(2), June 2013, pp. 189–204. doi:10.1111/j.1728-4465.2013.00352.x

  13. ^ Stanlie M. James, "Female Genital Mutilation," in Bonnie G. Smith (ed.), The Oxford Encyclopaedia of Women in World History, Oxford University Press, 2008 (pp. 259–262), p. 261: "The most frequently mentioned rationale is the need to control women, especially their sexuality."

    Martha Nussbaum, "Judging Other Cultures: The Case of Genital Mutilation," Sex and Social Justice, Oxford University Press, 1999, p. 124: "Female genital mutilation is unambiguously linked to customs of male domination."

    WHO 2008, p. 5: "In every society in which it is practised, female genital mutilation is a manifestation of gender inequality that is deeply entrenched in social, economic and political structures," and WHO 2014: "FGM is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women.

    Anika Rahman and Nahid Toubia, Female Genital Mutilation: A Guide to Laws and Policies Worldwide, Zed Books, 2000, pp. 5–6: "A fundamental reason advanced for female circumcision is the need to control women's sexuality ... FC/FGM is intended to reduce women's sexual desire, thus promoting women's virginity and protecting marital fidelity, in the interest of male sexuality."

    Gerry Mackie, "Ending Footbinding and Infibulation: A Convention Account", American Sociological Review, 61(6), December 1996 (pp. 999–1017, also here), pp. 999–1000: "Footbinding and infibulation correspond as follows. Both customs are nearly universal where practiced; they are persistent and are practiced even by those who oppose them. Both control sexual access to females and ensure female chastity and fidelity. Both are necessary for proper marriage and family honor. Both are believed to be sanctioned by tradition. Both are said to be ethnic markers, and distinct ethnic minorities may lack the practices. Both seem to have a past of contagious diffusion. Both are exaggerated over time and both increase with status. Both are supported and transmitted by women, are performed on girls about six to eight years old, and are generally not initiation rites. Both are believed to promote health and fertility. Both are defined as aesthetically pleasing compared with the natural alternative. Both are said to properly exaggerate the complementarity of the sexes, and both are claimed to make intercourse more pleasurable for the male."

  14. ^ Gerry Mackie and John LeJeune, "Social Dynamics of Abandonment of Harmful Practices: A New Look at the Theory", working paper, UNICEF Innocenti Research Centre, 2008, pp. 6–7: "In the majority of cases it is mothers or grandmothers who organize and support the cutting of their daughters, and in many places the practice is considered 'women's business'. ... The perpetuation of FGM/C and professed support of the practice by women represent one of the chief puzzles that researchers have sought to better understand."

    Mackie 1996, p. 1009; "Changing attitudes to female circumcision", BBC News, 8 April 2002, quoting Sudanese surgeon Nahid Toubia: "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." For figures showing support and opposition among women, see UNICEF 2013, pp. 52–55.

  15. ^ UNICEF 2013, p. 8: "Twenty-six countries in Africa and the Middle East have prohibited FGM/C by law or constitutional decree. Two of them – South Africa and Zambia – are not among the 29 countries where the practice is concentrated. ... Legislation prohibiting FGM/C has also been adopted in 33 countries on other continents, mostly to protect children with origins in practising countries.

    "Legislation on FGM/C varies in scope. In Mauritania, for example, the law is restricted to a ban on the practice in government health facilities and by medical practitioners. In Mauritania, the United Republic of Tanzania and some non-African countries, including Canada and the United States, FGM/C is illegal only among minors. Laws banning FGM/C at all ages have been passed in the majority of African countries."

  16. ^ a b Emma Bonino, "Banning Female Genital Mutilation", The New York Times, 19 December 2012.

    "General Assembly Strongly Condemns Widespread, Systematic Human Rights Violations", United Nations General Assembly, 20 December 2012: "[T]he Assembly adopted its first-ever text aimed at ending female genital mutilation, concluding a determined effort by African States."

  17. ^ Eric Silverman, "Anthropology and Circumcision", Annual Review of Anthropology, 33, 2004 (pp. 419–445), p. 427.

    Also see Richard Shweder, "'What About Female Genital Mutilation?" And Why Understanding Culture Matters in the First Place," in Richard A. Shweder, Martha Minow, Hazel Rose Markus (eds.), Engaging Cultural Differences: The Multicultural Challenge In Liberal Democracies, Russell Sage Foundation, 2002, p. 212 (in Daedalus, 129(4), Fall 2000).

  18. ^ Rahman and Toubia 2000, p. x; UNICEF 2013, pp. 6–7.
  19. ^ James Karanja, The Missionary Movement in Colonial Kenya: The Foundation of Africa Inland Church, Cuvillier Verlag, 2009, p. 93, n. 631.
  20. ^ Louisa Kasdon, "A Tradition No Longer, World & I, November–December 2005, p. 67.
  21. ^ For example, Rose Oldfield Hayes, "Female Genital Mutilation, Fertility Control, Women's Roles, and the Patrilineage in Modern Sudan: A Functional Analysis", American Ethnologist 2(4), November 1975, pp. 617–633.
  22. ^ WHO 2008, p. 22; Claudi Cappa, Tessa Wardlaw, and Bettina Shell-Duncan, "Changing a harmful social convention: female genital cutting/mutilation", Innocenti Digest, UNICEF 2005, pp. 1–2.

    For dominant term, Martha Nussbaum, "Judging Other Cultures: The Case of Genital Mutilation," Sex and Social Justice, Oxford University Press, 1999, p. 119.

  23. ^ Comfort Momoh, "Female genital mutilation" in Comfort Momoh (ed.), Female Genital Mutilation, Radcliffe Publishing, 2005, p. 6; for FGM/C, UNICEF 2013, p. 7; "Annex to USAID Policy on Female Genital Mutilation/Cutting (FGM/C): Explanation of Terminology", USAID, 2000. In 2014 the UN's Commission on the Status of Women agreed to stop referring to FGM as cutting; see Liz Ford, "Campaigners welcome 'milestone' agreement at UN gender equality talks", The Guardian, 23 March 2014.
  24. ^ Bilkis Vissandjée, "Female genital cutting (FGC) and the ethics of care: community engagement and cultural sensitivity at the interface of migration experiences", BMC International Health and Human Rights, 14, April 2014, p. 13. doi:10.1186/1472-698X-14-13
  25. ^ Rahman and Toubia 2000, p. 3.
  26. ^ Chantal Zabus, "The Excised Body in African Texts and Contexts," in Merete Falck Borch (ed.), Bodies and Voices: The Force-field of Representation and Discourse in Colonial and Postcolonial Studies, Rodopi, 2008, p. 47.
  27. ^ Mackie 1996, pp. 1004–1005.
  28. ^ Chantal Zabus, "Between Rites and Rights: Excision on Trial in African Women's Texts and Human Contexts," in Peter H. Marsden and Geoffrey V. Davis (eds.), Towards a Transcultural Future: Literature and Human Rights in a ' Post'-Colonial World, Rodopi 2004, pp. 112–113.
  29. ^ a b Raqiya D. Abdalla, "'My Grandmother Called it the Three Feminine Sorrows': The Struggle of Women Against Female Circumcision in Somalia," in Rogaia Mustafa Abusharaf (ed.), Female Circumcision: Multicultural Perspectives, University of Pennsylvania Press, 2007, p. 190.
  30. ^ Ellen Gruenbaum, The Female Circumcision Controversy: An Anthropological Perspective, University of Pennsylvania Press, 2001, pp. 3, 148.
  31. ^ Raqiya Haji Dualeh Abdalla, Sisters in Affliction: Circumcision and Infibulation of Women in Africa, Zed Books, 1982, p. 10.
  32. ^ Janice Boddy, Civilizing Women: British Crusades in Colonial Sudan, Princeton University Press, 2007), p. 1.
  33. ^ a b Susan Elmusharaf, Nagla Elhadi, Lars Almroth, "Reliability of self reported form of female genital mutilation and WHO classification: cross sectional study", British Medical Journal, 332(7559), 27 June 2006.
  34. ^ a b c UNICEF 2013, p. 46.
  35. ^ a b UNICEF 2005, p. 7: "The large majority of girls and women are cut by a traditional practitioner, a category which includes local specialists (cutters or exciseuses), traditional birth attendants and, generally, older members of the community, usually women. This is true for over 80 percent of the girls who undergo the practice in Benin, Burkina Faso, Côte d'Ivoire, Eritrea, Ethiopia, Guinea, Mali, Niger, Tanzania and Yemen. In most countries, medical personnel, including doctors, nurses and certified midwives, are not widely involved in the practice." Also see UNICEF 2013, pp. 42–44.

