Female genital mutilation

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"FGM" redirects here. For other uses, see FGM (disambiguation).
Road sign near Kapchorwa, Uganda, 2004.
FGM was outlawed there in 2009, but is 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

Days 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 some or all of the external female genitalia. Typically carried out by a traditional circumciser with a blade or razor, with or without anaesthesia, FGM is practised by ethnic groups in 27 countries in sub-Saharan and north-east Africa, in Yemen and Iraqi Kurdistan, and to a lesser extent elsewhere in Asia and within immigrant communities around the world.[8] The age at which it is conducted varies from days after birth to puberty; in half the countries for which national figures were available in 2000–2010, most girls were cut before the age of five.[5]

The procedures differ according to the ethnic group. They include removal of the clitoral hood and part of the clitoris, and removal of the clitoris and inner labia. In the most severe form (known as infibulation), the inner and outer labia are removed and the vulva is closed; a small hole is left for the passage of urine and menstrual blood, and the vagina is opened for intercourse and childbirth.[9] 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.[10] There are no known health benefits.[11]

The practice is rooted in gender inequality, attempts to control women's sexuality, and ideas about purity, modesty and aesthetics. It is usually initiated and carried out by women, who see it as a source of honour, and who fear that failing to have their daughters and granddaughters cut will expose the girls to social exclusion.[12] Over 125 million women and girls have experienced FGM in Africa, Yemen and Iraqi Kurdistan; half of them live in Egypt and Ethiopia.[13] Over eight million women and girls have been infibulated, a practice most common in Djibouti, Eritrea, Ethiopia, Somalia and Sudan.[14]

FGM has been outlawed or restricted in most of the countries in which it occurs, but the laws are poorly enforced.[7] There have been international efforts since the 1970s to persuade practitioners to abandon it, and in 2012 the United Nations General Assembly voted unanimously to intensify those efforts.[15] The opposition is not without its critics, particularly among anthropologists. Eric Silverman writes that FGM has become one of anthropology's central moral topics, raising difficult questions about cultural relativism, tolerance and the universality of human rights.[16]



Samburu FGM ceremony photographed by Louisa Kasdon, Laikipia plateau, northern Kenya, 2004.[17]

Until the 1980s FGM was widely known in English as "female circumcision," which implied an equivalence in severity with male circumcision.[18] In 1929 the Kenya Missionary Council began referring to it as the "sexual mutilation of women," following the lead of Marion Scott Stevenson, a Church of Scotland missionary.[19] References to it as mutilation increased as opposition grew throughout the 1970s. Anthropologist Rose Oldfield Hayes used the term "female genital mutilation" in 1975 in the title of a paper, and in 1979 Austrian-American researcher Fran Hosken called it mutilation in her influential The Hosken Report: Genital and Sexual Mutilation of Females.[20]

The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children began calling it female genital mutilation in 1990, as did the World Health Organization (WHO) the following year.[21] In April 1997 the WHO, the United Nations Children's Fund (UNICEF) and the United Nations Population Fund (UNFPA) issued a statement defining FGM as "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons."[22] That term is now widely used and is dominant within the medical literature.[23] Other terms include female genital cutting (FGC) and female genital mutilation/cutting (FGM/C), often used by those working with practitioners.[24]

Local terms

The many variants of FGM, which depend on the ethnic group and individual practitioner, are reflected in dozens of local terms in countries where it is common; women in Niger responded to a survey in 1998 using 50 different terms.[25] These often refer to purification. A common Arabic term for purification has the root t-h-r, used for both male and female circumcision (tahur and tahara).[26] In the Bambara language in Mali FGM is known as bolokoli ("washing your hands") and in the Igbo language in Nigeria as isa aru ("having your bath").[27]

The mildest form (clitoridectomy) is widely known as sunna circumcision; sunna means following the tradition of Muhammad, although the procedure is not required by Islam.[28] A sunna kashfa in Sudan, for example, involves removing half the clitoris.[29] Nuss ("half") in Sudan is for anything between clitoridectomy and infibulation, and juwaniya ("the inside type") is where only the inner labia are sewn together.[30] In Somalia removal of the clitoris and inner labia is known as xalaalays or gudniin.[31]

The term infibulation derives from fibula, Latin for pin or clasp, and is said to refer to the Ancient Roman practice of fastening a clasp across the labia of female slaves.[32] Infibulation is known as tahur faraowniya ("pharaonic purification") in Sudan, but as "Sudanese circumcision" in Egypt.[33] In Somalia it is known simply as qodob ("to sew up").[31]

Procedures, health effects

Circumcisers, methods, ages

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, FGM is more likely to be carried out by health professionals. Surveys in Egypt in 1997–2011 indicated that 77 percent of procedures were performed by medical professionals, often physicians.[36]

When traditional circumcisers are involved, non-sterile cutting devices are likely to be used, including knives, razors, scissors, glass, sharpened rocks and fingernails.[37] Cauterization is used in parts of Ethiopia.[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]

Depending on the involvement of healthcare professionals, the procedures may include a local or general anaesthetic, or neither. According to UNICEF in 2013, women in Egypt 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). Given the higher-than-usual involvement of physicians in FGM in that country, the percentage of procedures performed without anaesthesia is likely to be higher elsewhere.[34]

The age at which FGM is performed ranges from shortly after birth to the teenage years.[40] The variation signals that it is often not 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]



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.[44]

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.[25] 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.[45]

UNICEF divides FGM into 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.[46] The WHO categorizes the main procedures as Types I–III, and Type IV for symbolic circumcision and miscellaneous procedures.[47]

WHO Types I and II

Most women who undergo FGM experience WHO Types I or II.[14] Type I is further divided into Ia, the removal of the clitoral hood (rarely, if ever performed alone),[48] and the more common Ib (clitoridectomy), the partial or total removal of the clitoris and clitoral hood.[49]

[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.

— Susan Izett, Nahid Toubia (WHO), 1998[50]

Type II (excision) is the partial or total removal of the clitoris and inner labia, with or without removal of the outer labia. (The term excision in French often refers to any form of FGM.)[51]

Type III

External image
Swiss Medical Weekly, January 2011[10]

Type III (infibulation) is the removal of all the external genitalia and the fusion of the wound. The inner and/or outer labia are cut away, with or without removal of the clitoris. Type IIIa is the removal and fusion of the inner labia, and Type IIIb of the outer labia.[9]

A single 2–5 mm-hole is left for the passage of urine and menstrual blood by inserting something into the wound.[52] The vulva is then closed with surgical thread, agave or acacia thorns, or a poultice of raw egg, herbs and sugar. The girl's legs are tied together to help the tissue bond; the bindings are loosened after a week and usually removed after two.[53] The parts that have been removed might be placed in a pouch for the girl to wear.[54] Comfort Momoh, a specialist midwife in England, 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.[55]

Type III FGM is concentrated in Djibouti, Eritrea, Ethiopia, Somalia and Sudan; about eight million women in Africa, 15 years and older, have experienced it.[14] The vulva is opened with a penis or knife for sexual intercourse.[10] Psychologist Hanny Lightfoot-Klein interviewed 300 Sudanese women and 100 men in the 1980s:

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.[56]

The vulva is opened again (known as defibulation or deinfibulation) for childbirth and restored afterwards (reinfibulation). There is also a process, known 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.[57]

Type IV

The WHO defines Type IV as "[a]ll other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization."[2] The WHO does not classify cosmetic genital procedures or procedures used in sex reassignment surgery as FGM.[58] Type IV includes nicking of the clitoris (known as symbolic 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 scrape tissue away from around the vagina. Another procedure is hymenotomy, the removal of a hymen regarded as too thick, practised by the Hausa in West Africa.[60] Labia stretching is also categorized as Type IV; in Tanzania and the Congo girls are encouraged to stretch the clitoris and inner labia using sticks.[61]


