Female circumcision in Africa

Female Circumcision

Varying Conceptions of Female Genital Cutting

Female circumcision, common in many African nations, is commonly associated with many assumptions and stereotypes. Among these are the beliefs by many Westerners that female circumcision is forced on women, that it is carried out using primitive methods, and that it is horrible and barbaric in all cultures where it occurs (Dellenborg, 2004). Many of these assumptions are based in fact and do accurately depict the methods some women have undergone ("Female genital mutilation," 2006). Some current research, however, suggest an alternate view of female circumcision. Some cultures are carrying out these practices in a manner that defies stereotypes and reinforces cultural value, sometimes even increasing the roles and power of women in the community (Dellenborg, 2006; Absharaf, 2001). Researching the context and the current conditions surrounding what is a cultural, symbolic, personal, and often political subject is necessary to put the conceptions of female circumcision in Africa into perspective.

The World Health Organization (WHO), the United Nations Children's Fund (UNICEF), and other organizations offering aid in Africa place their concerns around female circumcision, also called female genital cutting, around the health and well being of the individuals they want to help ("Female genital mutilation," 2006). Their position is that female genital cutting poses a threat to the psychological, social, and physical well-being of girls and women, as well as all infants born to women with cutting. Yet, how extensive are these risks? How do they coincide with the implied social acceptance desired by those who commit themselves and their daughters to the tradition?

For thousands of years girls in Africa have endured genital cutting, often under conditions that did put their lives and well being at risk. Many areas now have better facilities, access to medical equipment, and trained (or partially trained) medical practitioners available. These advances have drastically affected both the choices and the outcomes for women in terms of female genital cutting. Some women and girls may undergo cutting in a safer environment, putting them at a lower risk for infection, hemorrhage, and complications. Those who have undergone cutting may also have access to medical facilities should there be complications with an operation or problems with childbirth due to female genital cutting.

These advances make female genital cutting even more difficult to fight against, especially since most supporters of the procedure are those who have undergone it themselves (von der Osten-Sacken & Uwer, 2007). Women who have undergone cutting and feel that it is necessary for their daughters are likely to use what they know of advancing medical availability in defense of what is an important tradition for them. As in many cultures, women (and men) are likely to prescribe themselves to traditions and conceptions of beauty and acceptability even under great risk or when outcomes are not considered ideal by outside cultures. In many communities, girls who have not undergone the procedure will be subject to harsh social judgment. How does this socially impact girls in comparison to the psychological and social impacts normally related to female genital cutting? If done in a physically safe manner, how unlike male circumcision is female genital cutting?

To identify risks related to female genital cutting it is necessary to look at the religious, social, physical, and political significance of the tradition. Since female genital cutting has a long history, many accounts exist both for and against it. Over the past century, many colonial attempts to restrict the tradition have also been made. Others attempts have been made to lessen the physical and social risks. How have all of these factors affected the current state of female genital cutting in Africa? Have medical and social advances, including globalization, affected the twenty-first century practice of female genital cutting?

Research investigating these questions is valuable on many levels. It is easy to accept the existing knowledge and research concerning female genital cutting, as it is easy for those in Western cultures to be horrified by the practice. However, much of the existing research falls short by providing inadequate data or by falling back on assumptions and information collected a decade or more ago. In an age of globalization, a lot can change in a decade. Using only research done in the twenty-first century, it is possible to identify what issues are still factors in the debate over female genital cutting. By doing so it may be possible to identify what physical, psychological, and social risks and implications female genital cutting has on the current population of African girls undergoing the procedure. It is also possible to identify what social and psychological gains may exist for the same women. Can varying conceptions of female genital cutting be reconciled? Is female genital cutting a barbaric tradition or does it play a crucial role in the cultural identity of African women?

Varying conceptions of female genital cutting in Africa in the twenty-first century: Cultural identity vs. barbaric tradition

1. Introduction

Female genital cutting evokes a strong emotional response from those in Western cultures. Many reports indicate that it is a barbaric practice, performed with un-sterilized cutting tools by untrained individuals (Boddy, 2006). Images of screaming girls forced to endure an un-anesthetized surgery are commonly indicated. Why would anyone do such a procedure on a young girl, likely a daughter or a loved one?

The answer to this question is quite complex. Thousands of years of history have played a part in the development of a tradition that has religious, social, cultural, physical, and even political impact (Abusharaf, 2001). Some might argue that female genital cutting is not unlike male circumcision but for the fact that the girls are normally older when the procedure occurs. Anthropologically, it is not uncommon for individuals of many cultures to undergo painful rituals to meet culturally prescribed ideals of beauty or acceptance. Yet, female genital cutting seems more disturbing to many because it affects the personal and sexual identities of women while also putting their lives and the lives of their children at risk.

