The Cut: Female Genital Mutilation in the Modern World

For many, the subject of female genital mutilation is an uncomfortable and difficult topic to broach or discuss.  

 

“Because it’s genitalia we don’t want to talk about it,” says Shelby Quast, Americas Director for Equality Now, a legal advocacy organization that protects and promotes the rights of women and girls globally. “It’s so prevalent. It’s likely in all our communities. It shouldn’t be approached with shame.”

 

Female genital mutilation or female circumcision is the removal or injury of parts or all of the external female genitalia for non-medical reasons.

 

Hibo Wardere was six years old when FGM was performed on her. She was held down by three women, and a cutter hired by the family removed her clitoris and labia with a “rusty blood-caked” razor.

 

She describes her experience in an excerpt from her book, Cut: One Woman’s Fight Against FGM in Britain Today, which chronicles the long-term repercussions and trauma:


“What I saw took the breath from my body. There was only one word for it—devastating. For the first time, I could see what I had been left with. It was just a hole. Everything else had been chopped off and sealed up. Despite the doctor opening my skin up to expose my urethra, there were no fleshy labia like other women had. No protection, no beauty, the area between my legs looked like dark brown sand that someone had dragged a faint line through, then as if someone had poked a stick into the sand, there at the bottom of the line was a hole. My vagina. I could see it was a little bigger than it had originally been stitched thanks to the doctor who opened me slightly. But there it was. The only clue that I was a woman. The rest of my genitals had been sliced off and discarded.”

 

According to UNICEF, at least 200 million girls and women in 30 countries have undergone some form of FGM, usually before the age of 15.  Additionally, 3 million girls are at-risk each year.

 

FGM is not a monolithic procedure carried out in the same manner globally, various forms of FGM exist. World Health Organization (WHO) Spokesperson Dr. Christina Pallitto, Scientist at WHO Department of Reproductive Health and Research and HRP, explains the different variations, which are categorized into four sub-types.

 

 

Type 1: Often referred to as clitoridectomy, this is the partial or total removal of the clitoris.  


Type 2: Often referred to as excision, this is the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva), with or without excision of the labia majora (the outer folds of skin of the vulva ).


Type 3: Often referred to as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoris (clitoridectomy).


Type 4: This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.

 

 

To read the full interview and Q&A with the WHO click here.

 

 

Nankali Maksud, Senior Advisor, Prevention of Harmful Cultural Practices at UNICEF, answered several of Politicsay’s question on the topic and explained the challenges they face in eliminating the practice, especially as a result of medical complicity observed in several countries, where FGM also becomes an additional source of income for practitioners:

 

“Another major challenge in ending FGM is the rising trend of medicalization in countries such as Egypt and Sudan where health professionals are often complicit, performing the procedure themselves. Within the Joint Programme, there are seven countries in which more than one in 10 girls who have undergone FGM are cut by health professionals: Egypt, Sudan, Guinea, Djibouti, Kenya, Yemen and Nigeria. In these countries, more than 20 million girls and women have undergone FGM at the hands of a health professional. This wrongly legitimizes the practice and creates the inaccurate impression that it is beneficial for girls’ and women’s health, violating the fundamental ethical code that requires that physicians, nurses, and midwives “do no harm” to any patient. Medicalization can also act as an additional source of income for health-care workers and can undermine efforts to eliminate the practice.”

 

 

To read our full interview and Q&A with UNICEF click here.

 

 

Despite being deeply entrenched, the practice has diminished in some areas. Dr. Pallitto adds, “There is evidence that the practice is being abandoned or declining in some communities and that attitudes are shifting especially among the younger generation, however, it is a deeply rooted social norm, and it takes time to change social norms. Research shows that, if practicing communities themselves decide to abandon FGM, the practice can be eliminated very rapidly.”

 

The procedure is described as overwhelmingly painful, even decades later the trauma is still evident. Amanda Parker, Senior Director, The AHA Foundation, founded by Ayaan Hirsi Ali, expounds on the long-term consequences with Politicsay via email:

 

“FGM has no health benefits and is associated with life-long health and psychological consequences.  Some long-term effects include fistula, difficulties with sexual intercourse and childbearing, recurrent bladder and urinary tract infections, infertility, and an increase in newborn deaths. Psychological consequences may include PTSD, depression, and self-harm.”

 

 

The practice has existed since antiquity and is maintained through social obligation, religion, “hygiene,” conformity, aesthetic, and preservation of virginity, among other reasons. Parker explains why the practice continues and local attitudes:

 

 

“FGM is generally done to control the sexuality of women and girls.  However, how a local population views the practice depends very much on which local population you ask.  Some think that FGM is necessary because they want to ensure a girl’s virginity on her wedding night.  Some think it is needed as part of cleanliness or to be feminine.  Some see it as aesthetically pleasing.  Some believe it will curb the libido of a woman or girl.  An important thing to note is that mothers (and it’s typically mothers who perpetuate this practice) don’t do this to harm their girls.  They do it because they think that they are doing the best thing they can as a mother to ensure a good future for their family.  In many cultures where FGM is practiced, a girl is not considered “marriageable” until she has been cut.  Not only is marriage the way that families know that their daughter will be taken care of in the future, but also represents an important opportunity for the groom and his family to form an alliance with the bride’s family.  This can be hugely important in tribal communities.  Because of this, by forcing a girl to be cut, a mother is helping to ensure a “good marriage” for her daughter, and is helping to secure the stability of the entire family in the process.”

