Female Genital Mutilation: Origins and Impact
By: Michelle Kwan
According to the WHO, female genital mutilation (FGM), also known as female circumcision or female genital cutting, consists of “the partial or total removal of external female genitalia or other injury to the female genital organs for non-medical reasons.” Recognized internationally as a severe human rights violation on the basis of sexual discrimination, the practice has no known health benefits and results in complications such as excessive bleeding, severe pain, post-traumatic stress disorder, sepsis, urinary infection or difficulties with urine retention, fistulas, hematocolpos (condition where the vagina and uterus fill with blood), infertility, and more. Moreover, this practice normally occurs within non-sterile environments, in which practitioners use the same set of tools on multiple cases, leading to an increased risk of transmission of bloodborne pathogens such as hepatitis B, hepatitis C, and HIV. [1]
Moreover, the WHO classifies FGM into 4 distinct categories.
Type I involves the partial or total removal of the clitoral glans and its prepuce, or the clitoral hood; this procedure is also known as a clitorectomy.
Type II consists of the removal of the clitoris and the labia minora, and in some instances the labia majora as well.
Type III, however, includes the removal of the clitoris and partial removal of the labia minora and majora, followed by the stretching and closing of the remaining labia via suturing, as shown in Figure 1. This procedure is also known as infibulation, and the practitioner inserts a small stick-like object, such as a twig, into the wound as it heals in order to create a small opening for urine and menstrual blood to pass through. This gap is widened prior to sexual intercourse throughout a process known as deinfibulation, and later stitched back together post-childbirth. This constant process of restitching and sealing the vaginal opening increasing the risk of infection and engenders extreme levels of distress and shame.
Type IV includes all other harmful procedures with a non-medical basis, such as nicking, piercing, incising, and cauterization.
Fig. 1. WHO classification of types of FGM
Rooted in cultural and traditional norms prevalent in an overtly patriarchal society, FGM arose as a physical manifestation of ensuring premarital virginity, also thought of as a way to decrease a woman’s libido. Through this controlling procedure that perpetuates the societal idolization of chastity and purity at the expense of the well-being of women and girls, this process serves as a rite of passage that signifies the move into adulthood. Moreover, social conventions dictate that a girl weds promptly after the ritual, repressing a girl’s access to further education or employment opportunities.
Fig. 2. Map of percentage of girls and women aged 15-49 who have undergone FGM by country
https://www.who.int/images/default-source/health-topics/fgm/percentage-of-girls-and-women-aged-15-to-49-years-who-have-undergone-fgm-by-country.jpg?sfvrsn=a17141dc_2
Research from the UN notes that FGM is most apparent in 30 countries in Africa, with the practice being almost universal in Somalia, Egypt, Malie, and Sudan. The practice also appears within countries in Asia, such as India, Indonesia, Malaysia, Pakistan, and Sri Lanka; the Middle East, including Oman, the United Arab Emirates, Yemen, Iraq, Iran, and the State of Palestine; Eastern Europe, which involves Georgia and the Russian Federation; South America, such as Columbia, Ecuador, Panama, and Peru; and other regions with immigrant populations in Western Europe, North America, Australia, and New Zealand. [3]
However, forms of FGM vary across such countries, with some areas carrying out the practice during infancy, childhood, the time of marriage, after the first pregnancy, or after the birth of the first child, but the most common time is between the ages of 0 to 15 years. [3]
In addition, the WHO reports that over 200 million women and girls, who are alive today have undergone some sort of FGM. They also note that approximately 4.16 million girls around the world are at risk in 2021 alone, and this number is subject to increase as populations grow proportionally in countries where FGM is primarily concentrated in. [2]
However, the WHO notes that aid focuses primarily on FGM prevention via rescue and relocation missions, whereas they hope to branch out towards rehabilitation efforts as well as admonishing the medicalization of FGM, which is when healthcare providers perform the practice. Through advancements in science and the understanding of sterile procedures, FGM procedures have shifted into the healthcare provider sphere as well, with the WHO noting that approximately 1 in 4 women who have undergone female genital mutation, or an estimate 52 million worldwide, had FGM performed on them by health personnel. With Egypt and Sudan leading in the medicalization of FGM, with approximately 78% and 77% of total cases at the hands of medical practitioners in 2018, respectively, UNICEF directly notes the contradiction between the medical mandate of “do no harm” and the practice itself. As a result, UNICEF and the UN hold education as a fundamental step in raising awareness about the procedure, especially in a medical sense, as training is necessary for both approaching and refusing patients desiring FGM and also through deinfibulation procedures to restore the vaginal opening. [4]
The ethics behind the medicalization of FGM lie mainly in the fact that healthcare providers facilitate the process in a sterile environment. However, the practice violates the medical ethic of “do no harm,” as any form of genital mutilation with no medical justification solely increases risks from surgery and puts the girls under extreme forms of duress. [3]
In the same vein, many believe that government policies should not interfere with the cultural practice, creating an ethical dilemma regarding how to approach resolution strategies with cultural sensitivity in mind. However, the UNFPA notes that, “[b]ehaviour 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.” Thus, organizations seeking to abolish the practice emphasize the prioritization of the physical safety and emotional well-being of girls and women.
