FGM

Female genital mutilation (FGM), also known as female genital cutting (FGC), female circumcision (FC), or female genital mutilation/cutting (FGM/C), is any procedure involving the partial or total removal of the external female genitalia or other injury to the female genital organs “whether for cultural, religious or other non-therapeutic reasons.”  The term is almost exclusively used to describe traditional or religious procedures on a minor, which requires the parents’ consent because of the age of the girl.

Amnesty International estimates that over 130 million women worldwide have been affected by some form of FGM, with over 3 million girls at risk of undergoing FGM every year.

FGM is mainly practiced in 28 different African countries. It is common in a band that stretches from Senegal in West Africa to Ethiopia on the East coast, as well as from Egypt in the north to Tanzania in the south. It is also practiced by some groups in the Arabian Peninsula. The country where FGM is most prevalent is Egypt, followed by Sudan, Ethiopia, and Mali. Egypt recently passed a law banning FGM.

Opposition is motivated by concerns regarding the consent (or lack thereof, in most cases) of the patient, and subsequently the safety and long-term consequences of the procedures. When the procedure is performed on and with the consent of an adult it is generally called clitoridectomy, or it may be part of labiaplasty or vaginoplasty. It also generally does not refer to procedures used in gender reassignment surgery, and the genital modification of intersexuals.

FGM consists of several distinct procedures. Their severity is often viewed as dependent on how much genital tissue is cut away. The World Health Organisation divides the procedure into four major types although there is some debate as to whether all common forms of FGM fit into these four categories, as well as issues with the reliability of reported data.

In the past several decades, there have been many concerted efforts by the World Health Organisation to end the practice of FGM. The United Nations has also declared February 6 as “International Day of Zero Tolerance to Female Genital Mutilation”.

Among practicing cultures, FGM is most commonly performed between the ages of four and eight, but can take place at any age from infancy to adolescence. Prohibition has led to FGM going underground, at times with people who have had no medical training performing the cutting without anaesthetic, sterilisation, or the use of proper medical instruments. The procedure can lead to death through shock from excessive bleeding. The failure to use sterile medical instruments may lead to infections.

As a result of immigration, the practice has also spread to Europe, Australia and the United States. Some tradition-minded families have their daughters undergo FGM whilst on holiday in their home countries. As Western governments become more aware of FGM, legislation has come into effect in many countries to make the practice of FGM a criminal offense. In 2006, Khalid Adem became the first man in the United States to be prosecuted for circumcising his daughter.

In February 2010, a study by Pharos, a Dutch group which gathers information on health care for refugees and migrants, found that many women who have undergone FGM suffer psychiatric problems. This was the first study into the psychiatric and social complaints associated with female circumcision. In the study 66 questioned Dutch African women, who had been subjected to the practice, were found to be “stressed, anxious and aggressive”. It also found that they were more likely to have relational problems or in some cases had fears of establishing a relationship. According to the study, an estimated 50 women or girls are believed to be circumcised every year in the Netherlands.

Other serious long term health effects are also common. These include urinary and reproductive tract infections, caused by obstructed flow of urine and menstrual blood, various forms of scarring and infertility. Epidermal inclusion cysts may form and expand, particularly in procedures affecting the clitoris. These cysts can grow over time and can become infected, requiring medical attention such as drainage. The first episode of sexual intercourse will often be extremely painful for infibulated women, who will need the labia majora to be opened, to allow their partner access to the vagina. This second cut, sometimes performed by the partner with a knife, can cause other complications to arise.

In recent years, surgical techniques to reverse FGM have been developed by gynaecologists such as Dr. Pierre Foldes and Dr. Marci Bowers. Techniques can include ablating scar tissue, reconstructing the labia, and drawing the internal part of the clitoris outward to compensate for clitoral excision.

Despite laws forbidding the practice, FGM remains an enduring tradition in many societies and cultural groups. Political leaders have found FGM difficult to eliminate on the local level because of its cultural and sometimes political importance.

There are two main anti-FGM frameworks: the health model and the human rights-based model. The health model campaign defines FGM as harmful to women’s health (physical and psychological trauma, sterility, damage to the urethra and anus, tetanus, child and maternal mortality and more recently HPV and HIV infection). This approach has failed to bring about large scale behavioural change and although the health model is against FGM and the adverse effects associated, they often reject methods to provide medical support to minimise FGM health risks.

The human rights-based model has in more recent times replaced the health based model as the preferred approach in anti-FGM campaigns. The human rights model encompasses four important human rights discourses: violence against women, rights of the child, freedom from torture and rights to health and bodily integrity.