In a global environment, Africa is no longer isolated in terms of knowledge and technology. More than one hundred years of colonial and missionary entry into the continent has made access to medical knowledge and care more prevalent. Though medical struggles are still obvious in a continent ravaged by both famine and HIV, it is no longer unheard of for women to receive prenatal care or to give birth in clinics ("Female genital mutilation," 2006). Has access to medical care and knowledge affected the risks involved in female genital cutting, or has it exacerbated it?

This paper intends to identify what risks or benefits exist for African women who undergo female genital cutting in the twenty first century. A review of the history and key terminology will establish a base knowledge on the subject, followed by a discussion of the religious/cultural, social, physical, and political significance. This paper will review existing literature on female genital cutting, with preference for essays and research committed after the year 2000. Discussion will identify what perceived risks and benefits exist for women undergoing female genital cutting in the twenty first century according to existing research and accounts. Do current modern conditions make the procedure an acceptable risk to maintain cultural identity? Is the cultural identity purportedly maintained by the tradition in itself a risk to the well being of girls in Africa? This paper will make conclusions and recommendations for additional research based on the relevance of the discussion.

2. Background

According to Yount (2007), classification of the different kinds of female genital cutting is currently under revision. However, there are historically four classifications, female genital mutilation/cutting (FGM/C) I-IV. Female genital cutting will be the preferred reference in this paper due to the neutral nature of its wording. It is sometimes also referred to as female circumcision. FGC I includes the removal or some or all of the clitoris. This may also be called clitoridectomy (Dellenborg, 2004). FGC II removes the clitoris and some or all of the labia minora (the inner vaginal lips). FGC III removes the clitoris, some or all of the labia minora, plus the cutting and suturing of the labia majora. This often includes the stitching or narrowing of the vaginal opening and is also called infibulation (Yount, 2007; "Female genital mutilation," 2006). FGC IV includes a variety of other, often radical, practices including cauterization, blood letting of the clitoris, cutting of the vagina, or the use of corrosive substances to tighten the area (Yount, 2007). Some methods are more common depending on the area and the person performing the procedure.

According to the World Health Organization, more than 100 million girls and women worldwide have undergone female genital cutting on some level ("Female genital mutilation," 2006). Girls undergoing the procedure range in age from a few days old to puberty (Abusharaf, 2001). Depending on the area, culture, ethnicity, class, and political climate, the procedure may be done secretly or may be a joyous community celebration. The actual surgery may be carried out by a trained or untrained midwife, a traditional healer, a barber, or a trained medical doctor or nurse (Abusharaf, 2001). Because of the private nature of the tradition and because the methods can range so greatly, it is difficult to adequately assess the details of female genital cutting in Africa.

The history of the tradition goes back thousands of years and is often (incorrectly) associated with religious dictates (von der Osten-Sacken & Uwer, 2007). It has long been associated with Islam, though there has been active opposition from many Islamic groups to prove otherwise; the procedure is not mentioned or sanctioned by the Quran (Abdelmagied, Salah, ElTahir, NurEldin, & Shareef, 2005; Abusharaf, 2001). However, it is mentioned in the Hadith, the oral tradition of Muhammad used by the Sunnah Muslim traditions; even here it does not advise for or against the procedure (von der Osten-Sacken & Uwer, 2007).

Still, many groups use religion as a way to explain female genital cutting. Dellenborg (2004) reports that clitoridectomy has been spreading as part of female cultural identity under Islam since the mid-twentieth century. Additionally, illiteracy and lack of access to information has led to the belief by many Muslims that some form of female genital cutting is prescribed for religious purity (von der Osten-Sacken & Uwer, 2007).

Whether a religion dictates the procedure or not, female genital cutting plays an extremely important cultural and social role in many areas. One common association with the procedure is that the removal of the clitoris and other genitalia is a symbol of chastity and purity (von der Osten-Sacken & Uwer, 2007). Theoretically, the removal of the external genitalia makes sexual contact less enjoyable so that a girl is less likely to be tempted by premarital sex. The most severe genital cutting and infibulation also proves a girl's virginity since she has been sewn shut (Morris, 2006). The implication of both of these arguments is that women participate in genital cutting to prove to men that they are virginal and chaste. This is partially true; chastity is, as in many cultures, valued in Muslim societies. However, Dellenborg (2004) and Abusharaf (2001) offer alternative views on the cultural need for genital cutting.

