Female genital mutilation

Female genital cutting (FGC), female genital mutilation (FGM), or female circumcision (FC), is the excision or tissue removal of any part of the female genitalia for cultural, religious or other non-medical reasons. It is not the same as the procedures used in gender reassignment surgery or the genital modification of intersexuals.

History of terminology

Different terms are used to describe female genital surgery. The procedure was once commonly referred to as female circumcision (FC), but the terms female genital mutilation (FGM) and female genital cutting (FGC) are now dominant throughout the international community. Opponents of the practice often use the term female genital mutilation, whereas groups that oppose the stigma of the word "mutilation" prefer to use the term female genital cutting. Also, a few organizations have started using the combined term female genital mutilation/cutting (FGM/C).

Female circumcision

The term female circumcision is a euphemism for the spectrum of genital cutting procedures. Advocates of male circumcision often argue that the term female circumcision results in unwanted associations between the two practices. The American Journal of Bioethics states that practices such as clitoridectomy and excision are not analogous to male circumcision because of the difference in relative harm. Genital integrity advocates, on the other hand, sometimes refer to all imposed forms of genital cutting as "mutilation."

Female genital mutilation

The term female genital mutilation gained growing support in the late 1970s. The word "mutilation" not only established clear linguistic distinction from male circumcision, but it also emphasized the gravity of the act. In 1990, this term was adopted at the third conference of the Inter African Committee on Traditional Practices Affecting the Health of Women and Children (IAC) in Addis Ababa. In 1991, the World Health Organization (WHO), a specialized agency of the United Nations (UN), recommended that the UN adopt this terminology; subsequently, it has been widely used in UN documents.

In this context, the term female circumcision was thus predominantly replaced by the term female genital mutilation:

The extensive literature on the subject, the support of international organizations, and the emergence of local groups working against the continuation practices appear to suggest that an international consensus has been reached. The terminology used to refer to these surgeries has changed, and the clearly disapproving and powerfully evocative expression of "female genital mutilation" has now all but replaced the possibly inaccurate, but relatively less value laden-term of "female circumcision".

Female genital cutting

Because the term female genital mutilation has been criticized for increasing the stigma associated with female genital surgery, some groups have proposed an alteration, substituting the word "cutting" for "mutilation." According to a joint WHO/UNICEF/UNFPA statement, the use of the word "mutilation" reinforces the idea that this practice is a violation of the human rights of girls and women, and thereby helps promote national and international advocacy towards its abandonment. They state that, at the community level, however, the term can be problematic; and that local languages generally use the less judgmental "cutting" to describe the practice. They also feel that parents understandably resent the suggestion that they are "mutilating" their daughters. In this spirit, in 1999, the UN Special Rapporteur on Traditional Practices called for tact and patience regarding activities in this area and drew attention to the risk of "demonizing" certain cultures, religions, and communities. As a result, they claim, the term "cutting" has increasingly come to be used to avoid alienating communities.

In 1996, the Uganda-based initiative REACH (Reproductive, Educative, And Community Health) began using the term female genital cutting, observing that female genital mutilation may "imply excessive judgment by outsiders as well as insensitivity toward individuals who have undergone some form of genital excision." While some international organizations, such as the UN and the WHO, continue to use the earlier term of female genital mutilation, a number of agencies, like UNICEF, now use the term female genital mutilation/cutting (FGM/C).

World Health Organization Categorization

There are several distinct practices of FGC that range in severity, depending on how much genital tissue is cut away. Four major types have been categorized by the WHO (see Diagram 1), although there is some debate as to whether all common forms of FGC fit into these four categories, as well as issues with the reliability of reported data.

Diagram 1:This image shows the different types of FGC and how they differ to the normal female anatomy.

Type I

The WHO defines Type I female genital mutilation as the removal or splitting of the clitoral hood, termed "hoodectomy" (or "clitorodotomy"), with or without excision of the clitoris, see Diagram 1B. The clitoral hood is homologous to the foreskin of the penis which is removed during circumcision.

Type II: Excision

Excision refers to clitoridectomy (removal of the prepuce and the clitoris) plus the partial or total removal of the labia minora, the inner lips of the vulva, see Diagram 1C. Type II circumcision is a more extensive form of FGC compared to Type I and due to the sewing together of the leftover labia minora epidermis, which contains sweat glands, a buildup of sweat and urine in the closed off space beneath this closure can lead to local or urinary infection, septicemia, hemorrhaging and cyst formation. This type of FGC is also called khafd, meaning reduction in Arabic.

Type III: Infibulation

Type III is the most severe form of FGC and is called infibulation or pharaonic circumcision (referring to the Pharaohs who were thought to practice this form). Infibulation involves extensive tissue removal of the external genitalia, including all of the labia minora and the inside of the labia majora, leaving a raw open wound. The labia majora are then held together using thorns or stitching and the girl's legs are tied together for two to six weeks, to prevent her from moving and allow the healing of the two sides of the vulva. Nothing remains of the normal anatomy of the genitalia, except for a wall of flesh from the pubis down to the anus, with the exception of a pencil-size opening at the inferior portion of the vulva to allow urine and menstrual blood to pass through, see Diagram 1D. Generally, a male nurse deemed to have the necessary skill carries out this procedure, and a local anesthetic is used. However, when carried out "in the bush," infibulation is often performed by an elderly matron or midwife of the village, with no anesthesia used.

