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.

Appendix I: National Anti-FGM Legal Policies by Country

The following table, ordered by year of first legal action, summarizes national anti-female-genital-cutting legal policies across selected countries (Boyle & Preves, 2000, p. 717).

France — Negligible prevalence. Existing assault law applied.

Sweden — Negligible prevalence. National ban enacted.

Switzerland — Negligible prevalence. National ban enacted.

United Kingdom — Negligible prevalence. National ban enacted.

Belgium — Negligible prevalence. Existing laws applied.

The Netherlands — Negligible prevalence. Child abuse law applied.

Sudan — 90% of women in the north affected. Health law enacted (no criminal law); NGO and government educational campaigns conducted.

United States — Negligible prevalence. Local bans beginning in 1991; national ban enacted in 1996.

Austria — Negligible prevalence. Existing laws applied.

Australia — Negligible prevalence. Child abuse law applied.

Canada — Negligible prevalence. Amendment to existing Criminal Code and Youth Offenders Act.

Ghana — National criminal law enacted; five arrests made in 1998; local NGO and governmental education campaigns.

Chad — Law adopted by transitional government makes FGM theoretically prosecutable as assault; active public education campaigns; strong opposition to elimination persists.

Djibouti — Prevalence as high as recorded. Penal Code prohibition; no convictions to date; UNFPA campaign underway.

Burkina Faso — Prevalence as high as recorded. Penal Code prohibition; education plan and sensitization campaign.

Central African Republic — Ordinance against FGM; awareness campaign.

Egypt — Health Ministry decree; NGO and government educational campaigns; enforcement of decree.

Kenya — Two presidential decrees ban FGM, but legislation was voted down in 1996. Prohibited in government hospitals and clinics.

Côte d'Ivoire — Prevalence as high as recorded. Law concerning crimes against women enacted in December; NGO campaigns; strong opposition to eradication persists.

Senegal — Council of Ministers approved legislation to ban FGM and submitted it to the National Assembly in December.

Togo — National law enacted, but no prosecutions; seminars held.

Tanzania — Government officials have called for elimination. Some local government officials have convicted and imprisoned persons who mutilated young girls; educational seminars held.

Benin — Government cooperation with NGOs; action plan developed; no formal law enacted.