Eliminating FGM

WHO is currently supporting studies that will increase knowledge on how best to contribute to the abolition of FGM.

The studies cover three major themes:

FGM and decision-making processes

Recent reviews suggest that one reason for the limited success in eliminating FGM is that there is insufficient understanding of the decision- making process. In most countries where FGM is prevalent, more women than men support the practice. Women's attitudes to FGM are complex: in countries where the practice is almost universal, many women say it should be stopped and a large proportion of the women who say it should be stopped still ensure that their own daughters undergo the procedure.

A study in areas on the Senegal–Gambia border is looking at how decisions on FGM are made. Preliminary results show that:

The main factors promoting abandonment of FGM were: fear of legal prosecution, fear of transmitting HIV/AIDS, and direct experiences of death or adverse health outcome.

Important factors in the continuation of the practice were: peer pressure, both for adults and children, and pressure from the older generation. Marriageability did not play a central role.

Decisions on FGM of daughters are generally taken by the extended family, in which grandmother and paternal aunts exercising considerable influence. Also some adult women are subjected to FGM when marrying into groups who practice FGM. In those cases, pressure from co-wives and the man's family is important.

Some information from the first phase of this study can be found in: Are there "stages of change" in the practice of female genital cutting?: qualitative research findings from Senegal and the Gambia - African Journal of Reproductive Health 2006; 10 [2]: 57-71

Community interventions to eradicate FGM

An operations research study has been designed to introduce a combination of community-based interventions that have been shown to contribute to the abandonment of FGM. An extensive review of interventions has shown that activities such as community awareness-raising, promotion of intergenerational dialogue, and other social mobilization activities can contribute to behaviour change. The study will start in Burkina Faso and Sudan in 2007.

FGM and sexuality

In the first half of 2006 the Programme issued a call for proposals for research on “the role of female sexuality in women’s continued support of FGM”. Specifically, the research should examine how sociocultural beliefs about, among other factors, female sexuality, sexual morality and femininity affect women’s support of FGM and also how interventions should best be designed to induce women to withdraw their support for the practice. HRP received 30 research proposals, of which two have been selected for funding. For reference see call for proposals (Call for proposals is closed)
Reference:
(1) WHO, http://www.who.int/reproductive-health/fgm/eliminating.htm

What will it take to stop FGM?

As long as women have no property or ownership rights, they cannot control their bodies and lives. It is obvious that it is in the economic interest of every African man to continue FGM. And because there is a global mutual support system among men (though it is never discussed), most men in all societies do not speak against practices to control women, let alone work effectively to stop them. Evidence of this complicity is seen in the failure of the vast number of international organizations such as WHO, UNICEF, and UNDP to do anything effective to stop this butchery. It is absolutely certain that if similar tortures were inflicted on boy children the whole world would rise up to stop it by any and all means.

Although FGM has been classified as a human rights violation by the U.N. Office of Human Rights in Geneva and at the 1993 U.N. Human Rights Conference in Vienna, and medicalization of FGM is a criminal offense and against the statutes of most national and international medical associations in much of the world, the means to globally carry out a ban on FGM in any form is lacking.

In spite of the historic 1948 document the Universal Declaration of Human Rights, which set the standards for the achievement of human rights and which has had a powerful influence on the development of contemporary international law; in spite of the U.N.'s 1952 Convention on the Political Rights of Women; in spite of the U.N.'s 1962 Convention on Consent to Marriage, Minimum Age for Marriage, and Registration of Marriages; in spite of the U.N.'s 1959 Declaration of the Rights of the Child and the 1989 Convention on the Rights of the Child (see Dianne Tangel-Cate's article on page 5 and David Gallup's article on page 7); and in spite of the U.N.'s 1967 Declaration on the Elimination of Discrimination Against Women, women and girl children are the victims of continuing and flagrant violations of their human rights. The incomprehensible part of all this is that most of the the countries that allow FGM have ratified these conventions.