A reverse infibulation can be performed to allow for sexual intercourse (often by the husband using a knife on the wedding night) or when undergoing labor, or by female relatives, whose responsibility it is to inspect the wound every few weeks and open it some more if necessary. During childbirth, the enlargement is too small to allow vaginal delivery, and so the infibulation must be opened completely and restored after delivery. Once again, the legs are tied together to allow the wound to heal, and the procedure is repeated for each subsequent act of intercourse or childbirth. When childbirth takes place in a hospital, the surgeons may preserve the infibulation by enlarging the vagina with deep episiotomies. Afterwards, the patient may insist that her vulva be closed again so that her husband does not reject her.

This practice is reported to cause the disappearance of sexual pleasure for the women affected, as well as major medical complications. However, a five-year study of 300 women and 100 men in Sudan found indications that "sexual desire, pleasure, and orgasm are experienced by the majority of women who have been subjected to this extreme sexual mutilation, in spite of their being culturally [bound] to hide these experiences."

Most advocates of the practice continue to perform the procedure in adherence to standards of beauty that are very different from those in the west. Many infibulated women will contend that the pleasure their partners receive due to this procedure is a definitive part of a successful marriage.

Type IV: Other types

There are other forms that are collectively referred to as Type IV and usually do not involve any tissue removal at all, but rather the "cutting" is simulated with a knife as part of a ceremony. This includes a diverse range of practices, including pricking the clitoris with needles, burning or scarring the genitals as well as ripping or tearing of the vagina or introducing herbs into the vagina to cause bleeding and a narrowed vaginal opening (ref). Type IV is found primarily among isolated ethnic groups as well as in combination with other types.

Prevalence

Map: Estimated Prevalence of Female Genital Cutting (FGC) in Africa.

Female genital cutting is today mainly practiced in African countries. It is common in a band that stretches from Senegal in West Africa to Somalia on the East coast, as well as from Egypt, which recently passed a law banning FGC, in the north to Tanzania in the south; see Map. In these regions, it is estimated that more than 95% of all women have undergone this procedure. It is also practiced by some groups in the Arabian peninsula.

The countries that practice FGC the most are Somalia, followed by Egypt, Sudan, Ethiopia, and Mali. Among ethnic Somali women, infibulation is traditional and nearly universal. In the Arab peninsula, Sunna circumcision is usually performed, especially among Arabs (ethnic groups of African descent are more likely to prefer infibulation).

Whilst FGC is widely practiced out in the open by Africans of all faiths, it is practiced in secrecy in some parts of the Middle East. The practice occurs "particularly in northern Saudi Arabia, southern Jordan, and Iraq. There is also circumstantial evidence to suggest it is present in Syria, western Iran, and southern Turkey. However, while this practice was suspected in the region, there was never solid proof that the procedure was so prevalent." In Oman, a few communities still practice FGC; however, experts believe that the number of such cases is small and declining annually. In the United Arab Emirates and Saudi Arabia, it is practiced mainly among foreign workers from East Africa and the Nile Valley.

The practice can also be found among a few ethnic groups in South America and very rarely in India (Dawoodi Bohra community). In Indonesia, the practice is fairly common among the country's Muslim women; however, in contrast to Africa, almost all are Type I or Type IV, the latter usually involving the symbolic pricking of blood release.

Amnesty International estimates that over 130 million women worldwide have been affected by some form of FGC with over 2 million procedures being performed every year.

Due to immigration, the practice has also spread to Europe, Australia and the United States. Some tradition-minded families have their daughters undergo FGC whilst on vacation in their home countries. As Western governments become more aware of FGC, legislation has come into effect in many countries to make the practice of FGC a criminal offense. In 2006, Khalid Adem became the first man in the United States to be prosecuted for mutilating his daughter.

Cultural Aspects

The practice of FGC predates both Islam and Christianity and there is no clear understanding of where or why the practice of FGC came into existence. Greek papyrus from 163 B.C. mentions girls in Egypt undergoing circumcision and it is widely accepted to have originated in Egypt and the Nile valley at the time of the Pharaohs. Evidence from mummies have shown both Type I and Type III FGC present. The spread of the practice of FGC is unknown, but the procedure is now practiced among Muslims, Christians, and Animists.

However, FGC transcends religion as it is primarily a cultural practice. UNICEF stated that when "looking at religion independently, it is not possible to establish a general association with FGM/C status."

