What is female genital mutilation (FGM)?
Female genital mutilation (FGM) refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for cultural or other non-medical reasons.
How many women and girls are affected?
An estimated 200 million girls and women alive today are believed to have been subjected to FGM; but rates of FGM are increasing, a reflection of global population growth. Girls and women who have undergone FGM live predominately in sub-Saharan Africa and the Arab States, but FGM is also practiced in select countries in Asia, Eastern Europe and Latin America. It is also practiced among migrant populations throughout Europe, North America, Australia and New Zealand.
If FGM practices continue at recent levels, 68 million girls will be cut between 2015 and 2030 in 25 countries where FGM is routinely practiced and more recent data are available.
A key challenge is not only protecting girls who are currently at risk but also ensuring that those to be born in the future will be free from the dangers of the practice. This is especially important considering that FGM-concentrated countries are generally experiencing high population growth and have large youth populations. In 2019, an estimated 4.1 million girls will be cut. This number of girls cut each year is projected to rise to 4.6 million girls in the year 2030.
How does FGM affect the health of women and girls?
FGM has serious implications for the sexual and reproductive health of girls and women.
The effects of FGM depend on a number of factors, including the type performed, the expertise of the practitioner, the hygiene conditions under which it is performed, the amount of resistance and the general health condition of the girl/woman undergoing the procedure. Complications may occur in all types of FGM, but are most frequent with infibulation.
Immediate complications include severe pain, shock, haemorrhage, tetanus or infection, urine retention, ulceration of the genital region and injury to adjacent tissue, wound infection, urinary infection, fever, and septicemia. Haemorrhage and infection can be severe enough to cause death.
Long-term consequences include complications during childbirth, anaemia, the formation of cysts and abscesses, keloid scar formation, damage to the urethra resulting in urinary incontinence, dyspareunia (painful sexual intercourse), sexual dysfunction, hypersensitivity of the genital area and increased risk of HIV transmission, as well as psychological effects.
Infibulation, or type III FGM, may cause complete vaginal obstruction resulting in the accumulation of menstrual flow in the vagina and uterus. Infibulation creates a physical barrier to sexual intercourse and childbirth. An infibulated woman therefore has to undergo gradual dilation of the vaginal opening before sexual intercourse can take place. Often, infibulated women are cut open on the first night of marriage (by the husband or a circumciser) to enable the husband to be intimate with his wife. At childbirth, many women also have to be cut again because the vaginal opening is too small to allow for the passage of a baby. Infibulation is also linked to menstrual and urination disorders, recurrent bladder and urinary tract infections, fistulae and infertility.
What are the consequences for childbirth?
A recent study found that, compared with women who had not been subjected to FGM, those who had undergone FGM faced a significantly greater risk of requiring a Caesarean section, an episiotomy and an extended hospital stay, and also of suffering post-partum haemorrhage.
Women who have undergone infibulation are more likely to suffer from prolonged and obstructed labour, sometimes resulting in foetal death and obstetric fistula. The infants of mothers who have undergone more extensive forms of FGM are at an increased risk of dying at birth.
Very recent estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division reveal that most of the high-FGM-prevalence countries also have high maternal mortality ratios and high numbers of maternal death. Two high-FGM-prevalence countries are among the four countries with the highest numbers of maternal death globally. Five of the high-prevalence countries have maternal mortality ratios of 550 per 100,000 live births and above.
Is there a link between FGM and the risk of HIV infection?
When one tool is used to cut several girls, as is often the case in communities where large groups of girls are cut on the same day during a socio-cultural rite, there is a risk of HIV transmission.
Additionally, due to damage to the female sexual organs, sexual intercourse can result in the laceration of tissue, which greatly increases risk of HIV transmission. The same is true for the blood loss that accompanies childbirth.
What are the psychological effects of FGM?
