Female Genital Mutilation

Female Genital Mutilation

Female genital mutilation (FGM), often euphemistically referred to as female circumcision, is a widespread practice. Estimates of its incidence vary widely, but they tend to agree that there are over 100 million women in the world who have been circumcised, with 2 million more at risk every year (Bosch, 2001). It is concentrated in northern Africa, but it also occurs to a lesser extent in the Middle East, southern Asia, among indigenous groups in South America, and even in some African immigrant populations in Europe, Australia, and North America. Numerous international health and human rights organizations have condemned the procedure for the extensive biological and psychological trauma it can impose on girls and women for their entire lives.

There are three broad types of FGM. The first and least severe of them is known as Sunna, or “following the traditions of the prophet Mohammed” (Arbesman et al, 1993), even though Mohammed’s own wives and daughters were not circumcised (Wright, 1996). Sunna circumcision involves removal of the prepuce—also known as the clitoral hood—while leaving the clitoris itself intact. The male prepuce is more commonly known as the foreskin, so Sunna circumcision is the female equivalent of male circumcision. Muslim scholar Eric Winkel (1995) claims, “There is no harm in not doing it, and there is some reward in doing it.” Dr. Nahid Toubia (1994), however, notes, “In my extensive clinical experience as a physician in Sudan, and after a careful review of the literature of the past 15 years, I have not found a single case of female circumcision in which only the skin surrounding the clitoris is removed, without damage to the clitoris itself.” The second variety of FGM, excision, goes further by intentionally removing the glans (tip) of the clitoris and adjacent parts of the labia minora. The most advanced stage of FGM—known as infibulation, pharaonic circumcision, or Sudanese circumcision—involves the removal of the entire clitoris, the labia minora, and adjacent portions of the labia majora, after which the two sides of the vulva are stitched closed, leaving only a small opening for urination and menstruation (Baker et al, 1993). According to a survey of 3,210 women in the northern part of Sudan, 98.8% of them were circumcised, of which 2.5% were Sunna circumcised, 12% were excised, and 83% were infibulated. 2% were unsure what was done to them. Sudan has one of the world’s highest concentrations of FGM, so these figures are not representative of all countries (Arbesman et al, 1993).

Approximately 95% of circumcisions are performed on children younger than 17 years old, with some as young as a day old. In some countries, large groups of girls are circumcised at once, while in other countries, the ritual is treated as a more personal, family matter, and each girl is circumcised individually. Women perform the circumcisions in most areas, but male barbers carry out the task in Egypt. To begin, a girl is stripped naked and either laid down or seated. During the procedure, she is restrained by other women, usually female relatives, and her legs may be tied together to reduce movement and promote healing. In urban areas of Africa, midwives sometimes use local anesthetic, but FGM is often an extremely crude operation performed without any form of analgesic. There are even cases in which the implement used is a piece of glass or a sharp stone (Wright, 1996).

Waris Dirie, a world-famous supermodel, was born in Somalia, a country with circumcision rates comparable to those of Sudan. She was infibulated at age five, and she is now one of the world’s most prominent crusaders against FGM. In her book, Desert Flower (2001), she relates her harrowing ordeal. Waris was laid on a flat rock, and the gypsy woman who would circumcise her retrieved a broken razorblade with dried blood, spitting on it and wiping it on her dress to clean it. After the “indescribable” pain of the cutting phase, Waris was sewn up with thorns and thread and tied from her ankles to her hips. Looking at the rock on which she had been mutilated, she noted, “It was drenched with blood as if an animal had been slaughtered there. Pieces if my flesh lay on top, drying in the sun.” After the procedure, she recuperated alone in a hut under a tree for the next few weeks. Her sister had to roll her on her side and scoop out a hole in the sand for her to urinate, and when she did, it “stung as if my skin were being eaten by acid.” The opening for urine, and later menstrual flow, was about the diameter of a matchstick.