FGM has no known health benefits.[11] It has immediate, short-term 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; and whether surgical thread was used instead of agave or acacia thorns. Other factors include 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).[10]

Road sign in Bakau, Gambia, 2005. FGM is not illegal in Gambia, where 76 percent of women and girls have experienced it.[62]

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.[10] It is not known how many girls and women die; few records are kept, complications may not be recognized, and fatalities are rarely reported.[63]

Short-term complications include necrotizing fasciitis, delay in wound healing due to infection, endometritis and hepatitis.[64] Late complications vary depending on the type of FGM performed.[10] 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.[64] Complete obstruction of the vagina results in hematocolpos and hematometra.[10] Other complications include epidermoid cysts that may become infected, neuroma formation involving nerves that supplied the clitoris, and pelvic pain.[65]

FGM may complicate pregnancy and place women at higher risk for obstetrical problems, which are more common with the more extensive FGM procedures.[10] Thus, in women with Type III who have developed vesicovaginal or rectovaginal fistulae (holes that allow urine or 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.[64] 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.[10]

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 centres 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.[66]

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.[10] They are more likely to report painful sexual intercourse and reduced sexual feelings.[67] 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.[68]


Prevalence in Africa and the Middle East

The practice is mostly found in what political scientist Gerry Mackie describes as an "intriguingly contiguous" zone in Africa – east to west from Somalia to Senegal, and north to south from Egypt to Tanzania.[69]

Information about its prevalence 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).[70]

A 2013 UNICEF report based on 70 of these surveys indicated that FGM is concentrated in 27 African countries, Yemen and Iraqi Kurdistan, and that 125 million women and girls in those countries have been affected.[70] The report grouped the countries according to the prevalence among women aged 15–49:[71]

FGM is concentrated in 27 countries in Africa, as well as Yemen and Iraqi Kurdistan.[72]

Nigeria, with a population of c. 167 million, has the highest number of women and girls who have experienced FGM, around one-quarter of the global number.[73] Around one in five cases is in Egypt.[74]

A country's national prevalence is affected by the practice's concentration among certain ethnicities. In Nigeria, which has a national rate of 27 percent, it is practised by the Yoruba, Hausa, Igbo, Ijaw and Kanuri ethnic groups, but not by the Fula.[73] In Iraq it is found mostly among the Kurds in Erbil, Sulaymaniyah and Kirkuk, giving the country an overall prevalence of eight percent.[75]

Outside the areas in which it is concentrated, FGM has been documented in India, the United Arab Emirates, among the Bedouin in Israel, and reported by anecdote in Colombia, Congo, Oman, Peru and Sri Lanka.[76] It is also practised in Jordan, Saudi Arabia, Indonesia and Malaysia,[77] and by immigrant communities in Australia and New Zealand, Europe, Scandinavia, the United States and Canada.[10]

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.[78] In 2005 UNICEF 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 without resistance from the child.[79]



Practitioners see the rituals as reinforcing community values and ethnic boundaries, and the procedure as an essential element in raising a girl.[80] The most common reasons for FGM that practitioners have cited in surveys include social acceptance, hygiene, preservation of virginity, marriageability, enhancement of male sexual pleasure, and religion.[81] Infibulation may enhance male pleasure as Gruenbaum writes that men seem to enjoy the effort of penetrating the infibulation.[82] The primary sexual concerns vary between communities. 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 aim is to reduce a woman's sexual desire so that her husband can take several wives.[83]

There are also aesthetic factors; according to physicians Miriam Martinelli and Jaume Enric Ollé-Goig, the preference within communities that practise FGM is for women's genitalia to be "flat, rigid and dry."[84] Several myths contribute to FGM's continuance, including that it controls genital discharges, aids conception and birth, that an uncut clitoris will keep growing, and that the clitoris will harm a baby if it comes into contact with the baby's head.[85] A more practical reason for its continuance is that circumcisers rely on the practice for their living.[86]

Mackie compares FGM to footbinding, which was outlawed in China in 1911. Like FGM, footbinding was an ethnic marker carried out on young girls, nearly universal where practised, and tied to ideas about honour, appropriate marriage, health, fertility and aesthetics. It was also supported by the women themselves.[87]

Support from women

Molly Melching of Tostan, celebrating the 10th anniversary of the abandonment of FGM by Malicounda Bambara, the first village in Senegal to do so.

Dahabo Musa, a Somali woman, described infibulation in a 1988 poem as the "three feminine sorrows": the procedure itself, the wedding night when the woman is cut open, then childbirth when she is cut again.[88] Despite the evident suffering, it is women 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 visit to relatives.[89]

Fadwa El Guindi argues that FGM is not simply a matter of male control of women, and is neither initiated by nor intended to appeal to men. She writes that across Africa male circumcision is viewed as defeminizing men and FGM as demasculinizing women, and that FGM is chosen by women for women, to reduce sexuality before marriage and to enhance it afterwards.[90]

Women are acutely aware of the low social status of uncut women in communities that practise FGM. Sociologist Elizabeth Heger Boyle writes that several ethnic groups may exclude uncut women from public events; UNICEF reported in 1995 that in Tanzania the Masai will not call an uncut woman "mother" when she has children.[91] Izett and Toubia write that the state of a woman's mutilation becomes part of her gender and social identity. They cite the case of a Somali woman who was advised to remain defibulated after childbirth to cure her gonorrhoea, but who insisted on being reinfibulated, leading to pain so severe she could hardly walk. They argue that she did this out of "her own sense of impurity and shame" at the idea of not being closed.[92]

Only 17.4 percent of 3,210 Sudanese women opposed FGM in a 1982 study, and nearly 59 percent said they preferred excision and infibulation over clitoridectomy.[93] Attitudes have changed somewhat since then. According to UNICEF in 2013, 79 percent of women aged 15–49 in Sudan in 1989–1990 said the practice should continue, compared to 48 percent in 2010. Over 50 percent of women in Mali, Guinea, Sierra Leone, Somalia, Gambia and Egypt support FGM's continuance, but elsewhere in Africa, Iraq and Yemen, most say it should end or are unsure.[94]

Mackie explains the willingness of women to have their daughters and granddaughters cut with the concept 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 may be failure to have descendants, because uncut women might not find husbands.[95] Mackie has worked with UNICEF to develop programmes in which villages pledge not to cut girls and to allow their sons to marry uncut girls, which provides the critical mass of support needed for collective abandonment.[96] The American non-profit group Tostan, founded by Molly Melching in 1991, has used this model successfully in Senegal; in 1997 Malicounda Bambara became the first village in Senegal to abandon the practice.[97]


Surveys have shown a widespread belief in practising countries, particularly in Mali, Eritrea, Mauritania, Guinea and Egypt, that FGM is a religious requirement.[98] Gerry Mackie and John LeJeune write that practitioners may not distinguish between religion, tradition and chastity, making it difficult to interpret the data.[99]

Mackie writes that FGM is found "only in or adjacent to" Islamic groups.[100] There is no mention of it in the Quran. It 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.[101] Although its origins are pre-Islamic, FGM became associated with Islam because of that religion's focus on female chastity and seclusion.[102] In 2007 the Al-Azhar Supreme Council of Islamic Research in Cairo ruled, according to UNICEF, that FGM had "no basis in core Islamic law or any of its partial provisions."[103]

FGM is also practised by animist groups, particularly in Guinea and Mali,[104] and by Christians.[105] In Niger, for example, 55 percent of Christian women and girls have experienced FGM, compared with two percent of their Muslim counterparts.[106] There is no mention of FGM in the Bible, and Christian missionaries in Africa were among the first to object to it.[107] The only Jewish group known to have practised it are the Beta Israel of Ethiopia; Judaism requires male circumcision, but does not allow FGM.[108]



The origins of the practice are unknown.[109] Gerry Mackie has suggested that it began with the Meroite civilization in present-day Sudan.[110] He writes that its east-west, north-south contiguous distribution in Africa intersects in Sudan, and speculates that infibulation originated there with imperial polygyny, before the rise of Islam, to control access to women and increase confidence in paternity.[111]

Spell 1117

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 ['m't] and the flakes of skin [šnft] of an uncircumcised bald man.

