Female genital mutilation

Female Genital Cutting (FGC) refers to the excision or tissue removal of any part of the female genitalia for cultural, religious or other non-medical reasons. The term FGC does not refer to gender reassignment surgery or the genital modification of intersexuals, which are usually done for personal, rather than cultural, reasons. Cultures that practice female genital cutting consider the alteration it causes to the female form to be the natural way for women to look. It is considered to be a mark of beauty and a transition into womanhood and marriage.

"Mutilation" versus "Circumcision" versus "Cutting" Debate: Different terms are used to describe the act of female genital cutting, but regardless of the terminology the same practice is being referred to. Opponents of these practices use the term Female Genital Mutilation (FGM), whilst groups who support and practice this female ritual tend to use the term Female Circumcision (FC), which is also considered a euphemism. Advocates of male circumcision argue that the term "female circumcision" results in unwanted associations between the two practices, while genital integrity advocates might refer to all child genital cutting as mutilation.

The expression 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 recommended that the United Nations adopt this terminology and subsequently, it has been widely used in UN documents.

The Amnesty International and World Health Organization refer to this practice as 'Female Genital Mutilation' (FGM)^,,,.

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. At the community level, however, the term can be problematic. Local languages generally use the less judgmental “cutting” to describe the practice; parents understandably resent the suggestion that they are “mutilating” their daughters. In this spirit, in 1999, the UN 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, the term “cutting” has increasingly come to be used to avoid alienating communities.

In 1996 the UNFPA-sponsored Reproductive, Educative, And Community Health program coined the term 'Female Genital Cutting'(FGC), observing that the 'Female Genital Mutilation' may "imply excessive judgment by outsiders as well as insensitivity toward individuals who have undergone some form of genital excision. .

The Different Types of FGC

There are several distinct practices of FGC that range in how severe the genital tissue is cut or removed. Four major types have been categorized (see Diagram 1).

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

TYPE I: Clitoridectomy

Clitoridectomy involves the removal or splitting of the clitoral hood, termed "hoodectomy", with or without excision of the clitoris, see Diagram 1B. The clitoral hood is the female prepuce, homologous to the foreskin of the male. In the Islamic culture Type I FGC is also known as Sunna (tradition) circumcision. This term was devised in The Sudan by the Anglo-Sudanese administration in 1946 in an attempt to promote this "milder" form of FGC instead of the more severe Type III, infibulation or pharaonic circumcision, that was widely practiced. Although labeled Sunna by Islamic advocates of the practice, most Muslim clergy oppose all forms of female genital cutting as it is viewed as a social custom, rather than a religious practice. According to Dr. Sami A. Aldeeb Abu-Salieh at the Swiss Institute of Comparative Law:

Islamic juridical logic cannot acknowledge the distinction between female and male circumcision, both being the mutilation of healthy organs which is damaging to the physical integrity of the child, whatever the underlying religious motivations. Furthermore, both practices violate the Koran: "Our Lord, You did not create all this in vain" (3:191), and "[He] perfected everything He created" (32:7). In our opinion, a god who demands that his believers be mutilated and branded on their genitals the same as cattle, is a god of questionable ethics.

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 female 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 left over labia minora epidermis, which contains sweat glands, a buildup of sweat and urine in the closed off space beneath this closure can occur leading 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 Pharaoh's 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 - 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 see Diagram 1D. This type of FGC is often carried out by and elderly matron or midwife of the village on girls between the ages of two and six, without anaesthetic and under unhygenic conditions.

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 vagina 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, although advocates of the practice deny this, and continue to carry it out.

TYPE IV: All other types of unclassified FGC

Other forms 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.

In general, while FGC is generally thought of in the West as involving the complete destruction of the female sexual organs in an effort to eliminate the female's sexual pleasure, some forms of female circumcision is often claimed to be analogous to male circumcision, in that both procedures can involve the removal of the prepuce and the frenulum. Others have argued, however, that it is not analogous at all and that the removal of the female clitoris is more akin to the removal of the penis, its male counterpart (ref).

FGC: Geographical Practice

Map: 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 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, especially among a minority (20%) in Yemen. The majority of Muslim countries (except in parts of sub-Saharan Africa) do not practice it.

The countries that practice FGC the most are: Somalia, followed by Egypt, The Sudan, Ethiopia, and Mali. Among ethnic Somali women, infibulation is traditionally almost 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 African Muslims, it is practiced in secrecy in some parts of the Middle East. The practice occurs particularly in northern Saudi Arabia, southern Jordan, and Iraq, and there is also circumstantial evidence to suggest it is present in Syria, western Iran and southern Turkey. In Oman a few communities still practice FGC; however, experts believed that the number of such cases was small and declining annually. In the United Arab Emirates and also 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 India. In Indonesia and Malaysia 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 circumcising his daughter.

