FGC/FGM refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for cultural or other non-medical reasons.
The World Health Organization (WHO) has identified four types:
Excision of the prepuce, with or without excision of part or all of the clitoris.
Excision of the clitoris with partial or total excision of the labia minora
Excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation). Sometimes referred to as pharaonic circumcision.
Others, such as pricking, piercing or incising, stretching, burning of the clitoris, scraping of tissue surrounding the vaginal orifice, cutting of the vagina, introduction of corrosive substances or herbs into the vagina to cause bleeding or to tighten the opening.
Types I and II are the most common, with variation among countries. Type III, infibulation, constitutes about 20 per cent of all affected women and is most likely in Somalia, northern Sudan and Djibouti.
refers to making cuts in the clitoris, cutting free the clitoral prepuce, but also relates to incisions made in the vaginal wall and to incision of the perineum and the symphysis.
refers to partial or total removal of the clitoris
refers to the removal of the clitoris and partial or total removal of the labia minora. The amount of tissue that is removed varies widely from community to community.
refers to the removal of the clitoris, partial or total removal of the labia minora and stitching together of the labia majora.
this is a collective name that is used to describe a variety of practices involving the cutting of the female genitalia. It often refers to operations that fall under type I FGM/FGC. This term is considered as confusing by some since it seems to equate male circumcision with FGM/FGC. However, the only form that anatomically is comparable to male circumcision is that form in which the clitoral prepuce is cut away. This form seldom occurs. It is sometimes argued that the term circumcision obscures the serious physical and psychological effects of genital cutting on women.
this is also a collective name to describe procedures that involve partial or total removal of the external female genitalia or other injury to female genital organs whether for cultural or other non-medical reasons. This term is used by a wide range of women's health and human rights organizations and activists, not just to describe the various forms but also to indicate that the practice is considered a mutilation of the female genitalia and as a violation of women's basic human rights. Since 1994, the term has been used in several United Nations conference documents, and has served as a policy and advocacy tool.
Some organizations have opted to use the more neutral term 'female genital cutting'. This stems from the fact that communities that practice FGC often find the use of the term 'mutilation' demeaning, since it seems to indicate malice on the part of parents or circumcisers. The use of judgmental terminology bears the risk of creating a backlash, thus possibly causing an alienation of communities that practice FGM/FGC or even causing an actual increase in the number of girls being subjected to FGM/FGC. In this respect it should be noted that the Special Rapporteur on Traditional Practices (ECOSOC, Commission on Human Rights) recently called for tact and patience regarding FGC eradication activities and warned against the dangers of demonizing cultures under cover of condemning practices harmful to women and girls.
Infibulation creates a physical barrier to sexual intercourse and childbirth. An infibulated woman therefore has to undergo gradual dilation of the vaginal opening before sexual intercourse can take place. Often, infibulated women are cut open on the first night of marriage (by the husband, or a circumciser), in order to enable the husband to be intimate with his wife. At childbirth, many women also have to be cut again, because the vaginal opening is too small to allow for the passage of a baby. Attempts at forcible penetration may cause rupture of scars and sometimes perineal tears, dyspareunia, and vaginismus. Excessive penile force during first intercourse can cause severe bleeding, shock and infection.
In some communities, the raw edges of the wound are sutured again after childbirth, recreating a small vaginal opening. This is referred to as re-infibulation.
The origins of the practice are unclear. It predates the rise of Christianity and Islam. There is mention made of Egyptian mummies that display characteristics of FGM/FGC. Historians such as Herodotus claim that in the fifth century BC the Phoenicians, the Hittites and the Ethiopians practised circumcision. It is also reported that circumcision rites were practised in tropical zones of Africa, in the Philippines, by certain tribes in the Upper Amazon, and in Australia by women of the Arunta tribe. It also occurred among the early Romans and Arabs. As recent as the 1950s, clitoridectomy was practised in Western Europe and the United States to treat 'ailments' in women as diverse as hysteria, epilepsy, mental disorders, masturbation, nymphomania, melancholia and lesbianism. In other words, the practice of FGM/FGC has been followed by many different peoples and societies across the ages and the continents.
