By ANJALI BHAVAN, New Delhi, India
Worldwide, millions of women are subjected to the practice of Female Genital Mutilation/Cutting (FGM/C) every year, every month, every day. This practice of cutting up female genitalia for a variety of reasons either around birth or puberty violates child and women rights to their very core and has consequences, both immediate and long-term, on the mental, physical and emotional health and well-being of many women across the world—even claiming the lives of many women and children, who die from the pain or subsequent onset of sepsis or reproductive illnesses. Such mutilation is steeped in tradition, religion and culture, often attributed to religion and performed as a rite of purification, and this superstition is passed on for generations, thus perpetrating a vicious cycle. This research aims to assess this practice—that is, delve on its history, both social and cultural, the current scenario and the impact of such mutilation on women and children, examined through the life story of victims of such mutilation. This research also hopes to spread awareness to mitigate the problem at hand and provide relief to countless women who undergo this ritual as a mark of womanhood.
Definition and terminology
According to the World Health Organisation (WHO), FGM/C comprises “all procedures which involve partial or total removal of the external female genitalia or injury to the female genital organs whether for cultural or any other nontherapeutic reasons” (WHO, 2010). It was, until the 1980s, called female circumcision, but it was recognized as being different from male circumcision, for a larger amount of skin and genitalia are removed—hence the term female genital cutting is now more widely used.
FGM/C has dozens of local terms in various countries; most of these terms refer to the ritual being a purifying one, to make a woman pure before marriage. For instance, it is known in Arabic as khafd or khifad (Asmani, Abdi, 2008).
After the procedure, a single hole is left for passage of urine and menstrual blood, and for sexual penetration and childbirth after marriage by inserting things like twigs inside it. The wound is covered with poultices or surgical thread (Swiss Med Weekly, 2011). If the hole is too big, the procedure is repeated (Abdalla, 2007).
History of FGM/C
The origins of circumcision of both genders are highly ambiguous and unclear; the first report of circumcision comes from the writings of Herodotus, who reported it in the 5th century BC. Since Islam and Christianity came into existence much later, the notion of FGM/C for religious purposes by people professing their faith in the above mentioned religions has a doubtful veracity. The geographical distribution of FGM/C suggests that it originated on the west coast of the Red Sea.
Egyptian women are shown to be infibulated on a Greek Papyrus in the British Museum dated 163 BC, which gives strong evidence that the practice was fairly widespread in Egypt. Circumcision was practiced by the early Romans and Arabs too, though according to the Historia Augusta, the Roman emperor Hadrian issued orders to ban circumcision in the empire (Hodges, 2001), for the prepuce was much valued in Rome. The Hebrew Bible commands Jews to circumcise their male children on the eighth day of their life, and to circumcise their male slaves (Genesis 17:11-12).
From its probable origins in Egypt and the Nile Valley, female circumcision is thought to have diffused to the Red Sea coastal tribes, along with Arab traders, and from there into eastern Sudan. (Modawi, S., 1974)
Doctors in 19th century Europe and the United States would perform clitoridectomies to treat insanity and masturbation, which was seen as leading to mental illnesses—including lesbianism (Rodriguez, 2008).
Isaac Baker Brown, an English gynaecologist believed that masturbation led to hysteria, spinal irritation, mania and death, for it was an ‘unnatural irritation’ (Elachal et al.,1997). According to a 1985 paper in the Obstetrical & Gynaecological Survey, clitoridectomy was performed in the US into the 1960s to treat hysteria, erotomania and lesbianism (Cutner, 1985).
In the US, a doctor J Marion Sims was a follower of Brown’s work, and in 1862 amputated a woman’s clitoris and slit her cervix when she complained of bladder problems, convulsions and menstrual pain.
Reasons and justification behind FGM/C
As the various customs differ (in ancient Rome, rings were threaded through female slaves’ labia to prevent them from getting pregnant) in various regions, so do the reasons behind them – though the fundamental justifications remain the same across borders. Today, the most common reason evoked for supporting FGM/C is the belief that the practice is a "good tradition"(Toubia, N. 1993). Other reasons include religious requirement(s); rite of passage to womanhood; cleanliness; prevention of promiscuity among girls; preservation of virginity; better marriage prospects; enhancement of male sexuality; prevention of excessive clitoral growth; and facilitation of childbirth by widening the birth canal (Demographic and Health Survey - Egypt., 1995). The ability of a husband to penetrate his wife’s infibulation after marriage is seen as an indicator of his sexual potency; some men are unable to do so, so accost a midwife to pry it open with a knife in great secrecy, for this is considered a sign of low potency and hence a source of great humiliation for the man (Lightfoot-Klein, 1989). FGM/C is seen as a purification ritual, a way to prepare woman for marriage and raising families. Abstinence is seen as a rebellion against society, and girls are warned that if they resist, their husbands would cease to find them sexually attractive and move on to other wives—and also, to never refuse the husband’s demands for sex.
