Female Genital Cutting

Female Genital Cutting: Examining a Harmful Traditional Practice

Female genital cutting (FGC) is defined as the ‘removal of any part or the whole of the external female genitalia, or any injury to the female genital organs for traditional, cultural, religious or other non-therapeutic reasons.’ Between 100 million and 140 million girls and women are estimated to have undergone some form of the practice, with approximately 3 million girls being subjected to the practice each year. FGC is most common in Indonesia, sub-Saharan Africa, Egypt and Sudan.

Types of FGC

What is often called circumcision or a Sunna (Type I) cutting refers to the excision of the prepuce of the clitoris. A clitoridectomy (Type II) refers to a more extensive procedure where the clitoris and the labia minora are removed. The most extensive procedure, called excision or infibulation (Type III) refers to the total removal of the clitoris, labia minora and parts of the labia majora as well as the suturing together of the remaining labia leaving a small opening for menstruation and urination. Other forms of FGC (Type IV) can include pricking, burning, scarring, stretching and other forms of excision of the external female genitalia.

FGC is most commonly performed by a senior female member of the community, often a midwife or respected tribal or religious elder. Practitioners are regularly revered for their role and earn a significant living this way. The procedure usually takes place during a girl’s childhood, in some cases during infancy or puberty and in more rare cases, at the time of marriage. The average ages are between 4-10 years old. The girl is usually unaware of what will take place but is made to feel that something special and exciting will happen to her.

'Little girls often put pressure on their mothers to have the procedure done, not knowing of the pain. Girls are not allowed to know what takes place, or witness the procedure. They often hear that when they are infibulated, they will be getting special gifts and be like beautiful little queens.'

— Kowser Omer Hashi, Somali nurse and midwife

What’s In a Name?

FGC is also referred to as female genital mutilation (FGM) and female circumcision. What to call the practice has been contentious, much like the issue itself. While supporters tend to use the term female circumcision, drawing parallels to that of male circumcision, opponents deem that term biologically incorrect and euphemistic, favouring the term female genital mutilation as they see this to be what is taking place. Some have taken issue with the word mutilation, seeing this as a normative naming of a procedure that over 130 million have undergone: what is mutilation to one is the norm for another. As a result of this, the term ‘cutting’ has become more commonly used. FGC is seen as the most objective description of what in fact takes place during the procedure. Many organizations, understanding the alienating capabilities of the term ‘mutilation’, continue to use it, claiming it is the best way to garner opposition to the practice they believe to be wrong.

Why?

Learning about FGC often inspires an overwhelming ‘why?’ in those unfamiliar with the practice. While it is commonly believed that the traditional practice is indicated in religious Islamic scriptures there is in fact no integral relationship with the practice and the tenets of Islam. The cited reasons for the continuation of the harmful practice are numerous. Many are related to history and tradition, as communities claim that this is the way it has always been and if families stop cutting their daughters a number of harmful consequences will befall them. (The first known case of FGC was observed on an Egyptian mummy dating back to 200 BC).

So what are the reasons for this practice? Firstly, proponents claim that FGC preserves the chastity of the woman, quelling nymphomania and reducing her sexual desire, thereby ensuring her virginity at marriage and her faithfulness and submission to her husband thereafter. Many claim the practice enhances the male sexual experience and the aesthetic appearance of the vulva. Some believe the parts of genitalia that are removed in the procedure are ‘male’ aspects of anatomy and their removal ensures the girls femininity and marks her passage into womanhood. Other notions, such as the idea that the removal of the clitoris will prevent homosexuality and improve fertility and hygiene, are prevalent. Mythology is also present. Another cited benefit of the practice is the ‘balancing of [a woman's] psychology’.

What are the effects of FGC?

The negative effects of FGC are multiple. Short-term and long-term medical complications are common, as are psychological effects. The immediate effects may include extreme pain, shock, infection, tetanus, blood poisoning, hemorrhage, blood loss, urine retention, damage to adjoining organs and sometimes death. Long term effects may include cysts at the site of infibulations, chronic pain and infection, pelvic inflammatory disease, abscesses in the vulva, infertility due to scarring and infection, increased likelihood of prolonged labour and sexual dysfunction. Women have reported such psychological effects as nightmares and anxiety, depression, fear of sex, fear of childbearing, anger, loss of trust and resentment. However, women also report feelings of pride, inclusion and beauty.