    Amal Abd El Hadi, "Female Genital Mutilation in Egypt" in Meredeth Turshen (ed.), African Women's Health, Africa World Press, 2000, p. 148: "In the main dayas (female traditional birth attendants) and barbers (male traditional health workers) perform the circumcision, particularly in rural areas and popular urban areas."

  36. ^ UNICEF 2013, pp. 43–45: "In some countries, such as Egypt, Sudan and Kenya ... a substantial number of health-care providers perform the procedure. This phenomenon is most acute in Egypt, where mothers report that in three out of four cases (77 per cent), FGM/C was performed on their daughters by a trained medical professional. In Egypt, this is most often a doctor, the only country where this holds true. In most countries where medical personnel play a significant role in performing FGM/C, nurses, midwives or other trained health personnel carry out the procedure" (p. 43). See p. 45 for the reference to 1997–2011 surveys.
  37. ^ a b c d Elizabeth Kelly, Paula J. Hillard, "Female genital mutilation", Current Opinion in Obstetrics & Gynecology, 17(5), October 2005, pp. 490–494 (review), p. 491.
  38. ^ "Female Genital Mutilation: A Teachers' Guide", World Health Organization, 2005, p. 31: "FGM is carried out using special knives, scissors, razors, or pieces of glass. On rare occasions sharp stones have been reported to be used (e.g. in eastern Sudan), and cauterization (burning) is practised in some parts of Ethiopia. Finger nails have been used to pluck out the clitoris of babies in some areas in the Gambia. The instruments may be re-used without cleaning."
  39. ^ Wairagala Wakabi, "Africa battles to make female genital mutilation history", The Lancet, 369 (9567), 31 March 2007, pp. 1069–1070.
  40. ^ UNICEF 2013, p. 50; Nahid Toubia, "Female Circumcision as a Public Health Issue", The New England Journal of Medicine, 331(11), 1994, pp. 712–716. doi:10.1056/NEJM199409153311106
  41. ^ Gerry Mackie, "Female Genital Cutting: The Beginning of the End," in Bettina Shell-Duncan and Ylva Hernlund (eds.), Female "Circumcision" in Africa: Culture Controversy and Change, Lynne Rienner Publishers, 2000 (pp. 253–282), p. 275 (also here).
  42. ^ UNICEF 2013, pp. 47, 50; the figures were collected between 2000 and 2010.
  43. ^ UNICEF 2005, p. 6: "In Yemen, the Demographic and Health Survey carried out in 1997 found that as many as 76 per cent of girls underwent FGM/C in their first two weeks of life."
  44. ^ Bettina Shell-Duncan, Ylva Hernlund (2000). Female "circumcision" in Africa: Culture, Controversy, and Change. Lynne Rienner Publishers. p. 17. ISBN 1555879950. Retrieved 30 July 2014. 
  45. ^ UNICEF 2013, p. 3–7 (see p. 126 for the questions).
  46. ^ UNICEF 2013, p. 48.
  47. ^ "Classification of female genital mutilation", World Health Organization, 2013.

    For more details, see "Eliminating Female Genital Mutilation", World Health Organization, 2008, pp. 4, 22–28. See p. 4, and Annex 2, p. 24, for the classification into Types I–IV; Annex 2, pp. 23–28, for a more detailed discussion.

  48. ^ UNICEF 2013, p. 48: "These categories do not fully match the WHO typology. Cut, no flesh removed describes a practice known as nicking or pricking, which currently is categorized as Type IV. Cut, some flesh removed corresponds to Type I (clitoridectomy) and Type II (excision) combined. And sewn closed corresponds to Type III, infibulation."
  49. ^ WHO 2013; WHO 2008, p. 25: "[There is a] common tendency to describe Type I as removal of the prepuce, whereas this has not been documented as a traditional form of female genital mutilation. However, in some countries, medicalized female genital mutilation can include removal of the prepuce only (Type Ia) (Thabet and Thabet, 2003), but this form appears to be relatively rare (Satti et al., 2006). Almost all known forms of female genital mutilation that remove tissue from the clitoris also cut all or part of the clitoral glans itself."

    Toubia 1994: "In my extensive clinical experience as a physician in Sudan, and after a careful review of the literature of the past 15 years, I have not found a single case of female circumcision in which only the skin surrounding the clitoris is removed, without damage to the clitoris itself."

  50. ^ WHO 2013; WHO 2008, p. 4; Toubia 1994.
  51. ^ Susan Izett and Nahid Toubia, Female Genital Mutilation: An Overview, World Health Organization, 1998.
  52. ^ WHO 2013; WHO 2008, p. 4: "Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision)"; p. 24: "When it is important to distinguish between the major variations that have been documented, the following subdivisions are proposed: Type IIa, removal of the labia minora only; Type IIb, partial or total removal of the clitoris and the labia minora; Type IIc, partial or total removal of the clitoris, the labia minora and the labia majora. Note also that, in French, the term "excision" is often used as a general term covering all types of female genital mutilation."
  53. ^ Amish J. Dave, Aisha Sethi, Aldo Morrone, "Female Genital Mutilation: What Every American Dermatologist Needs to Know", Dermatologic Clinics, 29(1), January 2011 (pp. 103–109, review), p. 104. doi:10.1016/j.det.2010.09.002
  54. ^ For twig or rock salt, Momoh 2005, pp. 6–7; Abdulcadira et al 2011: "In the case of infibulation, the urethral orifice and part of the vaginal opening are covered by the scar. In a virgin infibulated woman the small opening left for the menstrual blood and the urine is not wider than 2–3 mm; in sexually active women and after the delivery the vaginal opening is wider but the urethral orifice is often still covered by the scar."
  55. ^ Kelly and Hillard 2005, p. 491 (Kelly and Hillard say 2–6 weeks); Momoh 2005, pp. 6–7; for the egg mixture and progressive loosening of the binding, Edna Adan Ismail, "Female genital mutilation survey in Somaliland", Edna Adan Maternity and Teaching Hospital, 2009, p. 14.
  56. ^ Momoh 2005, pp. 6–7.

