Calling for an End to Female Genital Mutilation/Cutting

• Immediate and long-term consequences
• Reasons for the practice
• Emerging trends
• The holistic approach: UNFPA at work

Female genital mutilation, also called female genital cutting, refers to the removal of all or part of the female genitalia. Despite global efforts to promote abandonment of the practice, FGM/C remains widespread in many developing countries, and has spread to other parts of the world, such as Europe and North America, where some immigrant families have now settled.

Some 3 million women and girls face FGM/C every year, while some 100 to 140 million have already undergone the practice. The majority live in 28 countries in Africa and Western Asia. The practice has also been reported among certain populations in India, Indonesia and Malaysia. 

Immediate and long-term consequences

Female genital mutilation/cutting has both immediate and long-term consequences for the health of women. The effects of FGM/C depend on the type performed, the expertise of the practitioner, the conditions under which it is conducted, the amount of resistance and general health condition of the girl/woman undergoing the procedure. Complications may occur in all types of FGM/C, but are most frequent with infibulations, which includes stitching or narrowing of the vaginal opening.

The practice of FGM/C has had immediate and lifelong psychological effects on the estimated 100 to 140 million women and girls who have been subjected to this procedure. The experience has also been related to a range of psychological and psychosomatic disorders which, in turn, affect eating, sleeping, moods and cognition. Symptoms can manifest themselves in various
ways, including those associated with post-traumatic stress syndrome. Severe physical health consequences can also emerge.

A recent study that surveyed the status of FGM/C in 28 obstetric centres in six African countries – Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan – found that women who had undergone FGM/C were significantly more likely than others to have adverse obstetric outcomes such as Caesarean sections, post-partum haemorrhaging, prolonged labour, resuscitation of the infant and low birth weight, and in-patient prenatal deaths. The inquiry
also discovered that the risk seemed to increase among women who had undergone more extensive forms of FGM/C.

Reasons for the practice

One of the most common explanations for continuing the FGM/C practice is local custom. Women themselves are sometimes unwilling to give up the practice, as they see it as a long-standing tradition passed on from generation to generation. The practitioners are often unaware of the real implications of FGM/C and the health risks that it poses. Family honour,
cleanliness, protection against spells and the insurance of virginity and faithfulness to the husband are used as rationales to continue the practice.

Additional factors underlying the practice include:

• Sociological: As an initiation for girls into womanhood,
  social integration and the maintenance of social cohesion;

• Hygienic and aesthetic: Where it is believed that the
  female genitalia are dirty and unsightly;

• Sexual: To control or reduce female sexuality;

• Health: In the belief that it enhances fertility and child survival;

• Religious: In the belief that it is a religious requirement;

• Socio-economic factors:

  • Where it is believed that FGM/C is a prerequisite for marriage and where
    women are largely dependent on men - economic necessity can be
    a determinant to undergo the procedure.

  • FGM/C may may also be a major source of income for circumcisers.Various cultures offer many justifications for these practices. A girl who is not “circumcised” is considered unclean in some communities and therefore
    unable to marry. A girl who does not have her clitoris removed can also be
    considered a great danger and, ultimately, fatal to a man’s health.

Emerging trends

The percentage of girls whose FGM/C is performed by medical personnel has increased, as more parents try to minimize the immediate health effects or complications, including bleeding and pain. This ‘medicalization’ of the practice is conducive to high prevalence as mothers continue to deem it safe for their daughters. UNFPA, WHO, UNICEF and a number of governments have all publicly declared that under no circumstances should health professionals practice FGM/C in any form.

Another trend is that girls are being subjected to the practice at much younger ages than previously. The majority of FGM/C cases are performed between the ages of 4 and 14 years.An increasing trend towards the “lesser cut” instead of total abandonment of the practice is also being seen in some communities. This may be indicative of shifts in awareness and subsequent change of practice within communities. However, it is still an unacceptable practice.

The holistic approach: UNFPA at work

UNFPA addresses FGM/C in a holistic manner by funding and implementing culturally sensitive programmes for the abandonment of the practice, advocating for legal and policy reforms, while building national capacity to stop all forms of FGM/C. UNFPA also supports treatment and care to women and girls suffering from its immediate or long term complications.