As is continually pointed out, the U.N. has no enforcement powers nor will the nation-states willingly "give up" male control of women and children. Only with a World Court of Law will there be protection for the oppressed of the world.

Reference:
(1) By Marcia L. Mason, http://images.google.com/imgres?imgurl=http://www.worldservice.org/issues/junjul96/fgm.gif&imgrefurl=http://www.worldservice.org/issues/junjul96/fgm.html&h=774&w=544&sz=102&hl=en&start=31&um=1&tbnid=DWNNio99kLZeIM:&tbnh=142&tbnw=100&prev=/images%3Fq%3DFGM%26start%3D20%26ndsp%3D20%26svnum%3D10%26um%3D1%26hl%3Den%26sa%3DN

The key to the problem

In the rural economy of Africa, which includes a traditional caste system, "women are chattel and the wholly owned property of men," according to Fran Hosken. In other words, they are slaves! They are traded or sold (by bride-price) between men, and they and their children are used as the male-owned agricultural labor force. Most women have no access to health care and are completely ignorant about the most basic and vital functions of their bodies, even though many in Africa go through 10 or more pregnancies-often until they die in childbirth. But then, ignorance is a means of control as is FGM, wife abuse and rape-traditional rights of African men. Educated young women in the cities who are self-supporting often remain single to avoid male abuse.

What drives women to continue FGM? Fear! In a society where a woman has no economic rights-cannot own property, is not allowed to work for herself, has little access to education-marriage is all-important. And when the controlling gender insists FGM is an essential requirement for marriage in all African societies where it is practiced, the only recourse is to submit or escape.

Reference:
(1) By Marcia L. Mason, http://images.google.com/imgres?imgurl=http://www.worldservice.org/issues/junjul96/fgm.gif&imgrefurl=http://www.worldservice.org/issues/junjul96/fgm.html&h=774&w=544&sz=102&hl=en&start=31&um=1&tbnid=DWNNio99kLZeIM:&tbnh=142&tbnw=100&prev=/images%3Fq%3DFGM%26start%3D20%26ndsp%3D20%26svnum%3D10%26um%3D1%26hl%3Den%26sa%3DN

Testimony

'I was genitally mutilated at the age of ten. I was told by my late grandmother that they were taking me down to the river to perform a certain ceremony, and afterwards I would be given a lot of food to eat. As an innocent child, I was led like a sheep to be slaughtered.

Once I entered the secret bush, I was taken to a very dark room and undressed. I was blindfolded and stripped naked. I was then carried by two strong women to the site for the operation. I was forced to lie flat on my back by four strong women, two holding tight to each leg. Another woman sat on my chest to prevent my upper body from moving. A piece of cloth was forced in my mouth to stop me screaming. I was then shaved.

When the operation began, I put up a big fight. The pain was terrible and unbearable. During this fight, I was badly cut and lost blood. All those who took part in the operation were half-drunk with alcohol. Others were dancing and singing, and worst of all, had stripped naked.

I was genitally mutilated with a blunt penknife.

After the operation, no one was allowed to aid me to walk. The stuff they put on my wound stank and was painful. These were terrible times for me. Each time I wanted to urinate, I was forced to stand upright. The urine would spread over the wound and would cause fresh pain all over again. Sometimes I had to force myself not to urinate for fear of the terrible pain. I was not given any anaesthetic in the operation to reduce my pain, nor any antibiotics to fight against infection. Afterwards, I haemorrhaged and became anaemic. This was attributed to witchcraft. I suffered for a long time from acute vaginal infections.''

Hannah Koroma, Sierra Leone

Why FGM is practised?

Cultural identity

''Of course I shall have them circumcised exactly as their parents, grandparents and sisters were circumcised. This is our custom.''

An Egyptian woman, talking about her young daughters [4]Custom and tradition are by far the most frequently cited reasons for FGM. Along with other physical or behavioural characteristics, FGM defines who is in the group. This is most obvious where mutilation is carried out as part of the initiation into adulthood.

