Thursday, February 06, 2014

The International Day for Zero Tolerance of Female Genital Mutilation

Today is the eleventh International Day advocating zero tolerance for female genital mutilation (FGM).  This UN sponsored event focuses attention on the negative aspects of the practice and its prevalence.  It is largely concentrated among 29 countries in Africa and the Middle East and the diaspora from those countries.  It is estimated that 140 million women and girls alive today (125 million in the African countries where the practice is most common)  have undergone some form of the operation, which can carry both instant and long-term health risks, including life-threatening ones.

The reasons for the practice are largely cultural and traditional.  FGM can be viewed as a rite of passage, a custom passed on from older women to younger women,  but its ultimate reason is in the belief that it is important to control women's sexuality, both for the family honor and in order to make women into wives who are less likely to stray.  Whether practices such as infibulation (see below) might also have more direct sexual motives is unclear to me but seems possible.

There are four main types of FGM:

Clitoridectomy: partial or total removal of the clitoris or, in very rare cases, only the prepuce.

Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora.

Infibulation: narrowing of the vaginal opening through the creation of a covering ‘seal’. The seal is formed by cutting and repositioning the inner or outer labia, with or without removal of the clitoris.

Unclassified: all other harmful procedures to the female genitalia for non-medical purposes,
e.g. pricking, piercing, incising, scraping and cauterising the genital area.

The health problems FGM can cause are several:

FGM has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls' and women's bodies.
Immediate complications can include severe pain, shock, haemorrhage (bleeding), tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue.
Long-term consequences can include:
  • recurrent bladder and urinary tract infections;
  • cysts;
  • infertility;
  • an increased risk of childbirth complications and newborn deaths;
  • the need for later surgeries. For example, the FGM procedure that seals or narrows a vaginal opening (type 3 above) needs to be cut open later to allow for sexual intercourse and childbirth. Sometimes it is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing and repeated [sic] both immediate and long-term risks.

Preventing the practice is usually given priority, but Senegal is right now experimenting with corrective surgery for those who wish to have it.  It is not yet clear how effective the surgery is.

The arguments against FGM are strong.  It is an operation which can cause future health problems without any manifested health benefits, it can reduce tactile sensitivity in the genital area and thus one's ability to enjoy sex and it can be seen as a form of controlling the behavior of women in order to ensure their adherence to only the approved female roles.

But those who support the practice argue for its cultural significance.  For example (quote taken from a manuscript still in the editing process; the final form of it appears to have been published here):

What the Health Ministries in Nigeria should be doing in respectful consultation with traditional leaders - is restricting themselves to improving the safe performance of circumcision, or conducting randomized controlled studies to evaluate various traditional approaches to the matter, not dabbling into making jaundiced value judgements (through an arbitrary western prism) about an ancient blood ritual. That decision is for villages and clans to make, not the country as a whole.

Opinions surveys about FGM are available for many of the 29 countries where the practice is concentrated.  For example, in surveys about women and girls:

Girls’ and women’s attitudes about FGM/C vary widely across countries...The highest levels of support can be found in Mali, Guinea, Sierra Leone, Somalia, Gambia and Egypt, where more than half the female population think the practice should continue. However, in most countries where FGM/C is concentrated (19 out of 29), the majority of girls and women think it should end.
Younger women and girls are more likely to want the practice to end than older women, and in some countries these age differences are wide. 

In surveys about men and boys:

Information on the attitudes of boys and men towards FGM/C is only available for 16 of the 29 countries where FGM/C is concentrated.  Moreover, this information has not always been collected in the latest surveys for which data on women’s attitudes are available. This means that data on boys’ and men’s opinions of the practice are generally less up to date than data on girls and women, and may not reflect recent attitudinal changes.

The most recent data show that the level of support for the continuation of FGM/C among boys and men varies widely across countries...,  as is the case for girls and women. In four countries with high FGM/C prevalence (Mauritania, Mali, Egypt and Guinea), the majority of boys and men report that they want FGM/C to continue. By contrast, in nine countries, the majority of them favour stopping the practice. While in most of these countries FGM/C prevalence is relatively low, the list also includes Burkina Faso and Sudan, where the practice is widespread.