Female Genital Mutilation

Female circumcision is the English-language term used for many different traditional practices that involve cutting and modification of the female genitalia. Now considered a euphemistic term by many writers, it nevertheless embodies the intention of the practitioners to perform a traditional cutting ritual analogous to male circumcision practices. In the latter half of the twentieth century, the term female genital mutilation or FGM was popularized to draw attention to the severity of some forms of the practices as well as the international opposition to all forms, and to stimulate the movement for change. Female genital cutting (or FGC) is the term frequently used to stress the benign intent of the practitioners, even though the practices are known to be harmful in various ways.

The actual cutting that is done, as well as the ideas and purposes behind the practices, vary tremendously. In an effort to describe the physical consequences more systematically, the World Health Organization developed a typology that is widely used. The first type (Type I) is commonly referred to as clitoridectomy, which includes the partial or total removal of the clitoris and clitoral prepuce (hood). An intermediate form that includes the removal of the entire clitoris, clitoral prepuce, and some or all of the labia minora (inner lips) and often some or all of the labia majora (outer lips) is usually referred to as excision (Type II). Infibulation is done in Type III, which refers to procedures that include the removal of tissues such as in Types I and II plus the partial closing of the vaginal opening by joining the raw tissue on the two sides together so that scar tissue forms across the vaginal opening. In the practice of this very severe type—found mostly in northern Sudan, Somalia, Eritrea, and Djibouti—a straw or other thin object is used during healing to preserve a single tiny aperture for urination and menstrual flow. For infibulated women, first intercourse is extremely difficult, resulting in tissue damage or the necessity of cutting a bride open at marriage (usually by a midwife). In societies where infibulation is culturally practiced, it is common to reinfibulate the vulva following each birth, a practice also called recircumcision. Reinfibulation may also be done at other times, such as when a woman wants to have herself tightened. Any other practices that change or affect the female genitalia are categorized together as Type IV. This category includes the custom of labia stretching found in some cultures, the use of astringents, or piercing.

ORIGINS AND CULTURAL SIGNIFICANCE

Female circumcision practices have carried differing meanings in the historical periods and in the cultures and where they are practiced. Female genital cutting practices have existed since ancient times in northeast Africa and may have existed as long in many of the countries where they are found in the twenty-first century. The practice was reported in the ancient Nile Valley, but some of the stories told about its origins are not factual, being used as origin myths either to reinforce or discredit people's beliefs in the practice. Some stories attribute infibulation to the sexual preferences of the ancient pharaohs or their need to monitor births of potential rivals, whereas another story attributes the origin to the revenge of the biblical Sarah on her husband's concubine Hagar. Some speculate that female circumcision with infibulation may have originated as a way to protect shepherd girls from rape by strangers or nomads. While these stories have no basis in evidence, contemporary Nile Valley peoples do presume that the severe form known as pharaonic circumcision dates back to the time of the pharaohs. Although evidence has not been found by studying the remains of predynastic or later mummies from Egypt, there is documentary evidence from Herodotus that Egyptians, Phoenicians, Hittites, and Ethiopians practiced female excision about 500 bce. Lililan Passmore Sanderson (1981) cites several ancient references to the rites translated as circumcision of girls, including a papyrus dated 163 bce that refers to the circumcision of girls in Memphis, Egypt, at the age when they received their dowries. Writers believe that it may have been ideologically grounded in the concept of bisexuality of gods, reflected in the human anatomy. Circumcision would have represented the removal of the feminine "soul" of the man and the masculine "soul" of the woman so that each could be more fully male or female. This is a widespread idea in circumcising cultures, that circumcisions serve to establish unambiguous gender identity. In the Nile Valley, the practices predated the spread of Christianity and later Islam, and survived and were syncretized into the belief systems of ordinary believers in those faiths.