Jomo Kenyatta, the late President of Kenya, argued that FGM was inherent in the initiation which is in itself an essential part of being Kikuyu, to such an extent that ''abolition... will destroy the tribal system''.[2] A study in Sierra Leone reported a similar feeling about the social and political cohesion promoted by the Bundo and Sande secret societies, who carry out initiation mutilations and teaching.

Many people in FGM-practising societies, especially traditional rural communities, regard FGM as so normal that they cannot imagine a woman who has not undergone mutilation. Others are quoted as saying that only outsiders or foreigners are not genitally mutilated. A girl cannot be considered an adult in a FGM-practising society unless she has undergone FGM.

Gender identity

FGM is often deemed necessary in order for a girl to be considered a complete woman, and the practice marks the divergence of the sexes in terms of their future roles in life and marriage. The removal of the clitoris and labia - viewed by some as the ''male parts'' of a woman's body - is thought to enhance the girl's femininity, often synonymous with docility and obedience. It is possible that the trauma of mutilation may have this effect on a girl's personality. If mutilation is part of an initiation rite, then it is accompanied by explicit teaching about the woman's role in her society.

''We are circumcised and insist on circumcising our daughters so that there is no mixing between male and female... An uncircumcised woman is put to shame by her husband, who calls her 'you with the clitoris'. People say she is like a man. Her organ would prick the man...''

An Egyptian woman [3]

Control of women's sexuality and reproductive functions

''Circumcision makes women clean, promotes virginity and chastity and guards young girls from sexual frustration by deadening their sexual appetite.''

Mrs Njeri, a defender of female genital mutilation in Kenya[4]

In many societies, an important reason given for FGM is the belief that it reduces a woman's desire for sex, therefore reducing the chance of sex outside marriage. The ability of unmutilated women to be faithful through their own choice is doubted. In many FGM-practising societies, it is extremely difficult, if not impossible, for a woman to marry if she has not undergone mutilation. In the case of infibulation, a woman is ''sewn up'' and ''opened'' only for her husband. Societies that practise infibulation are strongly patriarchal. Preventing women from indulging in ''illegitimate'' sex, and protecting them from unwilling sexual relations, are vital because the honour of the whole family is seen to be dependent on it. Infibulation does not, however, provide a guarantee against ''illegitimate'' sex, as a woman can be ''opened'' and ''closed'' again.

In some cultures, enhancement of the man's sexual pleasure is a reason cited for mutilation. Anecdotal accounts, however, suggest that men prefer unmutilated women as sexual partners.

Beliefs about hygiene, aesthetics and healthCleanliness and hygiene feature consistently as justifications for FGM. Popular terms for mutilation are synonymous with purification (tahara in Egypt, tahur in Sudan), or cleansing (sili-ji among the Bambarra, an ethnic group in Mali). In some FGM-practising societies, unmutilated women are regarded as unclean and are not allowed to handle food and water.

Connected with this is the perception in FGM-practising communities that women's unmutilated genitals are ugly and bulky. In some cultures, there is a belief that a woman's genitals can grow and become unwieldy, hanging down between her legs, unless the clitoris is excised. Some groups believe that a woman's clitoris is dangerous and that if it touches a man's penis he will die. Others believe that if the baby's head touches the clitoris during childbirth, the baby will die.

Ideas about the health benefits of FGM are not unique to Africa. In 19th Century England, there were debates as to whether clitoridectomy could cure women of ''illnesses'' such as hysteria and ''excessive'' masturbation. Clitoridectomy continued to be practised for these reasons until well into this century in the USA. However, health benefits are not the most frequently cited reason for mutilation in societies where it is still practised; where they are, it is more likely to be because mutilation is part of an initiation where women are taught to be strong and uncomplaining about illness. Some societies where FGM is practised believe that it enhances fertility, the more extreme believing that an unmutilated woman cannot conceive. In some cultures it is believed that clitoridectomy makes childbirth safer.

