50th Agenda 

50th Session Issues

Female Genital Mutilation

by
Elizabeth A. Estabrooks

The World Health Organization defines female genital mutilation as "the partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons." There are three main varieties, including:

  1. "Sunna" circumcision is the removal of the prepuce and/or the tip of the clitoris;
  2.  Clitoridectomy, or excision is the removal of the entire clitoris and adjacent labia;
  3.  Infibulation (pharaonic circumcision) is removal of the clitoris and entire labia and then joining the scraped sides of the vulva across the vagina using thorns or catgut, leaving only a small opening for passage of urine and menstrual blood.

Generally, FGM is performed in unsanitary conditions using unclean sharp instruments, such as pieces of glass, knives, or razor blades. Often the same instrument is used on many girls and/or women without cleaning, leading to the transmission of various viruses, such as HIV.

The terminology from "female circumcision" to "female genital mutilation" was changed by the United Nations upon recommendation by WHO in 1991, after having been proposed in 1990.

While numbers vary, UNICEF estimates that over 130 million women in African countries alone have been mutilated using one of the above three methods of FGM.

History

Commonly, when we think of FGM, we think only of African countries. Certainly the highest number of victims are in African countries, but FGM historically occurs or has occurred in many countries, including the Arabian Peninsula, Asia, Australia, France, England and the United States.

In most countries, FGM is practiced out of local custom, for religious reasons, or as a traditional rite of passage. Ages at which FGM is done vary from age three through adulthood. In Tanzania, the Kurya ethnic group organizes an annual FGM ceremony, which encompass a very large number of young girls (up to 2500 on December 8, 1998). It is their belief that it brings respect to women, who enter adulthood at the time of circumcision. Uncircumcised women in the Kuryan tribe are not respected and cannot marry.

From approximately 1900 - 1939, FGM was practiced in Australia kindergartens as a method of 'curing the precocious masturbator'. This practice was not confined to Islamic groups, as some may suspect, but included Australians of European heritage.

In Britain, the greatest period of clitoridectomies was from 1858 - 1866. Clitoridectomies were continued in the United States through 1925, replaced by circumcision through as late as 1937, and possibly 1948. It was believed that these procedures would stop masturbation, reduce women's mental disorders, cure female complaints and prevent or stop nymphomania.

Even as late as 1979, Dr. James E. Burt was performing sunna circumcision on women in the United States. While Dr. Burt was stopped, the practice continues in the United States, having been reintroduced (or maintained) by immigrants. One report commissioned by Rep. Louise M. Slaughter estimates that more than 160,000 girls and/or women have been or are at risk of FGM in the U.S.

During international efforts to eradicate FGM, arguments have been made that females have a choice in the matter. Even if a true choice is allowed, pressure, age-old belief systems, a desire to uphold family honor, fear, and threats of rejection frequently compel young women or parents to submit. Often, for those families who choose otherwise, others who strongly believe in FGM willingly disregard their decision.

This was true in the case of the twelve year old girl in Kenya who was abducted by three relatives and circumcised by a traditional surgeon when her parents refused to allow the ritual to be performed on her. She was taken to Kehancha District Hospital in critical condition, bleeding profusely. This case clearly reflects the lack of respect by some for any decision that contradicts or opposes the custom of FGM.

Religion has been a long-held argument for FGM. In fact, neither the Koran nor the Bible support or condone FGM. There are no Islamic or Christian justifications or origins for FGM, and interpretations claiming otherwise are incorrect.

History of UN Involvement

United Nations involvement in FGM began in 1952 when the UN Commission on Human Rights raised the issue for the first time. The first action was taken six years later when the ECOSOC invited WHO to commence a study of "persistence of customs subjecting girls to ritual operations", resolution 680 BII (XXVI), and to subsequently present their findings to the Commission on the Status of Women. Between that date and 1979, the UN continued to charge WHO with studying the issue.

In 1982, WHO made a formal statement of its position opposing the medicalization of FGM to the UN Human Rights Commission and strongly advised health workers not to perform FGM under any conditions. At the same time, they expressed they were both willing and ready to support national efforts towards the elimination of FGM.

