Female Genital Mutilation: Cultural Practice and Human Rights

Introduction and Population Overview

While the population for this study is women worldwide — since gender violence is a matter affecting all women — the particular focus of this research is Female Genital Mutilation (FGM). Certain cultural communities in Africa and the Middle East have practiced what is known within those cultures as female circumcision, but which is also referred to as Female Genital Mutilation by those outside the practice. There are variations in how and by whom these procedures are performed; frequently they are carried out without anesthesia by unlicensed practitioners, often midwives or other family members. It is a tradition that usually goes back many generations, and its origins are often quite difficult to discern. In fact, it predates both Islam and Christianity, as evidenced by a Greek papyrus found in Egypt dating from circa 163 BCE (Lane & Rubinstein). While many cite it as a religious practice, there is often little or no reference to the procedure in any original religious text such as the Quran (Muslim Clerics).

This practice is described as a rite of passage for girls who range in age from eight to fourteen, and it includes the removal of the clitoris and labia. In some cases it also entails the suturing of the vaginal cavity, leaving only enough room for urination. This latter procedure is typically reversed upon marriage, often serving to prove that the wife has remained a virgin — one of its primary stated purposes.

This practice is so deeply embedded in many cultures that it is simply considered the norm:

Circumcision is often cited as a necessary prerequisite for marriage, and there are numerous additional explanations for the practice.... Perhaps the most important rationale for female circumcision is that because it is such an ancient and commonly practiced tradition, reduced or infibulated genitals are simply considered normal. Indeed, when Sudanese or Egyptian villagers have discussed the custom with female Western researchers, they have been shocked to discover that the female researchers have not themselves been circumcised. (Lane & Rubinstein, p. 31)

These practices are often physically harmful, and many cultures are increasingly viewing them as appalling in light of global norms and women's human rights. However, the practice continues not only in other countries but in the United States as well. Many immigrants who practice this cultural ritual feel even more strongly that it must be performed on women living abroad in order to keep them connected to their cultural identity.

Doctors in countries where this practice typically occurs under unsanitary and unsafe conditions have attempted to mitigate complications by performing the procedure in hospitals. However, this approach has also attracted strong criticism:

The procedures are increasingly being performed by physicians, who often claim that they are minimizing the harm that would potentially result if the procedure were performed by traditional operators. Arab and African feminists strongly condemn the medicalization of female circumcision, which they believe will promote its continuation rather than its abandonment. (Lane & Rubinstein, p. 31)

It is important to recognize that most societies practicing FGM view it as routine — as unremarkable as an appendectomy was in the early to mid-twentieth century. Many even believe that the procedure improves a woman's appearance. Allowing hospitals to perform the surgery further reinforces its perceived legitimacy. Combined with apparent religious affiliation and other cultural norms, this creates a formidable barrier to change:

In Kenya, women's decisions to have their daughters circumcised are associated with various individual and community-level characteristics, such as education, media exposure, and ethnicity, according to an analysis of data from a national survey. Overall, 38% of women reported experiencing genital cutting, and 46% of circumcised women already had or planned to have their daughters circumcised. (Rosenberg, 2005, p. 151)

In the case scenario presented, Nawal is under significant pressure from older family members to have her daughter undergo this procedure. Although it is often characterized as a matrilineal decision, male family members also strongly promote FGM as a means of controlling female offspring and ensuring that prospective wives remain virgins. As a healthcare professional, one would need to emphasize the risks to the daughter and carefully evaluate Nawal's own cultural perceptions of the practice. Having resided in the United States for five years with a thirteen-year-old daughter likely means that neither are U.S. citizens, making a return to Sudan a possibility that may influence Nawal's decision. However, after five years of exposure to American cultural norms, there may be an opportunity to help her see FGM in a new light — and that would be the primary avenue a healthcare professional should pursue in this situation. Research has shown that "the likelihood that a mother would decide to have her daughter circumcised decreased as her level of education and exposure to media rose" (Rosenberg, 2005, p. 151). The more informed a mother is about this procedure and the more she is exposed to other cultural frameworks, the less likely she is to subject her daughter to this practice.

Clinical Question: From a best-practices standpoint, what is the most effective way to address the elimination of this form of cultural violence against women? Many issues must be resolved before the subject can be raised at a national or global level. While the international community appears largely united in its condemnation of FGM, actually persuading the cultures that perpetuate it remains a daunting challenge.

Magda was 13 years old when her mother and a group of female neighbors held her down while a local doctor circumcised her. "All the women were holding my arms and legs... I was crying and screaming... It was a hideous and painful experience," she recalls. (Ezzat, 1994, p. 35)

FGM Overview: Personal Stories and Medical Dangers

This account reflects a generalized experience for women who have undergone the ritual known politely as female circumcision but globally as Female Genital Mutilation. Through this experience, women are expected to become more compliant members of their society through the curtailment of overt sexual desire, thereby assuring their virginity and prospects for a favorable marriage. The issue has been part of the political and cultural discourse for several decades and has also entered the realm of art and literature.