FGM/FGC is usually carried out by elderly people in the community (usually, but not exclusively, women) who have been specially designated for this task, or by traditional birth attendants. These people receive a fee from the girls' family members, in money or in kind. In some cases, medical personnel perform the operation as well, for a fee. Among certain populations, FGM/FGC may be carried out by traditional health practitioners, (male) barbers, members of secret societies, herbalists, and sometimes by a female relative.
FGM/FGC is carried out with special knives, scissors, scalpels, pieces of glass or razor blades. Anaesthetic and antiseptics are not generally used except when carried out by medical practitioners. In communities where infibulations is practised, the girls' legs are often bound together to immobilize her for a period of 10 - 14 days, to allow formation of scar tissue.
The age at which FGM/FGC is performed varies. In some areas it is carried out during infancy (as early as a couple of days after birth), in others during childhood, at the time of marriage, during a woman's first pregnancy or after the birth of her first child. The most typical age is 7 - 10 years or just before puberty, although reports suggest that the age is dropping in some areas.
The practice is common in parts of Africa, Asia and in some Arab Countries. It is practiced among communities in : Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Cote d'Ivoire , Democratic Republic of Congo, Djibouti, Egypt, Ethiopia, Eritrea, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Togo, Uganda.
FGM/FGC is also practiced among certain ethnic groups in a number of Asian countries (India, Indonesia, Malaysia, Pakistan); among some groups in the Arabian Peninsula (in Oman, United Arab Emirates, Yemen); Iraq; occupied Palestinian territories and among certain immigrant communities in Europe, Australia, Canada and the United States.
Cultural practices such as FGM/FGC are rooted in a set of beliefs, values, cultural and social behaviour patterns that govern the lives of people in society. There are many reasons given for practicing FGM/FGC. These can be categorised under five headings:
FGM/FGC is carried out as a means to control women’s sexuality (which is argued to be insatiable if parts of the genitalia, especially the clitoris, are not removed). It is thought to ensure virginity before and fidelity after marriage and/or to increase male sexual pleasure.
Sociological and cultural reasons:
FGM/FGC is seen as part of a girl’s initiation into womanhood and as an intrinsic part of a community’s cultural heritage/tradition. Various myths exist about female genitalia (e.g. that if uncut the clitoris will grow to the size of a penis; FGM/FGC would enhance fertility or promote child survival, etc) and these serve to perpetuate the practice.
Hygiene and aesthetic reasons:
In some communities, the external female genitalia are considered dirty and ugly and are removed ostensibly to promote hygiene and aesthetic appeal.
Although FGM/FGC is not sanctioned by either Islam nor by Christianity, supposed religious prescripts (e.g. the mention of ‘Sunna” in the Koran) are often used to justify the practice.
In many communities, FGM/FGC is a prerequisite for marriage. Where women are largely dependent on men, economic necessity can be a major determinant to undergo the procedure. FGM/FGC sometimes is a prerequisite for the right to inherit. FGM/FGC may also be a major income source for practitioners.
It is estimated that from 100 to 140 million girls and women have undergone some form of genital mutilation/cutting, and at least 3 million girls are at risk of undergoing the practice every year.
The effects of FGM/FGC depend on the type performed, the expertise of the circumciser, the hygienic 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/FGC, but are most frequent with infibulation.
FGM/FGC has both immediate and long-term consequences to the health of women.
These include severe pain, shock, haemorrhage, tetanus or infection, urine retention, ulceration of the genital region and injury to adjacent tissue, wound infection, urinary infection, fever and septicaemia. Haemorrhage and infection can be of such magnitude as to cause death.