It is observed that older women who themselves have been victims of FGM/C are one of the strongest proponents of the practice; often, mothers and grandmothers drag their daughters or other young female relatives to the traditional circumciser, usually an old woman with much experience in cutting up female genitalia—or sometimes even the local barber (UNICEF, 2013).
There is also a preference for dry vaginas amongst locals, and men are said to enjoy penetrating infibulations (Gruenbaum, 2005). Beliefs persist that infibulation enhances hygiene, and that it enhances male sexual pleasure. The health consequences are downplayed by the circumcisers, and families believe they must conform to the custom of infibulation for the sake of honour and a good marriage (Mackie, 2003).
The practice is seen as a way to define gender boundaries and eliminate androgynous body parts; removal of the clitoris and labia is seen as removal of the male parts of the female’s body, while removal of the foreskin is seen as defeminisation of the male. The female body is covered and closed, while the male body is exposed, open (Boddy, 2007). This is a typical Sudanese belief, that if left uncut, a clitoris will grow like a penis and even longer.
Many clerics use a Hadith to justify circumcision, which shows a conversation between Prophet Muhammad and Um Habibah – despite there being no mention of FGM/C in the Quran. Prophet Muhammad inquires if she will continue the practice of excising female slaves’ genitalia, to which she replies in the affirmative, that she won’t stop unless forbidden. To this the Prophet doesn’t object; he instead attempts to teach her the method, for such excising brings radiance to the face and is pleasing to husbands (Sami A. Aldeeb Abu Sahlieh, 1994).
Aim of this research
I took up this topic for my first research paper because it stands out uniquely amongst all kinds of gender violence—for its ubiquity, lack of any awareness and the extremity of the health consequences, the pain and suffering. It seemed as a topic nobody talks about, nobody touches on, which intrigued me.
Through this research, I hope to answer the following questions:
In a report by UNICEF in February 2016, nearly 70 million more girls than the previous 200 million have been known to have undergone FGM/C, a disturbing trend. Also, nearly half of the number of victims are concentrated in just three nations—Indonesia, Ethiopia and Egypt, with the highest prevalence of FGM/C in Somalia, where 98% of females in the age group 15-49 years have undergone the procedure.
Around 44 million victims are under the age of 14, some barely infants, with the highest prevalence in this age group in Gambia (56%), Mauritania (54%) and Indonesia (50%).
However, the impetus against the eradication of FGM/C is slowly increasing; FGM/C prevalence rates have dropped among girls aged 15 to 19, including by 41 percentage points in Liberia, 31 in Burkina Faso, 30 in Kenya and 27 in Egypt over the last 30 years.
The table below shows the latest percentage of the prevalence of FGM/C amongst various African and Asian Countries. (Source: UNICEF)
It is quite evident that Somalia, Djibouti and Sierra Leone are the countries with the highest incidences of FGM/C, mostly by traditional circumcisers, women or local barbers who mutilate the genitalia using rusty knives or blades, and sewing the wound up using a thread or twigs.
In half of the countries with available data, the majority of girls are cut below the age of 5. In Chad, Somalia, Egypt and the Central African Republic, approximately 80% girls are cut between the ages 5 to 14, often the same type of FGM/C being performed on them as the previous generations. Nearly one in five girls who have undergone FGM/C have endured the most severe form, the type 3 of FGM/C, also called infibulation—involving cutting off the majority of the flesh around the vagina, both the labia minora and majora, and then sewing up the wound to leave a small hole.
However, trend data shows that the practice of FGM/C is declining at various rates in nearly all the countries surveyed, with Benin, the Central African Republic, Iraq, Liberia and Nigeria registering a halving in the rate of prevalence of FGM/C amongst adolescent girls. In Ethiopia and Burkina Faso, the percentage of prevalence in the 15-19 age group has dropped by 19 to 31 percentage points. Egypt and Sierra Leone have shown slight declines, though with the increasing population, more and more women stand at risk.