The arguments used to defend FGC are multifaceted and vary between societies that practices this; they range from health-related to social benefits, and are summarized below.:

• maintenance of cleanliness
• maintenance of good health
• preservation of virginity
• enhancement of fertility
• prevention of stillbirths in women pregnant for the first time
• prevention of promiscuity
• increase of matrimonial opportunities
• pursuance of aesthetics
• improvement of male sexual performance and pleasure
• promotion of social and political cohesion

Maintenance of cleanliness is considered very important in some African cultures and consider FGC part of maintaining cleanliness as it removes secreting parts of the genitalia. Other societies claim FGC cures females from a diverse range of psychological diseases such as depression, hysteria, insanity, but also even kleptomania. FGC provides a proof of virginity—a guarantee against premarital sex, which is a necessary condition for marriage in many FGC societies. Parents may then demand a high bridal price, and hence in a socio-economic context circumcised women have an advantage over uncircumcised. Additionally, in some of these societies, men are forbidden to marry uncircumcised women. Yet other FGC practicing societies like Mossi of Burkina Faso and the Ibos of Nigeria believe that babies die if they touch the clitoris during birth. Removal of the clitoris is believed to decrease the risk of female promiscuity, since it reduces or removes sexual pleasure. Some FGC societies believe that FGC enhances beauty. This stems from their belief that male foreskin is removed for aesthetic reasons, and that the clitoris thus should be removed for the same reason since it is the counterpart to the penis. FGC is believed to prolong sexual pleasure of men, because it is believed that the clitoris increases sexual stimulation. Women who have had genital surgeries are considered to have higher status than those who are not and are entitled to positions of religious, political and leadership nature. While FGC is not a religious practice, it is practiced within particular religious sub-cultures.

Judaism

FGC is not mentioned in any Jewish religious text.[3][4]

FGC was practiced by the minority Ethiopian Jewish community (Beta Israel), formerly known as Falasha, most of whom now live in Israel, but it is not known if the practice has persisted following their emigration to Israel.[5]

In general, traditional Judaism maintains that the body of a person belongs not to the person but to God. Any permanent modification of the body which does not serve the purpose of correcting a deformity is considered to be a defacement of God's property;thus, tattoos and body modifications are forbidden, with the exception of male circumcision, which is mandated.

Islam

While FGC predates Islam and is not practiced by the majority of Muslims, it has been discussed in some hadiths. FGC is not an Islamic religious practice, though some advocates will quote hadiths to support its practice in Islamic cultures. The meaning and legitimacy of such mentions are disputed by the greater islamic community. Genital modification and mutilation of is not endorsed by the Qur'an. In Saudi Arabia, in the area known as the Hijaz, where Islam originated, FGC was already being practiced during the lifetime of Muhammad. To call a man a "circumciser of women" was an insult among the pagan Arabs at the time. Islamic allusions to the practice encourage the mildest form of FGC and this was thought to be supported by Muhammad.

According to Muhammad Lutfi As-Sabbagh, Professor in Islamic Studies in Riyadh University, one of these sayings of Muhammad was rejected by the majority of Medieval scholars, noting "the two great Imams, Abu Dawud and Al-`Iraqi, have judged this Hadith to be da`if (weak). Shams Ed-Din Al-Haq Al-`Azim Abadi explains the legal import of such weakness, "[t]he Hadith of female circumcision has been reported through so many ways all of which are weak, blemished and defective, and thus it is unacceptable to prove a legal ruling through such ways." and accepted by only a clear minority of Islamic scholars, states that "a woman used to perform circumcision in Medina. Muhammad said to her, 'Do not cut severely as that is better for a woman and more desirable for a husband.'" While a majority of scholars hold that this hadith does not require anyone to perform or undergo a circumcision, some scholars go further and hold that, as "games of chance" (maysir) are prohibited in the Qur'an, the rather unspecified term "severely" intentionally inherits the risk of a cut being deemed as too severe by Muhammad and/or God so that the tradition could easily be abolished later on. Only one of the four Islamic schools of jurisprudence or law, the Shafi'i school, ordered for a "slight trimming" of the hood of the clitoris, supposedly in order to enhance sexual pleasure for the woman.

While some scholars, such as Sheikh Sayyid Sabiq, author of Fiqh As-Sunnah argue that "[h]adiths stating the legality of female circumcision are da`if (weak); none of them is sahih (authentic)",[6] other scholars argue that authenticity alone does not confer legitimacy. One of the sayings used to support FGC practices is the`hadith (349) in Sahih Muslim: Aishah narrated an authentic Hadith that the Prophet said:"When a man sits between the four parts (arms and legs of his wife) and the two circumcised parts meet, then ghusl is obligatory." Dr. Muhammad Salim al-Awwa, Secretary General of the World Union of the Muslim Ulemas states that while the hadith is authentic, it is not evidence of legitmacy. In idiomatic usage, the Arabic for "the two circumcision organs" is a single word, orkhitaanaan, where the plural of one word is used to denote not two of the same form, but two different forms characterized as a singular of the more prominent form. While the female form is used to denote both male and female genitalia, it is identified with the prominent aspect of the two forms, which in this case is the male circumcised organ. The connotation of circumcision is not transitive. Using the hadith is specious because "such an argument can be refuted by the fact that in Arabic language, two things or persons may be given one quality or name that belongs only to one of them for an effective cause." [eg. abawaani is the dual of aba (father) meaning parents (father and mother, not "two fathers"; qamarani is the dual form of qamar (moon), meaning "sun and moon" (not "two moons");; usage in "Qur'an in Surah Al-Furqan(25):53" bahrayn is the dual form of bahr (sea) meaning "sea (salty and bitter) and river (sweet and thirst-allaying) (not "two seas"); sometimes the word with the female gender is chosen to make the dual form, such as in the expression "the two Marwas", referring to the two hills of As-Safa and Al-Marwa (not "two hills, each called Al-Marwa") in Mecca]