FGC: Culture or Religion?

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 Pharoahs. Evidence from mummies have shown both Type I and Type III FGC present . It was most likely spread throughout the Northern parts of Africa with Arab slave traders and is now practiced among Muslims, Christians and Animists. However, religion alone is not the common thread amongst FGC advocates, as it transcends both culture and religion. UNICEF stated that when "looking at religion independently, it is not possible to establish a general association with FGM/C status."

FGC is never performed out of hatred or anger, in fact quite the opposite is true as fathers and mothers fully believe that they have their child's best interest at heart. The main reasons for FGC can be categorized into four most common social justifications:

1. The custom and tradition of becoming a woman involves this "rite of passage" from childhood to adulthood (ensuring she is good marriage material);

2. The need to control women's sexuality (virginity, morality and marriageability);

3. A cultural practice that sometimes has a religious identification (a females honor is a reflection on her entire family, and believing it is Gods will);

4. Social conformity to the community

and one other reason why it has been difficult to stop the practice:

5. FGC is a primary source of income for many midwives/practitioners, who propagate the practice.

Islam and FGC

FGC predates Islam and is not practiced by the majority of Muslims, but has acquired a religious dimension . Honor and hygiene are often tied up with the practice, however no form of genital modification and mutilation is mentioned in the Q'uran, in fact quite the contrary: "We have indeed created man[kind] in the best of moulds" (Al-Tin 95:4). In Saudi Arabia at Hijaz, where Islam originated, FGC was practiced during the life-time of Muhammad. To call a man a "circumciser of women" was an insult among the pagan Arabs at the time. Any Islamic allusion to the practice encourages the mildest form of FGC and this was thought to be supported by the Muhammad. A saying of Muhammad accepted by some 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 in the light of "games of chance" or (maysir) being prohibited in the Qur'an, the rather unspecified term "severely" inherits the risk of a cut being deemed as too severe by Muhammad and/or God. Most contemporary scholars reject this hadith completely. 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.

In general the Islamic clergy do not support the practice; Shaykh Faraz Rabbani states "As for excision, FGC, or other harmful practices [including that which take sexual pleasure away from women], 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. However, in March 2005, Dr Ahmend 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 .

In Shi'ite Islam, the practice of female circumcision has never been to remove the clitoris, and this form is outlawed by all leading Marjas that interpret Sharia traditions. The main form of surgery is to remove a small piece of the hood over the clitoris in order to increase sexual pleasure. This act is considered Mustahab, "duties recommended, but not essential", and not Wajib or compulsory. In countries such as Iran, where the majority is of this school of thought, this practice in reducing the hood is common.

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) attempted to bring 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 handball 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.

Christianity and FGC

As the FGC rituals predated the missionaries work in North Africa, many African tribes continue the practice as a matter of tradition, despite their religious conversion. In primarily Christian countries (for instance, Ghana), women undergoing circumcision make reference to the practice in the Old Testament, being performed by one of Abraham's wives, Sarah.

Other Groups

In some other African cultures, such as animists, 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 (ref).

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. As with any surgery of this nature, it should be performed under hygienic conditions and with the application of an appropriate anaesthetic. However, this technology has only been available for a relatively short time, and even today the procedure is usually carried out under unsanitary conditions in villages, which have no access to anesthesia. As a consequence the girl undergoing FGC endures immense pain and may suffer from infection or hemorrhaging following the procedure . Prohibition has led to FGC going underground, with people who have had no medical training performing the cutting without anesthetic or sterilization. The procedure, when performed without any anesthetic, can lead to death through shock or excessive bleeding. The failure to use sterile medical instruments may lead to infections and the spread of disease, such as HIV, especially when the same instruments are used to perform procedures on multiple women.

Practices such as infibulation, when carried out with shards of glass and other unsanitary tools, can commonly cause infections, sometimes resulting in death or serious long term health effects. 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 always be extremely painful, and infibulated women will also need the labia majora to be opened, to allow their husband access to the vagina. This second cut 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 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 the 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. Please refer to Pierre Foldes, French surgeon, who developed modern surgical corrective techniques.

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 this can also be a very mental process for a woman. 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 1980's asking women who had FGC this very question:"How often do you experience orgasm?" following sexual intercourse with their husband . Most of the women she interviewed 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 very open to talking about their experiences and thought it was amusing. They were able to describe in great detail exactly what an orgasm meant to them, often alluding to feeling like electricity had entered their bodies, or being unable to move for some time afterwards

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.

I feel as if I am losing consciousness, and I seem to love him most intensely at that moment. I tremble all over. My vagina contracts strongly, and I have a feeling of great joy. Then I relax all over, and I am so happy to be alive and to be married to my husband. Patient.