    For other descriptions, see Ismail 2009, pp. 12–14; Janice Boddy, Wombs and Alien Spirits: Women, Men, and the Zar Cult in Northern Sudan, University of Wisconsin Press, 1989, p. 50; Guy Pieters and Albert B. Lowenfels, "Infibulation in the Horn of Africa," New York State Journal of Medicine, 77(6), April 1977, pp. 729–731; Jacques Lantier, La Cité Magique et Magie En Afrique Noire, Libraire Fayard, 1972.

  57. ^ "The Gambia Committee on Traditional Practices Affecting the Health of Women and Children", Global Fund for Women, accessed 25 July 2014; for 76 percent, UNICEF 2013, p. 2.
  58. ^ Hanny Lightfoot-Klein, "The Sexual Experience and Marital Adjustment of Genitally Circumcised and Infibulated Females in The Sudan", The Journal of Sex Research, 26(3), 1989, pp. 375–392 (also available here). Also see Lightfoot-Klein, Prisoners of Ritual: An Odyssey Into Female Genital Circumcision in Africa, Routledge, 1989.
  59. ^ WHO 2008, p. 24.
  60. ^ Mairo Usman Mandara, "Female genital cutting in Nigeria: View of Nigerian Doctors on the Medicalization Debate," in Shell-Duncan and Hernlund, 2000, p. 95ff.

    Also see Stanlie M. James, "Female Genital Mutilation," in Bonnie G. Smith (ed.), The Oxford Encyclopaedia of Women in World History, Oxford University Press, 2008 (pp. 259–262), p. 259.

  61. ^ "Female Genital Mutilation: A Teachers' Guide", World Health Organization, 2005, p. 31.
  62. ^ a b WHO 2008, p. 28.
  63. ^ WHO 2008, p. 1.
  64. ^ UNICEF 2005, p. 16.
  65. ^ a b c Kelly and Hillard 2005, pp. 491–492
  66. ^ Amish J. Dave, Aisha Sethi, Aldo Morrone, "Female Genital Mutilation: What Every American Dermatologist Needs to Know", Dermatologic Clinics, 29(1), January 2011, pp. 103–109 (review).
  67. ^ E. Banks, et al, "Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries", The Lancet, 367(9525), 3 June 2006, pp. 1835–1841. For the WHO press release about the study, see "New study shows female genital mutilation exposes women and babies to significant risk at childbirth", World Health Organization, 2 June 2006.
  68. ^ Rigmor C. Berg, Eva Denisona, "A Tradition in Transition: Factors Perpetuating and Hindering the Continuance of Female Genital Mutilation/Cutting (FGM/C) Summarized in a Systematic Review", Health Care for Women International, 34(10), 2013 (review). doi:10.1080/07399332.2012.721417
  69. ^ Boyle 2002, pp. 34–35.
  70. ^ UNICEF 2013, pp. 3–5, 22 (see the table on p. 5 for information about how recent the data is).

    For more on UNICEF's data collection, "Multiple Indicator Cluster Survey (MICS)", UNICEF, 25 May 2012.

    For Iraqi Kurdistan, also see Berivan A. Yasin, et al, "Female genital mutilation among Iraqi Kurdish women: a cross-sectional study from Erbil city", BMC Public Health, 13, September 2013.

  71. ^ Mackie and LeJeune 2008, p. 5.
  72. ^ UNICEF 2013, p. 22.
  73. ^ Yoder and Khan (USAID) 2008, p. 7.

    For Nigeria, also see T. C. Okeke, et al, "An Overview of Female Genital Mutilation in Nigeria", Annals of Medical Health Sciences Research, 2(1), Jan–June 2012, pp. 70–73. Okeke writes that FGM is practised in Nigeria by the Yoruba, Hausa, Igbo, Ijaw and Kanuri ethnic groups, but not by the Fulani.

  74. ^ UNICEF 2013, p. 27. In Iraq the practice is concentrated in Erbil, Sulaymaniyah and Kirkuk in Iraqi Kurdistan.
  75. ^ WHO 2008, pp. 29–30. For more about the Bedouin, see Zukerman, Wendy. "Female genital mutilation becomes less common in Egypt", New Scientist, 18 August 2011.
  76. ^ UNICEF 2013, p. 23.
  77. ^ UNICEF 2013, p. 99; "Overwhelming opposition to female genital mutilation/cutting, yet millions of girls still at risk", UNICEF press release, 22 July 2013.
  78. ^ Kathy Dettwyler, Dancing Skeletons: Life and Death in West Africa, Waveland Press, 1994, p. 27.
  79. ^ Rogaia Mustafa Abusharaf, "Introduction: The Custom in Question," in Rogaia Mustafa Abusharaf (ed.), Female Circumcision: Multicultural Perspectives, University of Pennsylvania Press, 2007, p. 8; WHO 2013: "FGM is often considered a necessary part of raising a girl properly, and a way to prepare her for adulthood and marriage."
  80. ^ Mackie 1996, pp. 999–1000; Mackie 2000, p. 256, for footbinding having been outlawed in 1911.
  81. ^ UNICEF 2013, pp. 63, 65–68; also see footnote on p. 67; Mackie and LeJeune 2008, pp. 9–11.
  82. ^ Boddy 1989, p. 52; Gruenbaum 2001, p. 140.
  83. ^ James 2008, p. 261; Rahman and Toubia 2000, pp. 5–6.
  84. ^ Nussbaum 1999, p. 125.
  85. ^ Rahman and Toubia 2000, pp. 5–6.
  86. ^ M. Martinelli, J. E. Ollé-Goig, "Female genital mutilation in Djibouti", African Health Sciences, 12(4), December 2012.
  87. ^ Dettwyler 1994, p. 27.
  88. ^ For the baby's head, Gruenbaum 2001, p. 196; for the other myths, J. Steven Svoboda, "The Limits of the Law: Comparative Analysis of Legal and Extralegal Methods to Control Child Body Mutilation Practices," in George C. Denniston, et al, Understanding Circumcision, Springer, 2001, p. 325.

    For circumcisers relying on it, Sarah Windle, et al, "Harmful Traditional Practices and Women's Health: Female Genital Mutilation" in John Erihi (ed.), Maternal and Child Health: Global Challenges, Programs, and Policies, Springer 2009, p. 180.