In the Shi'ite tradition of Islam, the practice of female circumcision has never been practiced. This procedure is outlawed by all leading Shi'ite Marjas that interpret Sharia traditions and is considered a custom left over from pre-Islamic times. In general the Islamic clergy do not support the practice; Shaykh Faraz Rabbani states "As for excision, FGM, or other harmful practices, which have become culturally widespread, none of these are in any way permitted." However there are some who have been adamant about its religious importance amongst Muslims. In 1994, Egyptian Mufti Sheikh Jad Al-Hâqq 'Ali Jad Al-Hâqq issued a fatwa stating, "Circumcision is mandatory for men and for women. If the people of any village decide to abandon it, the village imam must fight against them as if they had abandoned the call to prayer." The Al-Azhar University in Cairo has issued several fatwas endorsing FGC, in 1949, 1951 and 1981.

In March 2005, Dr Ahmed Talib, Dean of the Faculty of Sharia at the Al-Azhar University, stated: "All practices of female circumcision and mutilation are crimes and have no relationship with Islam. Whether it involves the removal of the skin or the cutting of the flesh of the female genital organs... it is not an obligation in Islam. Both Christian and Muslim leaders have publicly denounced the practice of FGC since 1998.

Many Muslim scholars believe FGC is practiced as a result of ignorance and misconceived religious fervor rather than for reasons of true religious doctrine. A recent conference at the Al-Azhar University in Cairo (December, 2006) brought prominent Muslim clergy to denounce the practice as not being necessary under the umbrella of Islam. Although there was some reluctance amongst some of the clergy, who preferred to hand the issue to doctors, making the FGC a medical decision, rather than a religious one, the Grand Mufti Ali Jumaa of Egypt, signed a resolution denouncing the practice.

In June 2007, 12-year-old girl named Bedur Ahmed Shaker was taken by her mother to a private clinic in Minya , a town on the Nile south of Cairo, for the FGC operation. She died before she could be transferred to hospital. The resultant outcry by human rights organizations and the public has resulted in a ban of FGC by the Egyptian health ministry, which is expected to be backed up by legislation.

Christianity

As FGC rituals predated the missionaries work in North Africa, many African tribes continue the practice as a matter of cultural tradition. In primarily Christian countries (for instance, Ghana), women undergoing circumcision make reference to the practice in the Old Testament, being performed by Abraham's wife, Sarah. However Genesis 17:23-27 only mentions circumcision being performed on male members of the household, and not on Sarah.

In the United States, as recently as 1938, FGC was advocated by some Christian evangelists as a method of preventing masturbation. As one preacher prescribed: "While incest and illicit commerce of the sexes is abominable, there is another even more so--if that be possible--that is, the heinous sin of self-pollution or masturbation... In some cases where there may be impingement of the clitoris, a slight operation may be necessary to relieve the tension and irritation..."

Other groups

In some areas of Africa, there exists the belief that a newborn child has elements of both sexes. In the male body the foreskin of the penis is considered to be the female element. In the female body the clitoris is considered to be the male element. Hence when the adolescent is reaching puberty, these elements are removed to make the indication of sex clearer. [7]

Medical consequences

Among practicing cultures, FGC is most commonly performed between the ages of four and eight, but can take place at any age from infancy to adolescence. Prohibition has led to FGC going underground, at times with people who have had no medical training performing the cutting without anesthetic, sterilization, or the use of proper medical instruments. The procedure, when performed without any anesthetic, can lead to death through shock from immense pain or excessive bleeding. The failure to use sterile medical instruments may lead to infections.

Other serious long term health effects are also common. These include urinary and reproductive tract infections, caused by obstructed flow of urine and menstrual blood, various forms of scarring and infertility. The first time having sexual intercourse will often be extremely painful, and infibulated women will need the labia majora to be opened, to allow their husband access to the vagina. This second cut, sometimes performed by the husband with a knife, can cause other complications to arise.

The health consequences of FGC vary from region to region and from researcher to researcher. An in-depth analysis by Carla Obermeyer (2003) shows that past studies, plagued by "incomplete analysis" and "inconsistent numbers," have greatly overestimated the likelihood of serious medical complications resulting from FGC procedures (401). She notes that there is no significant statistically represented relationship between FGC and sexually transmitted diseases/infections, infertility or birth complications (402). Her study illustrates how the opposers of FGC may be relying on inadequate health data to justify their opposition, and instead more meaningful and relevant medical research needs to be conducted in order to help support the cessation of this practice.

A June 2006 study by the WHO has cast doubt on the safety of genital cutting of any kind. This study was conducted on a cohort of 28,393 women attending delivery wards at 28 obstetric centers in areas of Burkina Faso, Ghana, Nigeria, Kenya, Senegal and The Sudan. A high proportion of these mothers had undergone FGC. According to the WHO criteria, all types of FGC were found to pose an increased risk of death to the baby (15% for Type I, 32% for Type II, and 55% for Type III). Mothers with FGC Type III were also found to be 30% more at risk for cesarean sections and had a 70% increase in postpartum hemorrhage compared to women without FGC. Estimating from these results, and doing a rough population estimate of mothers in Africa with FGC, an additional 10 to 20 per thousand babies in Africa die during delivery as a result of the mothers having undergone genital cutting.