In February 1984, FGM was condemned yet again as a health hazard and a cause of unnecessary human suffering during the Seminar on Traditional Practices Affecting the Health of Women and Children in Dakar. The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children (currently with committees in 26 African Countries) was formed.

Following the formation of this committee the Commission on Human Rights recommended the formation of another committee for the purpose of performing more studies on traditional practices affecting the health of women and children. In 1985 the World Health Assembly resolution WHA 38.27 recognized the problem of harmful traditional practices and called for concrete action to eliminate FGM.

From 1986 through 1995, the UN funded studies, formed committees, held seminars, reaffirmed previous statements opposing FGM, condemned harmful traditional practices (with FGM as a priority), adopted policies, and made urgent recommendations for the elimination of female genital mutilations.

In 1994, the Sub-Commission on Prevention of Discrimination and Protection of Minorities adopted a Plan of Action for the Elimination of Harmful Traditional Practices Affecting the Health of Women and Children (resolution 1994/30 of 26 August 1994) and recommended a further in-depth analysis of the issue. In 1995, the World Health Assembly again formally recognized the problem of harmful traditional practices and called for definite action to eliminate FGM (resolution WHA47.10).

In 1995, the World Conference on Human Rights was held in Geneva. During the course of that conference, it was acknowledged that the international community had continually neglected violations of women's human rights, and have continued to do so (Conference Report, page 4 - 6). It acknowledged obstacles to the collection of information (page 8-9), made recommendations (page 12 - 13), and addressed the issue of development and application of minimum standards.

Interestingly, it was here that the Commission openly stated that gender-based violence and harmful traditional practices, such as FGM, are obstacles to the very fundamental human rights they are addressing, and yet these very obstacles, and reference to them, have been left out of the General Comment (page 14, paragraph 46).

Growing awareness of the dangers of FGM led UNICEF, the World Health Organization (WHO) and UNFPA to form a joint initiative in April 1997 whose goal is to affect a major decline in FGM within ten years and eliminate the practice within three generations. The project aims to educate communities about the physical and emotional damage of FGM, and help governments implement national polices to end the practice.

Present Situation

Over the years, some countries where FGM has taken place have passed laws forbidding the procedure, especially on children. Countries with laws banning FGM include parts of Africa (Senegal, Egypt, Kenya, Djibouti, Togo, Ghana, Guinea, Burkina Faso and Sudan, although sunna is still allowed in Sudan), France, Sweden, Canada, New Zealand, the United States, and the United Kingdom.

A law can be effective only if there is the belief of a crime being committed, a person or persons operate within the law, or if the victim reports the crime. Unfortunately, these laws are often ignored. As was seen in France recently, it was not until victims of FGM became adults capable of making their own decisions that the law benefited them. The law did not prevent them from being mutilated as children.

Critics point out that laws are only passed to satisfy Americans. Indeed, the number of girls being subjected to FGM in some countries where it is illegal has not been reduced (Sarkis, M., 1995). For example, Egypt's law forbids circumcision operations, even if the parents agree to it, but allows for it if "medically necessary". It is up to the physician to make that determination, and those physicians can be found.

Multitudes of task forces, organizations, and individuals continue to address this issue. There are arguments that say the laws only engender spite and anger among those whose cultures have supported and encouraged FGM. While laws against FGM are certainly necessary and important, one thing that has become apparent: is that education, information, and communication are what actually stop FGM. Laws are what give recourse to the victims, providing a public protest against the violence.

Another important aspect of successful elimination programs has been the recognition of independent decision-making by each village, or group of villages. The combination of education and autonomy in the process, as exemplified by the Tostan and REACH projects, shows that the greatest successes come not from passing laws, but from giving knowledge.

Our good intentions based on our laws and belief systems have led to defiant acts of Ngaitana ("I cut myself") or en masse circumcisions. However, the truth is that FGM isn't viewed by those taking part in it as violence against women or a barbaric practice, but rather as a part of their culture - a necessary act for the benefit of the girl. That is the belief system with which we must work.

