The most severe form is infibulation (pharaonic circumcision). Infibulation consists of the combination of clitoridectomy (in which all or part of the clitoris is removed), excision (removal of all or part of the labia minora), and cutting of the labia majora to create raw surfaces. These raw surfaces are then stitched or held together, sometimes by thorns or metal, to form a cover over the vagina as they heal. A small hole is then left to allow urine and menstrual blood to escape. Sometimes, in less conventional methods, less tissue is removed and a larger opening is left. Infibulation makes up approximately 15% of all mutilations performed in Africa.
Clitoridectomy (excision) consists of doing all the same stages as in infibulation, except that the labia majora are not cut and the girl is not sewn up. Clitoridectomy constitutes about 85% of mutilations in Africa.
Other less radical procedures involve merely removing the clitoral hood, holding a knife near the genitals, pricking the clitoris, cutting the pubic hair, or creating light scarification in the genital or upper thigh area.
FGM can be performed on a girl any time from infancy to right before her first pregnancy, but most commonly it is done while the girl is between 4 and 8 years old. The procedure can be performed on a girl alone, but more often it is done as a group of sisters, close female relatives, or close neighbors. If the FGM is being performed as an initiation ceremony (seen the most in eastern, central, and western Africa), it is done at the same time to all the girls in a community who are of a certain age group, only women are present, and it often involves festivities and gifts.
The following is a quote from Amnesty International's Female Genital Mutilation: A Human Rights Pack:
"Sometimes a trained midwife will be available to give a local anesthetic. In some cultures, girls will sit beforehand in cold water to numb the area and reduce the likelihood of bleeding. More commonly, however, no steps are taken to reduce the pain. The girl is immobilized, held, usually by older women, with her legs open. Mutilation may be carried out using broken glass, a tin lid, scissors, a razor blade, or some other cutting instrument. When infibulation takes place, thorns or stitches may be used to hold the two sides of the labia majora together, and the legs may be bound together for up to forty days. Antiseptic powder may be applied, or more usually, pastes-containing herbs, milk, eggs, ashes, or dung-which are believed to facilitate healing. The girl may be taken to a specially designated place to recover where, if the mutilation has been carried out as art of an initiation ceremony, traditional teaching is imparted. For the very rich, the mutilation procedure may be performed by a qualified doctor in a hospital, under local or general anesthetic." (Amnesty, 1998)There are several questions that are raised by this quote.
In answer to the first question, there are three types of possible side effects caused by FGM: general physical, sexual, and psychological. The possible general physical side effects can occur at the time of the mutilation, afterwards, and appear over the long term. Initial effects can be pain, shock, hemorrhage, and damage to surrounding organs. Afterwards it is possible for FGM to cause urine infections, HIV, intermittent bleeding, and abscesses, and small benign tumors of the nerve. The long term effects specifically for infibulation, are chronic urinary infections, stones in bladder and urethra, kidney damage, reproductive tract infection (from obstructed menstrual flow), pelvic infections, infertility, scar tissue, keloids, and dermoid cysts. Also, several problems may occur when a woman is sustaining FGM during pregnancy, such as tearing, cutting, and restitching at and after births.
Possible sexual side effects are very painful first intercourse, continued pain during intercourse, and loss of sexual enjoyment. As an interesting not, however, Amnesty International stated that, " . . . one study found that 90% of the infibulated women interviewed reported experiencing orgasm. The mechanisms involved in sexual enjoyment and orgasm are still not fully understood, but it is thought that compensatory processes, some of them psychological, may mitigate some of the effects of removal of the clitoris, and other sensitive parts of the genitals." (Amnesty, 2001)
Possible psychological problems from FGM depend on the cultural norms of the majority culture in which a specific community is practicing FGM. In communities in which the practices, such as FGM, are supported by the surrounding culture, psychological problems would occur if a girl was not circumcised, as in she would be more likely to have to deal with rejection at not being mutilated than have to deal with any feelings of terror, anxiety, humiliation, or betrayal. These last felling would come with FGM, if the community that practiced FGM, was not supported in its actions by the larger surrounding culture.
In answer to the second question, according to amnesty international, 135 million women and girls in the world have had FGM performed on them, and 2 million are at risk each year, approximately 6,000 per day. According to the Religious Tolerance Organization, the rough statistics on FGM show that it has been performed on 90% or more of girls and women in Djibouti, Ethiopia, Eritreq, Sierra Leone, Somalia, and Northern Sudan; and over 50% of the girls and women in Benin, Burkina Faso, Central African Republic, Chad, Cote d'lvoire, Egypt, Gambia, Guinea, Guinea Bissau, Kenya, Liberta, Mali, Nigeria, and Togo.