 


Many survivors are outspoken about the sexual difficulties rendered by FGM. Due to tissue removal and damage, along with PTSD, intimacy can be painful and uncomfortable, especially for those who have undergone infibulation.

 

In an interview, Wardere describes what sex is like after female genital mutilation:

 

 

“Even if the doctor has opened you up, what they’ve left you with is a very tiny space. Things that were supposed to be expanding have gone. So the hole that you have is very small and sex is very difficult. You do get pleasures— but it’s once in a blue moon. First, you have a psychological block because the only thing you associate with that part of you is the pain. The other part is the trauma you experienced. So anything that’s happening down there, you never see it as a good thing.”

 

Despite the trauma, some women are still capable of experiencing arousal and orgasm. “Many women and girls are still able to receive sexual pleasure even after being cut,” says Parker. “However it may never be the same as it would have been had they not undergone FGM.”

 

Female Genital Mutilation also occurs in the United States. In April 2017, a Michigan doctor was arrested for performing FGM on two seven-year-olds and is alleged to have been active for over a decade.

 

Nikki Mayes, Spokesperson for the Center for Disease Control (CDC) explains the data, trends, and occurrences of FGM within the U.S.:

 

How prevalent is FGM in the United States? Are there regions or communities in the U.S. with a higher frequency?

“According to CDC’s most recent estimate on this topic (a 2016 paper published in Public Health Reports), as many as 513,000 women and girls in the United States could be at risk of having undergone female genital mutilation/cutting in the past or may be at risk of experiencing it in the future. (Note: this is not an estimate of how frequently female genital mutilation/cutting (FGM/C) occurs in the US or an estimate of how many U.S.-resident women and girls have actually experienced FGM/C. National prevalence data do not exist on FGM/C among women and girls living in the US, nor are U.S. regional-level data available.)”

 

What has the CDC’s experience been with the issue? Are more cases being identified?

“That paper shows a three-fold increase in the number of women and girls in the US who may have undergone genital cutting in the past or may experience it in the future compared with a previous 1997 paper. The estimated increase is largely due to the growing number of U.S.-resident women from countries where FGM/C is prevalent. We believe this increase reflects rapid growth in the number of people coming from countries practicing FGC – not an increase in FGC.”

 

 

To read the full interview with the CDC click here.

 

 

Many organizations, especially survivor-led ones, are fighting on both the national and international stages to dissuade families from cutting their daughters; and creating legislation to criminalize the practice.

 

“The AHA Foundation works to prevent FGM in several ways,” says Parker.  “The first is we support women and girls who come to us at risk of FGM and work with them to get the help they need.  For example, we have helped women secure pro bono immigration attorneys when they are seeking asylum to prevent their daughters from being cut, or to prevent themselves from being cut upon returning to their country of origin.”

 

Equality Now advocates for laws that protect women and girls, and support grassroots initiatives and activists.  

 

Maksud explains the legal and protective challenges faced in countries that share borders with practicing (or non-criminalized FGM) nations, and the lack of collaboration between bordering countries:

 

“There is a gap in the protection afforded by existing legal frameworks. Most countries have criminalized FGM when it takes place on national territory or when a girl is taken abroad for mutilation if she is a citizen or permanent resident of the country. This fails to recognize the obligation of countries to protect all children within their jurisdiction and does not take into consideration the mobile, transnational character of practicing communities. A further challenge is an insufficient collaboration among Governments across borders. Girls living near border areas are most vulnerable, particularly if they are living next to countries with weaker legislation against the practice than their own.”

 

The WHO has implemented a multi-faceted strategy in eliminating the practice, Dr. Pallitto details the approach:

 

  • “Strengthening the health sector response: developing guidelines, tools, training, and policy to ensure that health professionals can provide medical care and counseling.”
  • “Building evidence: generating knowledge about the causes and consequences of the practice, the health and economic costs of FGM, and why healthcare professionals carry out procedures, how to eliminate it, and how to care for those who have experienced FGM;”
  • “Increasing advocacy: developing publications and advocacy tools for international, regional and local efforts to end FGM within a generation.”

 

Regular citizens can also help end FGM. “Have conversations, that’s how we see change,” says Quast. Dialogues bring more attention to the issue, which begets laws, and removes shame, while empowering communities and women to denounce and end the practice. Equality Now puts it well, “FGM is global, but so is the movement to end it.”

Madari Pendas