In cases of repairing the damage resulting from FGC, called de-infibulation when reversing Type III FGC, this is usually carried out by a gynecologist. See also Pierre Foldes, French surgeon, who developed modern surgical corrective techniques.

A 12 year-old Egyptian girl, Badour Shaker, died in June, 2007 during or soon after a circumcision. She died from an overdose of anesthesia. The girl's mother, Zeniab Abdel Ghani, paid $9.00 [or 5 British pounds] to a female doctor, in an illegal clinic in the southern town of Maghagh, for the operation. The doctor tried to give her $3,000 to withdraw a lawsuit, but the mother refused.

Sexual consequences

Sexual excitement and arousal for a woman, during intercourse, involves a complex series of nerve endings being activated and stimulated in and around her vagina, vulva (labia minora and majora) and clitoris. It is generally well accepted that clitoral stimulation is important to reach orgasm, although reaching orgasm can also be a mental process for some people.

Whether or not a woman who has undergone FGC can achieve an orgasm, especially those who have had their clitoris excised, is a question that tends to have more than one answer. Hanny Lightfoot-Klein traveled throughout The Sudan (where Type III is the prevalent form of FGC, ~90%) in the early 1980s asking women who had FGC this very question: "How often do you experience orgasm?" following sexual intercourse with their husband. Many of the women had no idea what an orgasm was, but others interviewed (especially if the surgery excised less tissue) not only insisted that they did achieve orgasm, ranging from 90% of the time when they were young to 10% of the time once they had children, but were open to talking about their experiences. They were able to describe in great detail exactly what an orgasm meant to them.

I feel as if I am trembling in my belly. It feels like electric shock going around my body - very sweet and pleasurable. When it finishes, I feel as if I want to faint.

— Patient

I feel as if I have had a shot of morphine. My body vibrates all over. Then I feel shocked and cannot move. At the end, I relax all over.

— Director of Nursing

About one-third of women interviewed said they experience some sexual sensitivity at the area of their scar as well as internally, whilst others reported only internally or only externally.

There were also women who did not enjoy sex at all, as it was too painful or did not leave them with any feelings.

Attempts to end the practice of FGC

Despite laws forbidding the practice, FGC has proven to be an enduring tradition difficult to overcome on the local level with deeply held cultural and sometimes political significance. For instance, prohibition by the British of the procedure among tribes in Kenya significantly strengthened the tribes' resistance to British colonial rule in the 1950s and increased support for the Mau Mau guerrilla movement. Thus, colonial efforts to stampe out the practice had the contradictory result of making it even more common, as it was seen as a form of resistance towards colonial rule.

A significant difficulty lies in the fact that the practice, as an identifying feature of indigenous culture, is intimately associated with the endogamous potential of young women. Thus for only one or a few families within a given locale to "deprive" their daughters of the operation is to significantly disadvantage them in finding husbands. This damages the survivability of their culture in a hostile, "globalizing" social environment.

Because the practice holds such cultural and marital significance, anti-"circumcision" activists increasingly recognize that to end the practice it is necessary to work closely with local communities. What must happen, some have noted, is that members of a marriage network must all give up the practice simultaneously so no individuals are handicapped, as happened, for example, under similar circumstances with the rapid abandonment of foot binding among the Chinese early in the 20th century.

Often activists working for the practice's elimination offer a universalizing psychological rationale. Working from an axiom of a "normal" psyche, they commonly assume that female genital cutting rituals represent deviance from a transcultural behavioral norm. Of course, these rituals are seen in these cases as violent disfigurement, likened to child abuse and rape. They seek to bring practitioners and "victims" of such "barbarism" to reason by convincing them that the practice is indeed a wrong-doing. This attitude is an echo of the colonial and missionary campaigns against the practice in the first half of the 20th century.

An example of successful efforts to end the practice is occurring in Senegal, initiated by native women working at the local level in connection with the Tostan Project. Since 1997, 1,271 villages (600,000 people), some 12% of the practicing population in Senegal, have voluntarily given up FGC and are also working to end early and forced marriage. This has come about through the voluntary efforts of locals carrying the message out to other villages within their marriage networks in a self-replicating process. By 2003, 563 villages had participated in public declarations, and the number continues to rise. By then, at least 23 villages in Burkina Faso had also held such community wide ceremonies, marking "the first public declaration to end FGC outside of Senegal and showing the replicability of the Tostan program for large-scale abandonment of this practice". Molly Melching of TOSTAN believes that in Senegal the practice of female genital mutilation could be ended within 2–5 years. She credits the approach of education versus cultural imperialism for the rapid and significant changes which have occurred in Senegal. The approach going into Senegal was one of non judgment which allowed the men and women of Senegal to question their own traditions and make change as opposed to being put in a position where they would have felt the need to defend their traditions against the criticisms of others.