The most successful solution for elimination of female genital mutilation is the model used by the Tostan project. Founded in 1991, Tostan uses a three-pronged approach utilizing basically the same method used to bring an end to footbinding in China in less than a generation. It cannot be imposed or legislated. It involves education and training programs, and an understanding of the problems and risks involved without judgment, harsh propaganda, and demands. The most important aspect, according to Mackie, is that those who are doing it must make the decision.

Another successful program is the Reproductive-Educative-and Community Health (REACH) Programme, begun in 1996 in Kapchorwa, Uganda. Using education as its primary tool in eliminating FGM, REACH formed the Sabiny Elders Association, using these principal figures to reach the people. Ultimately, the communities made their own the decisions to stop. The Kapchorwa district saw a 36 percent decrease in circumcisions between 1994 and 1996.

FORWARD, USA is an action group located in San Jose, California, and operating from Oakland to Richmond. Mimi Ramsey founded it in 1996 with recognition that FGM in the United States was an ever-growing concern that was often overlooked. Forward USA offers education, intervention, and medical care, and currently is working towards a free hotline for FGM victims. It is the only organization in the U.S. offering personal support services to victims of FGM.

Questions

1. How do we insure continuation of funding for successful programs?
2. What can the UN, WHO, UNICEF, and other governmental bodies do to actively support success programs of NGOS as a priority over assigning committees and passing of resolutions?
3. How can we safeguard refugees who are escaping FGM?
4. How can educational information best be distributed to medical providers worldwide to assist both in the elimination process, and in the support process for those who have undergone FGM?
5. How can UNICEF safeguard against their funding being used in clinics that provide FGM operations?

Sources

1. The Economist (US), Feb 13, 1999, v350, i8106, p.45.
2. Ciment, James. British Medical Journal. February 6, 1999, v318, i7180, p. 348.
3. Barker-Benfield, Ben. 'Sexual Surgery in Late Nineteenth-Century America'. International Journal of Health Services. Vol. 5, No. 2, 1975, pp. 123-131.
4. Ehrenreich, Barbara and English, Deidre. "For Her Own Good: 150 Years of Experts' Advice to Women'. London, 1979, p. 111.
5. Passmore, Sanderson, Lilian, "Against the Mutilation of Women: The Struggle to End Unnecessary Suffering, London, 1981, p II; ibid., pp. 28-29.
6. People Weekly, Nov 2, 1998, p 149.
7. Richter, Gritt. Awaken, Vol 3, no 1, March, 1999, pp. 12-13.
8. The Daily Nation, Awaken, p. 8.
9. WIN News, Autumn 1998, v24, i4, p. 27.
10. Report of the Expert Group Meeting on the Development of Guidelines for the Integration of Gender Perspectives into United Nations Human Rights Activities and Programmes, Center for Human Rights and the United Nations Development Fund for Women, July, 1995, Part One, p. 4.
11. Sarkis, Marianne, 'Female Genital Mutilation: An Introduction', FGM Network, 1995, p. 3.
12. Weil-Curiel, Linda, (Feb. 1999) "The French Experience", FORWARD UK23 Conference Paper. Retrieved August 24, 1999: http://www.forwardusa.org.
13. "ACLU Special Report", (June, 1999). ACLU Website, Retrieved August 12, 1999: http://www.aclu.org.
14. The Economist, February 13, 1999, p. 45.
15. Armstrong, S., (Nov/Dec., 1998), "Not My Daughter", Homemaker's Magazine, Retrieved August 24, 1999: http://www.fgm.org.
16. Eliah, Elaine, Population, December 1998/January 1999, pp. 11-13.
17. Ramsey, Mimi, (n.d.) "Together Against FGM", Forward USA Introduction, Retrieved August 24,1999: http://www.forwardusa.org.

Web Sources

Equality Now Website, http://www.equalitynow.org
Awaken Website, http://www.equalitynow.org/awaken
Female Genital Mutilation Education & Networking Website: http://www.fgmnetwork.org/
National Organization of Circumcision Information Resource Centers Website: http://www.nocirc.org/index.html#directory  and http://www.nocirc.org/symposia/
WHO FGM information website: http://www.who.int/frh-whd/topics/fgm.htm
Tostan website: http://www.townonline.koz.com