— Inscription on Egyptian sarcophagus
c. 1991–1786 BCE[112]

Historian Mary Knight writes that there may be a reference to an uncircumcised girl ('m't), written in hieroglyphs in what is known as Spell 1117 of the Coffin Texts (translation right, image below):

a m a
D53 B1

The spell was found on the sarcophagus of Sit-hedjhotep, now in the Egyptian Museum, and dates to Egypt's Middle Kingdom, c. 1991–1786 BCE.[113] Paul F. O'Rourke argues that it probably refers to a menstruating woman.[114]

The proposed circumcision of an Egyptian girl, Tathemis, is mentioned on a Greek papyrus from 163 BCE in the British Museum:

Sometime after this, Nephoris [Tathemis's mother] defrauded me, being anxious that it was time for Tathemis to be circumcised, as is the custom among the Egyptians. She asked that I give her 1,300 drachmae ... to clothe her ... and to provide her with a marriage dowry ... if she didn't do each of these or if she did not circumcise Tathemis in the month of Mecheir, year 18 [163 BCE], she would repay me 2,400 drachmae on the spot.[115]

The examination of mummies has shown no evidence of FGM. Citing the Australian pathologist Grafton Elliot Smith (1871–1937), who examined hundreds of mummies in the early 20th century, Knight writes that the genital area may resemble 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. It was similarly not possible to determine whether Types I or II had been performed, because soft tissues had been removed by the embalmers or had deteriorated.[116]

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 ...

Strabo, Geographica.[117]

The Greek geographer Strabo (c. 64 BCE – c. 23 CE) wrote about FGM after visiting Egypt around 25 BCE.[117] The philosopher Philo of Alexandria (c. 20 BCE – 50 CE) also makes reference to the practice: "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."[118] It is mentioned briefly in a work attributed to the Greek physician Galen (129 – c. 200 CE): "When [the clitoris] sticks out to a great extent in their young women, Egyptians consider it appropriate to cut it out."[119]

Another Greek physician, Aëtius of Amida (mid-5th to mid-6th century CE), offered more detail in book 16 of his Sixteen Books on Medicine, citing the physician Philomenes. The procedure was performed in case the clitoris, or nymphê, grew too large or triggered sexual desire when rubbing against clothing. "On this account, it seemed proper to the Egyptians to remove it before it became greatly enlarged," Aëtius wrote, "especially at that time when the girls were about to be married":

The surgery is performed in this way: Have the girl sit on a chair while a muscled young man standing behind her places his arms below the girl's thighs. Have him separate and steady her legs and whole body. Standing in front and taking hold of the clitoris with a broad-mouthed forceps in his left hand, the surgeon stretches it outward, while with the right hand, he cuts it off at the point next to the pincers of the forceps.

It is proper to let a length remain from that cut off, about the size of the membrane that's between the nostrils, so as to take away the excess material only; as I have said, the part to be removed is at that point just above the pincers of the forceps. Because the clitoris is a skinlike structure and stretches out excessively, do not cut off too much, as a urinary fistula may result from cutting such large growths too deeply.[120]

The genital area was then cleaned with a sponge, frankincense powder and wine or cold water, and wrapped in linen bandages dipped in vinegar until the seventh day, when calamine, rose petals, date pits or a "genital powder made from baked clay" might be spread on the wound.[120]

Whatever the practice's origins, infibulation became linked to slavery.[121] Mackie 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."[122] The English explorer William Browne (1768–1813) wrote in 1799 that the Egyptians practised excision, and that slaves in that country were infibulated to prevent pregnancy.[123] Thus, Mackie argues, a "practice associated with shameful female slavery came to stand for honor."[95]

Europe and the United States

Isaac Baker Brown "set to work to remove the clitoris whenever he had the opportunity of doing so."[124]

Gynaecologists in 19th-century Europe and the United States removed the clitoris to treat insanity and masturbation.[125] British doctor Robert Thomas suggested clitoridectomy as a cure for nymphomania in 1813.[126] 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.[127]

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.[124]

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.[128]

In the United States J. Marion Sims (1813–1883) followed Brown's work, and in 1862 slit the neck of a woman's uterus and amputated her clitoris, "for the relief of the nervous or hysterical condition as recommended by Baker Brown," after she complained of period pain, convulsions and bladder problems.[129] G. J. Barker-Benfield writes that clitoridectomy continued in the US until at least 1904 and perhaps into the 1920s.[130] 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.[131]


Colonial opposition in Kenya


Little knives in their sheaths
That they may fight with the church,
The time has come.
Elders (of the church)
When Kenyatta comes
You will be given women's clothes
And you will have to cook him his food.

— from the Muthirigu (1929), Kikuyu dance-songs protesting church opposition to FGM[132]

Protestant missionaries in British East Africa (present-day Kenya), began campaigning against FGM in the early 20th century when Dr. John Arthur (1881–1952) joined the Church of Scotland Mission (CSM) in Kikuyu. The practice was known by the Kikuyu, the country's main ethnic group, as irua for both girls and boys, and involved excision (Type II) for girls and removal of the foreskin for boys. It was an important ethnic marker, and unexcised Kikuyu women, known as irugu, were outcasts.[133]

Jomo Kenyatta (c. 1894–1978), general secretary of the Kikuyu Central Association and Kenya's first prime minister from 1963, wrote in 1938 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 proper Kikuyu man or woman would marry or have sexual relations with someone who was not circumcised. A woman's responsibilities toward the tribe began with her initiation; her age and place within tribal history was traced to that day, and the group of girls with whom she was cut was named according to current events. Kenyatta gave as an example a famine occurring around the time of a ceremony; that group of initiates would thereafter be known as "famine," an oral tradition that allowed the Kikuyu to track people and events going back hundreds of years.[134]

Missionary Hulda Stumpf was murdered in Kikuyu in 1930 after opposing FGM.

