FGM/C refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for cultural or other non-medical reasons.
The World Health Organization (WHO) has identified four types of FGM:
Type I, also called clitoridectomy: Partial or total removal of the clitoris and/or the prepuce.
Type II, also called excision: Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora. The amount of tissue that is removed varies widely from community to community.
Type III, also called infibulation: Narrowing of the vaginal orifice with a covering seal. The seal is formed by cutting and re-positioning the labia minora and/or the labia majora. This can take place with or without removal of the clitoris.
Type IV: All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping or cauterization.
Other terms related to FGM include incision, deinfibulation and reinfibulation:
Incision refers to making cuts in the clitoris or cutting free the clitoral prepuce, but it also relates to incisions made in the vaginal wall and to incision of the perineum and the symphysis.
Deinfibulation refers to the practice of cutting open a woman who has been infibulated to allow intercourse or to facilitate childbirth.
Reinfibulation is the practice of sewing the external labia back together after deinfibulation.
An estimated 200 million girls and women alive today are believed to have been subjected to FGM; but rates of FGM are increasing, a reflection of global population growth. Girls and women who have undergone FGM live predominately in sub-Saharan Africa and the Arab States, but FGM is also practiced in select countries in Asia and Latin America and amongst migrant populations in Europe, North America, Australia and New Zealand.
A key challenge is not only protecting girls who are currently at risk but also ensuring that those to be born in the future will be free from the dangers of the practice. This is especially important considering that FGM-concentrated countries are generally experiencing high population growth and have large youth populations. In 2010, for example, more than 45 per cent of the female populations in the Gambia, Mali, Somalia and Uganda were under age 15.
FGM has serious implications for the sexual and reproductive health of girls and women.
The effects of FGM depend on a number of factors, including the type performed, the expertise of the practitioner, the hygiene conditions under which it is performed, the amount of resistance and the general health condition of the girl/woman undergoing the procedure. Complications may occur in all types of FGM, but are most frequent with infibulation.
Immediate complications include severe pain, shock, haemorrhage, tetanus or infection, urine retention, ulceration of the genital region and injury to adjacent tissue, wound infection, urinary infection, fever, and septicemia. Haemorrhage and infection can be severe enough to cause death.
Long-term consequences include complications during childbirth, anaemia, the formation of cysts and abscesses, keloid scar formation, damage to the urethra resulting in urinary incontinence, dyspareunia (painful sexual intercourse), sexual dysfunction, hypersensitivity of the genital area and increased risk of HIV transmission, as well as psychological effects.
Infibulation, or type III FGM, may cause complete vaginal obstruction resulting in the accumulation of menstrual flow in the vagina and uterus. Infibulation creates a physical barrier to sexual intercourse and childbirth. An infibulated woman therefore has to undergo gradual dilation of the vaginal opening before sexual intercourse can take place. Often, infibulated women are cut open on the first night of marriage (by the husband or a circumciser) to enable the husband to be intimate with his wife. At childbirth, many women also have to be cut again because the vaginal opening is too small to allow for the passage of a baby. Infibulation is also linked to menstrual and urination disorders, recurrent bladder and urinary tract infections, fistulae and infertility.
A recent study found that, compared with women who had not been subjected to FGM, those who had undergone FGM faced a significantly greater risk of requiring a Caesarean section, an episiotomy and an extended hospital stay, and also of suffering post-partum haemorrhage.
Women who have undergone infibulation are more likely to suffer from prolonged and obstructed labour, sometimes resulting in foetal death and obstetric fistula. The infants of mothers who have undergone more extensive forms of FGM are at an increased risk of dying at birth.
Very recent estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division reveal that most of the high-FGM-prevalence countries also have high maternal mortality ratios and high numbers of maternal death. Two high-FGM-prevalence countries are among the four countries with the highest numbers of maternal death globally. Five of the high-prevalence countries have maternal mortality ratios of 550 per 100,000 live births and above.
When one tool is used to cut several girls, as is often the case in communities where large groups of girls are cut on the same day during a socio-cultural rite, there is a risk of HIV transmission.
Additionally, due to damage to the female sexual organs, sexual intercourse can result in the laceration of tissue, which greatly increases risk of HIV transmission. The same is true for the blood loss that accompanies childbirth.
