The following information is sensitive in nature and suited for mature readers only. Also, this material should not be regarded as medical or legal advice.
What is female genital cutting (FGC)?
The terms female genital cutting (FGC), female circumcision, and female genital mutilation (FGM) are all used to describe the cultural practice of partly or totally removing portions of the external female genitalia. FGC ranges in severity from removing the clitoris with or without removing all or part of the labia. The minor form of FGC is when the clitoris is removed. The most severe form of FGC is when all external genitalia are removed and the vaginal opening is stitched nearly closed. Only a small opening is left for urine and menstrual blood.
The World Health Organization (WHO) condemns the practice of FGC as damaging to women both physically and emotionally. FGC is typically done without anesthesia or antibiotics. In some regions, midwives in the community perform FGC, but in many cases, people who are not medically trained perform it.
At what ages do young women undergo FGC?
FGC is performed on infants, girls and women of all ages. Sometimes it is done right before marriage or during a woman’s first pregnancy. On average, FGC is done on those between the ages of 4 and 12.
Where is FGC practiced?
The act of FGC is a cultural tradition generally performed across central Africa, in the southern Sahara, and in parts of the Arab peninsula. Although both Easterners and Westerners believe that FGC is associated with Islam, it is not. FGC is not condoned by any religions and is condemned by religious leaders. The practice however crosses religious barriers. Muslims, Christians and Jews in these regions have been known to circumcise their girls. FGC’s false association with religion has played a major role in perpetuating it.
Why is FGC practiced?
The reasons behind FGC are multifold and very complex. The fear of stopping this practice is also very real. Parents who support FGC believe that having it done will empower their daughters, ensure their ability to get married and protect the family’s reputation. In some groups, FGC is performed as a rite of passage into womanhood. It also is performed to preserve a woman’s chastity by restraining her sexual behavior. FGC is believed (by those who practice it) to lower a woman’s sexual desire. In some communities, women who are not circumcised can be viewed as dirty and be treated as outcasts. As mentioned above, religion is also used as a method of perpetuating the practice. Some communities believe that in order to be a good Muslim, one must circumcise their daughters.
There are also many superstitions surrounding female circumcision, such as:
The clitoris will continue to grow as a girl gets older and so it must be removed.
The external genitalia are unclean and can actually cause the death of an infant during delivery.
This controversial practice is deeply engrained into the community and the majority of parents are truly viewing their role as protecting their daughter’s future, and not harming or mutilating them.
How many women have received FGC?
More than 130 million girls and women have received FGC, and there are more than two million girls at risk of having FGC each year. In 1990, about 168,000 girls and women in the United States had either undergone FGC or were at risk for FGC. Of these, 48,000 were younger than 18 years old. According to the African Women’s Health Center, the new figures have increased. Using the 2000 census, 228,000 women have either undergone FGC or are at risk. Of these, 62,500 are under the age of 18.
What are the health problems caused by FGC?
FGC can cause a range of health problems, both short-term and long-term, depending upon the degree of the circumcision. But, the majority of circumcised women don’t suffer long-term complications. Those listed here tend to occur to some of the women who have undergone the most severe form.
Short-term health problems:
Bleeding or hemorrhaging: This happens in about 25 percent of both girls and women who have FGC. If the bleeding persists, girls can die.
Infection: The wound can get infected and develop into an abscess. Girls can get fevers, sepsis (a blood infection), shock and even death, if left untreated.
Pain: Girls are routinely cut without being numbed or having anesthesia. The worst pain tends to occur the day after when they have to urinate onto the wound.
Long-term health problems (usually occurs to women with the most severe form of FGC):
Problems going to the bathroom. In severe cases, women are left with only a small opening for urinating and menstrual bleeding. This can slow or strain the normal flow of urine, which can cause infections.
Not being able to have sex normally. The most severe form of FGC leaves women with scars that cover most of their vagina. This makes sex very painful. These scars can also develop into bumps (cysts or abscesses) or thickened scars (keloids) that can be uncomfortable.
Problems with gynecological health. Women who have had FGC sometimes have painful menstruation. It can also be hard for a health care provider to examine a woman’s reproductive organs if she has had a more severe form of FGC. Normal tools cannot be used to perform a Pap test or a pelvic exam.
Increased risk of sexually transmitted diseases (STDs), including HIV/AIDS. People who have no medical training, under unclean conditions, perform most forms of FGC. Many times, one tool is used for several procedures without sterilization. There is a growing concern that these conditions greatly increase the chance of spreading life-threatening infections such as hepatitis and HIV/AIDS.