Religion

FGM predates Islam and is not practised by the majority of Muslims, but has acquired a religious dimension. Where it is practised by Muslims, religion is frequently cited as a reason. Many of those who oppose mutilation deny that there is any link between the practise and religion, but Islamic leaders are not unanimous on the subject. The Qur'an does not contain any call for FGM, but a few hadith (sayings attributed to the Prophet Muhammad) refer to it. In one case, in answer to a question put to him by 'Um 'Attiyah (a practitioner of FGM), the Prophet is quoted as saying ''reduce but do not destroy''.

Mutilation has persisted among some converts to Christianity. Christian missionaries have tried to discourage the practice, but found it to be too deep rooted. In some cases, in order to keep converts, they have ignored and even condoned the practice.

FGM was practised by the Falasha (Ethiopian Jews), but it is not known if the practise has persisted following their emigration to Israel. The remainder of the FGM-practising community follow traditional Animist religions.

Reference:
(1) http://web.amnesty.org/library/index/ENGACT770061997
(2) Kenyatta, J., Facing Mount Kenya: The Tribal Life of the Kikuyu, Secker and Warburg, London, 1938.
(3) Assaad, M.B., ibid.
(4) Katumba, R., ''Kenyan Elders Defend Circumcision'', Development Forum, September, 1990, p. 17.

The origins of FGM

It is believed that FGM started in Egypt some 2,000 years ago and spread from there (The Hosken Report: Genital and Sexual Mutilation of Females). Since then, the number of mutilated women and girls in 26 African countries, parts of Asia and the Middle East is continuously increasing due to population growth. (See the table on Female Genital Mutilation, "Estimate: Total Number of Girls and Women Mutilated in Africa," page 12). Due to growing civil wars and ethnic strife, more refugees from Africa are coming mainly to Europe and North America, most of them bringing their customs along-including FGM.

Only a few years ago, FGM was considered a cultural tradition. Now the United Nations has labeled FGM a violation of human rights. Canada has declared FGM grounds for seeking asylum. The Dutch government states in no uncertain terms that the genital mutilation of girls is a punishable offense in the Netherlands and will not be tolerated. And the U.S. Immigration Service, because of the bravery of Fauziya Kasinga (see below), could be considering FGM a type of harm, even persecution, that could qualify someone for protection under the Refugee Act.

Reference:
(1) Marcia L. Mason, http://images.google.com/imgres?imgurl=http://www.worldservice.org/issues/junjul96/fgm.gif&imgrefurl=http://www.worldservice.org/issues/junjul96/fgm.html&h=774&w=544&sz=102&hl=en&start=31&um=1&tbnid=DWNNio99kLZeIM:&tbnh=142&tbnw=100&prev=/images%3Fq%3DFGM%26start%3D20%26ndsp%3D20%26svnum%3D10%26um%3D1%26hl%3Den%26sa%3DN

Trends

Although prevalence data obtained over the last decade have shown little change in the frequency of FGM, they do reveal several trends. Possibly as a result of an emphasis on the negative health implications of FGM, there has been a dramatic increase in the proportion of FGM operations carried out by trained health-care personnel. Today, 94% of women in Egypt arrange for their daughters to undergo this “medicalized” form of FGM, 76% in Yemen, 65% in Mauritania, 48% in Côte d’Ivoire, and 46% in Kenya. This approach may reduce some of the immediate consequences of the procedure (such as pain and bleeding) but, as WHO and UNICEF point out, it also tends to obscure its human rights aspect and could hinder the development of long-term solutions for ending the practice.
There has also been a lowering in some countries of the average age at which a girl is subjected to the procedure. This could be to some extent the result of anti-FGM legislation: the younger the girl, the easier it is to elude legal scrutiny. Another possible adverse effect of legislation is, as often occurs with abortion, its tendency to drive FGM underground or encourage a cross-border movement of women from a country where the practice is illegal to a neighbouring country where it is allowed.
One encouraging trend seen consistently in countries for which data from at least two surveys are available is that women aged 15–19 years are less likely to have been submitted to FGM than are women in older age groups. In almost all of these countries, support for the discontinuation of the practice is particularly high among younger women.