This indigenous movement began with a few women who had participated in a literacy program that taught women skills in research, project management and social advocacy. The program also included neutrally presented facts about female reproduction and the health effects of female circumcision (see Obermeyer above for counter-point to presumed "neutrality"). Students did group projects as the culmination of their 18-month training and one such group chose the topic of FGC for their project. Having received assurance from their local imam during their research that the practice was a custom and not a religious requirement, they went on to create dramatic reenactments of the suffering and deaths the practice had brought to their own lives and to share them throughout their village. At the end of a year, their entire village of some 15,000 people joined in a public ceremony to collectively reject the practice for their daughters and prospective daughters-in-law. From there, the imam and other leaders in their village began visiting other villages within the local marriage network and sharing their story. As a result, the new practice began to spread.

Some countries in the area of practice have prohibited FGC but the practice still goes on in secret. In many cases, the enforcement of this prohibition is a low priority for governments, whilst some countries have tried to medicalize the procedure. The movement to end FGC is a slowly growing trend and this is not helped by those countries who have yet to place prohibitions on FGC.

On June 28, 2007 Egypt banned female genital cutting after the death of 12-year old Badour Shaker during a genital circumcision. The Guardian of Britain reported that her death "sparked widespread condemnation" of the practice. Egyptian newspapers reported that earlier in the day of her surgery, the girl had given out sweets, in celebration of her excellent grades in school. (See earlier in this article for details of the death, and see the details in the next section regarding the ban on female genital cutting.)

The United States-based women's and girls' rights organization, Tahirih Justice Center, is a non-governmental organization (NGO) named after Táhirih, a 19th Century Persian advocate of women's rights. It provides pro bono direct legal services and social and medical service referrals to immigrant women and girls who are fleeing from gender-based violence and persecution. It helps women who are attempting to escape from such abuse as female genital cutting, domestic violence, human trafficking, torture and rape. The organization also conducts public policy initiatives, such as International Marriage Broker Regulation Act (IMBRA). Layli Miller-Muro founded the Tahirih Justice Center in 1997 following the Matter of Kasinga, an asylum case in the United States for Fauziya Kassindja in order to escape a tribal practice of female genital cutting, in which Miller-Muro was involved as a student attorney.

Laws and outreach programs

The countries where FGC is commonly practiced were identified by the US State Department.[8] Other information in this section is from Skaine (2005), Appendix I.

Burkina Faso (71.6% prevalence, Type II)

A law prohibiting FGC was enacted in 1996 and went into effect in February 1997. Even before this law, however, a presidential decree had set up the National Committee against excision and imposed fines on people guilty of excising girls and women. The new law includes stricter punishment. Several women excising girls have been handed prison sentences.

Central African Republic (43.4% prevalence, Type I and II)

In 1996, the President issued an Ordinance prohibiting FGC throughout the country. It has the force of national law. Any violation of the Ordinance is punishable by imprisonment of from one month and one day to two years and a fine of 5,100 to 100,000 francs (approximately US$8-160). No arrests are known to have been made under the law.

Côte d'Ivoire ( 44.5% prevalence, Type II)

A December 18, 1998 law provides that harm to the integrity of the genital organ of a woman by complete or partial removal, excision, desensitization or by any other procedure will, if harmful to a women's health, be punishable by imprisonment of one to five years and a fine of 360,000 to two million CFA Francs (approximately US$576-3,200). The penalty is five to twenty years incarceration if the victim dies and up to five years' prohibition of medical practice, if this procedure is carried out by a doctor.

Djibouti (90-98% prevalence, Type II)

FGC was outlawed in the country's revised Penal Code that went into effect in April 1995. Article 333 of the Penal Code provides that persons found guilty of this practice will face a five year prison term and a fine of one million Djibouti francs (approximately US$5,600).

Egypt (78-97% prevalence, Type I, II and III)

Egypt's Ministry of Health and Population has banned all forms of female genital cutting since 2007. The ministry's ban order declared it is 'prohibited for any doctors, nurses, or any other person to carry out any cut of, flattening or modification of any natural part of the female reproductive system'. Islamic authorities in the nation also stressed that Islam opposes female circumcision. The Grand Mufti of Egypt, Ali Gomaa, said that it is "Prohibited, prohibited, prohibited." The June 2007 Ministry ban eliminated a loophole that allowed girls to undergo the procedure for health reasons. There had previously been provisions under the Penal Code involving "wounding" and "intentional infliction of harm leading to death," as well as a ministerial decree prohibiting FGC. In December 1997, the Court of Cassation (Egypt's highest appeals court) upheld a government banning of the practice providing that those who did not comply would be subjected to criminal and administrative punishments. This law had proved ineffective and in a survey in 2000, a study found that 97% of the country's population still practiced FGC. There had been press reports on the prosecution of at least 13 individuals under the Penal Code, including doctors, midwives and barbers, accused of performing FGC that resulted in hemorrhage, shock and death. In light of the widespread practice of FGC, even after the ban in 1997, some Egyptian villages decided to voluntarily give up the practice, as was the case with Abou Shawareb, which vowed in July of 2005 to end the practice. However, it remains a culturally accepted practice, and a 2005 study found that over 95% of Egyptian women have been victims of Female Genital Mutilation.

Eritrea (90-95% prevalence, Type I, II and III)

Eritrea has outlawed all forms of female genital cutting since 2007. There have been no arrests made yet under the new law.

Ghana (9-15% prevalence, Type I,II and III)

In 1989, the head of the government of Ghana, President Rawlings, issued a formal declaration against FGC and other harmful traditional practices. Article 39 of Ghana's Constitution also provides in part that traditional practices that are injurious to a person's health and well being are abolished. There is the opinion by some that the law has driven the practice underground.