Long term consequences:
These include anemia, the formation of cysts and abscesses, keloid scar formation, damage to the urethra resulting in urinary incontinence, dyspareunia (painful sexual intercourse) and sexual dysfunction, hypersensitivity of the genital area. Infibulation can cause severe scar formation, difficulty in urinating, menstrual disorders, recurrent bladder and urinary tract infection, fistulae, prolonged and obstructed labour (sometimes resulting in fetal death and vesico-vaginal fistulae and/or vesico-rectal fistulae), and infertility (as a consequence of earlier infections). Cutting of the scar tissue is sometimes necessary to facilitate sexual intercourse and/or childbirth. Almost complete vaginal obstruction may occur, resulting in accumulation of menstrual flow in the vagina and uterus. During childbirth the risk of hemorrhage and infection is greatly increased.
Because the procedure is coupled with the loss of blood and use is often made of one instrument for a number of operations, the risk of HIV/AIDS transmission is increased by the practice. Also, due to damage to the female sexual organs, sexual intercourse can result in lacerations of tissues, which greatly increases risk of transmission. The same is true for childbirth and subsequent loss of blood.
Genital mutilation/cutting may leave a lasting mark on the life and mind of the woman who has undergone the procedure. The psychological stress may trigger behavioural disturbances in children, closely linked to the loss of trust and confidence in care-givers. In the longer term, women may suffer feelings of anxiety, depression, and frigidity. Sexual dysfunction may also be the cause for marital conflicts and eventual divorce.
No. The practice of FGM/FGC is not prescribed by Islam, nor in the Bible. In fact, the practice predates Islam, and many religious leaders have denounced it. The practice cuts across religions and is practiced by Muslims, Christians, Ethiopian Jews, Copts, as well as by followers of certain traditional African religions. FGM/FGC is thus more a cultural than a religious practice.
No. FGM/FGC in any form should not be practised by health professionals in any setting - including hospitals or other health establishments. Unnecessary bodily mutilation cannot be condoned by health providers. FGM/FGC is harmful to the health of women and girls and violates their basic human rights and medicalization of the procedure does not eliminate this harm. On the contrary, it reinforces the continuation of the practice by seeming to legitimize it. Health practitioners should provide all necessary care and counseling for complications that may arise as a result of FGM/FGC.
Yes. The function of culture and tradition is to provide a framework for human well-being; cultural arguments can never be used to condone violence against persons, male or female. Moreover, culture is not static, but constantly changing and adapting. Nevertheless, activities for the elimination of FGM/FGC should be developed and implemented in a way that is sensitive to the cultural and social background of the communities that practice it. Behaviour can change when people understand the hazards of certain practices and when they realize that it is possible to give up harmful practices without giving up meaningful aspects of their culture.
Benin, Burkina Faso, Central African Republic, Chad, Cote d'Ivoire, Djibouti, Egypt (Ministerial decree), Ghana, Guinea, Kenya, Niger, Nigeria (multiple states), Senegal, Tanzania, Togo. In Sudan only the most severe form of FGM/FGC is forbidden by law.
Australia, Belgium, Canada, Denmark, New Zealand, Norway, Spain, Sweden, United Kingdom, United States (federal law, and specific state laws).
Penalties range from a minimum of six months to a maximum of life in prison. Several countries also include monetary fines in the penalty. As of June 2000, there have been prosecutions or arrests in Burkina Faso, Egypt, Ghana, France and Senegal. Belgium. Benin, Nigeria, and Uganda are proposing laws to ban the practice of FGM/FGC.
In September 2001, the European Parliament adopted a resolution on Female Genital Mutilation . The resolution calls on the member states of the European Union to pursue, protect and punish any resident who has committed the crime of FGM even if committed outside the frontier ("extraterritoriality") and calls on the Commission and the Council to take measures in regard to the issuing of residence permits and protection for the victims of the practice. The resolution also calls on the member states to recognise the right to asylum of women and girls at risk of being subject to FGM/FGC.