Figure 1: Prevalence of FGM in women and daughters

Notes: Countries are listed from higher to lower levels of FGM/C among women
Source: Female genital mutilation/cutting: a statistical exploration. New York, NY: UNICEF; 2005.

Reference:
(1) http://www.who.int/reproductive-health/fgm/trends.htm
(2) Yoder PS, Abderrahim N, Zhuzhuni A. Female genital cutting in the Demographic Health Surveys: a critical and comparative analysis. Calverton, MD: ORC Marco; 2004 (DHS Comparative Reports No. 7).

The physical and psychological effects of female genital mutilation

Physical effects

The effects of genital mutilation can lead to death. At the time the mutilation is carried out, pain, shock, haemorrhage and damage to the organs surrounding the clitoris and labia can occur. Afterwards urine may be retained and serious infection develop. Use of the same instrument on several girls without sterilization can cause the spread of HIV.

More commonly, the chronic infections, intermittent bleeding, abscesses and small benign tumours of the nerve which can result from clitoridectomy and excision cause discomfort and extreme pain.

Infibulation can have even more serious long-term effects: chronic urinary tract infections, stones in the bladder and urethra, kidney damage, reproductive tract infections resulting from obstructed menstrual flow, pelvic infections, infertility, excessive scar tissue, keloids (raised, irregularly shaped, progressively enlarging scars) and dermoid cysts.

First sexual intercourse can only take place after gradual and painful dilation of the opening left after mutilation. In some cases, cutting is necessary before intercourse can take place. In one study carried out in Sudan, 15% of women interviewed reported that cutting was necessary before penetration could be achieved.Some new wives are seriously damaged by unskilful cutting carried out by their husbands. A possible additional problem resulting from all types of female genital mutilation is that lasting damage to the genital area can increase the risk of HIV transmission during intercourse.

During childbirth, existing scar tissue on excised women may tear. Infibulated women, whose genitals have been tightly closed, have to be cut to allow the baby to emerge. If no attendant is present to do this, perineal tears or obstructed labour can occur. After giving birth, women are often reinfibulated to make them ''tight'' for their husbands. The constant cutting and restitching of a women's genitals with each birth can result in tough scar tissue in the genital area.

The secrecy surrounding FGM, and the protection of those who carry it out, make collecting data about complications resulting from mutilation difficult. When problems do occur these are rarely attributed to the person who performed the mutilation. They are more likely to be blamed on the girl's alleged ''promiscuity'' or the fact that sacrifices or rituals were not carried out properly by the parents. Most information is collected retrospectively, often a long time after the event. This means that one has to rely on the accuracy of the woman's memory, her own assessment of the severity of any resulting complications, and her perception of whether any health problems were associated with mutilation.

Some data on the short and long-term medical effects of FGM, including those associated with pregnancy, have been collected in hospital or clinic-based studies, and this has been useful in acquiring a knowledge of the range of health problems that can result. However, the incidence of these problems, and of deaths as a result of mutilation, cannot be reliably estimated. Supporters of the practice claim that major complications and problems are rare, while opponents of the practice claim that they are frequent.

Effects on sexuality

Genital mutilation can make first intercourse an ordeal for women. It can be extremely painful, and even dangerous, if the woman has to be cut open; for some women, intercourse remains painful. Even where this is not the case, the importance of the clitoris in experiencing sexual pleasure and orgasm suggests that mutilation involving partial or complete clitoridectomy would adversely affect sexual fulfilment. Clinical considerations and the majority of studies on women's enjoyment of sex suggest that genital mutilation does impair a women's enjoyment. However, one study found that 90% of the infibulated women interviewed reported experiencing orgasm. The mechanisms involved in sexual enjoyment and orgasm are still not fully understood, but it is thought that compensatory processes, some of them psychological, may mitigate some of the effects of removal of the clitoris and other sensitive parts of the genitals.