Guinea (98.6% prevalence, Type I, II and III)

FGC is illegal in Guinea under Article 265 of the Penal Code. The punishment is hard labor for life and if death results within 40 days after the crime, the perpetrator will be sentenced to death. No cases regarding the practice under the law have ever been brought to trial. Article 6 of the Guinean Constitution, which outlaws cruel and inhumane treatment, could be interpreted to include these practices, should a case be brought to the Supreme Court. A member of the Guinean Supreme Court is working with a local NGO on inserting a clause into the Guinean Constitution specifically prohibiting these practices.

Indonesia (No national prevalence figures avail., Type I and IV)

Officials are preparing to release a decree banning doctors and paramedics from performing FGC. FGC is still carried out extensively in Indonesia, the worlds largest Muslim nation. Azrul Azwar, The director general of community health, stated that, "All government health facilities will also be instructed to spread information about the decision as well as the redundancy of female circumcision."

Nigeria (25.1% prevalence, Type I, II and III)

There is no federal law banning the practice of FGC in Nigeria. Opponents of these practices rely on Section 34(1)(a) of the 1999 Constitution of the Federal Republic of Nigeria that states "no person shall be subjected to torture or inhuman or degrading treatment" as the basis for banning the practice nationwide. A member of the House of Representatives has drafted a bill, not yet in committee, to outlaw this practice.

Senegal (5-20% prevalence, Type II and III)

A law that was passed in January 1999 makes FGC illegal in Senegal. President Diouf had appealed for an end to this practice and for legislation outlawing it. The law modifies the Penal Code to make this practice a criminal act, punishable by a sentence of one to five years in prison. A spokesperson for the human rights group RADDHO (The African Assembly for the Defense of Human Rights) noted in the local press that "Adopting the law is not the end, as it will still need to be effectively enforced for women to benefit from it."

Somalia (90-98% prevalence, Type I and III)

There is no national law specifically prohibiting FGC in Somalia. There are provisions of the Penal Code of the former government covering "hurt", "grievous hurt" and "very grievous hurt" that might apply. In November 1999, the Parliament of the Puntland administration unanimously approved legislation making the practice illegal. There is no evidence, however, that this law is being enforced.

Sudan (91% prevalence, Type I,II and III)

Currently there is no law forbidding FGC, although Sudan was the first country to outlaw it in 1946, under the British. Type III was prohibited under the 1925 Penal Code, with less severe forms allowed. Outreach groups have been trying to eradicate the practice for 50 years, working with NGO's, religious groups, the government, the media and medical practitioners. Arrests have been made but no further action seems to have taken place.

Tanzania (17.6% prevalence, Type II and III)

Section 169A of the Sexual Offences Special Provisions Act of 1998 prohibits FGC. Punishment is imprisonment of from five to fifteen years or a fine not exceeding 300,000 shillings (approximately US$380) or both. There have been some arrests under this legislation, but no reports of prosecutions yet.

Togo (12% prevalence, Type II)

On October 30, 1998, the National Assembly unanimously voted to outlaw the practice of FGC. Penalties under the law can include a prison term of two months to ten years and a fine of 100,000 francs to one million francs (approximately US$160 to 1,600). A person who had knowledge that the procedure was going to take place and failed to inform public authorities can be punished with one month to one year imprisonment or a fine of from 20,000 to 500,000 francs (approximately US$32 to 800).

Uganda (<5% prevalence, Type I and II)

There is no law against the practice of FGC in Uganda. In 1996, however, a court intervened to prevent the performance of this procedure under Section 8 of the Children Statute, enacted that year, that makes it unlawful to subject a child to social or customary practices that are harmful to the child's health.

See also

• Breast ironing - a practice of flattening the breasts of girls
• Foot binding - an old, primarily Chinese, practice of constricting feet
• Labiaplasty - a recently developed cosmetic practice