In other parts of Africa, female circumcision practices are not necessarily related to Nile Valley origins. The practices vary widely, as do the timing, purpose, and techniques. The areas where female circumcision is most common include northeastern, eastern, central, and western Africa, but not all ethnic groups in those regions practice it. In all, about twenty-eight countries of Africa, including all the countries of coastal West Africa (Mauritania to Cameroon) and across the continent to the east coast from Tanzania to Egypt, include some groups who practice some form of female genital cutting. The highest incidence of the severe forms is found in Djibouti, Somalia, some areas of Eritrea and Ethiopia, and central and northern Sudan. Only very small percentages of women are circumcised in Zaire, Uganda, and Tanzania (5-10%); less than half (20-30%) in Mauritania, Senegal, Ghana, and Niger; and half or more in the remaining countries of the region.

Terminologies vary a great deal, and the terms used provide clues to people's ideas and beliefs about the origin and meaning of these practices. In Sudan and Egypt the surgeries, of whatever type, have been commonly referred to by the Arabic word for "purification" (tahur or tahara). Purification is thought to render the girl clean and pure, physically and morally. When clitoridectomy is combined with infibulation—the most common practice in Sudan, Somalia, and Eritrea—people call it pharaonic purification (tahur faroniya in Sudanese Arabic), underscoring their belief about its origins in the ancient civilizations in the Nile Valley. For the partial or total clitoridectomy or prepuce removal, Sudanese commonly used the term sunna purification (tahur as-sunna). By using the term for the traditional practices associated with the prophet Muhammad (sunna), practitioners invoke the contested idea that the prophet approved removal of the prepuce or even partial or total clitoridectomy. Many Muslim scholars, however, assert that any sort of circumcision of females is against the teachings of Islam, criticizing what they see as misuse of the term sunna. Nevertheless, many Muslims continue to use the term sunna for whatever form of the surgeries they practice, including excision of all external genitalia.

Although often assumed to have religious meanings, female genital cutting has been practiced by members of all the major religions in Africa, including Islam, Christianity, and Judaism, as well as by followers of other African indigenous religious belief systems. It is found in diverse cultures and given different meanings. In some cultural groups, such as the Gikuyu and Maasai of Kenya, excision traditionally has marked a girl's transition to womanhood, usually performed between the ages of eight and thirteen. The Maasai did excisions just weeks prior to marriage, and the Gikuyu prior to first menstruation. In these cases, the surgeries are commonly accompanied by symbolic rituals (such as the shaving of heads among the Maasai) and communal celebrations; the girls are expected to adopt changes in behavior or clothing. Young women experience the transition individually among the Maasai, collectively among the Gikuyu. Where such transitions are ritualized collectively, the circumcision experience may form the basis of an age-set, as among the Gikuyu. In addition, being circumcised according to traditions has often been interpreted as necessary to affiliation with one's ethnic group.

The age of circumcision in many cultures is so young that it is clearly not intended to mark the onset of womanhood. Sudanese girls are most commonly infibulated between the ages of five and seven, although research indicates some practitioners have begun performing clitoridectomies on babies; in western Africa, circumcision seems to be not uncommon as young as age three. Instead of marking womanhood, it seems to mark the end of early childhood, a rite to be completed before a girl enters school or begins to be significantly involved in family labor that takes her outside the home, long before she approaches sexual maturity. In some cultures the goal of genital cutting is explicitly to reduce sexual desire in preadolescent girls and women. In the case of infibulation, there is the added goal of preventing illicit intercourse by constructing a barrier of scar tissue. Among Arab Sudanese of many ethnic groups, failure to preserve a daughter's virginity in this socially marked way would dishonor the entire family, so timely genital cutting is considered vital. Additional reasons given include cleanliness, femininity and the removal of "masculine" parts, and an aesthetic preference for smoothness. European missionaries under colonial regimes, medical workers, and administrators participated in efforts to suppress female circumcision. Nationalist reaction, most notably in Kenya, led to political defense of the practices. Even at the turn of the twenty-first century, some African leaders expressed strong resentment toward outsiders who condemn the practices without understanding their significance.