Psychological effects

The psychological effects of FGM are more difficult to investigate scientifically than the physical ones. A small number of clinical cases of psychological illness related to genital mutilation have been reported. Despite the lack of scientific evidence, personal accounts of mutilation reveal feelings of anxiety, terror, humiliation and betrayal, all of which would be likely to have long-term negative effects. Some experts suggest that the shock and trauma of the operation may contribute to the behaviour described as ''calmer'' and ''docile'', considered positive in societies that practise female genital mutilation.

Festivities, presents and special attention at the time of mutilation may mitigate some of the trauma experienced, but the most important psychological effect on a woman who has survived is the feeling that she is acceptable to her society, having upheld the traditions of her culture and made herself eligible for marriage, often the only role available to her. It is possible that a woman who did not undergo genital mutilation could suffer psychological problems as a result of rejection by the society. Where the FGM-practising community is in a minority, women are thought to be particularly vulnerable to psychological problems, caught as they are between the social norms of their own community and those of the majority culture.

Short-term consequences

Severe pain and bleeding are the most common immediate consequences of all forms of FGM. Since in most cases the procedure is carried out without anaesthesia, the resulting pain and trauma can produce a state of clinical shock. In some cases, bleeding can be protracted and result in long-term anaemia.

Infections are also common, particularly if the procedure is carried out in unhygienic conditions or with unsterilized instruments, and in severe cases can include potentially fatal septicaemia and tetanus. Urinary retention is also a frequent complication, especially when skin is stitched over the urethra.

Long-term consequences

Long-term adverse effects include abscesses, painful cysts and thick, raised scars called keloids, which can, in turn, cause problems during subsequent pregnancy and childbirth. Deinfibulation, for the purpose of reopening the vaginal orifice after it has been stitched or narrowed, and reinfibulation, to reduce the vaginal opening after deinfibulation, are sometimes performed at each birth, with potentially dire health consequences. Other long-term complications include infertility and haematocolpos (the accumulation of menstrual fluid in the vagina).

Up to now, attempts to determine scientifically the incidence, prevalence and risk of specific health consequences of FGM have been hampered by the lack of well designed large-scale studies on the subject, as well as the reluctance and/or inability of many women and girls who have undergone the procedure to provide accurate details about the circumstances of their experience and the medical consequences that might, or might not be, attributable to it. What is believed to be the first large-scale study to break through the silence and confusion enshrouding the subject was conducted by an HRP study group. Based on direct observation of more than 28 000 women in six African countries, the prospective study shows clearly that FGM is associated with an increased risk of obstetric complications, including caesarean section, postpartum haemorrhage, extended hospital stays, the need for infant resuscitation, stillbirth, early neonatal death and low birth weight. (3)

Physical consequences are only part of the damage that a girl or woman may suffer as a result of FGM. A wide range of psychological and psychosomatic disorders have been attributed to the practice, among them disordered eating and sleeping habits, changes in mood and symptoms of impaired cognition that include sleeplessness, recurring nightmares, loss of appetite, weight loss or excessive weight gain, as well as panic attacks, and difficulties in concentrating and learning. (4,5)

The extent of psychological damage produced by FGM is difficult to ascertain. As Sudanese physician and surgeon Nahid Toubia, who is also associate professor at Columbia University School of Public Health in New York, USA, notes, “the psychological effects are often subtle and are buried in layers of denial”.(6) She believes that there may be additional psychological implications for the immigrant women who live in western societies in which FGM is not traditionally practiced. These women have to deal with the conflicting attitudes of their traditional culture and of western culture towards FGM, sexuality and women’s rights. Evidence of the psychological effects of FGM is beginning to appear among immigrant communities in Europe, America and Australasia. (7)