From 1925, beginning with the CSM mission, several missionary churches declared that FGM was prohibited for African Christians. The CSM announced that Africans practising it would be excommunicated, resulting in hundreds leaving or being expelled.[135] The stand-off turned FGM into a focal point of the Kenyan independence movement; the 1929–1931 period is known in the country's historiography as the female circumcision controversy.[136]

In 1929 the Kenya Missionary Council began referring to FGM as the "sexual mutilation of women," rather than circumcision, and a person's stance toward the practice became a test of loyalty, either to the Christian churches or the Kikuyu Central Association.[137] Hulda Stumpf (1867–1930), an American missionary with the Africa Inland Mission who opposed FGM in the girls' school she helped to run, was murdered in 1930 after apparently being circumcised by her attacker.[138]

In 1956 the council of male elders (the Njuri Nchecke) in Meru announced a ban on FGM. Over the next three years, as a symbol of defiance, thousands of girls cut each other's genitals with razor blades. The movement came to be known in Meru as Ngaitana ("I will circumcise myself"), because to avoid naming their friends the girls said they had cut themselves. Historian Lynn Thomas describes the episode as significant in the history of FGM because it made clear that its victims were also its perpetrators.[139]

Growth of opposition

The first known non-colonial campaign against FGM began in Egypt in the 1920s, when the Egyptian Doctors' Society called for a ban.[140] A parallel campaign began in Sudan in the 1920s and 1930s. Sudan, then under Anglo-Egyptian control, banned infibulation in 1946, but the law was unpopular and barely enforced.[141] The Egyptian government banned infibulation in state-run hospitals in 1959, but allowed partial clitoridectomy if parents requested it.[142] The UN asked the WHO to investigate FGM that year, but the latter responded that it was not a medical issue.[143]

Feminists took up the issue throughout the 1970s.[144] Egyptian physician Nawal El Saadawi's book, Women and Sex (1972), criticized FGM, was banned in Egypt, and saw El Saadawi lose her job as director general of public health.[145] She followed up with a chapter, "The Circumcision of Girls," in The Hidden Face of Eve: Women in the Arab World (1980), which described her own clitoridectomy when she was six years old:

Egyptian physician Nawal El Saadawi was one of the first African feminists to criticize FGM.
I did not know what they had cut off from my body, and I did not try to find out. I just wept, and called out to my mother for help. But the worst shock of all was when I looked around and found her standing by my side. Yes, it was her, I could not be mistaken, in flesh and blood, right in the midst of these strangers, talking to them and smiling at them, as though they had not participated in slaughtering her daughter just a few moments ago.[146]

In 1975 the American social scientist Rose Oldfield Hayes became the first female academic to publish a detailed account of FGM, aided by her ability to discuss the issues directly with women in Sudan. Her article in American Ethnologist called it "female genital mutilation," and brought it to wider academic attention.[147]

Fran Hosken's 1979 report was the first to estimate numbers.[148]

Four years later Austrian-American feminist Fran Hosken (1920–2006) published The Hosken Report: Genital and Sexual Mutilation of Females (1979), the first to estimate the global number of women cut; she wrote that 110,529,000 women in 20 African countries had experienced it.[148] Describing FGM as a "training ground for male violence," she accused female practitioners of "participating in the destruction of their own kind."[149] The language caused a rift between Western and African feminists; African women boycotted a session featuring Hosken during the UN's Mid-Decade Conference on Women in Copenhagen in July 1980.[150]

The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children called for an end to the practice in 1984, as did the UN's World Conference on Human Rights in 1993.[151] Throughout the 1990s and 2000s African governments banned or restricted it. In 2003 the United Nations began sponsoring an International Day of Zero Tolerance to Female Genital Mutilation every 6 February, and in July that year the African Union ratified the Maputo Protocol, promising to prohibit FGM.[152]

In December 2012 the UN General Assembly passed Resolution 67/146, calling for intensified efforts to end FGM.[15] By 2013 laws had been passed in 22 of the 27 African countries in which it is concentrated, though several fell short of a ban.[153] Egypt, where the practice may have originated, finally outlawed it in 2008 after two incidents attracted international attention: in 1994 CNN broadcast images of a child undergoing FGM in a barber's shop in Cairo,[154] a child died during an FGM procedure in 2007. The death prompted the Al-Azhar Supreme Council of Islamic Research, the country's highest religious authority, to rule that FGM had no basis in Islamic law, and the government outlawed it the following year.[103] The first criminal charges under the new law were laid in 2014.[155]

Law in non-practising countries

As a result of immigration, the practice spread to Australia, Europe, North America and Scandinavia.[156] 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.[157] 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.[158] It is banned or restricted in Australia, New Zealand, the European Union, the United States and Canada.[159]

Efua Dorkenoo, author of Cutting the Rose (1994) and founder of FORWARD, received an OBE for her work against FGM in the UK.[160]

Canada recognized FGM as a form of persecution in July 1994, when it granted refugee status to Khadra Hassan Farah, who had fled Somalia to avoid her daughter being cut.[161] FGM is outlawed by section 268 of the Criminal Code of Canada unless "the person is at least eighteen years of age and there is no resulting bodily harm."[162] As of May 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 FGM 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] The first civil suit was in 1982 and the first criminal prosecution in 1993.[166] In 1999 a woman was sentenced to eight years' imprisonment for having performed FGM on 48 girls.[167]

Nearly 66,000 women in England and Wales were living with FGM in 2001, according to the only national estimate.[168] It is an offence in the UK to perform FGM on children or adults. The Prohibition of Female Circumcision Act 1985 outlawed it, and the Female Genital Mutilation Act 2003 and the Prohibition of Female Genital Mutilation (Scotland) Act 2005 made it an offence to arrange it outside the country for British citizens or permanent residents.[169] The first charges were brought in March 2014, against a physician and another man, after the physician repaired the infibulation of a patient in London who had given birth.[170]

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.[171] A Nigerian woman successfully contested deportation in March 1994 on the grounds that her daughters might be cut,[172] and in 1996 19-year-old Fauziya Kasinga from Togo became the first to be granted asylum to escape FGM.[173] In September 1996 the Illegal Immigration Reform and Immigrant Responsibility Act made it illegal to perform FGM on minors for non-medical reasons,[174] and in January 2013 the Transport for Female Genital Mutilation Act prohibited knowingly transporting a minor out of the country for the purpose of FGM.[175] The first FGM conviction 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.[176]

Criticism of opposition

Tolerance versus human rights

Anthropologist Eric Silverman writes that FGM is one of the "central moral topics of contemporary anthropology." Anthropologists have accused FGM eradicationists of cultural colonialism; they, in turn, have been criticized for their cultural and moral relativism toward FGM, and a failure to defend the idea of universal human rights.[177] The debate highlights a tension between anthropology and feminism, with the former's focus on tolerance and the latter's on rights for all women, raising questions about the extent to which an embrace of multiculturalism implies that different standards ought to apply to African women. The French Association of Anthropologists accused feminists, in 1981, of reviving "the moralistic arrogance of yesterday's colonialism."[178]

Social scientist Stanlie James accused Alice Walker (pictured), whose novels Possessing the Secret of Joy (1992) and Warrior Marks (1993) criticize FGM, of trying to save African women from themselves.[179]

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.[180] Shweder argues against the idea of universal human rights, but maintains that if a rights perspective is adopted, it must take other rights into account, such as the right of African women to self-determination and freedom of religion.[181]

Ugandan law professor Sylvia Tamale writes that early Western opposition to FGM 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. She cautions that, while African feminists "do not condone the negative aspects of the practice, they take strong exception to the imperialist, racist and dehumanising infantilization of African women," inherent in much of the opposition.[182] A common trope in the literature about FGM, according to Christine J. Walley, is to present African women as "mentally castrated," participating in their own oppression and destruction as a result of false consciousness. Fran Hosken and the American feminist Mary Daly both promoted that position in the 1970s.[183]

As an example of the disrespect, historian Chima Korieh cites the publication by 12 American newspapers of the FGM 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 the images to be published or even taken.[184]

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 epidemiologist Carla Obermeyer, who suggested in 1999 and 2003 that serious complications are the exception.[185] Gerry Mackie disputed Obermeyer's findings.[186] 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.[187]

Comparison with other procedures

Several authors have drawn a parallel between cosmetic procedures and FGM.[188] 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 encouraging women to see natural variations as defects.[189] Anthropologist Fadwa El Guindi compares FGM to breast enhancement, in which the maternal function of the breast becomes secondary to men's sexual pleasure; indeed, she argues, breast enhancement could be called breast mutilation, particularly when the nipples lose sensation because of implants.[190] Benoîte Groult made a similar point in 1975, citing FGM and cosmetic surgery as sexist and patriarchal.[191] Carla Obermeyer argues that FGM may be conducive to women's well-being within their communities in the same way that breast implants, rhinoplasty and male circumcision may help people elsewhere.[192]