  89. ^ Sandra D. Lane, Robert A. Rubinstein, "Judging the Other: Responding to Traditional Female Genital Surgeries", Hastings Center Report, 26(3), May–June 1996 (pp. 31–40), p. 35.
  90. ^ Abdalla 2007, p. 187.
  91. ^ Hayes 1975, p. 620.
  92. ^ Mackie and LeJeune 2008, pp. 6–7.
  93. ^ Mackie 1996, p. 1009.
  94. ^ Hayes 1975, p. 624.
  95. ^ El Dareer 1983, p. 140. Also see Vicky Kirby, "Out of Africa: 'Our Bodies Ourselves'?" in Obioma Nnaemeka (ed.), Female Circumcision and the Politics of Knowledge: African Women in Imperialist Discourses, Praeger, 2005, p. 84.
  96. ^ Boddy 1989, p. 52.
  97. ^ UNICEF 2013, p. 54.
  98. ^ Elizabeth Heger Boyle, Female Genital Cutting: Cultural Conflict in the Global Community, Johns Hopkins University Press, 2002, p. 37.
  99. ^ Izett and Toubia 1998.
  100. ^ Liselott Dellenborg, "A Reflection on the Cultural Meanings of Female Circumcision," in Signe Arnfred (ed.), Re-thinking Sexualities in Africa, Nordic Africa Institute, 2004, p. 80, n. 1: "Female circumcision ... is not mentioned in the Quran, nor in the Bible or in the Torah"; Mackie 1996, p. 1004.
  101. ^ Mackie 1996, pp. 1004–1005: "FGM is found only in or adjacent to Islamic groups (some Christians practice it to avoid damnation). This is curious, because FGM, beyond the mild sunna supposedly akin to male circumcision, is not found in most Islamic countries nor is it required by Islam"; p. 1008: "FGM is pre-Islamic but was exaggerated by its intersection with the Islamic modesty code of family honor, female purity, virginity, chastity, fidelity, and seclusion."

    Ibrahim Lethome Asmani, Maryam Sheikh Abdi, "Delinking Female Genital Mutilation/Cutting from Islam", USAID/UNFPA, 2008.

  102. ^ Mackie 1996, pp. 1004–1005: "... several hadith (sayings attributed to Mohammed) recommend attenuating the practice for the woman's sake, praise it as noble but not commanded, or advise that female converts refrain from mutilation because even if pleasing to the husband it is painful to the wife"; Nussbaum 1999, p. 125: "The one reference to the operation in the hadith classifies it as a makrama, or nonessential practice."
  103. ^ "Call to end female circumcision", BBC News, 24 November 2006; Video of conference, Al-Azhar University, Cairo, 22 and 23 November 2006.

    UNICEF 2013, p. 70: "A great deal of effort by scholars and activists has concentrated on demonstrating a lack of scriptural support for the practice. In Egypt, for example, the most authoritative condemnation of FGM/C in Islam to date is the 2007 fatwa (religious edict) issued by the Al-Azhar Supreme Council of Islamic Research, explaining that FGM/C has no basis in Sharia (Islamic law) or any of its partial provisions, and that it is a sinful action that should be avoided. Several regional and national fatwas have followed in the years since, with the original statement as their basis."

    Wakabi (The Lancet) 2007: "Muslim leaders in countries like Egypt and Kenya are saying female genital mutilation is a cultural tradition that is unrelated to the teachings of Islam, and are campaigning for its abandonment."

    Maggie Michael, "Egypt Officials Ban Female Circumcision", The Associated Press, 29 June 2007, p. 2: "[Egypt's] supreme religious authorities stressed that Islam is against female circumcision. Its prohibited, prohibited, prohibited," Grand Mufti Ali Gomaa said on the privately owned al-Mahwar network."

  104. ^ Mackie 1996, p. 1004: "Mutilation is not practiced in Mecca or Medina, and Saudis reportedly find the custom pagan."
  105. ^ UNICEF 2013, p. 23: "Although no nationally representative data on FGM/C are available for countries including Colombia, Jordan, Oman, Saudi Arabia and parts of Indonesia and Malaysia, evidence suggests that the procedure is being performed."

    James Randerson, "Female genital mutilation denies sexual pleasure to millions of women", The Guardian, 13 November 2008, referring to Alsibiani S.A. and Rouzi A.A. "Sexual function in women with female genital mutilation", Fertility and Sterility, 93(3), February 2010, pp. 722–724. The Guardian added: "This clarification was added on Friday November 21, 2008. It was not correct to say that female genital mutilation is practiced 'frequently' in Saudi Arabia. The data on the practice of FGM there is not good and therefore its prevalence is unknown. Although some studies suggest that it does occur in the country FGM may be most common amongst immigrant populations. In Dr Sharifa Sibiani and Prof Abdulrahim Rouzi's study the participants were a mixture of migrants and women born in Saudi Arabia."

  106. ^ UNICEF 2013, pp. 69–70; see table on p. 71.
  107. ^ Mackie and LeJeune 2008, p. 8: "Data on the role of religion are difficult to interpret because in many cases, religion, tradition and chastity are not differentiated."
  108. ^ Mackie 1996, p. 1005; "What is the Christian perspective on Female Genital Mutilation?", Coptic Orthodox Diocese of the Southern United States.
  109. ^ Shaye J. D. Cohen, Why Aren't Jewish Women Circumcised? Gender and Covenant In Judaism, University of California Press, 2005, p. 59; Adele Berlin (ed.), "Circumcision," The Oxford Dictionary of the Jewish Religion, Oxford University Press, 2011, p. 173.
  110. ^ Mackie 1996, p. 1003.
  111. ^ a b Mary Knight, "Curing Cut or Ritual Mutilation?: Some Remarks on the Practice of Female and Male Circumcision in Graeco-Roman Egypt", Isis, 92(2), June 2001 (pp. 317–338), p. 330. Knight adds that Egyptologists are uncomfortable with the translation to uncircumcised, because the reference offers no information about what constituted the circumcised state.
  112. ^ Knight 2001, p. 318: "That custom is excision of the clitoris and other external female genitalia, sometimes called female circumcision but now usually referred to in Egypt as female genital mutilation (FGM); the first extant literary mention of it is by the Greek geographer Strabo, who visited Egypt in about 25 BCE: 'This is one of the customs most zealously pursued by them [the Egyptians]: to raise every child that is born and to circumcise the males and excise the females.'"

    Strabo, Geography of Strabo, Book VII, chapter 2, 17.2.5, wrote: "One of the customs most zealously observed among the Aegyptians is this, that they rear every child that is born, and circumcise [peritemnein] the males, and excise [ektemnein] the females, as is also customary among the Jews, who are also Aegyptians in origin, as I have already stated in my account of them."

    Strabo, Geography of Strabo, Book XVI, chapter 4, 16.4.9: "And then to the Harbour of Antiphilus, and, above this, to the Creophagi [meat-eaters], of whom the males have their sexual glands mutilated [kolobos] and the women are excised [ektemnein] in the Jewish fashion." A different translation here reads: "Then follows the harbour of Antiphilus, and above this a tribe, the Creophagi, deprived of the prepuce, and the women are excised after the Jewish custom."

