Overview - Female Genital Mutilation

Female Genital Mutilation, or FGM, is the ritual removal, in varying degrees, of female genitalia for cultural, religious, or "health" related reasons. It is often referred to as female "circumcision", however the degree of physical alteration and resulting trauma are far worse than its male counterpart. To this extent, circumcision is a misnomer. Reliable statistics on FGM are difficult to come by, as the cultures which practice it worldwide tend to be secretive about the practice, particularly as global sentiment against it is growing. But according to the best estimates from the World Health Organization, 130 to 137 million women worldwide have suffered the practice, and an estimated 4 to 5 million women per year are subjected to it—an average of 11,000 to 14,000 daily.

It’s known to occur in some 30 countries and on every continent, including the developed world. It occurs most commonly in impoverished and isolated areas, chiefly in Africa and throughout the Muslim world (thought the practice transcends religious boundaries, and appears to have picked up various religious rationalizations from whatever spiritual tradition it occurs in). In fact, it is estimated that 168,000 women are at risk for the practice in the United States alone—chiefly among immigrant populations—and nearly half of all domestic health care providers have observed complications from it. Many are aware that such practices exist, but most are surprised to learn how widespread it is.

Depending on the culture, FGM is practiced in varying degrees. The lowest level form involves a symbolic nicking, or incision, in the clitoris. More severe forms such as those practiced in Ethiopia and Somalia involve the complete removal of the clitoris, labia minora and majora, and a nearly complete sewing back up of the resulting wound—which must be reopened upon marriage for sex and childbirth. The ritual is usually performed on girls between the ages of 12 and 20 (average is 14 to 16). Depending on the circumstances, cutting may involve knives, specialized circumcision "tools", razors, broken glass, fire, and even teeth. It is almost never practiced in sanitary conditions. Immediate medical consequences include, shock, extreme pain, hemorrhage, local and systemic infections, anemia, bone fracture (clavicle, hip, humerus and femur), and even death.

Over 15 percent of cut women die of shock and blood loss within two weeks of being cut—this amounts to nearly 750,000 women annually worldwide. Long-term consequences include lameness (from tendons cut during the practice), infertility, incontinence, HIV/AIDS (from dirty tools), hepatitis B and C, death during childbirth, infant death during delivery (due to oxygen deprivation from physical deformity in the birth canal), dermoid cysts, fistulae, chronic pain, and a complete loss of sexual satisfaction. FGM is one of the most, if not the most, severe health care crises in the world today.

Rationalizations for the practice vary depending on culture. Typically cited reasons include tradition and cultural identity, that being cut is a necessary transition to cleanliness and womanhood (African cultures frequently refer to uncut women as "dirty little girls"), prevention of "promiscuous" behavior by women, that it "gives radiance to the face" (a commonly cited reason in Sub-Saharan Africa), that it keeps couples together, and various folk myths regarding its alleged health benefits. Some of these myths are unusually extreme in nature and removed from medical reality, yet are believed anyway. For instance, my wife and I have been working for some time with the Sabiny people of northeastern Uganda. We have two goddaughters we have adopted as part of a program to rescue them from the practice. In this culture, it is widely believed that without FGM, the clitoris would grow to knee length and be full of poison that could threaten the life of one's husband and children. The existence of such beliefs emphasizes the need for education among FGM practicing cultures.

In virtually every case, cultures that practice FGM sincerely believe they are caring for their women by doing so. Furthermore, contrary to what might be expected, FGM is often not a gender based issue. Quite often support for the practice is carried on by women even more frequently than by men. Numerous instances have been documented of women who have attempted to flee the practice, only to be pursued by family members, kidnapped and forcibly cut against their will (several such cases have turned up among immigrant populations right here in the United States). In most such cases that have been documented, the kidnapping and forcible cutting have been done by female family members—mothers, sisters, aunts. In fact, in many regions of Sub-Saharan Africa, resistance to the practice is actually growing faster among men than among women! In addition to the issue of "cultural imperialism", this greatly complicates the question of how best to deal with it.

To date, most anti-FGM governmental and NGO programs concentrate on education. Relief efforts have generally failed because the cultures that suffer most from it generally refuse to cooperate with these efforts. It is ironic that as horrific as the practice of FGM is, it's zealously guarded by the cultures that practice it. For a variety of reasons, great significance is attached to the ceremony and it is an integral part of their culture and historical identity. As such, many governmental and non-governmental organizations attempting to prevent the practice have been accused of "cultural imperialism". This has seriously interfered with reform. In August of 2001 my wife Audrey and I traveled to Uganda with two other people to work with one program that has found a unique and effective solution to these difficulties.

The program offers safe housing and education away from FGM practicing villages to girls at risk for it who wish to escape. By supporting girls who already want to be rescued from the practice and their families (who often support them in this when their larger villages will not), the "cultural imperialism" problem is resolved. Apart from programs like this, girls at risk for FGM would few if any alternatives. In the rural Ugandan cultures we work with for instance, girls who do not consent to being cut are often abandoned with virtually no economic opportunities and would quite literally starve unless they consent to the practice. While at school, the girls are safe from being cut (in the Sabiny and Pokot cultures we work with most, cutting only happens at certain times of the year, and only in even numbered years). The educational opportunities allow the girls to survive on their own which frees them from dependence on the villages that will insist on their being cut.

The program my wife and I worked with is established in Kampala, Uganda. There, with two other anti-fgm workers we visited Peace High School where such a program is run. It was a truly amazing and life changing experience. We saw firsthand how lives are being saved by this program. We met our own goddaughter Chesha Juliet, a striking young woman with an infectious smile that melted my heart when we first met. Today we have two lovely goddaughters who have since moved to another similarly structured education/boarding program in Kampala. To the best of our knowledge, programs like these are the only ones in existence that are actually rescuing girls from female genital mutilation.