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

The WHO does not include cosmetic procedures such as labiaplasty, vaginoplasty and clitoral hood reduction as examples of FGM; some elective practices do fall within its categories, but its broad definition aims to avoid loopholes.[58] Some of the legislation banning FGM would seem to cover cosmetic genital alteration too. 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.[193] Gynaecologist Birgitta Essén and anthropologist Sara Johnsdotter argue that it seems the law distinguishes between Western and African genitals, and deems only African women (such as those seeking reinfibulation after childbirth) unfit to make their own decisions.[194]

Arguing against these parallels, philosopher Martha Nussbaum writes that the key issue is that FGM is mostly conducted on children using physical force. She argues that the distinction between social pressure and physical force is always morally and legally salient, comparable to the distinction between seduction and rape, and that the literacy of women in practising countries, generally poorer than in the Western world, reduces their ability to make informed choices.[195]

Several commentators argue that children's rights are violated with the genital alteration of intersex children, who are born with anomalies that physicians choose to correct. 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."[196]


  1. ^ "Joint Programme on Female Genital Mutilation/Cutting: Accelerating Change", UNFPA–UNICEF, Annual Report 2012, p. 12; Andrew Masinde, "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, 2014.
  3. ^ a b Claudia Capper, et al, Female Genital Mutilation/Cutting: A Statistical Overview and Exploration of the Dynamics of Change, United Nations Children's Fund, July 2013 (hereafter UNICEF 2013), p. 2.
  4. ^ UNICEF 2013, pp. 22, 121, n. 62.
  5. ^ a b UNICEF 2013, p. 50.
  6. ^ UNICEF 2013, p. 9; for the bans, UNFPA–UNICEF annual report 2012, p. 12.
  7. ^ a b c UNICEF 2013, p. 8.
  8. ^ UNICEF 2013, p. 44 for traditional circumciser, pp. 45–46 for anaesthetic, p. 46 for blade or razor.

    For the 29 countries in which it is concentrated, UNICEF 2013, pp. 26–27; Eliminating Female Genital Mutilation, World Health Organization, 2008, pp. 29–30.

  9. ^ a b WHO 2014: "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).

    "Type IIIa, removal and apposition of the labia minora; Type IIIb, removal and apposition of the labia majora."

    Also see WHO 2008, p. 4.

  10. ^ a b c d e f g h i j k Jasmine Abdulcadira, et al, "Care of women with female genital mutilation/cutting", Swiss Medical Weekly, 6(14), January 2011 (review), doi:10.4414/smw.2011.13137
  11. ^ a b WHO 2008, p. 1: "Female genital mutilation has no known health benefits."
  12. ^ Martha Nussbaum, "Judging Other Cultures: The Case of Genital Mutilation," Sex and Social Justice, Oxford University Press, 1999, p. 124; WHO 2008, pp. 5–7.

    Anika Rahman and Nahid Toubia, Female Genital Mutilation: A Guide to Laws and Policies Worldwide, Zed Books, 2000, pp. 5–6.

    Gerry Mackie, "Ending Footbinding and Infibulation: A Convention Account", American Sociological Review, 61(6), December 1996 (pp. 999–1017, also here), pp. 999–1000.

  13. ^ For 125 million, UNICEF 2013, pp. 22, 121, n. 62; half in Egypt and Ethiopia, UNFPA–UNICEF 2012, p. 1.
  14. ^ a b c P. Stanley Yoder, Shane Khan, "Numbers of women circumcised in Africa: The Production of a Total", USAID, DHS Working Papers, No. 39, March 2008, pp. 13–14.
  15. ^ a b "67/146. Intensifying global efforts for the elimination of female genital mutilation", United Nations General Assembly, adopted 20 December 2012; Emma Bonino, "Banning Female Genital Mutilation", The New York Times, 19 December 2012.
  16. ^ Eric Silverman, "Anthropology and Circumcision", Annual Review of Anthropology, 33, 2004 (pp. 419–445), p. 427.
  17. ^ Louisa Kasdon, "A Tradition No Longer, World & I, November–December 2005, p. 67.
  18. ^ Martha Nussbaum, Sex and Social Justice, Oxford University Press, 1999, p. 119; 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. ^ 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; Fran Hosken, The Hosken Report: Genital and Sexual Mutilation of Females, Women's International Network, 1994 [1979].
  21. ^ Claudi Cappa, Tessa Wardlaw, and Bettina Shell-Duncan, Changing a harmful social convention: female genital cutting/mutilation, Innocenti Digest, UNICEF 2005, pp. 1–2.
  22. ^ Rogaia Mustafa Abusharaf, "Introduction: The Custom in Question," in Rogaia Mustafa Abusharaf (ed.), Female Circumcision, University of Pennsylvania Press, 2007, p. 5.
  23. ^ WHO 2008, p. 22; Abusharaf 2007, p. 5; for the medical literature, Nussbaum 1999, p. 119.
  24. ^ Comfort Momoh, "Female genital mutilation" in Comfort Momoh (ed.), Female Genital Mutilation, Radcliffe Publishing, 2005, p. 6; for FGM/C, UNICEF 2013, p. 7; Abusharaf 2007 p. 6.

    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.

  25. ^ a b UNICEF 2013, p. 48.
  26. ^ Fadwa El Guindi, "Had This Been Your Face, Would You Leave It as Is?" in Rogaia Mustafa Abusharaf (ed.), Female Circumcision: Multicultural Perspectives, University of Pennsylvania Press, 2007, p. 30.
  27. ^ 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.
  28. ^ Mackie 1996, pp. 1004–1005.
  29. ^ 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.
  30. ^ Ellen Gruenbaum, The Female Circumcision Controversy: An Anthropological Perspective, University of Pennsylvania Press, 2001, pp. 3, 148, 225.
  31. ^ a b Raqiya D. Abdalla, "'My Grandmother Called it the Three Feminine Sorrows': The Struggle of Women Against Female Circumcision in Somalia," in Abusharaf 2007, p. 190.
  32. ^ Raqiya D. Abdalla, Sisters in Affliction: Circumcision and Infibulation of Women in Africa, Zed Books, 1982, p. 10.
  33. ^ 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, doi:10.1136/bmj.38873.649074.55: "The most severe form, infibulation and excision, or WHO type III, is also known as 'pharaonic circumcision' in Sudan and 'Sudanese circumcision' in Egypt."

    For tahur faraowniya, Janice Boddy, Civilizing Women: British Crusades in Colonial Sudan, Princeton University Press, 2007, p. 1.

  34. ^ a b c UNICEF 2013, p. 46.
  35. ^ 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 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. ^ UNICEF 2013, p. 3–7 (see p. 126 for the questions).
  45. ^ Elmusharaf et al, 2006.
  46. ^ 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."
  47. ^ "Classification of female genital mutilation", World Health Organization, 2014; "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. ^ 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."

    Horowitz et al, letter: "The author states that there is no evidence that the clitoral prepuce is ever excised, without scarring, in a manner analogous to male circumcision. As health providers for refugees, we work with many Ethiopian and Eritrean women who underwent this form of circumcision as infants, just as their brothers were circumcised."

