The International Day of Zero Tolerance to Female Genital Mutilation (FGM) is held each 6 February to encourage the world to become aware of female genital mutilation (also called ‘cutting’) and to promote its eradication.
What is Female Genital Mutilation?
Female Genital Mutilation refers to the removal of all or part of the external female genitalia, or other injury to the female genital organs, for cultural or other non-medical reasons (the World Health Organization has identified several major types).
Reinfibulation - defined as the resuturing after delivery or gynecological procedures of the incised scar tissue resulting from infibulation - is still performed in various parts of the world, mainly by health professionals.
Procedures are mostly carried out on young girls sometime between infancy and age 15, and occasionally on adult women.
The origins of this practice are not clear, but it is known that it has been followed by many different peoples and societies throughout the ages. It is practised in about 30 countries, including parts of West, East and Central Africa, some parts of the Middle East and South Asia.
It has no health benefits for girls and women, and has known harmful effects on their reproductive and psychological health. It is therefore recognised as a violation of the human rights of girls and women.
FGM in global context
• An estimated 100 to 140 million girls and women worldwide are currently living with the consequences of FGM.
• At least three million girls are at risk of undergoing the practice each year.
• Although it is difficult to state an accurate number of reinfibulations, it is estimated that 6.5-10.4 million women are likely to have been reinfibulated.
• In Africa an estimated 92 million girls from 10 years of age and above have undergone FGM.
Why is it performed?
FGM is performed for a number of reasons, including:
• It is seen as part of a girl’s initiation into womanhood and as an integral part of a community’s heritage. Girls and women are encouraged to believe certain myths eg FGM will enhance their fertility.
• The procedure is often carried out as a means to control women’s sexuality, and is thought to ensure virginity before and fidelity after marriage and/or to increase male sexual pleasure. It is therefore often motivated by beliefs about what is considered ‘correct’ sexual behaviour.
• The external female genitalia are considered dirty and/or ugly in some communities, and their removal linked to feminine hygiene and aesthetic appeal. Women are obliged to keep ‘clean’, and ‘modest’, so removal of offending areas is encouraged.
• In some communities (where women are dependent on men), a woman will need to undergo FGM in order to get married - in short,out of economic necessity. It may also be required if the woman is to benefit from an inheritance.
• None of the major religions prescribes FGM, and the practice predates Judaism, Christianity and Islam. However, some practitioners still claim that the practice has some religious support.
Who performs FGM?
The practice is usually performed by specially designated elderly people within the local community (usually women), or by traditional birth attendants. In some instances, FGM may be carried out by members of secret societies, herbalists, or a female relative. In addition, some healthcare professionals perform the operation.
Risks and consequences
The risks and consequences of FGM are immense, and include severe pain, shock, haemorrhage, wound infection, abscess formation, septicaemia, tetanus, hepatitis and/or HIV, urine retention, genital ulceration and urinary tract infection.
Long-term gynecological complications include anaemia, cyst formation, urinary incontinence, sexual dysfunction, including apareunia, severe scar formation, difficulty in micturition, menstrual disorders, recurrent bladder and urinary tract infections, fistulae and infertility.
Obstetric complications for subsequent pregnancy and childbirth include increased relative risks for caesarean delivery (RR 1.31), postpartum haemorrhage (RR 1.69), extended maternal hospital stay (RR 1.98), infant resuscitation (RR 1.66), and stillbirth or early neonatal death (RR 1.55).
Serious adverse psychological and sexual effects can also afflict victims of FGM.
The global stance
Over the years, most governments in countries where FGM is prevalent have launched declarations protecting and promoting the healthcare issues of girls and women.
In 2008, the United Nations released a statement - ‘Eliminating Female Genital Mutilation’ - and called for its eradication within a generation. Ten agencies - OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM and WHO - supported this announcement, and their position was echoed by numerous NGOs and professional health and rights associations.
Following this statement, there was a resolution by the 61st World Health Assembly denouncing FGM as a violation of human rights and a barrier in the achievement of the Millennium Development Goals. The resolution calls on member states to accelerate actions towards the elimination of the practice, including the enactment and enforcement of legislation to protect women and girls from FGM and all forms of violence; the development of social and psychological support services; and greater research, guideline development and community-based action.
The 1994 Montreal FIGO General Assembly Resolution on FGM encourages FIGO’s societies to urge national governments to sign up to international human rights agreements condemning the practice and to support the work of national authorities, NGOs and intergovernmental organisations working to eliminate it.
The FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health has two guidelines opposing FGM, the most recent concerning medicalisation (London, 2006).
FIGO continues to recommend that individual obstetricians and gynecologists explain and educate about the consequences of FGM, while supporting community members opposing its continuation. Organisations and individuals are further encouraged to support research on the prevalence and effect of the practice, while opposing any attempts to medicalise the procedure or allow its performance in health establishments by health professionals.
FIGO and the issue of medicalisation
A recent WHO report stated that there was a growing tendency for FGM to be carried out by health professionals. Medicalisation underestimates the overall physical and psychological complications of FGM, creating an implied approval of the practice. FIGO strongly condemns this, and believes that all women and girls have the right to live their lives free from all forms of violence. FIGO is committed to working alongside other global organisations to help eradicate the scourge of FGM permanently.
In 2010, FIGO joined other agencies (UNFPA, UNHCR, UNICEF, UNIFEM, WHO, ICN, MWIA, WCPA and WMA) in launching a ‘Global strategy to stop health-care providers from performing female genital mutilation’. This strategy is intended for policy-makers, parliamentarians, international agencies, professional associations, community leaders, religious leaders, NGOs and other institutions.
Please click here for a specific statement from FIGO on the issue of medicalisation (June 2010).
FIGO’s other work on FGM
A major highlight of the 2009 FIGO World Congress in Cape Town was the launch of FIGO’s DVD on FGM - "The Cutting Tradition: insights into female genital mutilation" - in collaboration with filmmaker Nancy Durrell McKenna of SafeHands for Mothers, and award-winning actress Meryl Streep as narrator. The film aims to educate health professionals worldwide on the issues surrounding this highly controversial subject.
Sources: World Health Organization (WHO) and United Nations Population Fund (UNFPA)
61st World Health Assembly Resolution on Female Genital Mutilation - May 2008 http://www.who.int/gb/ebwha/pdf_files/A61/A61_R16-en.pdf
Eliminating Female Genital Mutilation - An Interagency Statement, 2008 http://www.who.int/reproductivehealth/publications/fgm/9789241596442/en/index.html
Global Strategy To Stop Health-Care Providers From Performing Female Genital Mutilation, 2010 http://www.who.int/reproductivehealth/publications/fgm/rhr_10_9/en/index.html www.safehands.org
Banks E, Meirik O, Farley T, Akande O, Bathija H, Ali M. WHO study group on female genital mutilation and obstetric outcome; WHO collaborative prospective study in six African countries. Lancet 2006; 367(9525):1835–41.
The issue of reinfibulation. Gamal I. Serour. International Journal of Gynecology and Obstetrics 109 (2010) 93–96.