FGM may have lasting effects on women and girls who undergo FGM. The psychological stress of the procedure may trigger behavioural disturbances in children, closely linked to loss of trust and confidence in caregivers. In the longer term, women may suffer feelings of anxiety and depression. Sexual dysfunction may also contribute to marital conflicts or divorce.
What are the different types of FGM?
The World Health Organization (WHO) has identified four types of FGM:
Type I, also called clitoridectomy: Partial or total removal of the clitoris and/or the prepuce.
Type II, also called excision: Partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora. The amount of tissue that is removed varies widely from community to community.
Type III, also called infibulation: Narrowing of the vaginal orifice with a covering seal. The seal is formed by cutting and re-positioning the labia minora and/or the labia majora. This can take place with or without removal of the clitoris.
Type IV: All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping or cauterization.
Other terms related to FGM include incision, deinfibulation and reinfibulation:
Incision refers to making cuts in the clitoris or cutting free the clitoral prepuce, but it also relates to incisions made in the vaginal wall and to incision of the perineum and the symphysis.
Deinfibulation refers to the practice of cutting open a woman who has been infibulated to allow intercourse or to facilitate childbirth.
Reinfibulation is the practice of sewing the external labia back together after deinfibulation.
Which types are most common?
Types I and II are the most common, but there is variation among countries. Type III – infibulation – is experienced by about 10 per cent of all affected women and is most likely to occur in Somalia, northern Sudan and Djibouti.
Why are there different terms to describe FGM, such as female genital cutting and female circumcision?
The terminology used for this procedure has gone through various changes.
When the practice first came to international attention, it was generally referred to as “female circumcision.” (In Eastern and Northern Africa, this term is often used to describe FGM type I.) However, the term “female circumcision” has been criticized for drawing a parallel with male circumcision and creating confusion between the two distinct practices. Adding to the confusion is the fact that health experts in many Eastern and Southern African countries encourage male circumcision to reduce HIV transmission; FGM, on the other hand, can increase the risk of HIV transmission.
It is also sometimes argued that the term obscures the serious physical and psychological effects of genital cutting on women. UNFPA does not encourage use of the term “female circumcision” because the health implications of male and female circumcision are very different.
The term “female genital mutilation” is used by a wide range of women’s health and human rights organizations. It establishes a clear distinction from male circumcision. Use of the word “mutilation” also emphasizes the gravity of the act and reinforces that the practice is a violation of women’s and girls’ basic human rights. This expression gained support in the late 1970s, and since 1994, it has been used in several United Nations conference documents and has served as a policy and advocacy tool. In Resolution 65/170, Member States clearly stated that female genital mutilation should be used to refer to this harmful practice.
In the late 1990s the term “female genital cutting” was introduced, partly in response to dissatisfaction with the term “female genital mutilation.” There is concern that communities could find the term “mutilation” demeaning, or that it could imply that parents or practitioners perform this procedure maliciously. Some fear the term “female genital mutilation” could alienate practicing communities, or even cause a backlash, possibly increasing the number of girls subjected to the practice.
Some organizations embrace both terms, referring to “female genital mutilation/cutting” or FGM/C.
What terminology does UNFPA use?
UNFPA embraces a human rights perspective on the issue, and the term “female genital mutilation” more accurately describes the practice from a human rights viewpoint.
Today, a greater number of countries have outlawed the practice, and an increasing number of communities have committed to abandon it, indicating that the social and cultural perceptions of the practice are being challenged by communities themselves, along with national, regional and international decision-makers. Therefore, it is time to accelerate the momentum towards full abandonment of the practice by emphasizing the human-rights aspect of the issue.
Additionally, the term “female genital mutilation (FGM)” is used in a number of UN and intergovernmental documents. One recent document is the 2016 UN Secretary General’s Report (A/71/209) on Intensifying global efforts for the elimination of female genital mutilations. Other documents using the term “female genital mutilation” include: Report of the Secretary-General on Ending Female Genital Mutilation, Communication from the Commission to the European Parliament and the Council: Towards the elimination of female genital mutilation, Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa; Beijing Declaration and Platform for Action; and Eliminating female genital mutilation: An interagency statement. And each year on 6 February, the United Nations observes the “International Day of Zero Tolerance for Female Genital Mutilation.”