Deep Cut is a play by Karim Alrawi that explores the issue from a creative perspective, addressing not only the procedure itself but also the need for asylum to be granted to women wishing to escape it. One character, Dr. Andrew Hepburn, holds the view that no culture has the right to interfere with another for any reason — a "prime directive" of sorts. Another character, Dr. Chan, challenges that notion: having been tortured following his involvement in the Tiananmen Square protests, he is appalled that Andrew's belief in non-interference would have prevented outside intervention on his behalf (Pressley, 1996, p. 15). This tension, creatively stated, is the crux of the current social and political debate.

Alice Walker also engaged this subject in her novel Possessing the Secret of Joy, which explores the psyche and experience of a protagonist facing this tradition. In a panel discussion of the book, Gloria Steinem offered the following gender perspective:

Female genital mutilation is a demonstration of patriarchy at its worst, a metaphor for the "psychic mutilation" that women suffer everywhere at the hands of their male "oppressors." Just as African patriarchs have fashioned a brutal practice that ensures the virginity of their brides, the "spirit-killing regimes of male dominance" in the West rob women of their "reproductive rights" by seeking to outlaw abortion, by insisting on unnecessary mastectomies and Caesarean births, by demanding a kind of subservience that kills the rebellious high-spiritedness of little girls, and so on. (Eichman, 1992, p. 52)

Voices from within these cultures also reveal the patriarchal logic behind the practice. As one Egyptian man stated: "It is all a part of men's everlasting attempts to maintain the upper hand and — in consequence — the patriarchal class system." Another said, "I would not have married my wife if she had not been circumcised," describing an uncircumcised woman as "a reflection of an immoral background and future" (Ezzat, 1994, pp. 41–42).

Female genital mutilation is practiced in some Asian and North and Central African countries, as well as by immigrant groups — mainly Muslim — in some Western countries. According to the World Health Organization's 1996 report, FGM was still practiced in 28 countries. According to Amnesty International, FGM is performed on more than 2,000,000 women, of whom 600,000 are in Africa (Kalev, 2004, p. 339). Rarely does FGM involve only a symbolic small cut on the clitoral hood, as the misnomer "female circumcision" would imply. More commonly it involves clitoridectomy — anatomically equivalent to amputation of the penis. Clitoridectomy is often followed by the more drastic procedure of infibulation, in which the external genitalia are completely excised and the labia are sewn together, leaving only a small opening for menstrual blood and urine. This opening is later cut for sexual intercourse and childbirth (Brant, 1995, p. 284).

FGM is often performed on girls under age twelve without anesthesia and using crude instruments. Frequent medical complications include infection, hemorrhage, and death. Unlike male ritual circumcision, two key consequences of female genital surgery are the permanent diminishment of sexual pleasure and the drastic alteration of sexual function, ensuring premarital chastity. Additionally, women who have undergone FGM face a significantly higher risk of adverse obstetric outcomes, with risks increasing in proportion to the severity of the mutilation, according to the first large-scale prospective study of the procedure's effects on maternal and neonatal health (Melhado, 2006).

Female genital surgery is practiced within a complex cultural context and carries social, political, and religious significance. Justifications offered for the practice include ensuring premarital virginity, inducing chastity in divorced women or those whose husbands are absent, birth control, initiation into womanhood, hygienic reasons, and purported religious requirements (Brant, 1995, p. 284).

These beliefs will be examined in greater detail below. It is necessary to note, however, that cultural habit accumulated over time overrides what outsiders may regard as the ethical implications of the practice. Moreover, the consequences of refusing or evading FGM within these communities are severe. Women who resist are often relegated to the lowest tier of female citizenship and subject to additional forms of social exclusion and abuse. In some parts of India, for example, sexual abuse is institutionalized in the practice of offering teenage girls as Devdasis — girls who are then sexually exploited and most of whom end up in prostitution.

Thus, the war against women starts in the womb. Females who survive against the odds are relegated to second-class status, where they endure human rights violations through domestic violence, sexual abuse, and dowry deaths. Bride burning persists in India despite laws against many of these practices, which are committed on cultural and religious grounds. (Kawewe & Dibie, 1999, p. 382)

Female genital mutilation has been practiced in cultures worldwide for many centuries, yet it is only in recent decades that it has been discussed publicly and condemned — mostly by those in the Western world. Cultural norms such as sexual slavery, mandated or condoned by religion in some parts of India and West Africa, have also persisted for centuries, yet only recently have these customs been brought into the light of the global community.