    Cohen 2005, p. 59ff, argues that Strabo conflated the Jews with the Egyptians. Jacob Neusner, Approaches to Ancient Judaism, Volume 4, Scholars Press, 1993, p. 148: "the Greek verb περιτέμνειν [peritemnein] 'to cut around/off,' denoted not only circumcision but could be used of any mutilation of body parts, such as the severing of a nose or ears; in Herodotus it is associated with various barbarian practices."

    Knight 2001, p. 326, writes that there is one extant reference from antiquity, from Xanthus of Lydia in the fifth century BCE, that may allude to FGM outside Egypt. Xanthus wrote, in a history of Lydia: "The Lydians arrived at such a state of delicacy that they were even the first to 'castrate' their women." Knight argues that the "castration," which is not described, may have kept women youthful, in the sense of allowing the Lydian king to have intercourse with them without pregnancy. Knight concludes that it may have been a reference to sterilization, not FGM.

  113. ^ Knight 2001, p. 333.
  114. ^ Knight 2001, p. 331, citing G. Elliot Smith, A Contribution to the Study of Mummification in Egypt, 1906, p. 30. Knight also quotes Marc Armand Ruffer (1859–1917), Studies in the Paleopathology of Egypt, University of Chicago Press, 1921, p. 171: "[T]he bodies are in such a state that it would often be difficult to state with certainty whether such an operation had been done." Knight adds: "In light of the fact that only rarely have scientific researchers autopsying mummies specifically looked for the presence or absence of FGM, conclusive remarks about the prevalence of the practice must await a detailed study of a large cohort of female mummies."
  115. ^ Mackie 1996, p. 1003. Also see C. G. Seligman, "Aspects of the Hamitic problems in the Anglo-Egyptian Sudan",The Journal of the Royal Anthropological Institute of Great Britain and Ireland, 1913, 40(3), (pp. 593–705), pp. 612, 639–640; Esther K. Hicks, Infibulation: Female Mutilation in Islamic Northeastern Africa, Transaction Publishers, pp. 1996, 19ff, 209ff.
  116. ^ Mackie 1996, p. 1003, citing João dos Santos, Ethiopia Oriental, 1609, in G. S. P. Freeman-Grenville (ed.), The East-African Coast: Select Documents from the First to the Earlier Nineteenth Century, Clarendon Press, 1962.
  117. ^ Mackie 1996, p. 1003. Footnote 4: The Swedish ethnographer, Carl Gösta Widstrand ("Female Infibulation," Studia Ethnographica Upsaliensia, XX, 1960, pp. 95–124) argued that slave traders had simply paid a higher price for women who were already infibulated.
  118. ^ Mackie 1996, p. 1009.
  119. ^ a b J. F. C. "Isaac Baker Brown, F.R.C.S.," Medical Times and Gazette, 8 February 1873, p. 155; Peter Lewis Allen, The Wages of Sin: Sex and Disease, Past and Present, University of Chicago Press, 2000, p. 106.
  120. ^ Sarah W. Rodriguez, "Rethinking the history of female circumcision and clitoridectomy: American medicine and female sexuality in the late nineteenth century", Journal of the History of Medicine and Allied Sciences. 63(3), July 2008, pp. 323–347.
  121. ^ Robert Thomas, 'The Modern Practice of Physick, etc, 1813, pp. 585–586; Edward Shorter, From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era, Simon and Schuster, 2008, p. 82.
  122. ^ Uriel Elchalal, et al, "Ritualistic Female Genital Mutilation: Current Status and Future Outlook", Obstetrical & Gynecological Survey, 52(10), October 1997, pp. 643–651.

    Also see Donald Campbell Black, On the Functional Diseases of the Renal, Urinary and Reproductive Organs, Lindsay & Blakiston, 1872, pp. 127–129; Shorter 2008, p. 82.

  123. ^ John Black, "Female genital mutilation: a contemporary issue, and a Victorian obsession", Journal of the Royal Society of Medicine, 90, July 1997 (pp. 402–405), p. 403, 404–405; Lewis 2000, p. 106.

    Elizabeth Sheehan, "Victorian Clitoridectomy: Isaac Baker Brown and His Harmless Operative Procedure", Medical Anthropology Newsletter, 12(4), August 1981.

    Isaac Baker Brown, On the Curability of Certain Forms of Insanity, Epilepsy, Catalepsy, and Hysteria in Females, Robert Hardwicke, 1866.

  124. ^ Deborah Kuhn McGregor, From Midwives to Medicine: The Birth of American Gynecology, Rutgers University Press, 1998, p. 146.
  125. ^ G. J. Barker-Benfield, The Horrors of the Half-Known Life: Male Attitudes Toward Women and Sexuality in Nineteenth-Century America, Routledge, 1999, p. 113.
  126. ^ L. P. Cutner, "Female genital mutilation", Obstetrical & Gynecological Survey, 40(7), July 1985, pp. 437–443, cited in Nawal M. Nour, "Female Genital Cutting: A Persisting Practice", Reviews in Obstetrics and Gynecology, 1(3), Summer 2008, pp. 135–139 (review).
  127. ^ a b Lynn M. Thomas, "'Ngaitana (I will circumcise myself)': Lessons from Colonial Campaigns to Ban Excision in Meru, Kenya" in Bettina Shell-Duncan and Ylva Hernlund (eds.), Female "Circumcision" in Africa: Culture Controversy and Change, Lynne Rienner Publishers, 2000, p. 132. For irua, Zabus 2008, p. 48.
  128. ^ Boddy 2007, pp. 241–245. For irugu, Zabus 2008, p. 49.
  129. ^ Mary E. Holding, "Women's Institutions and the African Church", International Review of Mission, 31(3), July 1942, pp. 290–300, cited in Thomas 2000, p. 136.
  130. ^ Robert Strayer, Jocelyn Murray, "The CMS and Female Circumcision," in Robert Strayer (ed.), The Making of Missionary Communities in East Africa, SUNY Press, 1978, p. 139ff.
  131. ^ Boddy 2007, p. 241.
  132. ^ Shweder 2002, p. 221 (also in Daedalus, 129(4), Fall 2000); Ann Beck, "Some Observations on Jomo Kenyatta in Britain, 1929–1930", Cahiers d'études africaines, 6(22), 1996 (pp. 308–329), pp. 321–322.

    Kenyatta wrote in a letter to The Guardian around 1930: "The real argument lies not in the defense of the general surgical operation or its details, but in the understanding of a very important fact in the tribal psychology of the Kikuyu – namely, that this operation is still regarded as the essence of an institution which has enormous educational, social moral and religious implications, quite apart from the operation itself. For the present it is impossible for a member of the tribe to imagine an initiation without clitoridoctomy [sic]. Therefore the surgical abolition of the surgical element in this custom means to the Kikuyu the abolition of the whole institution." See Kenneth Mufuka, "Scottish Missionaries and the Circumcision Controversy in Kenya, 1900–1960", International Review of Scottish Studies, 28, 2003, p. 49, citing an undated letter by Jomo Kenyatta (then known as Johnston Kenyatta) to The Guardian (then known as The Manchester Guardian), around 1930.