Where does the practice come from?
The origins of the practice are unclear. It predates the rise of Christianity and Islam. It is said some Egyptian mummies display characteristics of FGM. Historians such as Herodotus claim that, in the fifth century BC, the Phoenicians, the Hittites and the Ethiopians practiced circumcision. It is also reported that circumcision rites were practiced in tropical zones of Africa, in the Philippines, by certain tribes in the Upper Amazon, by women of the Arunta tribe in Australia, and by certain early Romans and Arabs. As recent as the 1950s, clitoridectomy was practiced in Western Europe and the United States to treat perceived ailments including hysteria, epilepsy, mental disorders, masturbation, nymphomania and melancholia. In other words, the practice of FGM has been followed by many different peoples and societies across the ages and continents.
At what age is FGM performed?
It varies. In some areas, FGM is carried out during infancy – as early as a couple of days after birth. In others, it takes place during childhood, at the time of marriage, during a woman’s first pregnancy or after the birth of her first child. Recent reports suggest that the age has been dropping in some areas, with most FGM carried out on girls between the ages of 0 and 15 years.
Where is FGM practiced?
The practice can be found in communities around the world.
In Africa, FGM is known to be practiced among certain communities in 29 countries: Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Cote d’Ivoire, Democratic Republic of Congo, Djibouti, Egypt, Eritrea, Ethiopia, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Somalia, Sudan, Tanzania, Togo, Uganda and Zambia.
Certain ethnic groups in Asian countries practice FGM, including in communities in India, Indonesia, Malaysia, Pakistan and Sri Lanka.
In the Middle East, the practice occurs in Oman, the United Arab Emirates and Yemen, as well as in Iraq, Iran and the State of Palestine.
In Eastern Europe, recent info shows that certain communities are practicing FGM in Georgia and the Russian Federation.
In South America, certain communities are known to practice FGM in Columbia, Ecuador, Panama and Peru.
And in many western countries, including Australia, Canada, New Zealand, the United States, the United Kingdom and various European countries, FGM is practiced among diaspora populations from areas where the practice is common.
Who performs FGM?
FGM is usually carried out by elderly people in the community (usually, but not exclusively, women) designated to perform this task or by traditional birth attendants. Among certain populations, FGM may be carried out by traditional health practitioners, (male) barbers, members of secret societies, herbalists or sometimes a female relative.
In some cases, medical professionals perform FGM. This is referred to as the “medicalization” of FGM. According to recent UNFPA’s estimates, around one in five girls subjected to FGM were cut by a trained health-care provider. In some countries, this can reach as high as three in four girls. According to estimates from demographic and health surveys and multiple indicator cluster surveys, countries where the majority of FGM cases are performed by health workers are Egypt (38%), Sudan (67%), Kenya (15%), Nigeria (13%) and Guinea (15%).
What instruments are used to perform FGM?
FGM is carried out with special knives, scissors, scalpels, pieces of glass or razor blades. Anaesthetic and antiseptics are generally not used unless the procedure is carried out by medical practitioners. In communities where infibulations is practiced, girls’ legs are often bound together to immobilize them for 10-14 days, allowing the formation of scar tissue.
Why is FGM performed?
In every society in which it is practiced, female genital mutilation is a manifestation of deeply entrenched gender inequality. Where it is widely practiced, FGM is supported by both men and women, usually without question, and anyone that does not follow the norm may face condemnation, harassment and ostracism. It may be difficult for families to abandon the practice without support from the wider community. In fact, it is often practiced even when it is known to inflict harm upon girls because the perceived social benefits of the practice are deemed higher than its disadvantages.
