Sunday, 23 November 2014

What is Female Genital Mutilation (FGM)?




Female genital mutilation (FGM), also known as female circumcision or female genital cutting, is defined by the World Health Organisation (WHO) as "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons".

It is estimated that approximately 100-140 million African women have undergone FGM worldwide and each year, a further 3 million girls are estimated to be at risk of the practice in Africa alone. Most of them live in African countries, a few in the Middle East and Asian countries, and increasingly in Europe, Australia, New Zealand, the United States of America and Canada.
The procedure is traditionally carried out by an older woman with no medical training. Anaesthetics and antiseptic treatment are not generally used and the practice is usually carried out using basic tools such as knives, scissors, scalpels, pieces of glass and razor blades. Often iodine or a mixture of herbs is placed on the wound to tighten the vagina and stop the bleeding.
The age at which the practice is carried out varies, from shortly after birth to the labour of the first child, depending on the community or individual family. The most common age is between four and ten, although it appears to be falling. This suggests that circumcision is becoming less strongly linked to puberty rites and initiation into adulthood.

"Mama tied a blindfold over my eyes. The next thing I felt my flesh was being cut away. I heard the blade sawing back and forth through my skin. The pain between my legs was so intense I wished I would die."
Waris Dirie, UNFPA Goodwill Ambassador and spokesperson on FGM



Where is FGM Practised?
The majority of cases of FGM are carried out in 28 African countries. In some countries, (e.g. Egypt, Ethiopia, Somalia and Sudan), prevalence rates can be as high as 98 per cent. In other countries, such as Nigeria, Kenya, Togo and Senegal, the prevalence rates vary between 20 and 50 per cent. It is more accurate however, to view FGM as being practised by specific ethnic groups, rather than by a whole country, as communities practising FGM straddle national boundaries. FGM takes place in parts of the Middle East, i.e. in Yemen, Oman, Iraqi Kurdistan, amongst some Bedouin women in Israel, and was also practised by the Ethiopian Jews, and it is unclear whether they continue with the practice now that they are settled in Israel. FGM is also practised among Bohra Muslim populations in parts of India and Pakistan, and amongst Muslim populations in Malaysia and Indonesia.
As a result of immigration and refugee movements, FGM is now being practiced by ethnic minority populations in other parts of the world, such as USA, Canada, Europe, Australia and New Zealand. FORWARD estimates that as many as 6,500 girls are at risk of FGM within the UK every year.



EFFECTS OF FGM

Immediate consequences of FGM include severe pain and bleeding, shock, difficulty in passing urine, infections, injury to nearby genital tissue and sometimes death. The procedure can result in death through severe bleeding leading to haemorrhagic shock, neurogenic shock as a result of pain and trauma, and overwhelming infection and septicaemia, according to Manfred Nowak, UN Special Rapporteur on Torture and other Cruel, Inhuman or Degrading Treatment or Punishment.
Almost all women who have undergone FGM experience pain and bleeding as a consequence of the procedure. The event itself is traumatic as girls are held down during the procedure. Risk and complications increase with the type of FGM and are more severe and prevalent with infibulations.

“The pain inflicted by FGM does not stop with the initial procedure, but often continues as ongoing torture throughout a woman’s life”, says Manfred Nowak, UN Special Rapporteur on Torture.
In addition to the severe pain during and in the weeks following the cutting, women who have undergone FGM experience various long-term effects - physical, sexual and psychological.
Women may experience chronic pain, chronic pelvic infections, development of cysts, abscesses and genital ulcers, excessive scar tissue formation, infection of the reproductive system, decreased sexual enjoyment and psychological consequences, such as post-traumatic stress disorder.
Additional risks for complications from infibulations include urinary and menstrual problems, infertility, later surgery (defibulation and reinfibulation) and painful sexual intercourse. Sexual intercourse can only take place after opening the infibulation, through surgery or penetrative sexual intercourse. Consequently, sexual intercourse is frequently painful during the first weeks after sexual initiation and the male partner can also experience pain and complications.
When giving birth, the scar tissue might tear, or the opening needs to be cut to allow the baby to come out. After childbirth, women from some ethnic communities are often sown up again to make them “tight” for their husband (reinfibulation). Such cutting and restitching of a woman’s genitalia results in painful scar tissue.
A multi-country study by WHO in six African countries, showed that women who had undergone FGM, had significantly increased risks for adverse events during childbirth, and that genital mutilation in mothers has negative effects on their newborn babies. According to the study, an additional one to two babies per 100 deliveries die as a result of FGM.


Justifications of FGM
The roots of FGM are complex and numerous; indeed, it has not been exactly possible to determine when or where the tradition of FGM originated.
The justifications given for the practise are multiple and reflect the ideological and historical situation of the societies in which it has developed. Reasons cited generally relate to tradition, power inequalities and the ensuing compliance of women to the dictates of their communities
Reasons include:
custom and tradition
religion; in the mistaken belief that it is a religious requirement
preservation of virginity/chastity
social acceptance, especially for marriage
hygiene and cleanliness
increasing sexual pleasure for the male
family honour
a sense of belonging to the group and conversely the fear of social exclusion
enhancing fertility
Many women believe that FGM is necessary to ensure acceptance by their community; they are unaware that FGM is not practised in most of the world.