FGM may have lasting effects on women and girls who undergo FGM. The psychological stress of the procedure may trigger behavioural disturbances in children, closely linked to loss of trust and confidence in caregivers. In the longer term, women may suffer feelings of anxiety and depression. Sexual dysfunction may also contribute to marital conflicts or divorce.
The origins of the practice are unclear. It predates the rise of Christianity and Islam. It is said some Egyptian mummies display characteristics of FGM. Historians such as Herodotus claim that, in the fifth century BC, the Phoenicians, the Hittites and the Ethiopians practiced circumcision. It is also reported that circumcision rites were practiced in tropical zones of Africa, in the Philippines, by certain tribes in the Upper Amazon, by women of the Arunta tribe in Australia, and by certain early Romans and Arabs. As recent as the 1950s, clitoridectomy was practiced in Western Europe and the United States to treat perceived ailments including hysteria, epilepsy, mental disorders, masturbation, nymphomania and melancholia. In other words, the practice of FGM has been followed by many different peoples and societies across the ages and continents.
The terminology used for this procedure has gone through various changes.
When the practice first came to international attention, it was generally referred to as “female circumcision.” (In Eastern and Northern Africa, this term is often used to describe FGM type I.) However, the term “female circumcision” has been criticized for drawing a parallel with male circumcision and creating confusion between the two distinct practices. Adding to the confusion is the fact that health experts in many Eastern and Southern African countries encourage male circumcision to reduce HIV transmission; FGM, on the other hand, can increase the risk of HIV transmission.
It is also sometimes argued that the term obscures the serious physical and psychological effects of genital cutting on women. UNFPA does not encourage use of the term “female circumcision” because the health implications of male and female circumcision are very different.
The term “female genital mutilation” is used by a wide range of women’s health and human rights organizations. It establishes a clear distinction from male circumcision. Use of the word “mutilation” also emphasizes the gravity of the act and reinforces that the practice is a violation of women’s and girls’ basic human rights. This expression gained support in the late 1970s, and since 1994, it has been used in several United Nations conference documents and has served as a policy and advocacy tool.
In the late 1990s the term “female genital cutting” was introduced, partly in response to dissatisfaction with the term “female genital mutilation.” There is concern that communities could find the term “mutilation” demeaning, or that it could imply that parents or practitioners perform this procedure maliciously. Some fear the term “female genital mutilation” could alienate practicing communities, or even cause a backlash, possibly increasing the number of girls subjected to the practice.
Some organizations embrace both terms, referring to “female genital mutilation/cutting” or FGM/C.
It varies. In some areas, FGM is carried out during infancy – as early as a couple of days after birth. In others, it takes place during childhood, at the time of marriage, during a woman’s first pregnancy or after the birth of her first child. Recent reports suggest that the age has been dropping in some areas, with most FGM carried out on girls between the ages of 0 and 15 years
The practice can be found in communities around the world.
In Africa, FGM is known to be practiced among certain communities in 29 countries: Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Cote d’Ivoire, Democratic Republic of Congo, Djibouti, Egypt, Ethiopia, Eritrea, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Togo, Uganda and Zambia.
Certain ethnic groups in Asian countries practice FGM, including in communities in India, Indonesia, Malaysia, Pakistan and Sri Lanka.
In the Middle East, the practice occurs in Oman, the United Arab Emirates and Yemen, as well as in Iraq, Iran, the State of Palestine and Israel.
In South America, certain communities are known to practice FGM in Columbia, Ecuador and Peru.
And in many western countries, including Australia, Canada, Europe, the United States and the United Kingdom, FGM is practiced among diaspora populations from areas where the practice is common.
FGM is usually carried out by elderly people in the community (usually, but not exclusively, women) designated to perform this task or by traditional birth attendants. Among certain populations, FGM may be carried out by traditional health practitioners, (male) barbers, members of secret societies, herbalists or sometimes a female relative.
In some cases, medical professionals perform FGM. This is referred to as the “medicalization” of FGM. According to recent UNFPA’s estimates, around one in five girls subjected to FGM were cut by a trained health-care provider. In some countries, this can reach as high as three in four girls. According to estimates from demographic and health surveys and multiple indicator cluster surveys, countries where the majority of FGM cases are performed by health workers are Egypt (77%), Sudan (55%), Kenya (41%), Nigeria( 29%) and Guinea (27%).
source: United Nations Population Fund