The reasons given for practicing FGM fall generally into five categories:
Psychosexual reasons: FGM is carried out as a way to control women’s sexuality, which is sometimes said to be insatiable if parts of the genitalia, especially the clitoris, are not removed. It is thought to ensure virginity before marriage and fidelity afterward, and to increase male sexual pleasure.
Sociological and cultural reasons: FGM is seen as part of a girl’s initiation into womanhood and as an intrinsic part of a community’s cultural heritage. Sometimes myths about female genitalia (e.g., that an uncut clitoris will grow to the size of a penis, or that FGM will enhance fertility or promote child survival) perpetuate the practice.
Hygiene and aesthetic reasons: In some communities, the external female genitalia are considered dirty and ugly and are removed, ostensibly to promote hygiene and aesthetic appeal.
Religious reasons: Although FGM is not endorsed by either Islam or by Christianity, supposed religious doctrine is often used to justify the practice.
Socio-economic factors: In many communities, FGM is a prerequisite for marriage. Where women are largely dependent on men, economic necessity can be a major driver of the procedure. FGM sometimes is a prerequisite for the right to inherit. It may also be a major income source for practitioners.
Is FGM required by certain religions?
No religion promotes or condones FGM. Still, more than half of girls and women in four out of 14 countries where data is available saw FGM as a religious requirement. And although FGM is often perceived as being connected to Islam, perhaps because it is practiced among many Muslim groups, not all Islamic groups practice FGM, and many non-Islamic groups do, including some Christians, Ethiopian Jews, and followers of certain traditional African religions.
FGM is thus a cultural rather than a religious practice. In fact, many religious leaders have denounced it.
Since FGM is part of a cultural tradition, can it still be condemned?
Yes. Culture and tradition provide a framework for human well-being, and cultural arguments cannot be used to condone violence against people, male or female. Moreover, culture is not static, but constantly changing and adapting. Nevertheless, activities for the elimination of FGM should be developed and implemented in a way that is sensitive to the cultural and social background of the communities that practice it. Behaviour can change when people understand the hazards of certain practices and when they realize that it is possible to give up harmful practices without giving up meaningful aspects of their culture.
Does anyone have the right to interfere in age-old cultural traditions such as FGM?
Every child has the right to be protected from harm, in all settings and at all times. The movement to end FGM – often local in origin – is intended to protect girls from profound, permanent and completely unnecessary harm. The evidence shows that most people in affected countries want to stop cutting girls, and that overall support for FGM is declining even in countries where the practice is almost universal (such as Egypt and Sudan). Ending FGM will take intensive and sustained collaboration from all parts of society, including families and communities, religious and other leaders, the media, governments and the international community.
What is the link between FGM and ethnicity?
Ethnicity is the most significant factor in FGM prevalence, cutting across socio-economic class and level of education. Members of certain ethnic groups often adhere to the same social norms, including whether or not to practice FGM, regardless of where they live. The FGM prevalence among ethnic Somalis living in Kenya, for example, at 94 per cent, is similar to the prevalence in Somalia, and far higher than the Kenyan national average of 21 per cent, according to the most recent information available.
But there are exceptions. In Senegal, for example, there are major variations in FGM prevalence among Mandingue women, depending on where they live – 55 per cent in urban areas versus 84 per cent in rural areas. Similarly, FGM prevalence among the Poular ranges from 41 per cent in urban areas to 56 per cent in rural areas.
What do women and girls who have experienced FGM say about it themselves?
Women around the world are speaking out about their experiences and advocating change.