EFFORTS TO END THE PRACTICES

Change efforts accelerated over the last several decades of the twentieth century. Young Gikuyu women and urban Kenyans have largely given up circumcision, and many urban and rural Sudanese have shifted to the less severe sunna or stopped doing any form. However, there has also been persistence or even expansion of the practices in situations where migrants or displaced persons seek to assimilate to the practices of higher-status ethnic groups with more severe forms.

Hygienic conditions have improved in many areas. Well-trained circumcisers with access to modern equipment and supplies perform clitoridectomy and infibulation with sterile razors, needles, and sutures, and utilize antibiotic powder, but for many areas unhygienic circumstances are still a concern. However, there has been growing consensus among reformers that medicalization or reduced severity of the cutting should be rejected and only complete abandonment of the practices should be advocated.

Psychological and sexual impairment have not yet been extensively researched, although a few researchers have begun to focus on these topics. More common has been information on the health risks associated with these surgeries (including hemorrhage, septicemia, shock, infections, urine retention, and obstructed labor), and it has been mostly the medical issues that have prompted criticism. By the first decade of the twenty-first century, however, international and African criticisms of the practice in all its forms had grown tremendously, with human rights concerns becoming increasingly central to change efforts. International organizations (UNICEF, WHO), government ministries, international and local non-governmental organizations (CARE, Inter-African Committee Against Harmful Traditional Practices), and committed individuals have begun to develop effective strategies for public health education programs in each of the affected countries.

The human rights focus has drawn particular attention because the surgeries are usually performed on children, with or without their consent. Change agents are promoting the right to bodily integrity for girls, and in some cases simply encouraging delay—to let the girl decide for herself when she is older—has been explored. Delay is a particularly useful strategy because change is not a one-time act, but rather requires resolve to continue to resist the social pressures of traditional values. Adding months or years of delay allows the parents to avoid confronting change, yet it improves the chance that a girl will not be circumcised since she or her parents may become influenced by the new ideas about abandonment of the practice.

Particularly important has been the development of theological discussions about the practices. Some religious leaders have become active in questioning and even condemning some or all types of the practices. Particularly in light of the fact that some people use religion to justify continuing the sunna form of circumcisions, the increased involvement of Islamic religious teachers who are speaking out against the idea that sunna circumcision is permissible has been significant. However, there continue to be some Muslim leaders who defend the less severe form, so the ongoing theological discussions are important.

In some countries, change agents have successfully promoted alternate rituals without cutting. Governments and organizations have cooperated on projects to raise awareness in neighborhoods and rural communities, combining religious messages, health messages, songs, and skits. The (IAC) Inter-African Committee Against Harmful Traditional Practices has sponsored boys' soccer tournaments (the FGM Cup, for example) to promote male awareness. Posters, videos, radio programs, and religious songs with anti-circumcision messages are being utilized. Basic work to promote women's literacy and empowerment continues to be important.

Resistance to change is attributed to such concerns as the fear that daughters will be unmarriageable, male sexual preferences for infibulated women, and the desire to preserve ethnic traditions and identity.

see also Clitoris.

BIBLIOGRAPHY

Abusharaf, Rogaia Mustafa, ed. 2006. Female Circumcision: Multicultural Perspectives. Philadelphia: University of Pennsylvania Press.

Gruenbaum, Ellen. 2001. The Female Circumcision Controversy: An Anthropological Perspective. Philadelphia: University of Pennsylvania Press.

Sanderson, Lilian Passmore. 1981. Against the Mutilation of Women. London: Ithaca.

Shell-Duncan, Bettina, and Ylva Hernlund, eds. 2000. Female "Circumcision" in Africa: Culture, Controversy, and Change. Boulder: Lynne Reinner.

UNICEF. 2005. Changing a Harmful Social Convention: Female Genital Mutilation/Cutting. Florence, Italy: UNICEF Innocenti Research Centre. Available from www.unicef.org/irc.

                                           Ellen Gruenbaum