The type of FGM also varies across regions; 90% of the mutilation practiced is either Type 1 or Type 4, with Type 3 accounting for 9-10% of FGM/C prevalence; this type is mostly practiced in the north-eastern regions of Africa such as Djibouti, Somalia, Ethiopia and Sudan.
Overall, however, the practice is now being seen in an increasingly negative light and being abandoned, with the most decline in the countries with the smallest percentages of prevalence. Women are now calling to light the fact that there are no health benefits to this practice; on the contrary, it causes a variety of life-threatening and debilitating illnesses.
FGM/C is prevalent in Europe and the Americas too. Around 180,000 girls are at risk in Europe, while 507,000 US women and girls have either undergone the procedure or are at risk. The most common countries of origin for women and girls in the United States at risk for FGM/C or its consequences were Egypt (20%), Ethiopia (18%), and Somalia (12%). This includes women and children who were born in FGM/C practicing countries, and also children born to women from such countries (Goldberg et al., 2012).
If no comprehensive steps are taken for reduction of the practice of FGM/C, the number of girls and women cut per year can go up to 6.6 million by 2050, whereas if the rate of progress over the past 30 years is maintained, the number can stay at around 4.1 million. Either way, the number of girls undergoing FGM/C per year is expected to increase to the population growth (UNICEF, 2016).
Complications from FGM/C depend largely on the type performed, the method, the instruments used and the age and health status of the victim (Reyners, 2004). They are both short-term and long-term, and the more extensive the cutting, the more lifelong agony a victim has to endure. Infibulation i.e. Type 3 FGM/C is particularly the most damaging form; it can leave victims with severe reproductive and urinary problems in addition to infections and excruciating pain.
A study of FGM/C victims in a rural area in Gambia found that 36.8% of the women had complications related to their FGM and in 63.2% of women in that group, those complications were long term and included infections (Hechavarría, Martin, Bonhoure, 2011). FGM/C also significantly increases chances of transmission of Hepatitis B, C and HIV by the usage of unsterilized, shared instruments.
Complications from FGM/C can be divided into 5 categories: short-term, long-term, pregnancy and childbirth, sexual and psychological.
1. Haemorrhage from cutting across the high-pressure clitoral artery; failure to stop the bleeding can even cause death
2. Shock, both haemorrhagic and neurogenic, also fatal.
3. Pain from the excision, which is often carried out without anaesthesia; the pain could cause psychological problems and even become chronic.
4. Urinary retention and infection can occur if the girl is afraid to pass urine through the injury, or due to pain and inflammation of the adjacent tissues.
5. A variety of infections can develop. There is a good chance of tetanus and septicaemia too, if unsterilized instruments are used.
6. Fractures can occur if the girl is held too tightly; often, orders are given to hold the girl tight enough to break her bones so she may not struggle. Also, the legs are bound tightly together after cutting, which prevents wound drainage and causes pain.
1. Pain due to improper healing which may leave nerve endings open
2. Difficulties due to damage to the urethral opening or scarring of tissue, like chronic incontinence or problems during menstruation.
3. Chronic pelvic, genital and urinary infections due to wounds, scarring and obstructions; often, poultices or medicines applied after mutilation could cause extensive damage and breed bacteria. The infections are painful and may be accompanied by discharge, and can spread to the uterus and kidneys.
4. Vulval abscesses due to stitches and improper healing, leading to infections.
5. Dermoid cysts due to inclusion of epithelium while healing of wounds, leading to swelling or secretions; can be very painful and a barrier to sexual intercourse.
6. Fistulate may result from de-infibulation, re-infibulation or sexual intercourse, also from damage due to FGM/C and labour. It can develop into a lifelong inconvenience.
3) Pregnancy and childbirth:
1. Foetus retention in case of miscarriage in the uterus or birth canal; difficulties in extracting it out.
2. Increased risk of bleeding, infections and complications to the foetus due to damage to the reproductive organs from extensive mutilation.
3. Increased risk of neonatal resuscitation, low birth-rate, stillbirth and early neonatal death with FGM thought to lead to an extra 1–2 perinatal deaths per 100 deliveries. (Reisel, Creighton, 2015)
4. Further damage to already-damaged area due to opening of the vagina during labour.
5. Women who have undergone FGM suffer more frequently from prolonged, difficult labour, have a higher rate of obstetric lacerations, more often require instrumental delivery, and have increased rates of obstetric haemorrhage (Reisel, Creighton, 2015)
6. Particularly with type 3 FGM/C (infibulation), increased scarring and delays in the second stage of labour are observed (Browning, Allsworth, Wall, 2010), in addition to perineal tears (Milligo-Traore et al., 2007).