International Opposition

The International Federation of Obstetrics and Gynaecology (FIGO) released a resolution on the practice in 1994 stating that FGC is unethical and violates human rights principles. Other important international bodies also oppose the practice, including the WHO, UNICEF, UNFPA and the International Confederation of Midwives. International protocols, statements and agreements also denounce the practice. Common strategies to reduce the practice have included criminalization, public education campaigns, liaising with community leaders, and the promotion of religious, political and cultural opposition to the practice.

Not Medically Indicated – The Risks of Medicalization

There are no medical benefits to FGC. In fact, the practice violates the human right to the highest attainable standard of health and to bodily integrity in the absence of any medical benefit. It is discrimination based on gender and a violation of the rights of the child. Recent attempts to medicalize the practice by having doctors perform FGC with the use of anesthetics and sterile equipment are considered stealth attempts to legitimate the practice and quell opposition.

'The skin of vulva and vaginal canal is normally soft and elastic to enable it expand easily during childbirth to allow the baby come out without difficulty. FGM makes the area dense and hard because of scarring and very difficult for child to come out during childbirth.'

— Okumephuna Chinwe Celestine, Nigeria

What is being done?

In an attempt to keep with tradition alternative rites of passage have been developed to replace FGC. Retreats for girls entering puberty where the importance of personal hygiene and their role as women are discussed and celebrated with song and dance are being promoted as alternatives for families who wish to honour their cultural traditions. In some communities safe houses for girls have been established. Having political and religious leaders speak out against the practice has also been seen to be an important tool to encourage an end to the practice. Public education surrounding myths regarding FGC are another strategy.

Additionally, many countries have banned the practice, making it illegal and occasionally charging practitioners with criminal activity. Criminalization has not inspired a significant reduction in FGC. While it is seen as positive to criminalize the practice, there have been legitimate concerns that this is pushing the practice more underground, making the circumstances under which the girls receive the procedure all the more dangerous. For sustainable prevention there has been a push to train practitioners in other lucrative skills so that they do not continue to rely on their incomes as FGC providers.

Men need to be onboard to stop the practice. Many women fear their daughters won’t be able to marry without FGC. Organizations have been actively engaging men in dialogues about the harmful effects of FGC in an attempt to stop the practice from continuing.

FGC is present in Canada.

'I had previous birth, which was normal, but when the doctor examined me he said, ‘You are like a time bomb that can explode. Please seek one of your own people who can handle your birth.’

— Woman with FGC as cited in ‘Female Genital Mutilation and Obstetric Care’

Canadian health care practitioners need to be aware of the practice. Women with FGC have reported negative experiences at the hands of Canadian health care providers, though others have been pleased with the sensitivity and support doctors and midwives have provided.

Caring for all people with sensitivity and respect is important and all deserve to have their sexual and reproductive rights protected. Health care practitioners may feel discomfort when caring for women with FGC, particularly if there are requests for re-infibulation. The FIGO guidelines and WHO publications on FGC and texts such as “Female Genital Mutilation and Obstetric Care” by Beverley Chalmers and Kowser Omer-Hashi can help health care practitioners learn best practices when caring for women with FGC.

Suggested Resources:

Book: “Female Genital Mutilation and Obstetric Care” by Beverley Chalmers and Kowser Omer-Hashi

Film: ‘Mooladé’ by Ousmane Sembene

Web:

Female Genital Mutilation Education and Networking Project
www.fgmnetwork.org

The Donors Working Group on Female Genital Mutilation/Cutting
www.fgm-cdonor.org

FIGO Resolution on Female Genital Mutilation, available at
http://www.figo.org/projects/general_assembly_resolution_FGM

Where is FGC Most Prevalent?
Source: FGM Education Network
Indonesia 99%
Guinea 98.6%
Egypt 97%
Somalia 90-98%
Mali 91.6%
Djibouti 90-98%
Sudan 90%
Eritrea 88.7%
Sierra Leone 80-90%
Ethiopia 79.9%
Burkina Faso 76.6%
Gambia 60-90%

 

'Leaving a girl uncircumcised endangers both her husband and her baby. If the baby’s head touches the uncut clitoris during birth, the baby will be born hydrocephalic [excess cranial fluid]. The milk of the mother will become poisonous. If a man’s penis touches a woman’s clitoris he will become impotent.'

— Female Genital Mutilation Education and Networking Project

 

'An uncircumcised vulva is unclean . . . no man would dream of marrying an unclean woman. He would be laughed at by everyone.'

— Female Genital Mutilation Education and Networking Project