  133. ^ Lynn Thomas, Politics of the Womb: Women, Reproduction, and the State in Kenya, University of California Press, 2003, pp. 89–91. Also see Thomas 2000, pp. 129–130.

    Lynn M. Thomas, "'Ngaitana (I will circumcise myself)': The Gender and Generational Politics of the 1956 Ban on Clitoridectomy in Meru, Kenya", Gender and History, 8(3), November 1996, pp. 338–363.

  134. ^ Thomas 2000, p. 131.
  135. ^ S. Abd el Salam, "A Comprehensive Approach for Communication about Female Genital Mutilation in Egypt," in George C. Denniston, Frederick Mansfield Hodges and Marilyn Fayre Milos (eds.), Male and Female Circumcision: Medical, Legal, and Ethical Considerations in Pediatric Practice, Springer, 1999, pp. 318–320.

    UNICEF 2013, p. 10, calls the Egyptian Doctors' Society opposition the "first known campaign" against FGM.

  136. ^ Boyle 2002, p. 41; Leonard Kouba, et al, "Female Circumcision in Africa: An Overview", African Studies Review, 28(1), March 1985 (pp. 95–110, p. 106.
  137. ^ a b UNICEF 2013, pp. 8–9.

    The African countries in which FGM is concentrated, and which have passed legislation against it, as of 2013 (UNICEF 2013, p. 9; does not include laws passed during colonial rule): Benin (2003), Burkina Faso (1996), Central African Republic (1966, amended 1996), Chad (2003), Côte d'Ivoire (1998), Djibouti (1995, amended 2009), Egypt (2008), Eritrea (2007), Ethiopia (2004), Ghana (1965, amended 2007), Guinea (1965, amended 2000), Guinea-Bissau (2011), Kenya (2001, amended 2011), Mauritania (2005), Niger (2003), Nigeria (1999–2006, some states), Senegal (1999), Somalia (2012), Sudan (2008–2009, some states), Togo (1998), Uganda (2010), United Republic of Tanzania (1998). It has also been outlawed in Yemen (2001) and Iraqi Kurdistan (2011). South Africa and Zambia have outlawed it, but are not among the countries in which it is concentrated (p. 8).

  138. ^ a b Gruenbaum 2001, p. 22.

    Homa Khaleeli, "Nawal El Saadawi: Egypt's radical feminist", The Guardian, 15 April 2010; Jenna Krajeski, "The Books of Nawal El Saadawi", The New Yorker, 7 March 2011; Jenna Krajeski, "Rebellion", The New Yorker, 14 March 2011.

  139. ^ a b Lora Wildenthal, The Language of Human Rights in West Germany, University of Pennsylvania Press, 2012, pp. 145–146.
  140. ^ Yoder and Khan (USAID) 2008, p. 2.
  141. ^ Oldfield Hayes 1975, p. 618; Gruenbaum 2001, p. 21.
  142. ^ Rahman and Toubia 2000, pp. 10–11; Boyle 2002, p. 45; Zabus 2008, p. 56.

    For the opposition being linked to feminism, see Birgitte Bagnol, Esmeralda Mariano, "Politics of naming sexual practices," in Sylvia Tamale (ed.), African Sexualities: A Reader, Pambazuka Press, 2011, p. 281.

  143. ^ Yoder and Khan (USAID) 2008, p. 2; Gruenbaum 2001, p. 22.

    Fran Hosken, The Hosken Report: Genital and Sexual Mutilation of Females, Women's International Network, 1994 [1979].

    Also see UNICEF 2013, p. 8; Wildenthal 2012, p. 145; Ross 2008, p. 477; Joseph P. Khan, "Fran P. Hosken, 86; activist for women's issues globally", The Boston Globe, 12 February 2006; Rahman and Toubia 2000, p. 10; Robin Morgan, Gloria Steinem "The International Crime of Female Genital Mutilation," Ms. magazine, March 1980, p. 65.

  144. ^ Hosken 1994 [1979], p. 5, cited in Sara Johnsdotter and Birgitta Essén, "Genitals and ethnicity: the politics of genital modifications", Reproductive Health Matters, 18(35), 2010 (pp. 29–37), p. 31.
  145. ^ Boyle 2002, p. 47; Rogaia Mustafa Abusharaf, "Revisiting Feminist Discourses on Inbulation: The Hosken Report," in Shell-Duncan and Hernlund 2000, pp. 160–163; "U.N. World Conference of the U.N. Decade for Women", report of Congressional staff advisers to the US delegation, December 1980, p. 52ff.
  146. ^ The Convention on the Elimination of All Forms of Discrimination against Women was adopted by the UN General Assembly in December 1979. See Elizabeth Fee, "Review of The Hosken Report: Genital and Sexual Mutilation of Females by Fran P. Hosken", Signs, 5(4), Summer 1980 (pp. 807–809), p. 809.

    Robin Morgan and Gloria Steinem wrote about FGM in Ms magazine; see "The International Crime of Female Genital Mutilation," Ms. magazine, March 1980. Sudanese physician Asma El Dareer published an influential study of FGM in Sudan, Woman, Why Do You Weep? (1982). The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children called for an end to the practice in 1984 (Rahman and Toubia 2000, p. 10), as did the UN's World Conference on Human Rights in 1993 (UNICEF 2013 p. 8; Toubia 1994), and the Fourth World Conference on Women in Beijing in 1995 (Boddy 2007, p. 2).

  147. ^ UNICEF 2013, p. 8.
  148. ^ Emma Bonino, "A brutal custom: Join forces to banish the mutilation of women", The New York Times, 15 September 2004.

    Charlotte Feldman-Jacobs, "Commemorating International Day of Zero Tolerance to Female Genital Mutilation", Population Reference Bureau, February 2009; "Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa", African Commission on Human and Peoples' Rights.

  149. ^ UNICEF 2013, pp. 2, 12, 22. Around one in five cases of FGM take place is Egypt (p. 22); the penalty, as of 2013, was up to two years' imprisonment and a fine of up to $1,000 (p. 12).
  150. ^ Jill Smolowe, "A Rite of Passage – Or Mutilation?", Time magazine, 26 September 1994; Peter Kandela, "Egypt sees U turn on female circumcision", British Medical Journal, 310(6971), 1995; Mae Ghalwash, "Cairo court rejects lawsuit against CNN in genital mutilation case", Associated Press, 30 August 1997.
  151. ^ Abd el Salam 1999, p. 322.
  152. ^ Maggie Michael, "Egypt Officials Ban Female Circumcision", The Associated Press, 29 June 2007; "Fresh progress toward the elimination of female genital mutilation and cutting in Egypt", UNICEF, 2 July 2007.
  153. ^ "Women, all over the world, together to #EndFGM". Oxfam. Retrieved 31 July 2014. 
  154. ^ "Multiple Indicator Cluster Survey 2011 - Preliminary Results: Northeast Zone, Somalia (Summary)". UNICEF. Retrieved 31 July 2014. 
  155. ^ "Multiple Indicator Cluster Survey 2011 - Preliminary Results: Somaliland (Summary)". UNICEF. Retrieved 31 July 2014. 
  156. ^ Warsidaha Ururka Ingiriiska Iyo Soomaalida, Volumes 33-40. The Society. 2003. p. 24. Retrieved 26 July 2014. 
  157. ^ UNICEF 2005, p. 4: "Beyond economic factors, migratory patterns have frequently reflected links established in the colonial past. For instance, citizens from Benin, Chad, Guinea, Mali, Niger and Senegal have often chosen France as their destination, while many Kenyan, Nigerian and Ugandan citizens have migrated to the United Kingdom.

