Female Genital Mutilation (FGM)

Background
One or more forms of female genital mutilation are practiced in 28 African countries. Looking at a map of Africa, female genital mutilation is practiced throughout the central area of the continent. Almost all the women in Somalia, Djibuti and Sudan (with the exception of non-Moslem populations in southern Sudan), the Ethiopian coast of the Red Sea, northern Kenya, North Nigeria and some regions of Mali undergo infibulation. Outside of the African continent, excision is practiced in Oman, Yemen, the United Arab Emirate, and in some areas of Indonesia and Malesia

About 100/130 million women and children throughout the world have been subjected to mutilation and approximately two million girls are at risk every year.

What do we mean by FGM?
FGM has been defined by the World Health Organisation (WHO) as "all procedures which involve partial or total removal of the external female genitalia or injury to the female genital organs whether for cultural or any other non-therapeutic reasons". It exists in a number of forms, although four main types are commonly recognised, and are classified as follows: 

Type 1
The removal of the prepuce with or without excision of part or all of the clitoris.

Type 2
Clitoridectomy; also known as excision. This is the removal of the clitoris with partial or total excision of the labia minora, and constitutes about 80% of FGMs performed.

Type 3
Infibulation; also known as pharaonic circumcision. This involves the removal of the clitoris, labia minora and labia majora with narrowing of the vaginal opening by means of stitching. It is the most extreme form of FGM and involves the removal of two thirds of the female genitalia. It constitutes approximately 15% of mutilations performed.  

Type 4
Unclassified: pricking/piercing/incising the clitoris and/or labia, cauterisation by burning of clitoris and surrounding tissue, scraping (angurya cuts) of the vaginal orifice or cutting (gishiri cuts) of the vagina to cause bleeding.

The procedures are usually performed without anaesthetic and in unhygienic conditions. The practitioner, who typically has no medical training, uses crude, non-sterile implements such as broken glass, pieces of a tin can or razors to perform the procedure. Where stitching is involved, this is often done using thorns. In Type 3 forms of FGM, the girl's legs are often bound together for up to 40 days to ensure the intended aperture. Women and girls undergoing the Type 3 procedure have the stitched vaginal opening either cut or torn open on their wedding night.

The health consequences of FGM
There are numerous short-term health consequences including:

- severe pain and shock;
- infection;
- urine retention;
- injury to adjacent tissues and organs (which can be severe, depending on the extent to which the girl or woman subject to the procedure struggles);
- immediate fatal haemorrhaging.

Longer-term implications of include:

- extensive damage of the external reproductive system;
- uterus, vaginal and pelvic infections;
- cysts and neuromas;
- increased risk of vesico-vaginal fistula;
- complications in pregnancy and childbirth, including obstructed labour;
- psychological damage resulting from trauma;
- sexual dysfunction and painful sexual relations;
- difficulties in menstruation.

Other potential problems include sterility, chronic pain and lameness. Victims of FGM, particularly where the procedure is performed on more than one girl or woman at a time, are also at a heightened risk of contracting HIV and other potentially fatal infections as a result of the use of non-sterile implements.  

Reasons advanced for the performance of FGM include:

- custom and tradition;
- religion (in the mistaken belief that FGM is a religious requirement);
- preservation of virginity/chastity;
- social acceptance (especially for marriage);
- hygiene and cleanliness;
- increasing sexual pleasure for the male;
- family honour; and
- enhancing fertility.

These details of complications are taken from the website of the Foundation for Women's Health, Research and Development, UK, http://www.forwarduk.org.uk/

See Female Genital Mutilation: A Matter of Human Rights, Centre for Reproductive Rights, New York, 2003.

Report of Seminar on Female Genital Mutilation/Cutting: A Call for EU Action, Donors Working Group on Female Genital Mutilation/Cutting in collaboration with No Peace Without Justice and MEP Emma Bonino, The European Parliament, Brussels, 1st June 2005.
The exact number of deaths due to FGM is difficult to assess. While some may die as an immediate consequence of the procedure - through blood loss and shock - other may die later of infections such as septicaemia or AIDS. In IRIN's Razor's Edge - The Controversy of Female Genital Mutilation, 2005, the author notes " It is difficult to determine the actual numbers of women who die from FGM-related complications, given the highly guarded nature of the practice. Medical record-keeping systems are also rarely configured to record FGM and FGM-related complications as causes of death."

See Female genital mutilation, WHO Fact sheet N°241, June 2000;
See also Frequently Asked Questions about Female Genital Cutting, United Nations Population Fund; website of Foundation for Women's Health, Research and Development.
See Female genital mutilation, WHO Fact sheet N°241, June 2000.
See Female Genital Mutilation - A Human Rights Information Pack, Amnesty International, 1997;
Female genital mutilation, WHO Fact sheet N°241, June 2000.