“It is what my grandmother called the three feminine sorrows: the day of circumcision, the wedding night and the birth of a baby.” –From “The Three Feminine Sorrows,” a Somali poem
“My two sisters, myself and our mother went to visit our family back home. I assumed we were going for a holiday. A bit later they told us that we were going to be infibulated. The day before our operation was due to take place, another girl was infibulated and she died because of the operation. We were so scared and didn’t want to suffer the same fate. But our parents told us it was an obligation, so we went. We fought back; we really thought we were going to die because of the pain. You have one woman holding your mouth so you won’t scream, two holding your chest and the other two holding your legs. After we were infibulated, we had rope tied across our legs so it was like we had to learn to walk again. We had to try to go to the toilet. If you couldn’t pass water in the next 10 days something was wrong. We were lucky, I suppose. We gradually recovered and didn’t die like the other girl. But the memory and the pain never really go away.” –Zainab, who was infibulated at the age of 8 (from WHO)
“I will never subject my child to FGM/C if she happens to be a girl, and I will teach her the consequences of the practice early on.” –Kadiga, Ethiopia
“In my village there is one girl who is younger than I am who has not been cut because I discussed the issue with her parents. I told them how much the operation had hurt me, how it had traumatized me and made me not trust my own parents. The decided they did not want this to happen to their daughter.” –Meaza, 15 years old
What does the term “medicalization of FGM” mean?
According to WHO, the medicalization of FGM is when FGM is performed by a health-care provider, such as a community health worker, midwife, nurse or doctor. Medicalized FGM can take place in a public or private clinic, at home or elsewhere. It also includes the procedure of reinfibulation at any point in time in a woman’s life. In 2010, a joint interagency Global Strategy to Stop Health-Care Providers from Performing FGM was released. In 2016, WHO also released guidelines on the management of health complications from FGM. This strategy reflects consensus between international experts, United Nations entities and the Member States they represent. In addition, the global commitment to eliminate all forms of FGM by 2030 is clearly stated in target 5.3 of the Sustainable Development Goals (SDG).
Isn’t it safer for FGM to be performed by a skilled health worker rather than by somebody without a medical background?
FGM can never be “safe”. Even when the procedure is performed in a sterile environment and by a health-care professional, there can be serious health consequences immediately and later in life. Medicalized FGM gives a false sense of security. There are serious risks associated with all forms of FGM, including medicalized FGM.
In addition, there is no medical justification for FGM. Advocating any form of cutting or harm to the genitals of girls and women, and suggesting that medical personnel should perform it is unacceptable from a public health and human rights perspective. Trained health professionals who perform female genital mutilation are violating girls’ and women’s rights to life, physical integrity and health. They are also violating the fundamental medical ethic to “do no harm.”
Furthermore, the belief that a “minor” genital cut will help avoid more severe forms of FGM is unproven. Several studies have shown that girls can be subjected to FGM repeatedly when members of their family or community are dissatisfied with the results of earlier procedures. There is also evidence that FGM procedures described as “just a nick” are often actually more severe forms of FGM. One study from Sudan found that, among the women who claimed to have undergone a type of FGM considered “just a prick,” about one third had actually been subjected to infibulation, and all had experienced the removal of their clitoris and labia minora.
When medical personnel perform FGM, they wrongly legitimize the practice as medically sound or beneficial for girls and women’s health. And because medical personnel often hold power, authority and respect in society, it can also further institutionalize the procedure.
What is UNFPA’s approach to FGM?
UNFPA and UNICEF jointly lead the largest global programme to accelerate the elimination of FGM and provide care for its consequences. This programme works with governments, civil society organizations, networks of religious leaders, parliamentarians, youth and human rights activists, and academia to:
• Support the development of policies and legislation, and ensure adequate resources, to end FGM;
• Amplify interventions that expand collective knowledge about the harms of FGM and empower champions for its elimination;
• Support gender equality and girls’ and women’s rights;
• Empower young people to end FGM in their communities;
• Address the trend of medicalization by galvanizing health professionals to view FGM as a human rights violation;
• Integrate FGM responses into sexual and reproductive health, maternal and child health, and child protection services – areas that offer entry points for identifying and supporting girls and women who are at risk or have been subjected to FGM.