In sharp contrast to the assumption that African women are helplessly at the whim of male dominated society, Abusharaf (2001) argues that some female genital cutting empowers women. He points to the tradition of women carrying out the ritual, explaining that it is an important rite of passage rather than a forced patriarchal custom (Abusharaf, 2001). Along the same lines, Dellenborg (2004) points to the women of Jola society in Senegal, Gambia. These women use clitoridectomy as a rite, initiating women into a female secret society that actually established power for them within their social circle. Dellenborg (2004) explains Western conceptions of femininity and sexuality have difficulty understanding this choice, as our ideas of femininity and sexuality are so drastically different. Yet, male circumcision is common in most westernized nations and it, too, reduces sexual pleasure in efforts to conform to social norms. The Jola have told researchers that clitoridectomy does not relate to their sexuality in a negative way and in fact enriches their lives as women (Dellenborg, 2004). Other rituals, like smoke-bathing and deplation, use heat and pain for purification and do not meet with such adamant arguments (Boddy, 2006).

One account from Sudan explains that the cultural and spiritual importance of the purification ritual maintains the important of the community unit (Boddy, 2006). The woman explains that the Arabic word for womb (rihm) is not usually used; instead, the idiom baytal-wilada, meaning house of childbirth, is used. The implication is that the woman's body, like the high-walled domestic structure used for childbirth, is meant to enclose and protect the value of their kin and family (Boddy, 2006). In this way, the suturing or sewing of the female genitalia is symbolic of the protection of family and family values.

Perhaps the most problematic argument against female genital cutting is the physical issues. Women are physically at risk from the procedure, as are their infants during birth and pregnancy ("Female genital mutilation," 2006). Historically, primitive methods incorporated in the procedures have caused infection and death in many girls. Hemorrhaging from a poorly done surgery is still a major risk where female genital cutting is performed by untrained individuals. Because genital cutting can cause scar tissue around the vaginal opening, giving birth is often problematic for women who have had extensive cutting performed on them. This puts infants at risk if labors are longer and puts both mother and child at risk in cases where scar tissue is cut away by midwives (Boddy, 2006).

Finally, the political significance of female genital cutting should be mentioned, as it ties in to the cultural and social aspects of the rite. Over the past century, missionaries and other colonial powers have observed female genital cutting with concern. A number of attempts to outlaw the procedure, in particular the most drastic methods of infibulation, were instituted beginning in the 1920s (Boddy, 2006). Some, like the work of Mabel Woolf, aimed to create safer and less harmful ways to do the procedure; she tried to improve sanitation and introduce safer birthing methods for women who had genital scarring from cutting procedures (Boddy, 2006). While Woolf and others were moderately successful in improving conditions, outlawing infibulation seems to have exacerbated the problems.

As with many areas being colonized, Africa was resistant to "forced" modernism and considered the illegalization of any female genital cutting as an attempt to control and diminish their cultural identities (Dellenborg, 2004). As a result, many fiercely defend female genital cutting expressly to preserve cultural identity that is threatened by imperialism (Abusharaf, 2001). It is also possible that these attempts to get rid of the ritual have caused an increase in its use. According to a study of more than 28,000 women in Africa in 2006, 97% or arab women, 96% of Nubian Sudanese women, 99% of Embu women in Kenya, and 98% of Bini women in Nigeria have undergone some form of genital cutting ("Female genital mutilation" 2006). Because numbers for individual ethnic groups are not available for earlier periods, it is difficult to compare. However, UNICEF estimated that 93% of Sudanese women were circumcised in 2000-2001, compared to 89% in 1979. While this may or may not be related to the backlash from imperialist pressures, it is nevertheless obvious that genital cutting has persevered into the twenty first century.

3. Literature Review

What is the status of female genital cutting today? The answer depends on where and how it is performed and the level of genital cutting. The cultural, social, and religious risks and benefits must be considered together. Closely related to these is the psychological risk that the procedure has on girls. This, obviously, can be linked to the methods used and the social expectations. Physical risks and methodologies still range from abhorrent to strictly medical. Together, the outcomes for each individual girl are comprised of these numerous factors, addressed in the literature through scientific study as well as through individual or group case studies.

Most available literature argues that the cultural, social, and religious implications of female genital cutting do not contribute to the well being of girls as they enforce ideals of patriarchy, inferiority, and poor self-worth. However, the current climate of many individual communities and tribes is that self-worth is defined by their place as an important part of the group. Female genital cutting may be a part of that and young women who do not participate may suffer psychologically as a result.

Morris (2006) argues that the important differentiation between cultural and personal well begin should be that it is a choice of the individual. In most female genital cutting, the individual does not make the choice. Instead, parents make the choice for girls and subject them to the procedure at whatever level is available and deemed appropriate. In areas where medical advances are not available, Morris (2006) argues that the trauma of undergoing such pain at the hands of one's parents is psychologically damaging to young girls and has permanent effects. So concerned about their child and their family's place in their culture and social structure, parents are willing to risk legal repercussions in many cases just to make sure that their daughter meets the religious, spiritual, and cultural norms expected (Morris, 2006).