Other current movements include the UN’s inclusion of FGM as target 3 within Goal 5, title “Reaching Female Equality,” of their 17 Sustainable Development Goals for their 2030 Agenda for Sustainable Development. [5] In a concentrated push to hopefully eradicate the practice by 2030, the UN designated February 6 as “International Day of Zero Tolerance for Female Genital Mutilation” in hopes of raising awareness about the practice and accepting donations that aid those who underwent FGM. [6] The UN has already apportioned approximately $2.4 billion over the next decade towards FGM reduction efforts, which translates to approximately $95 for each girl safeguarded.
In addition, the coronavirus pandemic puts more women and girls at risk for undergoing FGM, as the lockdown restrictions both restrict aid from outside sources and also increases opportunities for the ritual to be performed. The UN estimates 2 million more girls could be at risk of FGM due to the pandemic, which is compounded with the 3 million girls predicted to face FGM every year. This is one result of a larger phenomenon termed by the UN as a “shadow pandemic,” which consists of greater violence against women as a product of tension spurred by constant confinement and an inhibited ability to reach out for help. [7]
In sum, WHO’s approach towards eradicating female genital mutilation consists of first strengthening the health sector response, which consists of greater education towards medical personnel of the impacts of female genital mutilation and how to provide care and counseling to those who have undergone the process. Second, they emphasize the need to increase advocacy towards ending the practice by sharing stories and raising awareness of the international issue. Lastly, they intend on focusing on policy in order to pass legislation outlawing this practice.
For more information on FGM, visit the UNFPA FGM Dashboard (www.unfpa.org/data/dashboard/fgm)
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“Female Genital Mutilation.” World Health Organization, World Health Organization, www.who.int/news-room/fact-sheets/detail/female-genital-mutilation.
“2 Million Additional Cases of Female Genital Mutilation Likely to Occur over next Decade Due to COVID-19.” UNICEF, 26 Feb. 2021, www.unicef.org/press-releases/2-million-additional-cases-female-genital-mutilation-likely-occur-over-next-decade.
“Female genital mutilation (FGM) frequently asked questions” UNFPA, July 2020, https://www.unfpa.org/resources/female-genital-mutilation-fgm-frequently-asked-questions#
“What do we know about assessing healthcare students and professionals’ knowledge, attitude and practice regarding female genital mutilation? A systematic review.” Abdulcadir, J., Say, L. & Pallitto, C. Reprod Health 14, 64 (2017). https://doi.org/10.1186/s12978-017-0318-1
“THE 17 GOALS | Sustainable Development.” United Nations, United Nations, sdgs.un.org/goals.
“International Day of Zero Tolerance for Female Genital Mutilation.” United Nations, United Nations, www.un.org/en/observances/female-genital-mutilation-day.
“The Shadow Pandemic: Violence against Women during COVID-19.” UN Women, www.unwomen.org/en/news/in-focus/in-focus-gender-equality-in-covid-19-response/violence-against-women-during-covid-19.