Most governments in countries where FGM/FGC is practised have ratified international conventions and declarations that make provisions for the promotion and protection of the health of women and girls. These include, inter alia:
The Universal Declaration of Human Rights proclaims the right of all human beings to live in conditions that enable them to enjoy good health and health care (art. 25).
The International Covenants on Civil and Political Rights and on Economic, Social and Cultural Rights condemn discrimination on the grounds of sex, and recognize the universal right to the highest attainable standard of physical and mental health (art. 12).
The Convention on the Elimination of All Forms of Discrimination against Women requires State Parties to : "take all appropriate measure to modify or abolish customs and practices which constitute discrimination against women " (art. 2f). "modify social and cultural patterns of conduct of men and women, with a view to achieving the elimination of prejudices and customary and all other practices which are based on the idea of the inferiority or the superiority of either of the sexes" (art 5a).
General recommendation 24 (1999) to article 12 of the Convention (on women and health) emphasizes that certain cultural or traditional practices such as FGM/FGC carry a high risk of death and disability and recommends that State parties should ensure the enactment and effective enforcement of laws that prohibit FGM/FGC.
General recommendation 14 (1990) pertains particularly to FGM/FGC. It recommends that State parties take appropriate and effective measures to eradicate female circumcision; to collect and disseminate basic data on traditional practices; to support women's organization at the national and local levels that work for the elimination of harmful practices; to encourage politicians, professionals, religious and community leaders to co-operate in influencing attitudes; to introduce appropriate educational and training programmes; to include appropriate strategies aimed at eradication of female circumcision into national health policies; to invite assistance, information and advice from the appropriate organization of the United Nations system; to include in their reports to the Committee under articles 10 and 12 of the Convention information about measures taken to eliminate female circumcision.
The Convention on the Rights of the Child protects against all forms of mental and physical violence and maltreatment (art 19.1); to freedom from torture or cruel, inhuman or degrading treatment (art 37a), and requires States to take all effective and appropriate measures to abolish traditional practices prejudicial to the health of children (art 24.3)
The Vienna Declaration and the Programme of Action of the World Conference on Human Rights expanded the international human rights agenda to include gender-based violence including FGM/FGC.
The Programme of Action of the International Conference on Population and Development.
The Platform for Action of the Fourth World Conference on Women includes a section on the girl child and urges governments, international organization and non-governmental groups to develop policies and programmes to eliminate all forms of discrimination against the girl child, including female genital cutting.
The African Charter on Human and Peoples' Rights, article 4 on integrity of the person, article 5 on human dignity and protection against degradation, article 16 on the right to health, article 18 (3) on protection of the rights of women and children.
The Addis Ababa Declaration. At the Council of Ministers during its sixty-eighth Session in July 1998, the Organization of African Unity (OAU) adopted the Addis Ababa Declaration on violence against Women. This Declaration was later endorsed by the Assembly of heads of State and Governments. The Declaration serves as an important step towards the formulation of an African charter on violence against women, providing the framework for national laws against FGM/FGC.
The Banjul Declaration. The Inter-African committee on Traditional Practices Affecting the Health of Women and Children in collaboration with the Gambian committee on Traditional Practices (GAMCOTRAP) organized a symposium for religious leaders and medical personnel in Banjul, Gambia, from 20 to 24 July 1998. Participants agreed that FGM/FGC is not prescribed by any religion and unequivocally condemned the use of religion to justify the practice, emphasizing the importance of information campaigns to put and end to them. At the close of the symposium they issued a communique, a declaration and recommendations condemning and demanding eradication of FGM/FGC and other harmful traditional practices.
The United Nations Social, Humanitarian and Cultural Committee (Third Committee of the General Assembly) approved a resolution that calls upon States to implement national legislation and policies that prohibit traditional or customary practices affecting the health of women and girls, including FGM/FGC. It also calls upon States to prosecute perpetrators of practices that negatively affect the health of women and girls, and to intensify efforts to raise awareness and mobilize international and national opinion on the harmful effects of such practices.