Types of Female Genital Mutilation


The World Health (WHO) classifies FGM into four types:
Type I
involves the excision of the prepuce with or without excision of part or all of the clitoris.
Type II
excision of the prepuce and clitoris together with partial or total excision of the labia minora.
Type III
excision of part or all of the external genitalia and stitching or narrowing of the vaginal opening, also known as infibulation. This is the most extreme form and constitutes 15 per cent of all cases. It involves the use of thorns, silk or catgut to stitch the two sides of the vulva. A bridge of scar tissue then forms over the vagina, which leaves only a small opening (from the size of a matchstick head) for the passage of urine and menstrual blood.
Type IV
includes pricking, piercing or incision of the clitoris and/or the labia; stretching of the clitoris and or the labia; cauterisation or burning of the clitoris and surrounding tissues, scraping of the vaginal orifice or cutting (Gishiri cuts) of the vagina and introduction of corrosive substances or herbs into the vagina.
Terms for FGM: why 'Female Genital Mutilation' and not 'female circumcision'?
There are a number of different terms used to refer to the practice of Female Genital Mutilation, the most common ones being:
female circumcision, and
female genital cutting (FGC).
FORWARD chooses to use the term 'Female Genital Mutilation' as we believe it most accurately depicts what women affected by FGM have undergone, emphasising the gravity of this abuse of women's human rights. For these reasons, worldwide and especially amongst anti-FGM activists, there is an increasing tendency to use the term FGM.
FORWARD is particularly opposed to use of the term female circumcision, which implies that it is the female equivalent of male circumcision. Whilst FORWARD is opposed to genital mutilation or circumcision of any kind, FORWARD rejects the term female circumcision as it does not depict the true nature of FGM and implies that the practice and the consequences of FGM are far less severe than is the case.


Traditional and local terms for FGM
Country    Term used for FGM Language Meaning

EGYPT Thara Arabic Deriving from the Arabic word 'tahar' meaning to clean / purify
  Khitan Arabic Circumcision - used for both FGM and male circumcision
  Khifad Arabic Deriving from the Arabic word 'khafad' meaning to lower (rarely used in everyday language)

ETHIOPIA Megrez Amharic Circumcision / cutting
  Absum Harrari Name giving ritual

ERITREA Mekhnishab Tigregna Circumcision / cutting

KENYA Kutairi Swahili Circumcision - used for both FGM and male circumcision
  Kutairi was ichana Swahili Circumcision of girls

NIGERIA Ibi / Ugwu Igbo The act of cutting - used for both FGM and male circumcision
  Sunna Mandingo Religious tradition / obligation - for Muslims

SIERRA LEONE Sunna Soussou Religious tradition/ obligation - for Muslims
  Bondo Temenee Integral part of an initiation rite into adulthood - for non Muslims
  Bondo / Sonde Mendee Integral part of an initiation rite into adulthood - for non Muslims
  Bondo Mandingo Integral part of an initiation rite into adulthood - for non Muslims
  Bondo Limba Integral part of an initiation rite into adulthood - for non Muslims

SOMALIA Gudiniin Somali Circumcision used for both FGM and male circumcision
  Halalays Somali Deriving from the Arabic word 'halal' ie. 'sanctioned' - implies purity. Used by Northern & Arabic speaking Somalis.
  Qodiin Somali Stitching / tightening / sewing refers to infibulation

SUDAN Khifad Arabic Deriving from the Arabic word 'khafad' meaning to lower (rarely used in everyday language)
  Tahoor Arabic Deriving from the Arabic word 'tahar' meaning to purify

CHAD - the Ngama Bagne Used by the Sara Madjingaye
Sara subgroup Gadja dapted from 'ganza' used in the Central African Republic
GUINEA-BISSAU Fanadu di Mindjer Kriolu 'Circumcision of girls'
  Fanadu di Omi Kriolu 'Circumcision of boys'

GAMBIA Niaka Mandinka Literally to 'cut /weed clean'
  Kuyango Mandinka Meaning 'the affair' but also the name for the shed built for initiates
  Musolula Karoola Mandinka Meaning 'the women's side' / 'that which concerns women'


Other FGM-related terms and definitions
Angurya cuts:
A form of FGM type 4 that involves the scraping of tissue around the vaginal opening.
Clitoridectomy:
Refers to excision of the clitoris.
De-infibulation
(sometimes known as or referred to as deinfibulation or defibulation or FGM reversal): The surgical procedure to open up the closed vagina of FGM type 3.
Excision:
Refers to removal of the clitoral hood, with or without removal of part or all of the clitoris.
Infibulation or Pharaonic circumcision:
Refers to FGM type 3 (see above), the most extensive form of FGM.
Re-infibulation
(sometimes known as or referred to as reinfibulation or re-suturing): The re-stitching of FGM type 3 to re-close the vagina again after childbirth (illegal in the UK as it constitutes FGM).
Sunna:
the traditional name for a form of FGM that involves the removal of the prepuce of the clitoris only. The word 'sunna' refers to the 'ways or customs' of the prophet Muhammad considered (wrongly in the case of FGM) to be religious obligations. Studies show however, that the term 'sunna' is often used in FGM practicing communities to refer to all forms of FGM, not just FGM that involves only the removal of the hood of the clitoris.

Sources:
1. Amnesty international
2. FORWARD, 2006.