The purpose of this article is not to shock or cause controversy, but to increase awareness so that perhaps one day this cultural abomination will belong to the same category as foot binding in our colourful human history.
The World Health Organisation (WHO) defines female genital mutilation (FGM) as “all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.” For those who are not familiar with FGM there are four types: –
- Type I: Also known as clitoridectomy. Removal of the clitoral hood or partial or total removal of the clitoris.
- Type II: Also known as excision. Partial or total removal of the clitoris and the inner and/or the outer labia.
- Type III: Also known as infibulation or pharaonic circumcision. The removal of all external genitalia with or without the removal of the clitoris. The legs are then tied together until the wound has healed. The labial tissue heals and fuses across the vulva leaving a small hole for the passage of urine and menstrual blood. The vulva is cut open for intercourse and child birth.
- Type IV: Any other harmful procedure including pricking, piercing, incising, scraping, cauterising or stretching of the genitals. Includes the introduction of corrosive substances into the vagina, removal of the hymen (hymenotomy) and gishiri cutting, where the vaginal wall is cut with a knife.
The origins of FGM are obscure, however 5,000 year old Egyptian mummies bear marks which suggest that this was common practice at the time. Around 2,500 years ago Greek historian Herodotus reported that this custom was practised by the Egyptians, the Phoenicians, the Ethiopians and the Hittites. Greek physicians who visited Egypt roughly 2,000 years ago described FGM and explained that its purpose was the reduction of female sexual desire. As humans migrated, the practise migrated with them spreading out into Africa and the Middle East. However the following is very clear: even though FGM predominantly features in patriarchal societies, it cannot be confined to any particular culture or religion. This custom outdates Islam, Judaism and Christianity and can be found across all societies. Type I FGM was performed by gynaecologists in 19th century Britain to cure “female deviances” such as lesbianism, nymphomania, hysteria and masturbation.
In the year 2012 FGM is still widely practised in central Africa and in a number of Middle Eastern and Asian countries. Although FGM is perceived by many in the Western world to be a “foreign” phenomenon, in recent years it has become increasingly common in Europe, Australia, North America and Canada as a result of immigration. According to the WHO 100 – 140 million women worldwide have undergone FGM and each year around 3 million girls risk the same fate. Approximately 85% of women who undergo FGM experience Type I or II whilst 15% experience Type III. The age at which FGM is undertaken varies according to country and culture, but it’s customarily performed between infancy and puberty.
The procedure is usually carried out without anaesthesia by an older woman in the community: a traditional midwife, using an unsterile and unsuitable cutting device such as a knife, a razor blade, scissors, a sharpened rock or a piece of broken glass. The wound may then be treated with herbs, ash or even mixtures containing cow dung. In more affluent areas FGM is performed by a qualified medical practitioner in sterile surgical conditions with local or general anaesthetic.
Immediate complications include severe pain, physical trauma (due to the girl being forcibly held down), haemorrhaging, hypovolemic shock, urinary tract or wound infection, septicaemia or tetanus. When unsterile equipment is used there is also the risk of hepatitis B/C or HIV. Fatalities are rarely reported and no records are kept, so it is impossible to gauge the short-term mortality rate. Depending on what type of FGM was performed there are a number of late complications which may arise such as dysmenorrhea (pain during menstruation), dyspareunia (pain during intercourse), hematocolpos (vagina fills with menstrual blood), hematometra (uterus fills with menstrual blood), urine retention, incontinence and epidermoid cysts which increase the risk of infection and infertility. The WHO conducted a study in 2006 on 28,393 women attending delivery wards at 28 obstetric centres in 6 African countries. Neonatal mortality was greater for women with FGM: 15% for Type I, 32% for Type II and a staggering 55% for Type III. Women may well experience psychological problems, especially if they move to an area or country where FGM is not practised.
For many communities FGM is a deeply entrenched cultural tradition. The cutting ceremony is often seen as a girl’s rite of passage into womanhood. Women who are not cut bring shame on their families, will not be accepted for marriage and may be ostracised. Amongst groups who have strong cultural ideas of femininity and modesty, the external female genitalia is considered “unclean” and “male”, therefore cutting is used to make a woman “clean” and “beautiful”. FGM is used to control libido so that a woman resists “illicit” sexual acts, remaining a virgin before marriage and staying faithful to her husband. Some justify the practise for superstitious reasons, for example certain folklore states that as a girl ages, the clitoris will continue to grow or if a baby touches the clitoris during birth it will die or if a man’s penis touches the clitoris he will die. Although FGM pre-dates many religions, practitioners often believe the custom has religious support; however religious leaders take varying positions, some promoting it and others backing its elimination.
The answer lies not only in banning FGM, but in allowing attitudes to change gradually through research, awareness and education. Missionaries who visited Kenya in the early 20th century tried to prohibit the practise, but this only provoked anger amongst local communities who felt that the very fabric of their society was under threat. Nevertheless since the 1960s opposition to FGM has been growing not only in the international community, but in practising countries themselves, especially since the involvement of the WHO, the United Nations (UN), the United Nations Children’s Fund (UNICEF) and other organisations. Together they have been working to eradicate FGM. Popular approaches include community meetings, education – with a strong emphasis on medical problems and human rights – and revision of public policy and laws.
The good news is that in most practising countries the prevalence of FGM is decreasing and several African countries have passed legislation against it. However, due to the influx of migrants to industrialised western nations, action has had to be taken there also. In the United Kingdom, the Prohibition of Female Circumcision Act 1985 outlawed the procedure in the UK itself and the Female Genital Mutilation Act 2003 made it an offence for FGM to be performed anywhere in the world on British citizens or permanent residents. Even with this legislation in place there are up to 100,000 women in England and Wales who have undergone FGM and between 500 and 2,000 British girls are at risk each year. Daughters are either sent abroad to be cut on the proviso of visiting relatives or brought to “cutting parties” in the UK, the six-week long summer holiday being the most dangerous time of the year for these girls as they have enough time to heal before the beginning of the new school year.
It is my hope that new generations with access to more than just a basic education and the freedom to express themselves openly, will awaken to the barbarity of FGM and embrace a society where equality and common sense reign.
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