    "In the 1970s, war, civil unrest and drought in a number of African states, including Eritrea, Ethiopia and Somalia, resulted in an influx of refugees to Western Europe, where some countries, such as Norway and Sweden, had been relatively unaffected by migration up to that point. Beyond Western Europe, Canada and the USA in North America, and Australia and New Zealand in Australasia also host women and children who have been subjected to FGM/C, and are home to others who are at risk of undergoing this procedure."

    In the UK there was a report in 2009 that parents fly in "house doctors" to perform the procedure on multiple girls during the same ceremony in one of the family's homes; see Richard Kerbaj, "Thousands of girls mutilated in Britain",The Times, 16 March 2009 (courtesy link).

  158. ^ Birgitta Essén, Sara Johnsdotter, "Female Genital Mutilation in the West: Traditional Circumcision versus Genital Cosmetic Surgery", Acta Obstetricia Gynecologica Scandinavica, 83(7), July 2004 (pp. 611–613), p. 611.
  159. ^ Boyle 2002 p. 97.
  160. ^ "Review of Australia's Female Genital Mutilation Legal Framework", Attorney General's Department, Government of Australia.

    "Section 204A – Female genital mutilation – Crimes Act 1961", New Zealand Parliamentary Counsel Office.

    For the European Union, Megan Rowling, "France reduces genital cutting with prevention, prosecutions - lawyer", Thomson Reuters Foundation, 27 September 2012.

    "Family Violence: Department of Justice Canada Overview paper", Department of Justice, 31 July 2007, n. 4.

  161. ^ Clyde H. Farnsworth, "Canada Gives Somali Mother Refugee Status", The New York Times, 21 July 1994.
  162. ^ UNICEF 2013, p. 8.
  163. ^ Mobina S. B. Jaffer, "Criminal Code, Bill to Amend – Second Reading, Debates of the Senate (Hansard), 1st Session, 41st Parliament, 148(79), 15 May 2012: "Another example of legislation that was honourable in principle but lacked the resources to be effective was the one that criminalized female genital mutilation. In 1995, in the Second Session of the Thirty-fifth Parliament, Bill C-27 was passed making female genital mutilation a criminal act; therefore, in Canada this practice is considered a criminal offence. Those who perform this procedure can be charged under the Criminal Code of Canada. Unfortunately, over the past 17 years not one conviction has been made, even though there is evidence indicating that this practice still takes place in Canada."
  164. ^ Rahman and Toubia 2000, p. 152; Rowling 2012; John Lichfield, "The French way: a better approach to fighting FGM?", The Independent, 15 December 2013.
  165. ^ Colette Gallard, "Female genital mutilation in France", British Medical Journal, 310, 17 June 1995, p. 1592. That one was three months old, Rowling 2012.
  166. ^ Efua Dorkenoo, Linda Morison, Alison Macfarlane, "A Statistical Study to Estimate the Prevalence of Female Genital Mutilation in England and Wales", FORWARD, October 2007, p. 25.

    Amelia Hill, "Female genital mutilation campaigners face death threats and intimidation", The Guardian, 8 May 2013: "The first and only major piece of FGM research at a national level was in 2007 by the charity Forward, in collaboration with the London School of Hygiene and Tropical Medicine and the department of midwifery at City University, which was funded by the Department of Health." Also see J. A. Black, G. D. Debelle, "Female genital mutilation in Britain", British Medical Journal, 310, 17 June 1995.

  167. ^ "Prohibition of Female Circumcision Act 1985", "Female Genital Mutilation Act 2003", "Prohibition of Female Genital Mutilation (Scotland) Act 2005", legislation.gov.uk

    Tracy McVeigh, Tara Sutton, "British girls undergo horror of genital mutilation despite tough laws", The Guardian, 25 July 2010.

  168. ^ Alexandra Topping, "FGM: first suspects to be charged appear in court", The Guardian, 15 April 2014; "'Genital mutilation' doctor struck off after undercover press sting", BBC News, 30 May 2014.
  169. ^ Wanda K. Jones, et al, "Female Genital Mutilation/Female Circumcision: Who Is at Risk in the U.S.?", Public Health Reports, 112, September/October 1997 (pp. 368–377), p. 372.
  170. ^ Nussbaum 1999, pp. 118–119; Celia W. Dugger, "June 9-15; Asylum From Mutilation",The New York Times, 16 June 1996; Celia W. Dugger, "Woman's Plea for Asylum Puts Tribal Ritual on Trial", The New York Times, 15 April 1996.

    "In re Fauziya KASINGA, file A73 476 695", U.S. Department of Justice, Executive Office for Immigration Review, decided 13 June 1996.

  171. ^ "18 U.S. Code § 116 - Female genital mutilation", Legal Information Institute, Cornell University Law School; Susan Deller Ross, Women's Human Rights: The International and Comparative Law Casebook, Vantage Press, 2008, p. 509–511; "Legislation on Female Genital Mutilation in the United States", Center for Reproductive Rights, November 2004, p. 3.
  172. ^ "One Hundred Twelfth Congress of the United States of America", 3 January 2012, Sec 1088, p. 339.
  173. ^ "Man gets 10-year sentence for circumcision of 2-year-old daughter", Associated Press, 1 November 2006.
  174. ^ Silverman 2004, pp. 420, 427.
  175. ^ Sylvia Tamale, "Researching and theorising sexualities," in Sylvia Tamale (ed.), African Sexualities: A Reader, Fahamu/Pambazuka, 2011, pp. 19–20; Rogaia Mustafa Abusharaf, "Revisiting Feminist Discourses on Inbulation: The Hosken Report," in Shell-Duncan and Hernlund 2000, pp. 160–163.
  176. ^ Tamale 2011, p. 20.

    Historian Chima Korieh cites, as an example of the objectification of African women by opponents of FGM, the publication by 12 American newspapers of the circumcision ceremony of a 16-year-old girl in Kenya in 1996. The photographs won the Pulitzer Prize for Feature Photography, but according to Korieh the girl had not given permission for images of her naked body to be published or even taken. For the winning photographs, see "Stephanie Welsh", 1996 Pulitzer Prize winners. See Chima Korieh, "'Other' Bodies: Western Feminism, Race and Representation in Female Circumcision Discourse," in Obioma Nnaemeka (ed.), Female Circumcision and the Politics of Knowledge: African Women in Imperialist Discourses, Praeger, 2005, pp. 121–122.