Due to the modernization of many areas, many families have access to medical equipment within the home or in their home village. Since regulation has not yet caught up with advancements in many areas, this makes it possible for surgical procedures like infibulation to be carried out in homes, by doctors even in areas where infibulation and other drastic genital cutting has been outlawed (Morris, 2006).

The research of von der Osten-Sacken and Uwer (2007) found that men are rarely involved in the process of female genital cutting. In fact, they cite that none of the men interviewed had ever discussed genital cutting with their wives. They additionally consider that the ideas of patriarchy and the female body as filthy and in need of purification are still alive in the twenty first century (von der Osten-Sacken & Uwer, 2007). In psychological terms, girls who undergo genital cutting because of negative cultural conceptions of the female body will likely submit to the procedure completely due to poor self-confidence.

Abdelmagied et al. (2005) found most religious leaders were unaware of many issues related to female genital cutting. Sufists, Islamic Front leaders, Mosque Imams, Ansar Sunnas, and Sharia Law lecturers and professors in Sudan were all largely unaware of the differences between different types of female genital cutting. Only 5-15% of all religious leaders surveyed by Abdelmagied et al. (2005) denied that there were harmful effects from genital cutting. This implies that only a very small part of the religious leadership in Sudan is strongly defensive of genital cutting and would value additional information.

Boddy (2006) also looks as Anglo-Egypt Sudan. After identifying the effects of colonialism and imperialism on Sudan, Boddy does suggest that the best way to combat both physical and psychological problems associated with female genital cutting is to teach new ways to perform the purification ritual that do not inhibit women's health or well being. Early British midwifery teaching in Sudan tried to institute tahur al-wasit or tahur mitwasat, "intermediate purification" (Boddy, 2006). Performed by both midwives and doctors, this procedure reduces the amount of actual genital cutting while still maintaining the controversial stitching and suturing. The practitioner removes parts of the clitoris and inner labia and then stitches the outer labia, leaving a larger hole for urine and blood than in common in the fully cut methods (Boddy, 2006). While not ideal medically, the reduction of cutting means that there is less scar tissue and therefore, hypothetically, less birthing complications. Additionally, the larger area for blood and urine make hygiene more manageable and so may reduce infection (Boddy, 2006).

Genital cutting does cause medical complications for women, particularly during childbirth ("Female genital mutilation," 2006). The World Health Organization (WHO) followed the status of 28, 393 women in 38 different obstetric centers in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan in order to assess what relationship (if any) existed between birthing complications and genital cutting. Their findings report that threats to women and infants were significantly higher in women who had undergone genital cutting: an estimated 11-17 infant deaths per 1,000 births were specifically associated with genital cutting complications; women with genital cutting were more likely to have complications in labor including postpartum blood loss of more than 500 mL; and mothers with genital cutting were more likely to give birth to infants that needed resuscitation ("Female genital mutilation," 2006). Inpatient deaths of women who had genital cutting were also higher, most likely due to hemorrhaging and complications from scar tissue caused by the cutting. WHO estimates that these numbers do not adequately show the problems of increased medical needs since many women cannot or do not give birth in obstetric centers. Such women, if they have undergone genital cutting, are more likely to have complications since their cutting may have been done under poor conditions ("Female genital mutilations," 2006).

Yount (2007) finds that African women with genital cutting are also indirectly at a higher risk of HIV infection. This is in part to their higher risk for all reproductive infections due to genital wounds and limited hydiene. Additionally, women with genital cutting are also 1.72 times more likely to have older husbands or partners. African women with older partners are 2.65 times more likely to test positive for HIV (Yount, 2007).

Despite the numerous arguments against female genital cutting, Dellenborg (2004) offers a contrasting view. His research surrounding the Jola women shows the ritual clitoridectomy as an important rite of passage welcoming Jola women into the female secret society. Women enter into the group in order to pray, and practice the theoretical and magical practice of womanhood in their culture (Dellenborg, 2004). Unlike many other areas, men in Senegal have actually pushed for an end to the custom in concern for the possible sexual and physical problems. However, women have fiercely protected the ritual and actually feel that it makes them stronger individuals and stronger as a group (Dellenborg, 2004).

Abusharaf (2001) also argues that much of the Westernized assumptions about female genital cutting are just that: assumptions. He argues that in the call for an end to all female genital cutting, people "disregard culture, class, and ethnic differences" (Abusharaf, 2001, p. 204). He points to the importance anthropologically of rituals involving the body and body modifications. Rather than alienating girls, genital cutting in some cultures is about inclusion and initiation. In his collection of personal narratives, Abusharaf (2001) points out that many Africans are angered by the association that genital cutting is barbaric and vulgar and implies primitiveness in their cultures. Instead, Western nations lack the theoretical framework necessary to understand the ritual and social significance of female genital cutting.