The Ouagadougou Declaration. A workshop on concerted action against the practice of FGM/FGC in the West African Economic and Monetary Union (UEMOA) was organized in Ouagadougou from 4 to 6 May 1999. Participants made three recommendations : a) the preparation of an African charter on FGM/FGC; b) the adoption of specific legislation against FGM/FGC in all UEMOA States and ratification by these of regional and international instruments relating to the protection of women and girls; and c) the establishment of sub-regional networks of traditional and religious leaders and modern and traditional communicators to support the national committees in their campaign against FGM/FGC. A declaration known as the Declaration of Ouagadougou was adopted at the end of the workshop.
Key Actions for the Further Implementation of the Programme of Action of the International Conference on Population and Development. It calls for governments to promote human rights of women and girls and freedom from coercion, discrimination, violence, including harmful practice, and sexual exploitation and to review national legislation and amend those that discriminate against women and girls. It also calls for governments to ensure supervision of health providers to make sure that they are knowledgeable and trained to serve clients who have been subjected to harmful practice.
Further Actions and Initiatives to Implement the Beijing Declaration and Platform for Action. While it recognses the progress made in the national legislation process to ban the practice of FGM/FGC, it points out that discriminatory attitudes and norms persist that makes girls and women more vulnerable to gender-based violence including FGM/FGC. It calls for national governments' actions to combat and eliminate violence against women that are incompatible with the dignity and worth of the person.
Since FGM/FGC is practiced in different countries and cuts across ethnic groups, there are many different names used to describe different forms of FGM/FGC. For instance:
Sunna: Sunna means 'precept' or 'tradition' in Arabic and it refers to a range of practices that follow the teachings of Islam. It is used in various communities to refer to different types of FGM/FGC, varying from incisions in the clitoris to intermediate forms. References to the term 'sunna' in the Koran are often used to justify FGM/FGC as being a religious obligation.
In the following quotation Zainab (22) tells us that she was infibulated at the age of 8:
"My two sisters, myself and our mother went to visit our family back home. I assumed we were going for a holiday. A bit later they told us that we were going to be infibulated. The day before our operation was due to take place, another girl was infibulated and she died because of the operation. We were so scared and didn't want to suffer the same fate. But our parents told us it was an obligation, so we went. We fought back; we really thought we were going to die because of the pain. You have one woman holding your mouth so you won't scream, two holding your chest and the other two holding your legs. After we were infibulated, we had rope tied across our legs so it was like we had to learn to walk again. We had to try to go to the toilet, if you couldn't pass water in the next 10 days something was wrong. We were lucky, I suppose, we gradually recovered and didn't die like the other girl. But the memory and the pain never really goes". (WHO)
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The Programme of Action of the International Conference on Population and Development recognizes that violence against women is a widespread phenomenon. It states that : "In a number of countries, harmful practices meant to control women's sexuality have led to great suffering. Among them is the practice of female genital cutting, which is a violation of basic rights and a major lifelong risk to women's health (para 7.35).
The Programme of Action urges "Governments and communities (to). urgently take steps to stop the practice of female genital cutting and protect women and girls from all such similar unnecessary and dangerous practices. Steps to eliminate the practice should include strong community outreach programmes involving village and religious leaders, education and counseling about its impact on girls' and women's health, and appropriate treatment and rehabilitation for girls and women who have suffered cutting. Services should include counseling for women and men to discourage the practice." (para 7.40)
In Chapter 4 (Gender Equality, Equity and Empowerment of Women) the following paragraphs pertain to FGM/FGC:
Para 4.4: "Countries should act to empower women and should take steps to eliminate inequalities between men and women as soon as possibly by :
c) Eliminating all practices that discriminate against women; assisting women to establish and realize their rights, including those that relate to reproductive and sexual health".