One often neglected aspect of the medical and psychological problems ascribed to FGM is their impact on a girl’s education: absenteeism, poor concentration, low academic performance and loss of interest have been associated with FGM. (8)

References:
(1) http://web.amnesty.org/library/index/ENGACT770061997
(2) http://www.who.int/reproductive-health/fgm/impact.htm
(3) WHO study group on female genital mutilation and obstetric outcome. Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. Lancet 2006; 367:1835–41 (doi:10.1016/S0140-6736(06)68805-3).
(4) UNICEF. Global consultation on indicators, November 11–13, 2004, Child protection indicators framework. Female genital mutilation and cutting. New York, NY: UNICEF; 2004.
(5) Behrendt A, Moritz S. Posttraumatic stress disorder and memory problems after female genital mutilation. Am J Psychiatry 2005;162:1000–02.
(6) Toubia N. Female circumcision as a public health issue. N Engl J Med 1994;331:712–16.
(7) Johnsdotter S, Essén, B. Sexual health among young Somali women in Sweden: living with conflicting culturally determined sexual ideologies. Paper presented at the conference Advancing Knowledge on Psychosexual Effects of FGM: assessing the evidence, Alexandria, Egypt, 10–12 October, 2004; http://ask.lub.lu.se/ archive/00018019/01/Alexandria2004.pdf; visited on 24 July 2006.
(8) Basic education and female genital mutilation: GTZ topics. www.gtz.de/fgm/downloads/ eng_basic_education.pdf; visited on 24 July 2006.

Prevalence

FGC Around the World:

read this to get the infomation about FGC around the world:

http://www.fgmnetwork.org/intro/world.php

Estimates based on survey data suggest that worldwide between 100 million and 140 million girls and women alive today have undergone some form of FGM and that about 3 million do so every year. The procedure is generally carried out on girls under the age of 15 years, although obtaining data on FGM prevalence in that age group poses several methodological challenges, not least of which is ascertaining if and how the procedure was carried out. (2) Recent surveys have found that in Egypt 90% of girls who had undergone FGM were between five and 14 years of age when subjected to the procedure, 50% of those in Ethiopia, Mali and Mauritania were under five years of age, and 76% of those in the Yemen were not more than two weeks old. In some communities, women who are about to be married or are pregnant with their first child or who have just given birth also undergo the practice.

Most women who have experienced FGM live in one of the 28 countries in Africa or the Middle East where FGM is practised—nearly half of them in just two countries, Egypt and Ethiopia. The 28 countries span the continent in a belt running from Senegal on the west coast of Africa to Ethiopia and Somalia in the east, where Egypt juts to the north and Kenya and United Republic of Tanzania extend to the south. Recent survey data, available for 18 of these countries, show the prevalence of FGM to range from 5% to 97% of the female population (Figure 1).(2,3)

Some communities on the Red Sea coast of Yemen are also known to practise FGM and reportedly, though to a limited extent, FGM is also practised in Jordan, Oman, the Palestinian Territories (Gaza) and in certain Kurdish communities in Iraq. The practice has also been reported among population groups in India, Indonesia and Malaysia.
FGM is also practised among immigrant communities throughout the world. Families from Benin, Chad, Guinea, Mali, Niger and Senegal tend to migrate to France, where they continue the practice, whereas those from Kenya, Nigeria and Uganda generally settle in the United Kingdom. In the 1970s, refugees fleeing war and civil unrest in Eritrea, Ethiopia and Somalia brought FGM to several countries of Western Europe, including Norway, Sweden and Switzerland. Canada and the USA in North America, and Australia and New Zealand in Australasia also host women and children who have been subjected to FGM.