Waris was sewn so tightly that urine could only escape one drop at a time, and she claims that it usually took her about ten minutes to empty, but once she was “deinfibulated” in London years later, that malady, along with her painful menstruation, was remedied. She can never experience the pleasures of sex, but she appears to have no adverse long-term health effects from the mutilation. Waris was one of the lucky ones—if you can call any of these girls lucky—since numerous complications can result from FGM. Some immediate effects are hemorrhage, sepsis, tetanus, and urinary retention; while possible long-term effects include keloid formation, vulvar dermal inclusion cysts, recurrent urinary tract infections, painful menstruation, retained menstruation, difficult or painful sexual intercourse, recurrent vaginitis, chronic pelvic infection, pelvic pain, HIV infection, and infertility. Vaginal examination during labor is extremely difficult, which makes it hard to monitor the progress of labor. Women who are infibulated must be deinfibulated before delivering a child, and even then they run the risk of prolonged labor, perineal tears, vesicovaginal and rectovaginal fistulas, laceration of scar tissue followed by hemorrhaging, and fetal asphyxia or death (Baker et al, 1993). Women are usually reinfibulated after each time they give birth. Not surprisingly, the African countries that practice FGM have the highest rates of child mortality and maternal mortality, but most circumcised women don’t even connect their medical misfortunes to their mutilation (Arbesman et al, 1993; Wright, 1996).

Olayinka Koso-Thomas (1987) interviewed 400 women in Sierra Leone, 369 of whom had been circumcised, and asked why they thought women submit to circumcision. 257 answered tradition, 105 claimed societal acceptance, 51 said religion, and with 12 or fewer respondents each: increasing chances to marry, preservation of virginity, female hygiene, prevention of promiscuity, enhancement of fertility, to please husband, and to maintain health. It has already been mentioned that female circumcision clearly doesn’t improve female hygiene, enhance fertility, or maintain health, but it turns out that most of the rest of the rationales listed here are the result of misconceptions as well.

As Jane Wright (1996) points out, female circumcision has been performed since before the advent of all major religions, but it is still connected with the teachings of some religions, particularly those of Islam. However, nothing in the Koran promotes female circumcision, and it even instructs Muslims to “let there be no alteration in Allah’s creation.” Mohammed exalted the clitoris, noting that it contributes to the pleasure of both a woman and her husband (Winkel, 1995). Even Sunna circumcision, which is supposedly “following the traditions of the prophet Mohammed,” seems to be impossible to perform without altering the clitoris.

Preserving virginity, preventing promiscuity, pleasing one’s husband, and enhancing fertility are all ultimately seen as ways in which female circumcision contributes to a woman's increased chances of being married—and thus her acceptance by society—but there is nothing to support that it has these benefits. A survey of 500 unmarried female Nigerian university students found that many of them, regardless of their circumcision status, had lost their virginity (Arbesman et al, 1993), and 266 out of 300 Sudanese husbands with one infibulated wife and one non-infibulated wife stated that they preferred non-excised or Sunna-circumcised women sexually (Wright 1996).

The practice of female circumcision probably originated as a means to demonstrate that a woman’s body is the property of her husband and is intended solely for his pleasure and reproductive purposes; however, even today, many African women don’t wish to renounce the practice. Perhaps some of that is due to the fact that, except in Egypt, women carry out the task, and they derive a living and their status in the community through it. But beyond that, female circumcision has been occurring for so long that it has become a sacred tradition, an integral part of these cultures and the identity of the women who are a part of them. Most people in the Western world probably wonder why these African women, even when they are aware of the risks associated with FGM, would submit themselves or their children to it for no other reason than to be more accepted by their husbands and their communities. These women, however, are in a situation known in game theory as a “Prisoner’s Dilemma.” All the girls would be much better off if none of them were circumcised, since the men would be forced to marry uncircumcised women, but if only a small fraction of the girls weren’t circumcised, they would probably be rejected for marriage. In a culture where there is essentially no place for an unmarried woman, this does as much damage socially as FGM does physically. Although female genital mutilation is a patriarchal practice, the power is in the mothers’ hands to unite and refuse to let it continue.

As quick as we are to judge the practices of these cultures, they could theoretically be as quick to judge cosmetic surgeries, such as breast augmentation, which are popular in Western culture (Wright, 1996). Some North American and European women have even voluntarily undergone mutilation in an effort to devote more attention to their partners and not be encumbered by their own sexual desires. Although it is illegal to cut any part of a female minor’s genitals for any non-medical reason, adult women may legally choose to have themselves circumcised by a doctor in a clinical setting. Even still, this is an expensive procedure that costs many thousands of dollars, and illegal circumcisions of white Americans take place. One man was arrested after two FBI agents posing as an Egyptian woman and her Western husband got him to agree to circumcise their non-existent eight- and twelve-year-old daughters for $8,000 (Catchpole, 2004).