7. Prolonged and obstructed labour could lead to increased risk of uterine inertia, rupture or prolapse and haemorrhages. The baby may have increased risk of neonatal brain damage due to asphyxia.
4) Sexual: Victims of FGM/C experience pain and discomfort during sexual intercourse, lack of lubrication and poor sexual pleasure. Factors such as the type of FGM and cultural and social traditions figure largely in sexual function and sexuality. Vaginismus is also reported, though the incidences are rare.
5) Psychological: The act of mutilation of genitalia, the pain and the secrecy involved in addition to all the customs and patriarchal beliefs register FGM/C as a traumatic event in the minds of victims. Though there has been very little research on this aspect of FGM/C, women in general report feelings of betrayal, loss of self-esteem, agony, anxiety and bitterness. Some also appear to be proud and joyous for having gone through so much pain in order to become pure and marriageable (Chalmers, Hashi, 2000).
For many women, FGM/C holds such cultural significance that many of them actually look forward to it (Chalmers, Hashi, 2000). The ceremonial aspect of FGM/C makes girls feel proud about having reached adulthood (Almroth et al., 2001). The stigma of being uncut causes intense psychological distress, perhaps more than if they had had the procedure. In fact, in several societies uncircumcised women are at the lowest rung of the social ladder, forbidden to take part in social gatherings (Baron, Denmark, 2006).
Victim stories and interviews
In order to gauge the real impact of FGM/C on victims at large, it is important to look at it from their perspective. Given are excerpts from some victim interviews and stories from verified news sources.
1. Assita Kanko (Al-Jazeera English, 2016)
Kanko is today a politician in Brussels and successful in life. But she still remembers, in gory detail how she was mutilated forcibly and without anaesthesia.
"I was screaming out in pain and fear, but nobody bothered to comfort me," she remembers. "That was the worst thing: that people just didn't seem to care."
Her mother told her that she was taking her to a friend’s place—but instead, took her to somewhere else entirely.
"There were these old women who pushed me to the ground, who took off my underwear and forced me to spread my legs. And then there was this excruciating pain."
"I was told not to talk about it to anyone. So I was alone with my pain and I had no idea what had happened to me."
She went on to study hard, became a politician and married a man in Brussels and now had a child. She is currently 35 years old, but still remembers the gender divide that existed in her family—how she was the one washing clothes and helping around, while her brothers played and enjoyed leisurely. The scars and pain remain, but she is now a confident activist and politician in Brussels, having written books on gender equality.
2. Jaha Dukureh (UN News Centre, 2015)
Jaha was just a week old when she was infibulated.
“I’m not whole. I’m not intact. Something was taken away from me,” she says.
“Women don’t need to be mutilated in order for them to stay virgins and I don’t think we’re unclean if we don’t go through FGM,” Jaha says. “For girls who have not gone through FGM, they’re seen as unclean, not fit to be in the same room with women who have gone through FGM. They even go as far as to say they stink when they walk into a room. It’s discrimination, basically. We’re telling women they’re not clean because a part of their body is not cut.”
“I have three kids and every time that I’ve delivered my babies, having to go through that process, of getting stitched up because of FGM and the scars that I have and the pain that I go through when I’m delivering my baby. With all three kids that I have, my labour has been more than 18 hours and that is a direct result of FGM,” says Jaha.
Jaha has now founded Safe Hands for Girls, an NGO for ending gender violence, particularly FGM. She recently shared her story at a UN conference and called for stricter action and more awareness against FGM.
FGM/C is still a widespread problem across the world, not just the Middle East. There is an urgent requirement for more stringent laws; many countries still don’t ban FGM/C. FGM/C has many untoward consequences and is a source of lifelong agony and embarrassment for the victims. It is essential to bring this to international attention, spread awareness and impose stringent laws and regulations on the practice. If urgent and effective steps are not taken towards mitigating this problem, around 86 million more girls would be cut per year, according to UNICEF statistics. FGM/C involves the socio-economic and political aspects of various nations, and it is seen as a tradition, something to be adhered to at any cost—and this thinking is behind the millions of girls who line up to undergo mutilation of their genitals day after day, year after year.
Countries banning FGM/C (in green) are still a minority; this shows that tackling gender-based violence is a long process, more so when it is FGM/C.
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