Para 4.9: "Countries should take full measure to eliminate all forms of exploitation, abuse, harassment and violence against women, adolescents and children".
The Report of the Ad Hoc Committee of the Whole of the Twenty-first Special Session of the General Assembly, indicates key actions for the further implementation of the Programme of Action of the International Conference on Population and Development. It states that :
Para 42: "Governments should promote and protect the human rights of the girl child and young women, which include economic and social rights as well as freedom from coercion, discrimination and violence, including harmful practices and sexual exploitation."
Para 43: "Governments and civil society should take actions to eliminate attitudes and practices that discriminate against and subordinate girls and women and that reinforce gender inequality."
Para 48: "Governments should give priority to developing programmes and policies that foster norms and attitudes of zero tolerance for harmful and discriminatory attitudes, including son preference, which can result in harmful and unethical practices such as prenatal sex selection, discrimination and violence against the girl child and all forms of violence against women, including female genital mutilation, rape, incest, trafficking, sexual violence and exploitation."
Para 52 f: "Governments, in collaboration with civil society, including non-governmental organizations, donors and the United Nations system, should : Ensure that sexual and reproductive health programmes, free of any coercion, provide pre-service and in-service training and supervision for al levels of health-care providers to ensure that they maintain high technical standards, including for hygiene; respect the human rights of the people they serve; are knowledgeable and trained to serve clients who have been subjected to harmful practices, such as female genital mutilation and sexual violence."
Para 52 g: "Promote men's understanding of their roles and responsibilities with regard to respecting the human rights of women; .. and promoting the elimination of harmful practices, such as female genital mutilation, and sexual and other gender-based violence, ensuring that girls and women are free from coercion and violence."
UNFPA addresses the practice of FGM/FGC not only because of its harmful impact on the reproductive and sexual health of women, but also because it is a violation of women's fundamental human rights. The basis for a rights approach is the affirmation that human well-being and health is influenced by the way a person is valued, respected and given the choice to decide on the direction of her/his life without discrimination, coercion or neglect of attention. UNFPA addresses FGM/FGC in a holistic manner, within its cultural and religious context; however cultural arguments can not be used to condone harmful practices such as FGM/FGC.
"Female Genital Mutilation. A Joint WHO/UNICEF/UNFPA Statement." 1997
"Female Genital Mutilation: The Practice." WHO Information Package. 1994
"Visions and Discussions on Genital Mutilation of Girls. An International Survey." Jacqueline Smith, 1995.
"Caring for women with circumcision. A technical manual for healthcare providers." Nahid Toubia, Rainbo, 1999
"Socio-cultural aspects of female genital cutting." M. de Bruyn, KIT, 1998.
"Medical aspects of female genital mutilation." E. Leye, K. Roelens, M. Temmerman. International Center for Reproductive Health, University of Gent. 1998 CRLP Factsheet on FGC
"s Lands wijs, 's lands eer? Vrouwenbesnijdenis en Somalische vrouwen in Nederland". K. Bartels and I. Haaijer, 1992
"FGC management during pregnancy, childbirth and post-partum period.". Background paper for WHO Consultation, 15-17 October 1997, Geveva. Prof. H. Rushwan.
"Learning about social change. A research and evaluation guidebook using female circumcision as a case study". S. Izett, N. Toubia. Rainbo 1999
"Towards the Eradication of Female Genital Mutilation in Egypt". M. Hekmati, 1999
ECOSOC document E/CN.4/Sub.2/1999/14 : "Third report on the situation regarding the elimination of traditional practices affecting the health of women and the girl child", by Ms. Halima Embarek Warzazi, pursuant to sub-commission resolution 1998/16
General Assembly document A/54/34 : "Traditional or customary practices affecting the health of women". Report of the Secretary-General
General Assembly document A/C.3/54/C.13 : "Traditional or customary practices affecting the health of women and girls".