    Toubia's reply: "During 20 years of clinical experience with thousands of women from Sudan, Egypt, Ethiopia, and Eritrea, I have not seen a case of ritualistic childhood circumcision in which only the skin around the clitoris was removed, not the glans. As a pediatric surgeon, I cannot imagine how a traditional practitioner of circumcision could dissect and remove the few millimeters of skin in a screaming, unanesthetized girl. However, if such cases were appropriately documented, I would stand corrected and might suggest a different term."

  49. ^ WHO 2014; WHO 2008, p. 4.
  50. ^ Susan Izett, Nahid Toubia, Female Genital Mutilation: An Overview, World Health Organization, 1998.
  51. ^ WHO 2014: "Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision).

    "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."

    Also see WHO 2008, p. 4.

  52. ^ 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."
  53. ^ Kelly and Hillard 2005, p. 491 (Kelly and Hillard say the girls are tied for 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.
  54. ^ El Guindi 2007, p. 43.
  55. ^ Momoh 2005, p. 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.

  56. ^ 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 see Hanny Lightfoot-Klein, Prisoners of Ritual: An Odyssey Into Female Genital Circumcision in Africa, Routledge, 1989.

  57. ^ Kelly and Hillard 2005, p. 491.

    Also see Olukunmi O. Balogun, et al, "Interventions for improving outcomes for pregnant women who have experienced genital cutting", Cochrane Database of Systematic Reviews, 2, 2013.

    For reinfibulation, G. I. Serour, "The issue of reinfibulation", International Journal of Gynaecology and Obstetrics, 109(2), May 2010, pp. 93–96, doi:10.1016/j.ijgo.2010.01.001.

    R. J. I. Cook, B. M. Dickens, "Special commentary on the issue of reinfibulation", International Journal of Gynaecology and Obstetrics, 109(2), May 2010, pp. 97–99, doi:10.1016/j.ijgo.2010.01.004.

  58. ^ a b WHO 2008, p. 28.
  59. ^ WHO 2008, p. 24; UNICEF 2013, p. 7.
  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: "In some areas (e.g. parts of Congo and mainland Tanzania), FGM entails the pulling of the labia minora and/or clitoris over a period of about 2 to 3 weeks. The procedure is initiated by an old woman designated for this task, who puts sticks of a special type in place to hold the stretched genital parts so that they do not revert back to their original size. The girl is instructed to pull her genitalia every day, to stretch them further, and to put additional sticks in to hold the stretched parts from time to time. This pulling procedure is repeated daily for a period of about two weeks, and usually no more than four sticks are used to hold the stretched parts, as further pulling and stretching would make the genital parts unacceptably long."
  62. ^ "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.
  63. ^ UNICEF 2005, p. 16.
  64. ^ a b c Kelly and Hillard 2005, pp. 491–492
  65. ^ 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).
  66. ^ 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.
  67. ^ 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.
  68. ^ Boyle 2002, pp. 34–35.
  69. ^ Gerry Mackie, John LeJeune, "Social Dynamics of Abandonment of Harmful Practices: A New Look at the Theory", Innocenti Working Paper No. 2008-XXX, UNICEF Innocenti Research Centre, 2008, p. 5.
  70. ^ a b UNICEF 2013, pp. 3–5 (see the table on p. 5 for how recent the data is); for 125 million, pp. 22, 121, n. 62.

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

  71. ^ UNICEF 2013, p. 27.
  72. ^ UNICEF 2013, p. 26.
  73. ^ a b 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. Note: this source uses an alternate English name (Fulani) for the Fula in reporting its data.

    For population, "Nigeria over 167 million population: Implications and Challenges", National Population Commission, Nigeria.

  74. ^ UNICEF 2013, p. 22.
  75. ^ UNICEF 2013, p. 27; 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. This found that 58.6 percent of women aged 15–49 had experienced FGM (99.6 percent had Type I), although 70.3 percent reported that they had experienced it.
  76. ^ WHO 2008, pp. 29–30. For more about the Bedouin, see Wendy Zukerman, "Female genital mutilation becomes less common in Egypt", New Scientist, 18 August 2011.
  77. ^ 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."

    For Indonesia, also see Abigail Haworth, "The day I saw 248 girls suffering genital mutilation", The Observer, 18 November 2012.

    For Saudi Arabia, also see James Randerson, "Female genital mutilation denies sexual pleasure to millions of women", The Guardian, 13 November 2008, including the correction: "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." This refers to S. A. Alsibiani and A. A. Rouzi, "Sexual function in women with female genital mutilation", Fertility and Sterility, 93(3), February 2010, pp. 722–724, doi:10.1016/j.fertnstert.2008.10.035.

  78. ^ UNICEF 2013, p. 99: "In a number of countries, FGM/C prevalence is dramatically lower among adolescents aged 15 to 19, as compared to women aged 45 to 49. The decline is particularly sharp in some countries: In Kenya and the United Republic of Tanzania, for example, women aged 45 to 49 are approximately three times more likely to have been cut than girls aged 15 to 19. In Benin, Central African Republic, Iraq, Liberia and Nigeria, prevalence has dropped by about half among adolescent girls. On the contrary, no significant changes in FGM/C prevalence can be observed in Chad, Djibouti, Gambia, Guinea-Bissau, Mali, Senegal, Somalia, Sudan and Yemen."

    "Overwhelming opposition to female genital mutilation/cutting, yet millions of girls still at risk", UNICEF press release, 22 July 2013.

    In 2011 surveys in Somalia's autonomous Puntland and Somaliland regions indicated a drop in the 0–14 age group to 26 and 22 per cent respectively; Somalia banned the practice in 2012 and Puntland in 2014. See "Multiple Indicator Cluster Survey 2011 - Preliminary Results: Northeast Zone, Somalia (Summary)", UNICEF, 2011, p. 14; "Multiple Indicator Cluster Survey 2011 - Preliminary Results: Somaliland (Summary)", UNICEF, 2011, p. 13.

    "Somalia: Activists laud ban on FGM/C, say implementation will require more", Irin, 13 August 2012; "Somalia: Puntland bans Female Genital Mutilation (FGM)", Horseedmedia, 11 March 2014.

  79. ^ UNICEF 2005, p. 7: "The average age at which a girl is subjected to cutting is decreasing in some countries. Of the 16 countries surveyed by DHS, the median age at the time FGM/C was performed has dropped substantially in Burkina Faso, Côte d'Ivoire, Egypt, Kenya and Mali. Reasons for this may include the effect of national legislation to prohibit FGM/C, which has encouraged the practice to be carried out at an early age when it can be more easily hidden from the authorities. It is also possible that the trend is influenced by a desire on the part of those who support or perform the practice to minimise the resistance of the girls themselves."
  80. ^ Abusharaf 2007, p. 8; WHO 2013.
  81. ^ UNICEF 2013, pp. 63, 65–68; also see Mackie and LeJeune 2008, pp. 9–11.
  82. ^ Gruenbaum 2001, p. 140; also see Boddy 1989, p. 52.
  83. ^ Rahman and Toubia 2000, pp. 5–6.
  84. ^ M. Martinelli, J. E. Ollé-Goig, "Female genital mutilation in Djibouti", African Health Sciences, 12(4), December 2012.
  85. ^ 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.
  86. ^ 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.
  87. ^ Mackie 2000, p. 256; Mackie 1996, 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."
  88. ^ Abdalla 2007, p. 187.
  89. ^ Hayes 1975, pp. 620, 624.
  90. ^ El Guindi 2007, pp. 36–37.
  91. ^ Elizabeth Heger Boyle, Female Genital Cutting: Cultural Conflict in the Global Community, Johns Hopkins University Press, 2002, p. 37. For Tanzania, Boyle cites R. Mabala, S. R. Kamazima, The Girl Child in Tanzania: Today's Girl, Tomorrow's Woman, A Research Report, UNICEF, Dar es Salaam, 1995.
  92. ^ Izett and Toubia 1998, citing Anne van der Kwaak, "Female circumcision and gender identity: a questionable alliance," Social Science and Medicine, 1992, 35, pp. 777–787.
  93. ^ 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.
  94. ^ UNICEF 2013, pp. 54, 90.
  95. ^ a b Mackie 1996, p. 1009.
  96. ^ UNFPA–UNICEF 2012, p. 18; Gerry Mackie, John LeJeune, "Social Dynamics of Abandonment of Harmful Practices: A New Look at the Theory", Innocenti Working Paper No. 2009-06, UNICEF Innocenti Research Centre, May 2009.
  97. ^ Mackie 2000, pp. 253, 256–261; Jean Faraca, "Confronting Female Genital Cutting", Wisconsin Public Radio, interview with Molly Melching and Gerry Mackie, 3 November 2011, from 2:43 mins.