In answer to question three, as to why women perform FGM on women, and the overall cultural significance, female circumcision is a tradition that is passed down from older women to girls and a very important element in social standing and cultural permanence in many places. FGM signifies a woman's coming of age, gives beauty, is thought to promote cleanliness and health, brings honor to the family, and ensures that it will be easier for a girl to remain sexually pure and faithful, before and after marriage. Also, in some cultures, which revolve around these rituals, ritual circumcision is done in age groups at certain calendar times and the ceremonies and those generations of girls are used to mark the procession of time and important events in the life of the community or tribe.
Examples of types of initiations that might take place involving FGM would be easiest explained by giving a specific example of the Gikuyu nation in Kenya. This example comes form a book entitled Facing Mt. Kenya by Jomo Kenyatta. Here are a few quotes form the book along with explanations to give an outline of the ritual as performed by this tribe.
"The initiation of both sexes is the most important custom among the Gikuyu. It is looked upon as a deciding factor in giving a boy or girl the status of manhood or womanhood in the Gikuyu community."The tribe records historical events by naming the group undergoing the ritual at a certain time after the important event that has occurred during that time. By remembering the chronology of these groups, they maintain their tribal history.
"In the matrimonial relation, the Rite de Passage (rite of passage) is the deciding factor. No proper Gikuyu would dream of marrying a girl who has not been circumcised, and vice versa. It is taboo for a Gikuyu man or woman to share sexual relations with someone who has not undergone this operation."
"The moral code of the tribe is bound up with this custom and . . . it symbolizes the unification the unification of the whole tribal organization."
"Without this custom, a tribe which had no written record would not have been able to keep a record of important events and happenings I in the Kikuyu nation."Preparation for the initiation includes purification of the girl, family celebration and a blessing of the children, and the general singing and dancing of the tribe. It is a special and important multi-family event. On the day of the operation, the girl is fed with special food, then stripped and donned with ceremonial beads. All the girls who are going to be initiated meet together, and then numb themselves in the river for half an hour. The girls line up and march to the place for the operation. The girl's sponsor holds her legs open and numbs her female organs with cold water.
"The water is thrown on the girl's sexual organ to make it numb and to arrest profuse bleeding as well as to shock the girl's nerves at the time, for she is not supposed to show any fear or make any audible sign of emotion or even to blink." " . . . a woman specialist who has studied this form of surgery from childhood, dashes out of the crowd, dressed in a very peculiar way, with her face painted with black and white ochre."The girls then go to a special hut where no one is allowed to see them for a while, and they rest there for several days. Traditional teaching is performed in rituals like this. It is the teaching of the wisdom of womanhood, and talk about sex and responsibility and honor and marriage, all which are necessary for the girls to learn in preparation for their imminent marriages. (Kenyatta, 1938)
"With a stroke she cuts off the tip of the clitoris. As no other part of the girl's sexual organ is interfered with, this completes the girl's operation. Immediately, the older woman who . . . threw the water on the girls comes along with milk mixed with some herbs, which she sprinkles on the flesh wound to reduce the pain, and to check bleeding, and prevent festering or blood poisoning."
Question number seven deals with the use of formal medical facilities for the performance of FGM. An article entitled UNICEF and the Medicalization of Female Genital Mutilation said that, "The Daily Nation, Kenya's largest daily newspaper in March of 1997 reported that . . .'the Ministry of Health had indirectly helped promote the practice [of FGM] by allowing [it] to be carried out in some of its clinics . . . the local women were saying [that] if the nurses are willing to carry it out, it must be a good practice.'" (Africa, 2001)
Some of the medical professionals performing FGM are doing it for the extra money, while some, because of the unsanitary conditions in which it would alternately be performed, knew that a sanitary procedure would at least be less harmful to the girls. Mainly, until there is a way of eliminating the cultural necessity for the procedure, the medical profession feels a responsibility to see that it is done as safely as possible, when they are given the opportunity to do so. There have definitely been laws made against this practice, but the lack of information and the amount of empathy that is present in medical environments in many countries does not allow these laws to be followed consistently.