Further reading

Bibliography

• Al-Qaradawi, Y. (2004, February 7). Islamic ruling on female circumcision. Retrieved March 29, 2006.
• Al-Qaradawi, Y. (2004, December 13). Circumcision: Juristic, medical & social perspectives. Retrieved March 29, 2006.
• Boyle, E. H. (2002). Female genital cutting: Cultural conflict in the global community. Baltimore: Johns Hopkins University Press. ISBN 978-0-8018-7063-7.
• Dettwyler, Katherine A. (1994). Dancing skeletons: life and death in West Africa. Prospect Heights, Ill.: Waveland Press. ISBN 0-88133-748-X.
• Ferguson, I and Ellis, P. (1995). Female Genital Mutilation: a Review of the Current Literature Department of Justice, Canada. Working document
• Gruenbaum, E. (2001). The female circumcision controversy. Philadelphia: University of Pennsylvania Press. ISBN 978-0-8122-1746-9.
• Hoffman, B. (2002). Womanhood and Circumcision: Three Maasai women have their say. Berkeley: Berkeley Media.
• Johnson, Michelle C. (2000). Becoming a Muslim, Becoming a person: Female 'circumcision', religious identity, and personhood in Guinea-Bissau. In B. Shell-Duncan & Y. Herlund (Eds.), Female circumcision in Africa: Culture, controversy, and change. Boulder: Lynne Rienner Publishers.
• Kandela, P. (1995, January). Egypt sees U turn on female circumcision. British Medical Journal, 310, 12.
• Kassindja, F. (1998). Do they hear you when you cry. New York: Delacorte Press. ISBN 0-38531-832-4.
• Obermeyer, Carla Makhlouf (2003). The health consequences of female circumcision: Science, advocacy, and standards of evidence. Medical Anthropology Quarterly, 17(3), 394-412. PMID 12974204. doi:10.1525/maq.2003.17.3.394
• Pieters, G., & Lowenfels A. B. (1977). Infibulation in the horn of Africa. New York State Journal of Medicine, 77(5), 729-31. PMID 265433.
• Research papers from medical gynecologists, judges, linguistics, and social scientists on the subject (1994). University of Khartoum, Sudan. Umm Atteya Organization website (Arabic). Retrieved March 29, 2006.
• UNICEF (1999). Consultation on the elimination of female genital mutilation: 14 December-16 December 1998. New York: Author. 40 pp.
• World Health Organization. (1996). Female genital mutilation: Report of a WHO Technical Working Group (unpublished document WHO/FRH/WHD/96.10). Geneva: World Health Organization. Retrieved 2007-02-21.
• Vintage Africa by Zagourski (photos) and Conan Doyle - Downloadable

Print

• Aldeeb, Sami (2000). Male and Female Circumcision in the Jewish, Christian and Muslim Communities, Religious debate. Beirut, ISBN 1855134063.
• Daw, E. (1970). Female circumcision and infibulation complicating delivery. Practitioner, 204(222), 559-63. PMID 5443542.
• Dewhurst, C.J., & Michelson, A. (1964). Infibulation complicating pregnancy. British Medical Journal, 2(5422), 1442. PMID 14209371.
• Dirie, Waris (2001). Desert Flower. Autobiography of a Somali woman's journey from nomadic tribal life to a career as a fashion model in London and to the post of special ambassador at the United Nations. Dirie recounts her personal experience with female genital mutilation that began with circumcision at age five.
• Leonard, Lori (2000). We did it for pleasure only: Hearing alternative tales of female circumcision. Qualitative Inquiry, 6(2), 212-228.
• Mernissi, Fatima. Beyond the veil: Male-female dynamics in a modern Muslim society. Cambridge, MA: Schenkman Pub. Co. ISBN 0-470-59613-9.
• Mustafa, Asim Zaki (1966). Female circumcision and infibulation in the Sudan. Journal of Obstetrics and Gynaecology of the British Commonwealth, 73(2), 302–306. doi:10.1111/j.1471-0528.1966.tb05163.x.
• Robinett, Patricia (2006). The rape of innocence: One woman's story of female genital mutilation in the USA. N.p.: Aesculapius Press. ISBN 1-878411-04-7.

External links

• BBC report: Female circumcision increases infant mortality and childbirth complications
• FORWARD - a charity that campaigns against Female Genital Mutilation (FGM) and other gender-based discriminatory practices
• Justice For The World (JFW)
• World Health Organisation: Female genital mutilation
• No Peace Without Justice: International Campaign for the abandonment of Female Genital Mutilation
• "Female Circumcision Neither a Sunna, nor a Sign of Respect" by Dr. Muhammad Salim al-Awwa, Secretary General of the World Union of the Muslim Ulemas, (Al Alazhar, Cairo)
• Razor's Edge IRIN dossier on Female Genital Mutilation/Cutting
• Razor's Edge - A short documentary on Female Genital Cutting in Sierra Leone and Ethiopia(Realplayer Required)on OneWorldTV
• Female Genital Cutting/Mutilation(FGC/FGM) continues despite Damaging Health Repercussions
• Female Genital Mutilation - A Human Rights Information Pack by Amnesty International
• Female Genital Mutilation from the World Health Organization
• The Female Genital Cutting Education and Networking Project
• U.S. State Department estimates of prevalence of FGC in Africa
• Map: Prevalence of Female Genital Mutilation in Africa
• Article from ReligiousTolerance.org decrying FGC
• Target, a human rights organisation founded by Rüdiger Nehberg in 1998
• Medical Studies on Clitoral Hood Removal
• Islamic law on Female Genital Mutilation (FGM) and female circumcision
• Infibulation Explained
• Infibulation in the Horn of Africa
• Stop FGM campaign of No Peace Without Justice
• BBC article about threat of FGM
• Islam Outlaws Female Genital Mutilation (4 December 2006). YoursDaily.com. Article about the 2006 Muslim Scholars Conference at Azhar University in Cairo, which declared that FGM is inimical to Islam
• "The Unkindest Cut" Winter 2007 article from Ms. magazine about female genital mutilation in the Global North
• Report on female circumcision in Northern Tanzania from the UK's Channel 4 More4 News (embedded wmv video, requires javascript)
• American Academy of Pediatrics policy statement on FGM
• Badour Shaker case and national reaction
• Concern grows in Britain over female genital mutilation From CNN July/11/2007
• Female excision in the M'Bouaka tribe Congo by Casimir Zagourski