    Nafissatou J. Diop, Amadou Moreau, Hélène Benga, "Evaluation of the Long-term Impact of the TOSTAN Programme on the Abandonment of FGM/C and Early Marriage: Results from a qualitative study in Senega", UNICEF, January 2008.

    For Mackie's connection, Kwame Anthony Appiah, "The Art of Social Change", The New York Times Magazine, 22 October 2010, p. 2. As of 2012 Tostan was also using the programme in Mauritania, Guinea and the Gambia; see UNICEF-UNFPA 2012, pp. 21–22.

  98. ^ UNICEF 2013, pp. 69–70; table on p. 71.
  99. ^ 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."
  100. ^ Mackie 1996, p. 1004.
  101. ^ Mackie 1996, pp. 1004–1005: "The Koran is silent on FGM, but 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."
  102. ^ Mackie, 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."

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

  103. ^ a b "Fresh progress toward the elimination of female genital mutilation and cutting in Egypt", UNICEF, 2 July 2007; UNICEF 2013, p. 70.

    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. It's prohibited, prohibited, prohibited," Grand Mufti Ali Gomaa said on the privately owned al-Mahwar network."

  104. ^ UNICEF 2013, p. 175.
  105. ^ UNICEF 2013, p. 73.
  106. ^ UNICEF 2013, front page: "Niger. 55% of Christian girls and women have undergone FGM/C, compared to 2% of Muslim girls and women," and p. 73.
  107. ^ Samuel Waje Kunhiyop, African Christian Ethics, Zondervan, 2008, p. 297: "Nowhere in all of Scripture or in any of recorded church history is there even a hint that women were to be circumcised."

    For missionaries, Jocelyn Murray, "The Church Missionary Society and the 'Female Circumcision' Issue in Kenya 1929-1932", Journal of Religion in Africa, 8(2), 1976, pp. 92–104; Janice Boddy, Civilizing Women: British Crusades in Colonial Sudan, Princeton University Press, 2007.

  108. ^ 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.
  109. ^ Mackie 1996, p. 1003; Abusharaf 2007, p. 2.
  110. ^ Mackie 2000, p. 267; UNICEF 2013, p. 30; Shell-Duncan and Hernlund 2000, p. 13.
  111. ^ Mackie 2000, p. 264.

    He suggests that FGM's distribution suggests an origin "on the western coast of the Red Sea, where infibulation is most intense, diminishing to clitoridectomy in westward and southward radiation." Egyptians took captives as slaves in the south, he writes, from the Early Dynastic to Byzantine period, and Sudanic slaves were exported through the Red Sea to the Persian Gulf. See 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, 1996, p. 19ff.

  112. ^ 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 references Egyptian Museum sarcophagus cat. no. 28085. See Pierre Lacau, Sarcophages extirieurs au nouvel empire (no. 28001–29086 (Cairo: IFAO, 1904), sarcophagus no. 28085 (innercoffin), Vol. 1, p. 217. It is Coffin Text spell 1117, 448d–450d; see Adriaan de Buck and Alan H. Gardiner, The Egyptian Coffin Texts, Chicago University Press, 1961, Vol. 7, pp. 448–450.
  113. ^ Knight 2001, p. 330. For the hieroglyphs, Paul F. O'Rourke, "The 'm't-Woman", Zeitschrift für Ägyptische Sprache und Altertumskunde, 134(2), February 2007.

    Knight adds that Egyptologists are uncomfortable with the translation to uncircumcised, because there is no information about what constituted the circumcised state.

  114. ^ O'Rourke 2007, p. 172.
  115. ^ Knight 2001, pp. 329–330; F. G. Kenyon, Greek Papyri in the British Museum, British museum, 1893, pp. 31–32 (also here).
  116. ^ 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."
  117. ^ a b Knight 2001, p. 318.

    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.

  118. ^ Knight 2001, p. 333.
  119. ^ Knight 2001, p. 326. Knight writes that the attribution to Galen is suspect
  120. ^ a b Knight 2001, pp. 327–328. A paragraph break has been added for ease of reading.
  121. ^ Mackie 1996, p. 1003: "Whatever the earliest origins of FGM, there is certainly an association between infibulation and slavery."
  122. ^ 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.
  123. ^ 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.
  124. ^ 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.
  125. ^ 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.
  126. ^ Robert Thomas, The Modern Practice of Physick, Longman, Hurst, Rees, Orme, and Brown, 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.
  127. ^ 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.

  128. ^ 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.

  129. ^ Deborah Kuhn McGregor, From Midwives to Medicine: The Birth of American Gynecology, Rutgers University Press, 1998, p. 146.
  130. ^ 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.
  131. ^ 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).
  132. ^ Kenneth Mufuka, "Scottish Missionaries and the Circumcision Controversy in Kenya, 1900–1960", International Review of Scottish Studies, 28, 2003, p. 55.
  133. ^ Lynn M. Thomas,"'Ngaitana (I will circumcise myself)': Lessons from Colonial Campaigns to Ban Excision in Meru, Kenya" in Shell-Duncan and Hernlund, 2000, p. 132.

    For irua, Jomo Kenyatta, Facing Mount Kenya, Vintage, 1962 [1938], p. 129; for irugu being outcasts, Kenyatta, p. 127, and Zabus 2008, pp. 48–49.

  134. ^ Kenyatta 1962 [1938], pp. 127–130.
  135. ^ Klaus Fiedler, Christianity and African Culture, Brill, 1996, p. 75.
  136. ^ Boddy 2007, pp. 241–245.

    Also see Ronald Hyam, Empire and Sexuality: The British Experience, Manchester University Press, 1990; Jocelyn Murray, "The Church Missionary Society and the 'Female Circumcision' Issue in Kenya 1929-1932", Journal of Religion in Africa, 8(2), 1976, pp. 92–104.

  137. ^ Thomas 2000, p. 132; for the "sexual mutilation of women," Karanja 2009, p. 93, n. 631.

    Also see 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.

  138. ^ Boddy 2007, p. 241.
  139. ^ Thomas 2000, pp. 129–131 (p. 131 for the girls as "central actors"); Lynn Thomas, Politics of the Womb: Women, Reproduction, and the State in Kenya, University of California Press, 2003, pp. 89–91.

    Also see 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.

    Kenya criminalized FGM in 2001 for the under-18s and banned it from state-run facilities, then banned it completely with the Prohibition of FGM Act 2011. See UNICEF-UNFPA 2012, pp. 12, 14; Sarah Boseley, "FGM: Kenya acts against unkindest cut", The Guardian, 8 September 2011.

