Female Genital Cutting/ (FGC): An Introduction

According to UNICEF  4 million girls and women have experienced FGC in Kenya. Overall, 21% of girls and women aged 15 to 49 years have been subjected to the practice it is estimated that about ten thousand girls are at risk of this practice. FGC 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 FGC is practiced in mostly Islamic countries, it is not an Islamic practice. FGC 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.

Definition:

FGC is a term used to refer to any practice which includes the removal or the alteration of the female genitalia. There are three main types of FGC that are practiced through the world: Type I or Sunna circumcision, Type II or excision, and Type III or infibulation. These three operations range in intensity, from the “mildness” of Type I, to the extreme Type III. Type II is a recent addition to FGC. I will explain in the next sections what each of these practices involve, and outline some of the short-term and long-term effects that they have.

Type I — Sunna Circumcision

The first and mildest type of FGC 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 (See the World Health Organization definition).

Type I is practiced in a broad area all across Africa parallel to the equator. Fran Hosken enumerates the following countries: Egypt, Ethiopia, Somalia, Kenya, and Tanzania in East Africa to the West African coast, from Sierra Leone to Mauritania, and in all countries in-between including Nigeria, the most populous one. There are also reports of Type I taking place in areas of the Middle East such as in Oman, Yemen, Saudi Arabia and United Arab Emirates.

Type II – Clitoridectomy

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.

Type III – Infibulation or Pharaonic Circumcision

The third and most drastic type of FGC 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 Sea’s Coast.

FGC is mostly done in unsanitary conditions in which a midwife uses unclean sharp instruments such as razor blades, scissors, kitchen knives, and pieces of glass. These instruments are frequently used on several girls in succession and are rarely cleaned, causing the transmission of a variety of viruses such as the HIV virus, and other infections. Antiseptic techniques and anesthesia are generally not used, or for that matter, heard of. This is akin to a doctor who uses the same surgical instrument on a number of women at the same time without cleaning any of them.

Effects of Female Genital Cutting:

Beyond the obvious initial pains of the operations, FGC has long-term physiological, sexual, and psychological effects. The unsanitary environment under which FGC 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 FGC 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 FGC 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 FGC 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.

Justifications:

In various cultures there are many “justifications” for these practices. A girl who is not circumcised is considered “unclean” by local villagers and therefore unmarriageable. A girl who does not have her clitoris removed is considered a great danger and ultimately fatal to a man if her clitoris touches his penis.

One of the most common explanations of FGC is local custom. Women are often heard saying that they are unwilling to change these customs since they have always done it this way and are not about to change. Oftentimes the practitioners are kept ignorant of the real implications of FGC, and the extreme health risks that it represents.

Family honor, cleanliness, protection against spells, insurance of virginity and faithfulness to the husband, or simply terrorizing women out of sex are sometimes used as excuses for the practice of FGC.

Some people believe that FGC is a barbaric practice done to girls and women in some remote villages in foreign countries of the world. However, up until a few decades ago, it was still believed that the clitoris is a very dangerous part of the female anatomy. Who can forget S. Freud who stated in one of his books entitled Sexuality and the Psychology of Love that the “elimination of clitoral sexuality is a necessary precondition for the development of femininity.”

As recently as 1979, the “Love Surgery” was performed on women in the United States. Dr. James E. Burt, the so-called Love Surgeon, introduced “clitoral relocation” (i.e. sunna circumcision) to the medical establishment. He believed and acted upon the idea that excision does not prevent sexual pleasure but enhances it. Dr. Burt practiced in Ohio for almost ten years before he was exposed after which he gave up his license.

Because of the large number of cases of FGC and some of the deaths it has caused, FGC is now outlawed in some European countries (Britain, France, Sweden, and Switzerland) and some African countries (Egypt, Kenya, Senegal).

Eradication:

It is also important to note that even though FGC is currently illegal in many countries in Africa and the Middle East, this has not reduced the number of the girls that are mutilated every year. The governments of these countries have no way of monitoring the spread and practice of FGC. The United Nations, UNICEF, and the World Health Organization have considered FGC to be a violation of Human Rights and have made recommendations to eradicate this practice. However, trying to fight FGC on legal terms is ineffective since those who practice it oftentimes do not report it. FGC is also widely practiced in villages and remote places where the government does not have an easy access.

A better and more effective approach would be a cooperation on the national level as well as the international level. The UN and the WHO have already taken the first step in abolishing these practices. Countries also need to have rigid laws that deal with FGC cases. This is also insufficient by itself. Anthropologists, educators, social scientists, and activists have to go into these villages and areas and educate the practitioners of the dangers of FGC. Female Genital Cutting can only be abolished by a grassroots approach which would take into consideration all aspects of a particular culture and try to work within that system of beliefs to eradicate this practice.

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.

Kenya’s progress towards abandoning FGM is strong compared to other countries in Eastern and Southern Africa. Nonetheless, eliminating FGM by 2030 across the country requires additional efforts.

FGM is less common today than in previous generations. This progress has been achieved over the last three decades

Kenya’s programme to end FGM seeks to respond to the multidimensional drivers and consequences of the practice, and contribute to the Government’s target of ending it by 2022. The Ministry of Public Service and Gender leads the initiative, with contributions from line ministries; faith-based, community-based, civil society and non-governmental organizations; and UN agencies. Article 53 of the 2010 Kenya Constitution, which articulates the right of every child to be protected from harmful cultural practices, underpins the drive for elimination. Kenya enacted the Prohibition of Female Genital Mutilation Act 2011, and in 2019 adopted a revised National Policy for the Eradication of FGM that has shaped the national programme.

The programme relies on the following evidence-based strategies

1. Leadership and coordination: Progress towards ending FGM by 2030
   depends on strong coordination at the national, county and subcounty
   levels. The Anti-FGM Board, a semi-autonomous government agency under the Ministry of Public Service and Gender, coordinates an extensive network of stakeholders, provides leadership and holds partners accountable.
2. Comprehensive and innovative community engagement: The voices, opinions and local knowledge of community members must be sought in all efforts to address FGM. Sustaining dialogue sessions with girls, women, boys and men to acknowledge the problem, discuss solutions and recognize the challenges is an important step. This process should conclude with a community action plan that encourages girls to undergo all culturally accepted rites of passage without having to endure FGM.
3. Girls’ empowerment programmes: These include alternative rites of passage and mentorship programmes imparting life skills. Mentorship involves training girls to reject FGM, and connecting them with local champions for the abandonment of FGM as well as with law enforcement. Both can serve as resources for girls in resisting the practice.
4. Faith-based partnerships: In the North Eastern Region, where practising communities profess Islamic faith, and in Nyanza, where the Kuria Community has a Seventh Day Adventist following, taking a religious approach to ending FGM is crucial. Partnerships with faith-based agencies and associations foster anti-FGM messages in mosques and churches, and help delink the practice from any religion. When highly respected religious scholars take part in community dialogue sessions and other outreach programmes, they can exert a powerful influence in persuading communities to abandon FGM.
5. Interventions targeting practitioners: Programmes aimed at both traditional excisors and medical professionals aim to break the link
   between supply and demand. For traditional excisors, interventions
   focus on education around FGM as a violation of human rights, and
   on opportunities for developing alternative skills. Among healthcare
   providers and medical students, the emphasis is on existing
   codes of conduct and regulations that prohibit medicalized FGM.
6. Quality services: FGM-related services must effectively meet the needs of
   girls, and be located in close proximity to the family and community. Girls and their families are encouraged to report incidents and seek quality professional support to better cope with and resolve experiences of the practice.