Reference:

(1) WHO, http://www.who.int/reproductive-health/fgm/prevalence.htm

Terminology and the main types of FGM

International consensus about the classification of the different forms of female genital mutilation has, at this writing, not been reached. Even the terms, such as “mutilation” and “cutting”, used to designate the practice are still the subject of debate. Some sociologists fear that parents may resent the implication that they are “mutilating” their daughters. “Cutting”, they maintain, is less judgmental and corresponds more to the term used in many local languages. UNICEF and other organizations wishing to retain “mutilation” for its presumed dissuasive connotation propose a compromise: “female genital mutilation/cutting (FGM/C)”.

Four types of FGM are recognized (1) at the present time:

Type I — excision of the prepuce, with or without excision of part or the entire clitoris.

Type II — excision of the clitoris with partial or total excision of the labia minora.

Type III — excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation)

Type IV — pricking, piercing or incising of the clitoris and/or labia; stretching of the clitoris and/or labia; cauterization by burning of the clitoris and surrounding tissue; scraping of tissue surrounding the vaginal orifice (angurya cuts) or cutting of the vagina (gishiri cuts); introduction of corrosive substances or herbs into the vagina to cause bleeding or for the purpose of tightening or narrowing it; and any other procedure that falls under the definition given above.

Defibulation or deinfibulation – Cutting open the scar tissue that has formed around the vaginal opening to allow penetration by her husband or for the birth of a child.
Refibulation or reinfibulation or recircumcision – The sewing up of a circumcised woman’s vaginal opening after childbirth or periodically during her life when she feels as though her opening has gotten too big or loose.
Alternative rituals – An alternative to FGM in which the traditional ceremony takes place without the actual cutting. In Kenya, girls go through a week-long program designed as a coming-of-age workshop. This ritual is called “Ntanira Na Mugambo” or “Circumcision Through Words.” Introcision – A form of FGM/C that is practiced by the Pitta-Patta aborigines of Australia where the vaginal orifice is enlarged by tearing it downward with three fingers bound with an opossum string. The procedure is performed by an elderly man when the girl reaches puberty. In other districts, the perineum is split with a stone knife. Compulsory sexual intercourse with a number of young men usually follows the introcision. Mexico, Brazil, and Peru reportedly practice this form of FGM/C. In Peru, among a division of Pano Indians, an elderly woman uses a bamboo knife to cut around the hymen from the vaginal entrance and severs the hymen from the labia, at the same time exposing the clitoris. Medicinal herbs are applied, followed by the insertion of a phallic clay object into the vagina.

Reference:
(1) http://www.who.int/reproductive-health/fgm/terminology.htm

(2) H. L. DIETRICH , http://www.fgmnetwork.org/intro/world.php

What is Female Genital Mutilation (GFM)?

Female Genital Mutilation (FGM) is a cultural practice that started in Africa approximately 2000 years ago. It is primarily a cultural practice, not a religious practice. But some religions do include FGM as part of their practices. This practice is so well ingrained into these cultures, it defines members of these cultures. In order to eliminate the practice one must eliminate the cultural belief that a girl will not become a women without this procedure.

Female Genital Mutilation is the term used for removal of all or just part of the external parts of the female genitalia. There are three varieties to this procedure.

1. Sunna Circumcision - consists of the removal of the prepuce(retractable fold of skin, or hood) and /or the tip of the clitoris. Sunna in Arabic means "tradition".

2. Clitoridectomy - consists of the removal of the entire clitoris (prepuce and glands) and the removal of the adjacent labia.

3. Infibulation(pharonic circumcision)-- consists of performing a clitoridectomy (removal of all or part of the labia minora, the labia majora). This is then stitched up allowing a small hole to remain open to allow for urine and menstrual blood to flow through.

In Africa 85% of FGM cases consist of Clitoridectomy and 15% of cases consist of Infibulation. In some cases only the hood is removed.

Reference:
http://members.tripod.com/~Wolvesdreams/FGM.html