female genital mutilation (FGM)

As you are reading this article, there are between eight and ten million women and girls in the Middle East and in Africa who are at risk of undergoing one form or another of genital cutting. In the United States it is estimated that about ten thousand girls are at risk of this practice. FGM in a variety of its forms is practiced in Middle Eastern countries (the two Yemens, Saudi Arabia, Iraq, Jordan, Syria, and Southern Algeria). In Africa it is practiced in the majority of the continent including Kenya, Nigeria, Mali, Upper Volta, Ivory Coast, Egypt, Mozambique, and Sudan.

Even though FGM is practiced in mostly Islamic countries, it is not an Islamic practice. FGM is a cross-cultural and cross-religious ritual. In Africa and the Middle East it is performed by Muslims, Coptic Christians, members of various indigenous groups, Protestants, and Catholics, to name a few.

Type I - Sunna Circumcision

The first and mildest type of FGM is called "sunna circumcision" or Type I. The term "Sunna" refers to tradition as taught by the prophet Muhammad. This involves the "removal of the prepuce with or without the excision of part or all of the clitoris. More about this type.

Type II - Excision

The second type of FGC, Type II, involves the partial or entire removal of the clitoris, as well as the scraping off of the labia majora and labia minora . This takes place in countries where infibulation has been outlawed such as Sudan. Clitoridectomy was invented by Sudanese midwives as a compromise when British legislation forbade the most extreme operations in 1946. More about this type.

Type III - Infibulation or Pharaonic Circumcision

The third and most drastic type of FGM is Type III. This most extreme form, consists of the removal of the clitoris, the adjacent labia (majora and minora), and the joining of the scraped sides of the vulva across the vagina, where they are secured with thorns or sewn with catgut or thread. A small opening is kept to allow passage of urine and menstrual blood. An infibulated woman must be cut open to allow intercourse on the wedding night and is closed again afterwards to secure fidelity to the husband. Hosken also reports that infibulation is "practiced on all females, almost without exception, in all of Somalia and wherever ethnic Somalis live (Ethiopia, Kenya and Djibouti). It is also performed throughout the Nile Valley, including Southern Egypt, and all along the Red Seas Coast. More about this type.

Type IV - Other types

Other forms are collectively referred to as Type IV and usually do not involve any tissue removal at all, but rather the "cutting" is simulated with a knife as part of a ceremony. This includes a diverse range of practices, including pricking the clitoris with needles, burning or scarring the genitals as well as ripping or tearing of the vagina or introducing herbs into the vagina to cause bleeding and a narrowed vaginal opening (ref). Type IV is found primarily among isolated ethnic groups as well as in combination with other types.

Effects of Female Genital Mutilation

Beyond the obvious initial pains of the operations, FGM has long-term physiological, sexual, and psychological effects. The unsanitary environment under which FGM takes place results in infections of the genital and surrounding areas and often results in the transmission of the HIV virus which can cause AIDS. Some of the other health consequences of FGC include primary fatalities as a result of shock, hemorrhage or septicemia. In order to minimize the risk of the transmission of the viruses, some countries like Egypt made it illegal for FGM to be practiced by any other practitioners than trained doctors and nurses in hospitals. While this seems to be a more humane way to deal with FGM and try to reduce its health risks, more tissue is apt to be taken away due to the lack of struggle by the child if anesthesia is used.

Long-term complications include sexual frigidity, genital malformation, delayed menarche, chronic pelvic complications, recurrent urinary retention and infection, and an entire range of obstetric complications whereas the fetus is exposed to a range of infectious diseases as well as facing the risk of having his or her head crushed in the damaged birth canal. In such cases the infibulated mother must undergo another operation whereby she is "opened" further to insure the safe birthing of her child.

Girls undergo FGM when they are around three years old, though some of them are much older than that when they undergo the operation. The age varies depending on the type of the ritual and the customs of the local village or region.

Alternative Rituals

In many cultures, FGC serves as an initiation rite, and any efforts to eradicate it must take this into consideration. Some of the most successful eradication efforts have taken place in areas where FGC was replaced with "initiation without cutting" programs whereas a girl still goes through some initiation rites but this time, without any blood.

Alternative rituals are currently being implemented in countries like Ghana and Kenya, that do not include any bloodletting. A girl will still undergoes the celebrations and the rituals that usually accompany the circumcision ritual , however, the procedure itself is either replaced with a small pricking elsewhere on the body to let out a small drop of water, or bloodletting is completely done away with.

Other successful programs have also experimented with giving midwives monthly salaries for putting down their knives and becoming health care workers. They are now trained in various aspects of female health, and go from village to village educating women about the harmful effects of female circumcision, and the importance of proper nutrition during pregnancy, how to protect from sexually transmitted diseases and HIV, and proper usages of condoms, among other health topics.