Sometimes women would describe feelings of numbness and heart palpitations, which sounded more like anxiety attacks. Women who had undergone infibulation, the most extreme form of FGC, reported having both internal and external feelings of pleasure. 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. In general women with Type III FGC experienced strong to very weak orgasms, depending on the severity of the procedure. There were also women who did not enjoy sex at all, as it was too painful or did not leave them with any feelings.

Hanny also found that Sudanese women enjoyed having sex with their husbands and often used a "smoke ceremony" to convey their desire, as strict Muslim customs forbids women from verbally initiating sexual advances, even with their own husbands. The "smoke ceremony" involves the woman sitting naked over a pit of embers - that has been fed with ginger, cloves, cinnamon, frankincense, sandalwood and myrrh - whilst encased in a large robe, to hide her figure. The volatile oils permeate her skin, leaving behind a perfume which her husband can smell on her when he returns home.

When discussing the whole issue of sexuality and FGC many women are surprised that western, uncut women have any sensation between their legs or can enjoy the act of lovemaking. To them to be cut is the "natural" way and in the same way that the West perceives that FGC is horrific, they feel that they would feel less feminine without it. As more families have access to better information regarding FGC through outreach programs, there may be a shift from these current views, although it may take some time yet.

FGC and Human Rights

Most human rights organizations in the West, Africa, and Asia consider female genital cutting rituals a violation of human rights. Among these groups and governments, they are regarded as unacceptable and illegal forms of body modification and mutilation of those believed to be too young or otherwise unable to give informed consent.

FGC enters human rights discourse primarily on the basis of three issues: informed consent, patriarchal oppression, and violence against women. The issue of informed consent mirrors the debate about male circumcision, though with far more intensity. African feminists generally reject the imported women's rights discourse that universally adopts an assumption of male dominance, and prefer instead to realize their gender roles in their own terms. The issue of violence against women is complicated by the fact that the ritual is primarily continued by women and often against the wishes of a growing majority of men. African feminists believe that this issue is a convenient tool for powerful political units to manipulate in pursuing hidden agendas.

For example, Hillary Clinton, then first lady, stated in 1995 at the Fourth World Conference on Women in Beijing, China that “it is a violation of human rights when young girls are brutalized by the painful and degrading practice of genital mutilation”. The Report of the Fourth World Conference on Women makes ten mentions of female genital “mutilation” in a call to “prohibit” FGC, “enact and enforce legislation” and “give priority to…educational programmes…that emphasize the elimination of harmful attitudes and practices, including female genital mutilation…and recognizing that some of these practices can be violations of human rights and ethical medical principles”. Declaring FGC a human rights violation, the United States passed 22 U.S.C. § 262k–2 in 1997, a broadly worded law that threatens the denial of loans and aid from the eight largest international banks to counties in which FGC is practiced.

There is a growing movement in the West to see the practice on minors prohibited throughout the world. Advocates of the procedures argue that this is an example of Western cultural imperialism, while opponents of the procedures argue that human rights are universal and not subject to cultural exceptions, and that such involuntary practices are a severe violation of human rights. In Canada, girls and women can seek political asylum status if they feel they are at risk of undergoing FGC and in France, in recent years several women excising minor girls have been handed prison sentences of up to five years; courts have also handed sentences between 6 and 15 months for parents. In Sweden, it is possible to be convicted for FGC committed in another country . In Denmark, it was ruled in October 2006 that even elective cosmetic genital surgery of women, such as trimming of the labia, violates the penal code. In Spain, it was banned in 2003, and since 2005 it is punished even if performed outside of the country, though at present no one has been condemned for this reason.

There are also Other Practices of FGC, which are practiced in Western countries, outside the cultural and religious reasons seen in predominantly African countries.

Ending All Forms 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 of the procedure among tribes in Kenya significantly strengthened resistance to British colonial rule in the 1950s and increased support for the Mau Mau guerrilla movement. During that period, the practice became even more common, as it was seen as a form of resistance towards colonial rule.

The difficulty lies significantly 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 marriage networks must 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 was 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 (female genital cutting) 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. Unfortunately, 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.

Laws and Outreach Programs

The countries where FGC is commonly practiced were identified by the US State Department.; 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)

There is no law in Egypt specifically against FGC. There are provisions under the Penal Code involving "wounding" and "intentional infliction of harm leading to death", however, that might be applicable. There have been some 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. There also is 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 do not comply will be subjected to criminal and administrative punishments. Although the government banned the practice, FGC is continues in many villages throughout Egypt, although some have decided on their own to stop, such as the Egyptian village of Abou Shawareb, which made a vow in July of 2005 stating to end the practice.