Notwithstanding our own cultural idiosyncrasies, FGM of minors is an especially harmful practice that is usually performed on girls who aren’t even old enough to comprehend what is being done to them and the effects it could have on them for the rest of their lives, and something must be done about this. Many countries have banned FGM, but that doesn’t mean it no longer occurs. The West seeks to eliminate the ritual out of a genuine concern for the wellbeing of the women subjected to it, but the practicing cultures see it differently, as just another imperialist effort to destroy their way of life. In Kenya during the first half of the 20th century, a Presbyterian minister threatened to excommunicate any member of his church who didn’t agree to sign a pledge against circumcising their daughters. This dissolved into a political struggle, and FGM came to be seen as a symbol of Kenyan nationalism. Its prevalence had been declining before this time, but it soon regained popularity (Wright, 1996). Someone like Waris Dirie is extremely valuable to the fight against FGM, as she is not a foreigner in some international organization, but was once just a common Somalian girl who can connect with the people of these cultures.

As cruel as FGM is, outright bans on the practice don’t eliminate its occurrence; in fact, they don’t even come close. Even after President Daniel Arap Moi of Kenya banned FGM, it is estimated that 50% of girls in that country continue to be circumcised. Since FGM is bound to occur regardless of what foreign and even domestic governments and organizations decree, there have been calls to “medicalize” FGM. That would keep the procedure legal, but it would be performed by qualified physicians in a hospital setting under proper medical supervision; not gypsy ladies with broken, bloody razor blades. However, the World Medical Association, World Health Organization, and various feminist groups have condemned this idea, as it goes against the basic ethics of health care by condoning and committing unnecessary mutilation, and they don’t think medicalization will have much effect in reducing the incidence and severity of FGM (Wright, 1996).

One of the most promising measures to combat FGM is Ntanira Na Mugambo (NTM), or “circumcision through words,” which was implemented in one rural Kenyan community in August 1996. As of July 1998, approximately three hundred girls in thirteen communities had experienced this ritual in place of FGM. NTM involves all members of the community and educates them about the harmful effects of FGM, and the girls are secluded for a week while they learn about biological and social topics like basic anatomy and physiology, sexual and reproductive health, hygiene, gender issues, respect for adults, development of self-esteem, and how to deal with peer pressure. Once that is completed, they have entered into adulthood, and there is a celebration in the girl’s honor, complete with a certificate, presents, and the granting of special wishes. In this way, it is much like female rite of passage ceremonies of other cultures and religions, such as the Jewish Bat Mitzvah (Chelala, 1998).

Ultimately, the key to winning the war against FGM, as with so many other evils in this world, is through education. Instead of patronizing these cultures by enforcing an outright prohibition on FGM, trying to tell them what they can and can’t do, the best course of action is to provide them with information and valid alternatives. By giving them a choice and respecting their sovereignty, they can more easily see that we are only trying to help them, not subjugate them. No one expects FGM to disappear overnight, but hopefully, over time, these cultures will realize the horrible atrocities they are inflicting upon their daughters, and they will eradicate FGM of their own accord.

Sources

Arbesman, Marian; Lucinda Kahler; and Germaine Buck (1993). “Assessment of the impact of female circumcision on gynecological, genitourinary, and obstetrical health problems of women from Somalia: literature review and case series.” Women & Health; 20:3, 27-42.

Baker, Cathy; George Gilson; Maggie Vill; and Luis Curet (1993). “Female circumcision: obstetric issues.” American Journal of Obstetrics and Gynecology; 169:6, 1616-1618.

Bosch, Xavier (2001). “Female genital mutilation in developed countries.” The Lancet; 358:9288, 1177-1179.

Catchpole, Karen (2004). “Choosing female genital mutilation.” Jane, April 2004, 82-83.

Chelala, Cèsar (1998). “Novel alternative to female genital mutilation.” The Lancet; 352:9122, 126.

Dirie, Waris and Cathleen Miller (1998). Desert Flower: The Extraordinary Journey of a Desert Nomad. New York: Perennial/HarperCollins.

Koso-Thomas, Olayinka (1987). The Circumcision of Women: A Strategy for Eradication. London: Zed Press.

Toubia, Nahid (1994). “Female circumcision as a public health issue.” The New England Journal of Medicine; 331:11, 712-716.

Winkel, Eric (1995). “A Muslim perspective on female circumcision.” Women & Health; 23:1, 1-7.

Wright, Jane (1996). “Female genital mutilation: an overview.” Journal of Advanced Nursing; 24:2, 251-259.