In recent years, UNFPA has drawn public attention to the elimination of FGM/C, advocating specific actions – including the need to work with communities in order to prevent the practice. At country level, UNFPA has formed partnerships with relevant stakeholders, including government ministries, particularly ministries of health, social affairs, finance,gender, youth and education. UNFPA has also developed ties to non-governmental rganizations (NGOs), safe motherhood projects, community and faith-based organizations and religious leaders. In the legal arena, UNFPA took joint action with local human rights groups and governments in several countries to develop legislation in an effort to end the practice.

In Egypt, where the prevalence rate currently stands at 96 per cent, UNFPA collaborated with several other agencies to support to the National Council for Childhood and Motherhood in developing appropriate legal measures against the practice. Similarly in Senegal, UNFPA worked with the Senegalese Parliamentarian Network on Population and Development in its adoption of laws prohibiting FGM/C.

In Eritrea, where the vast majority of women are subjected to FGM/C, many before their first birthday, an interagency programme has been formed to encourage abandonment of the practice.  A programme update reflects on the various factors that contribute to the persistence of FGM/C in that country.

UNFPA has been establishing close ties with religious and cultural leaders throughout its efforts to end FGM/C to provide support to existing legal frameworks. In Ethiopia, for example, building alliances with faith-based organizations, religious and tribal leaders was critical in efforts to promote the abandonment of FGM/C and other harmful practices such as child marriage.

This type of partnership was also seen in Nigeria, where UNFPA worked with religious leaders – of both Muslim and Christian faiths – in sensitizing people about the dangers of FGM/C. In Egypt, UNFPA worked to foster dialogue with community actors, including religious leaders, members of the media, politicians and judges. Also under the FGM-Free Village Project – which
began in 2003 in 60 villages and is now expanding to 120 villages - UNFPA and partners provided technical support to strengthen the legal, judicial and health systems, in order to better respond to the issue of FGM/C.

Laws alone, however, are not enough to end the practice. Governments are far from being able to monitor FGM/C, which is usually underreported, particularly those cases occurring in remote locations. A negative cultural practice, such as FGM/C, can be changed without disrupting the positive underlying social value that the practice represents. An example of this is seen in Kenya, where alternative rites of passage ceremonies are at the forefront of change. One UNFPA-supported community organization, the Tsaru Ntomonik Initiative, promoted new ways for Maasai girls to be initiated into adulthood, without the actual cutting.

The community-based organization also served as a temporary ‘safe house’ for an increasing number of young girls who had escaped from FGM/C and forced child marriage. In addition to providing a shelter, the organization offered an array of services for the girls, including counselling, education, reunification with their families and reintegration into their communities. Tsaru Ntomonik worked with ex-circumcisers to ensure that they could fi nd alternative sources of income. UNFPA-supported initiatives in Uganda also provided ex-circumcisers with education and training in other types of employment. Guided by the knowledge that change cannot be imposed from the outside,UNFPA efforts at the country level had an underlying commonality in the promotion of community dialogue through reflection, discussion and decisionmaking.

Working towards the abolishment of FGM/C requires a thorough exploration of the beliefs and values which underpin the practice. In Burkina Faso, UNFPA supported a research initiative that studied FGM/C from a sociocultural perspective. Strengthening this type of evidence base helps to unravel the root causes and justifications for the practice and in turn - develop more effective programmes.

The involvement of men and boys throughout efforts to end FGM/C was a critical strategy in making progress. In the Gambia, UNFPA provided support to an NGO, the Foundation for Research on Women’s Health, Productivity and Development (BAFROW). BAFROW operated an innovative clinic that aimed at ending reproductive health-related problems using integrated approaches, including community awareness-raising and mobilization. Among the clinic’s
advocacy efforts was community sensitization involving radio programmes on which husbands discussed the harmful effects of FGM/C. UNFPA also supported BAFROW in translating several documents relating to FGM/C into local languages. UNFPA and UNICEF recently launched a joint initiative that aims at reducing FGM/C by 40 per cent in 16 countries by the year 2015.

Related links:
	Taking a Stand Against Harmful Practices
	Culturally Sensitive Approaches
	Promoting Gender Equality
	FAQs on FGM/C