• Mainstream FGM into health training programmes, mobilize doctors, nurses and midwives in support of FGM prevention and care, and empower health providers to serve as role models, counsellors and advocates in the effort to end FGM; and
• Establish a global knowledge hub for the measurement and dissemination of social norms and good practices captured by the Joint Programme for policy-making and improved programming.
The Joint Programme recognizes that eliminating FGM requires communities to make a collective and coordinated choice so that no single girl or family is disadvantaged by the decision.
This approach has seen progress. Civil society organizations are implementing community-led education and dialogue sessions on human rights and health. These networks are helping a growing number of communities declare their abandonment of FGM. A shift has occurred among religious leaders, many of whom have gone from endorsing the practice to actively condemning it. There has been a growing number of public declarations de-linking FGM from religion and supporting of abandonment of the practice.
With UNFPA technical guidance and support, there has been a surge in activities to strengthen the role of public health services in preventing FGM and, wherever possible, in treating its victims and mitigating its negative effects on women’s health. Health workers have been trained to treat complications caused by FGM, including the integration of FGM care into medical education curriculum. Referral systems that build coordination between health providers and community actors and organizations have also been strengthened.
Several countries have passed new national legislation banning FGM and developed national policies with concrete steps to achieve the abandonment of FGM. Radio networks have aired call-in shows about the harm caused by FGM. The use of media to galvanize public opinion against the practice has helped change perceptions and transformed public perceptions of girls who remain uncut.
In which countries is FGM banned by law?
Africa: Benin (2003); Burkina Faso (1996); Central African Republic (1996, 2006); Chad (2003); Cote d’Ivoire (1998); Djibouti (1994, 2009); Egypt (2008); Eritrea (2007); Ethiopia (2004); The Gambia (2015); Ghana (1994, 2007); Guinea (1965, 2000); Guinea Bissau (2011); Liberia (2018, by one-year executive order); Kenya (2001, 2011); Mauritania (2005); Niger (2003); Nigeria (2015); Senegal (1999); South Africa (2000); Sudan (2020); Tanzania (1998); Togo (1998); Uganda (2010); Zambia (2005, 2011)
Others: Australia (6 out of 8 states between 1994-2006); Austria (2002); Belgium (2000); Canada (1997); Colombia (Resolution No. 001 of 2009 by indigenous authorities); Cyprus (2003); Denmark (2003); France (Penal Code, 1979); Italy (2005); Ireland (2012); Luxembourg (on mutilations only, not specifically on ‘genital’ mutilation, 2008); New Zealand (1995); Norway (1995); Portugal (2007); Spain (2003); Sweden (1982, 1998); Switzerland (2005, new stricter penal norm in 2012); United Kingdom (1985); United States (1996)
Penalties range from a minimum of six months to a maximum of life in prison. Several countries also include monetary fines in the penalty.
What does the ICPD Programme of Action say about FGM?
The Programme of Action of the International Conference on Population and Development recognizes that violence against women is a widespread phenomenon. It states, “In a number of countries, harmful practices meant to control women’s sexuality have led to great suffering. Among them is the practice of female genital cutting, which is a violation of basic rights and a major lifelong risk to women’s health” (para 7.35).
The Programme of Action calls for “Governments and communities [to] urgently take steps to stop the practice of female genital cutting and protect women and girls from all such similar unnecessary and dangerous practices. Steps to eliminate the practice should include strong community outreach programmes involving village and religious leaders, education and counselling about its impact on girls’ and women’s health, and appropriate treatment and rehabilitation for girls and women who have suffered cutting. Services should include counselling for women and men to discourage the practice.” (para 7.40)
Chapter 4, para 4.4 states, “Countries should act to empower women and should take steps to eliminate inequalities between men and women as soon as possible by… eliminating all practices that discriminate against women; assisting women to establish and realize their rights, including those that relate to reproductive and sexual health.” Para 4.9, states, “Countries should take full measure to eliminate all forms of exploitation, abuse, harassment and violence against women, adolescents and children.”