  177. ^ Stanlie M. James, "Listening to Other(ed) Voices: Reflections around Female Genital Cutting," in Stanlie M. James and Claire C. Robertson (eds.), Genital Cutting and Transnational Sisterhood, University of Illinois Press, 2002, p. 89.
  178. ^ Shweder 2002, pp. 217–218; Boddy 2007, p. 3; Shell-Duncan and Hernlund 2000, p. 2; Silverman 2004, pp. 429–430.

    Carla Obermeyer, "Female Genital Surgeries: The Known, the Unknown and the Unknowable", Medical Anthropology Quarterly, 31(1), 1999 (pp. 79–106), pp. 92–93.

    Ahmadu, Fuambai. "Rites and Wrongs: An Insider/Outsider Reflects on Power and Excision," in Shell-Duncan and Hernlund 2000, p. 283ff.

  179. ^ Richard Shweder, "When Cultures Collide: Which Rights? Whose Tradition of Values? A Critique of the Global Anti-FGM Campaign," in Christopher L. Eisgruber and András Sajó (eds.), Global Justice And the Bulwarks of Localism, Martinus Nijhoff, 2005 (pp. 181–199]), pp. 190–193.
  180. ^ Shweder 2002, pp. 218–219; Obermeyer 1999, pp. 92–93: "On the basis of the vast literature on the harmful effects of genital surgeries, one might have anticipated finding a wealth of studies that document considerable increases in mortality and morbidity. This review could find no incontrovertible evidence on mortality, and the rate of medical complications suggests that they are the exception rather than the rule."

    Carla Obermeyer, "The Health Consequences of Female Circumcision: Science, Advocacy, and Standards of Evidence", Medical Anthropology Quarterly, 17(3), September 2003; Carla Obermeyer, "The Consequences of Female Circumcision for Health and Sexuality: An Update on the Evidence", Medical Anthropology Quarterly, 7(5), September–October 2005.

    More from Shweder in John Tierney, "'Circumcision' or 'Mutilation'? And Other Questions About a Rite in Africa", The New York Times, 5 October 2007.

  181. ^ Silverman 2004, p. 430; Gerry Mackie, ["http://www.jstor.org/stable/10.2307/3655332 Female Genital Cutting: A Harmless Procedure?"], Medical Anthropology Quarterly, 17(2), 2003, pp. 135–158.
  182. ^ Sweder 2005, pp. 187, 188–189; Linda Morison, et al, "The long-term reproductive health consequences of female genital cutting in rural Gambia: a community-based survey", Tropical Medicine & International Health, 6(8), August 2001, pp. 643–653.
  183. ^ Obermeyer 1999, p. 94.
  184. ^ Essén and Johnsdotter 2004, p. 613.
  185. ^ a b Johnsdotter and Essén 2010, p. 32; Samar A. Farage, "Female Genital Alteration: A Sociological Perspective," in Miranda A. Farage and Howard I. Maibach (eds.), The Vulva: Anatomy, Physiology, and Pathology, CRC Press, 2006, p. 267; Marge Berer, "It's female genital mutilation and should be prosecuted", British Medical Journal, 334(7608), 30 June 2007, p. 1335.
  186. ^ Wildenthal 2012, p. 148.
  187. ^ Ronán M. Conroy, "Female genital mutilation: whose problem, whose solution?", British Medical Journal, 333(7559), 15 July 2006.
  188. ^ Johnsdotter and Essén 2010, p. 32.

    In the UK the Female Genital Mutilation Act 2003 says: "A person is guilty of an offence if he excises, infibulates or otherwise mutilates the whole or any part of a girl's labia majora, labia minora or clitoris," unless "necessary for her physical or mental health." Although the legislation refers to girls, it applies to women too. See "Female Genital Mutilation Act 2003", legislation.gov.uk, and "Female Genital Mutilation Act 2003" (legal guidance), Crown Prosecution Service: "The Act refers to 'girls', though it also applies to women."

  189. ^ Nussbaum 1999, pp. 123–124.
  190. ^ Nancy Ehrenreich, Mark Barr, "Intersex Surgery, Female Genital Cutting, and the Selective Condemnation of 'Cultural Practices'", Harvard Civil Rights-Civil Liberties Law Review, 40(1), 2005 (pp. 71–140), pp. 74–75.

    Also see Chase, Cheryl. "'Cultural Practice' or 'Reconstructive Surgery'? US Genital Cutting, the Intersex Movement, and Medical Double Standards," in Stanlie M. James and Claire C. Robertson (eds.), Genital Cutting and Transnational Sisterhood, University of Illinois Press, 2002, p. 126ff.

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Further reading

Resources
"Factsheet on FGM", World Health Organization, February 2013.
British National Society for the Prevention of Cruelty to Children 24-hour national helpline for children at risk of FGM: 0800 028 3550
FORWARD, London, charity specializing in FGM research (FORWARD's list of hospitals and clinics in the UK offering specialist FGM services).
Desert Flower Foundation ("First Desert Flower Center opens in Berlin", 16 September 2013, first dedicated FGM clinic in Europe).
"Circumcision, female", The Kinsey Institute (bibliography 1960s–1980s).
Westley, David M. "Female circumcision and infibulation in Africa", Electronic Journal of Africana Bibliography, 4, 1999 (bibliography up to 1997).
The Guardian. FGM archive.
The Guardian. "The facts about female genital mutilation – interactive", interactive display showing facts and figures from UNICEF, 22 July 2013.
Books, articles
Bryk, Felix. Circumcision in Man and Woman: Its History, Psychology, and Ethnology, The Minerva Group, Inc., 2001, first published 1934.
Gollaher, David. "Female circumcision," Circumcision: A History of the World's Most Controversial Surgery, Basic Books, 2000, p. 187ff.
CNN. Report on FGM in Egypt, February 2009.
Cullen-Dupont, Kathryn. "Female genital mutilation," Encyclopedia of Women's History in America, Da Capo Press, 1998, p. 85.
Sembène, Ousmane. Moolaadé, 2004, a film about abandoning FGM.
Sinclair, Stephanie. '"Inside a Female-Circumcision Ceremony", The New York Times magazine, April 2006, slideshow of images from Indonesia (article).
Walker, Alice. Possessing the Secret of Joy, New Press, 1993 (novel).
UNICEF. "Towards the abandonment of female genital mutilation in five African countries", October 2010.
Yoder, P. Stanley; Noureddine, Abderrahim; Arlinda, Zhuzhuni. "Female Genital Cutting in the Demographic and Health Surveys: A Critical and Comparative Analysis", DHS Comparative Reports No. 7, 2004.
Personal stories
Ali, Ayaan Hirsi. Infidel: My Life, Simon & Schuster, 2007: Ali experiences FGM at the hands of her grandmother.
Dirie, Waris. Desert Flower, Harper Perennial, 1999: autobiographical novel.
Dirie, Waris. Desert Dawn, Little, Brown, 2003: Dirie's work as UN Special Ambassador against FGM.
Dirie, Waris. Desert Children, Virago, 2007: FGM in Europe
Kasinga, Fauziya, and Bashir, Layli Miller. Do They Hear You When You Cry, Delacorte Press, 1998.
El Saadawi, Nawal. Woman at Point Zero, Zed Books, 1975.