Even Western cultures are not without their own serious issues. Andrea Parrot, an expert in cultural practices and the challenges of changing them, argues that it is important to recognize the pathologies within each of our own cultures:

"The United States is not immune from cultural abuses, which include rape and domestic violence. 'Violence against women happens all over the world,' Parrot says. 'But it is manifested differently and in part determined by cultural issues: what is considered acceptable, what is not considered acceptable, how women are viewed, what men can get away with, and whether men are militarized or not.'" (Wilensky, 2003, p. 12)

Cultural Implications and Gender Violence

Parrot also recounts an instructive cautionary tale: missionaries in Uganda who discovered the practice of FGM approached community elders and pleaded with them to stop. The elders were so incensed by outsiders dictating their behavior that in the following year, FGM was performed three times as often as before. "Parrot describes this response as a community's reaction to outsiders' aggressive attempts to change their culture" (Wilensky, 2003, p. 14).

It is essential to remember that those who practice FGM consider themselves honorable, morally upright people who love their children and want what is best for them — precisely why they perform the ritual (Mackie, 2000). This is the heart of the dilemma between global human rights and individual cultural sovereignty. As Mangan poses it:

If cultures are to be allowed to dictate the terms of their own self-determination, to what extent must individual rights be compromised? Conversely, human rights should provide "a recognized vocabulary to frame political and social wrongs" — but at what expense to the vitality and expression of the culture?... To what extent are women's rights recognized or rendered accessible within a human rights framework in their own culture? (Mangan, 2006, p. 61)

There has been real progress, and the work of the global community has not been in vain. Growing criticism of FGM has emerged from within the cultures where it is most prevalent. Many governments have officially banned it — Sudan as early as 1945 and Kenya in 1982. Consciousness-raising programs coordinated with nongovernmental organizations and the United Nations have also had an effect. Even where the custom persists, it may be practiced in some communities but not others. Though widespread, there is growing internal opposition (Renteln, 2004, p. 52).

However, it remains relevant that the negative attitude toward these practices has always originated outside the cultures in question, and this continues to pose a significant obstacle to change. "Many practices and cultural norms around the world, such as female genital mutilation, sexual slavery, and feticide/infanticide of female babies, are perceived as wrong by outside cultures" (Wilensky, 2003, p. 12) — but within those cultures, they are simply the norm.

In the United Nations 1995 Human Development Report, the annual assessment of global social and economic progress noted that "gender-specific violence is almost a cultural constant, both emerging from and reinforcing the social relationships that give men power over women" (Nelson, 1996, p. 33). At that time, surveys in ten countries — including Colombia, Canada, and the United States — estimated that as many as thirty percent of women had been physically assaulted by an intimate male partner. More limited studies reported that rates of physical abuse among some groups in Latin America, Asia, and Africa may reach 60% or more (Nelson, 1996). This misogynistic tendency has been present across all cultures, not only those of developing nations.

Gender preferences manifest in various ways across cultures. In many developing nations, the simple fact that men are more highly valued than women has devastating consequences. In India, for example, a 1990 study of amniocentesis in a large Bombay hospital found that 95.5% of fetuses identified as female were aborted, compared with only a small percentage of male fetuses (Nelson, 1996, p. 34). Violence against women thus begins even before birth.

There are also purely economic factors behind this differential valuation of female lives. A woman without living sons has almost no economic status, and a woman who cannot produce sons may be divorced, cast out, and left with no means of subsistence except begging or prostitution — or she may simply be killed. "Only by increasing the value of females as something more than merely the bearer of sons, through enhanced social, political, and economic power for women, can we effectively and efficiently address the problem of human population expansion" (Spahn, 1997, p. 1310).

Some scholars suggest that cultural practices such as FGM may have origins in evolutionary or Darwinian behavior patterns — tied to biological imperatives rather than purely cultural or political forces:

But for a cultural behavior, presumably not genetically transmitted, which is enforced by the group through a system of rewards and punishments, it becomes fairly clear why individuals choose to conform and how a new generation would acquire the behavior. Can the evolutionary success of such a behavior be judged by the differential rates of population growth of groups that do it and groups that do not? (Gruenbaum, 2000, p. 42)

It therefore becomes incumbent upon the global community to understand why these practices are so prevalent and to find a workable, constructive dialogue between individual cultures and the broader international community — one that can accomplish some degree of unification of ideals.

One survivor of FGM and now a committed opponent of it, writing from within the Kono culture, offers a candid reflection:

It is difficult for me... to accept that what appear to be expressions of joy and ecstatic celebrations of womanhood in actuality disguise hidden experiences of coercion and subjugation. Indeed, I offer that the bulk of Kono women who uphold these rituals do so because they want to — they relish the supernatural powers of their ritual leaders over against men in society, and they embrace the legitimacy of female authority and, particularly, the authority of their mothers and grandmothers. (Shweder, 2000, p. 209)

It is crucial that every opportunity be seized to foster cultural comparison so that dialogue can emerge — dialogue that "must capitalize on the moments of mutual minimal recognition, the necessary empathy which unites us as human beings" (Mangan, 2006, p. 67). This lies at the center of creating global human rights policies and "invoking questions of cultural sovereignty, appropriate international and intercultural norms, and the place of women's rights in culture" (Mangan, 2006, p. 56).