  140. ^ UNICEF 2013, p. 10, calls the Egyptian Doctors' Society opposition the "first known campaign" against FGM; for independence, Boddy 2007, p. 147.
  141. ^ Boddy 2007, pp. 202, 299. FGM is still practised in Sudan, where 88 percent of women and girls have been cut; some states banned it in 2008–2009, but as of 2013 there was no national legislation; see UNICEF 2013, pp. 2, 9.
  142. ^ Boyle 2002, pp. 92, 103.
  143. ^ Boyle 2002, p. 41.
  144. ^ Birgitte Bagnol, Esmeralda Mariano, "Politics of naming sexual practices," in Sylvia Tamale (ed.), African Sexualities: A Reader, Pambazuka Press, 2011, p. 281.
  145. ^ 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.

  146. ^ Nawal El Saadawi, The Hidden Face of Eve, Zed Books, 2007 [1980], p. 14; Krajeski (The New Yorker), 7 March 2011.
  147. ^ Oldfield Hayes 1975, p. 618; Gruenbaum 2001, p. 21.
  148. ^ a b Yoder and Khan (USAID) 2008, p. 2.

    Fran Hosken, The Hosken Report: Genital and Sexual Mutilation of Females, Women's International Network, 1994 [1979]; also see Joseph P. Khan, "Fran P. Hosken, 86; activist for women's issues globally", The Boston Globe, 12 February 2006.

  149. ^ Hosken 1994 [1979], p. 5.
  150. ^ Boyle 2002, p. 47; Bagnol and Mariano 2011, p. 281.
  151. ^ Rahman and Toubia 2000, p. 10; UNICEF 2013 p. 8; Toubia 1994.
  152. ^ 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.
  153. ^ For example, UNICEF 2013 lists Mauritania as having passed legislation against it, but (as of that year) it is banned only from being conducted in government facilities or by medical personnel.

    For the 22 countries, UNICEF 2013, pp. 8–9; for Mauritania, p. 8. As of 2013 there is legislation in place against FGM in the following practising countries (several have introduced restrictions short of a ban; an asterisk indicates a ban according to the UNICEF–UNFPA 2012 annual report, p. 12, although that list may not be exhaustive):

    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, some states (1999–2006), Senegal (1999*), Somalia (2012*), Sudan, some states (2008–2009), Tanzania (1998), Togo (1998) and Uganda (2010*).

    South Africa and Zambia have outlawed it, but are not among the countries in which it is concentrated. Outside Africa it is concentrated in Yemen (2001) and Iraqi Kurdistan (2011), both of which have passed legislation against it.

  154. ^ Salam 1999, p. 322.
  155. ^ Phyllis Chesler, "Stopping the Flood of Female Genital Mutilation: Egypt Brings Historic Case", Breitbart, 22 May 2014; Patrick Kingsley, "Egyptian doctor to stand trial for female genital mutilation in landmark case", The Guardian, 21 May 2014.
  156. ^ 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."

  157. ^ 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.
  158. ^ Boyle 2002 p. 97.
  159. ^ "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.

    "Eliminating female genital mutilation", European Commission; "18 U.S. Code § 116 - Female genital mutilation", Legal Information Institute, Cornell University Law School; Section 268, Criminal Code of Canada.

  160. ^ "Efua Dorkenoo", The Huffington Post; Efua Dorkenoo, Cutting the Rose: Female Genital Mutilation, the Practice and its Prevention, Minority Rights Group, 1994.
  161. ^ Clyde H. Farnsworth, "Canada Gives Somali Mother Refugee Status", The New York Times, 21 July 1994.
  162. ^ Section 268, Criminal Code of Canada; 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. ^ For 1982, Gallard (BMJ) 1995, p. 1593; for 1993, Farnsworth (New York Times) 1994.
  167. ^ David Gollaher, Circumcision: A History of the World's Most Controversial Surgery, Basic Books, 2000, p. 189.
  168. ^ 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.

    Richard Kerbaj, "Thousands of girls mutilated in Britain",The Times, 16 March 2009 (courtesy link).

  169. ^ Female Genital Mutilation Act 2003: "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."

    "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.

  170. ^ "FGM: UK's first female genital mutilation prosecutions announced", BBC News, 21 March 2014.

    Another doctor was struck off the medical register in 2014 after discussing how to arrange FGM with an undercover journalist; see "'Genital mutilation' doctor struck off after undercover press sting", BBC News, 30 May 2014.

  171. ^ 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.
  172. ^ Patricia Dysart Rudloff, "In Re: Oluloro: Risk of female genital mutilation as 'extreme hardship' in immigration proceedings", 26 Saint Mary's Law Journal, 877, 1995.
  173. ^ Nussbaum 1999, pp. 118–119; Celia W. Dugger, "June 9–15; Asylum From Mutilation",The New York Times, 16 June 1996.

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

  174. ^ Abusharaf 2007, p. 22; "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.
  175. ^ "One Hundred Twelfth Congress of the United States of America", 3 January 2012, Sec 1088, p. 339.
  176. ^ "Man gets 10-year sentence for circumcision of 2-year-old daughter", Associated Press, 1 November 2006.

    In 2014 President Barack Obama spoke about FGM for the first time, calling it "a tradition that's barbaric and should be eliminated." See Nedra Pickler, "Obama To Rename Africa Young Leaders Program For Nelson Mandela", Huffington Post, 28 July 2014.

  177. ^ Silverman 2004, pp. 420, 427.
  178. ^ Christine J. Walley, "Searching for 'Voices': Feminism, Anthropology, and the Global Over Female Genital Operations" in Stanlie M. James and Claire C. Robertson (eds.), Genital Cutting and Transnational Sisterhood, University of Illinois Press, 2002, pp. 18, 43; for the quote, Bagnol and Mariano 2011, p. 281.
  179. ^ 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.
  180. ^ 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, pp. 217–218 (also in Daedalus, 129(4), Fall 2000); 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.

  181. ^ 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), p. 193.
  182. ^ Sylvia Tamale, "Researching and theorising sexualities," in Sylvia Tamale (ed.), African Sexualities: A Reader, Fahamu/Pambazuka, 2011, pp. 19–20.
  183. ^ Walley 2002, p. 34.
  184. ^ 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.

    For the photographs, "Stephanie Welsh", 1996 Pulitzer Prize winners.

  185. ^ Shweder 2005, p. 187; 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.

  186. ^ Gerry Mackie, "Female Genital Cutting: A Harmless Procedure?", Medical Anthropology Quarterly, 17(2), 2003, pp. 135–158; Silverman 2004, p. 430.
  187. ^ Sweder 2005, pp. 187–189; 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.
  188. ^ Sara Johnsdotter and Birgitta Essén, "Genitals and ethnicity: the politics of genital modifications", Reproductive Health Matters, 18(35), 2010 (pp. 29–37), 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.
  189. ^ Ronán M. Conroy, "Female genital mutilation: whose problem, whose solution?", British Medical Journal, 333(7559), 15 July 2006.
  190. ^ El Guindi 2007, pp. 33–34.
  191. ^ Lora Wildenthal, The Language of Human Rights in West Germany, University of Pennsylvania Press, 2012, p. 148.
  192. ^ Obermeyer 1999, p. 94.
  193. ^ Johnsdotter and Essén 2010, p. 32.
  194. ^ Johnsdotter and Essén 2010, p. 33; Essén and Johnsdotter 2004, p. 613.
  195. ^ Nussbaum 1999, pp. 123–124.

    Also see Yael Tamir, "Hands Off Clitoridectomy", Boston Review, Summer 1996; Martha Nussbaum, "Double Moral Standards?", Boston Review, October/November 1996.

  196. ^ 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 Cheryl Chase, "'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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