Problems getting pregnant, and problems during pregnancy and labor. Infertility rates among women who have had FGC are as high as 25 to 30 percent and are mostly related to problems with being able to achieve sexual intercourse. The scar that covers the vagina makes this very difficult. Once pregnant, a woman can have drawn out labor, tears, heavy bleeding and infection during delivery – all causing distress to the infant and the mother. Health care providers who are unfamiliar with the scar will sometimes recommend a cesarean section. This is not necessary as women will be able to deliver once the scar is cut open. With rising numbers of young women coming to the United States from countries that practice FGC, U.S. doctors have begun caring for more and more patients who have been circumcised and facing some of these challenges.
Psychological and emotional stress. FGC is typically performed on very young girls. Some may not understand what is being done to them or why. The psychological effects of this painful experience are similar to those of post-traumatic stress disorder. Although very rare, girls and women who have had FGC may have problems sleeping, have more anxiety, and become depressed.
Why is FGC a human rights issue?
The WHO and the United Nations Commission on Human Rights, along with several African and Asian nations, have called for an end to the practice of FGC. The WHO views the practice as a violent act against a girl that causes her serious lifetime consequences. The American Medical Association (AMA) also condemns FGC and supports laws against it. There is also growing international support for condemning FGC and a call for severe penalties given to those who practice it.
In some countries where FGC is performed, leaders have tried to reduce the physical problems caused by the procedure by asking hospitals and doctors to do the surgery. This “medicalization” of FGC offends the international medical community, and is seen as a way for FGC supporters to give reason to its practice. Advocates have charged that doctors should not perform FGC, as their profession requires them to do no harm to their patients, despite cultural beliefs and practices.
An advocate is someone who supports or speaks in favor of something or a position. Advocates against FGC speak out against the practice.
Some cultures that practice FGC view it as their right. FGC supporters say that the Western practices of enlarging breasts and having other plastic surgery is comparable to FGC.
What are the laws regarding FGC?
The United States. There is a Federal law that makes the practice of FGC on anyone younger than 18 years of age illegal within this country. It is a felony punishable by fines or up to a 5-year prison term.
Some argue that such sanctions only force young women to return to their homeland where the surgery may not be performed in sanitary or safe conditions. As more people from cultures practicing FGC come to Western nations, this controversy has grown.
Internationally. International health organizations and women’s rights advocates generally believe that lasting change towards FGC can only take place with the support of the governments and local communities within those countries affected. Pressure from outside those countries has little chance for success if there is no educational and legal support from within their borders.
What is being done about FGC?
These are the most popular approaches used to try to stop the practice of FGC:
Education. In many regions, education is slowly changing attitudes and influencing the choice to have FGC. Many programs are culturally sensitive and use respected local women to teach other women and girls in their communities about the harmful effects of FGC. Recent research shows that women in these regions are beginning to support the worldwide call to end FGC.
Substituting a ritual that does not involve cutting. Some cultural groups have successfully substituted a ritual that does not involve cutting the genitals to mark a girl’s rite of passage into womanhood. In this way, the culture preserves its honor and starts new traditions that cause no harm to women.
Changing attitudes. Right now, women are made to feel disloyal to their culture by not choosing to have FGC. This pressure can change if doctors and other health care workers would talk with women about the dangers of FGC and other options that don’t involve cutting. Some human rights advocates also suggest that men could help reduce the practice of FGC by openly marrying uncircumcised women. Many human rights organizations are also calling on religious leaders to openly confirm that their religions do not require women to have FGC.
Laws. The choice to have a procedure with such permanent physical and emotional effects should only be made by an adult woman for herself.
Some suggested legal actions against FGC include:
Prosecute parents who force FGC on their minor age children.
Make health care workers report all cases of FGC.
Classify FGC as child abuse and prosecute it as such.
Make the criminal consequences of performing FGC more public.
Thirteen African countries enacted laws against FGC following the International Conference on Population and Development held in Egypt ten years ago. Even countries with the highest rates of FGC have recently openly noted the need for banning this practice. Fines and jail sentences are typically minor, but most view any sanctions against FGC as a good start.
Research. There is ongoing research into the physical and psychological effects of FGC. A number of advocacy groups hope to bring FGC out into the open to discuss the harmful effects of this violent practice.
For More Information…
For more information on female genital cutting, contact the National Women’s Health Information Center at 1-800-994-9662 or the following organizations:
To obtain a list of published and unpublished literature on FGC, contact: The Population Information Program of the Johns Hopkins Center for Communications Programs, The FGM Resource Group, POPLINE, 111 Market Place, Suite 310 Baltimore, MD 21202-4012 Telephone: (410) 659-6300 Internet Address: http://www.jhuccp.org