Ghana (9-15%, 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.

FGC in Popular Culture

The subject of FGC has been addressed by many prominent authors, singers and performers across the world. Some examples:

• "Bravebird", a song by Amel Larrieux
• Possessing the Secret of Joy, a novel by Alice Walker
• Warrior Marks, a documentary film by Alice Walker. She subsequently wrote a book of the same name, which is about her travels and experiences while making the documentary.
• Desert Flower, a novel by Waris Dirie
• The River Between, a novel by Ngugi wa Thiong'o
• The Years of Rice and Salt, a novel by Kim Stanley Robinson (Book Nine features extracts from fictional articles protesting female circumcision)
• "Cornflake Girl", a song by Tori Amos
• Rüdiger Nehberg
• Moolaadé, a film by Ousmane Sembène
• The Whole Woman, a book by Germaine Greer
• The Fattening Hut, a book by Pat Lowery Collins
• No Laughter Here, a novel by Rita Williams-Garcia
• The Excised, a book by Evelyn Accad
• "Cut", a short story by Megan Lindholm published in Asimov's Science Fiction
• Almanac of the Dead (ISBN 0140173196), a novel by Leslie Marmon Silko, mentions porn films featuring female circumcision (p. 103, Book Four, South, Abortion).
• In the season 8 episode "Ritual" of the television crime drama Law & Order, a father kills his daughter's uncle, who had hired a doctor to perform the procedure on her, in his desire to protect his daughter from female circumcision.
• The Dark Child, a memoir by Camara Laye, mentions female excision on p. 129.
• In the episode "Manya Mabika" of the US television series Nip/tuck, a victim of FGC undergoes a procedure to reconstruct a functional clitoris.
• Fire Eyes: Female Circumcision, a film by Soraya Mire
• God's Sandbox, a film by Doron Eran

Other Cultural Rituals

• Molly Melching - director of Tostan project, Senegal
• Labiaplasty - a recent cosmetic and voluntary phenomenon
• Breast ironing - another practice perpetuated in some of the same cultures

Bibliography

• Al-Qaradawi, Yusuf (2004, February 7). Islamic Ruling on Female Circumcision. Retrieved March 29, 2006.
• Al-Qaradawi, Yusuf (2004, December 13). Circumcision: Juristic, Medical & Social Perspectives. Retrieved March 29, 2006.
• Boyle, Elizabeth H. (2002). Female Genital Cutting: Cultural Conflict in the Global Community. Baltimore: Johns Hopkins University Press.
• Dettwyler, Katherine A. (1994). Dancing Skeletons: Life and Death in West Africa. Prospect Heights, Ill.: Waveland Press. ISBN 0-88133-748-X.
• Egypt sees U turn on female circumcision (1995, January). British Medical Journal, 310, 12.
• Female Genital Mutilation: Report of WHO Technical Working Group, 17-19 July 1995 (1996). Geneva: World Health Organization.
• Gruenbaum, Ellen (2001). The Female Circumcision Controversy. Philadelphia: University of Pennsylvania Press.
• Hoffman, Barbara (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.
• Kassindja, Fauziya (1998). Do they hear you when you cry. New York: Dell Publishing.
• Obermeyer, Carla Makhlouf (2003). The health consequences of female circumcision: Science, advocacy, and standards of evidence. Medical Anthropology Quarterly, 17(3), 394-412.
• Pieters, Guy, & Lowenfels Albert B. (1977). Infibulation in the horn of Africa. New York State Journal of Medicine, 77(5), 729-31.
• 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.
• Skaine, Rosemarie (2005). Female genital mutilation: Legal, cultural and medical issues. Jefferson, N.C.: McFarland. ISBN 0-7864-2167-3.
• UNICEF (1999). Consultation on the elimination of female genital mutilation: 14 December-16 December 1998 (1999). New York: Author. 40 pp.

External links

• A new type of female circumcision intended to increase sexual pleasure
• BBC report: Female circumcision increases infant mortality and childbirth complications
• Mariama - A film script about a sensibilisation film in French
• 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

Further reading

Print

• Aldeeb, Sami (2000): Male and Female Circumcision in the Jewish, Christian and Muslim Communities, Religious debate. Beirut, ISBN 1 85513 406 3.
• 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.
• 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 & Gynaecology. of the British Commonwealth, 73(2), 302. 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.

Online

• 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
• Infibulation Explained
• Infibulation in the Horn of Africa
• International Campaign for the abandonment of Female Genital Mutilation of No Peace Without Justice
• "Solving female circumcision complications" cartoon, Arab European League website
• 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.
• V-DAY: Until the Violence Stops. "V-Day is a global movement to stop violence against women and girls."