To answer the eighth and final question raised by the previous quote, the following are some of the international policies on FGM, and where it has been or has tried to be banned:
In response to the second question, FGM actually has a very interesting history in the Western world. John Duffy Ph.D., Clinical Professor Emeritus1-Tulane University School of Medicine, and Professor Emeritus of History at the University of Maryland, wrote an article entitled "Clitoridectomy: A Nineteenth Century Answer to Masturbation". This is an article dealing with 19th century moralists who were trying to find cures for the harmful practice of masturbation in men and women. Also, it discusses how clitoridectomy was used as a cure for other "mental diseases". The following quotes are from this article.
"In 1866, an American journal discussed the work of a British physician, Dr. Isaac Brown Baker, who claimed success at treating epilepsy and other nervous disorders in female patients by excising the clitoris."The FGM Network Organization, in an article entitled "FGM: An Introduction", stated the following:
"In 1894, Dr. A.J. Bloch of New Orleans, in an article entitled 'Sexual Perversion in the Female' referred to female masturbation as 'moral leprosy'. In one of his cases, he described how a school girl of fourteen suffering from nervousness and pallor had been cured by 'liberating the clitoris' from its adhesions and by lecturing the patient on the dangers of masturbation."
"Some people believe that FGM 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 was a very dangerous part of the female anatomy. Who can forget S. Freud who stated that, " . . . the elimination of clitoral sexuality is a necessary precondition for the development of femininity."In response to the third question, the United States has very strict policies and laws about FGM on state and federal levels. The Senate of the United States ratified the "Federal Prohibition of Female Genital Mutilation Act of 1995". It is specific and harsh on practicing any form of FGM in the United States. Also, the U.S. has tackled the problem by compiling data on females who have been subjected to FGM who are living in the U.S., identifying communities who practice FGM and trying to create outreaches to raise consciousness, and adding curriculum on FGM to medical school curriculum.
"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' to the medical establishment. He believed and acted upon the idea that excision does not prevent sexual pleasure but enhances it. Dr. Burt practices for almost 10 years before he was exposed after which he gave up his license." (FGMN, 2001)
As one example of state law, in Illinois, there is the Illinois FGM law of 1995. anyone who is found guilty of performing FGM in the state of Illinois is convicted of a Class X felony and may be sentenced to a term of natural life imprisonment. Most states, especially those with large immigrant populations, have very similar laws on the books.
Medical professionals in the U.S. have recently begun to be trained to deal with victims of FGM. The FGM network talks about medical information in the U.S. They say that, "The National Organization of Circumcision Information Resource Centers (NOCIRC), a network organization, have brought together social scientists and medical practitioners from all over the world who are fighting FGM as well as male circumcision. NOCIRC also founded the FGM Awareness and Education Project in August 1996. one of the main goals of the project is to create an FGM module which will provide information and training material to health care professionals. NOCIRC has also organized the Fourth International Symposium on Sexual Mutilaitons. The Research Actions and Information Network for the Bodily Integrity of Women (RAINBO) has been conducting research and grass roots programs internationally as well as in the United States on women's reproductive sexual health as well as on female genital mutilation."
All the following information on FGM and human rights comes from Amnesty International's "FGM: A Human Rights Information Pack".
"The Universal Declaration of Human Rights (UDHE) . . . protects the right to security of person and the right not to be subjected to cruel inhuman or degrading treatment-rights which are of direct relevance to the practice of FGM. The traditional interpretaion of these rights has generally failed to encompass forms of violence against women such as domestic violence or FGM. This arises form a common misconception that states are not responsible for human rights abuses committed within the hime or community."Amnesty states that, "[FGM] is an instrument for socializing girls into prescribed roles within the family and community. It is therefore intimately linked to the unequal position of women in the political, social and economic structures of societies where it is practiced." (Amnesty, 2001)
I see that this is not the motivation in all cases, but that this ends up being the social result. Is this result, coming from a different motivation, culturally reprehensible or merely still morally reprehensible because of the result? Can a person be held accountable for results that do not form directly from the intents? Yes, I believe so. But it is only fault by neglect if the information is available to show a person that another way is not only better but necessary, and the person chooses to ignore this. We must be careful about swinging a club of Western Morality in an ethnocentric manner to condemn those who merely follow their own culture's traditions in what is seen in that culture to be a very honorable action.
"Gender based violence is recognized as a form of discrimination which seriously inhibits a woman's ability to enjoy the full range of rights and freedoms on a basis of equality with men."Just as a note, FGM is not a practice that is done because of Islam, as is wrongly thought by many. Only a few Islamic religious texts, supposed sating of Mohammed that are highly controversial, mention anything about FGM, while the other writings or the Q'uran actually fight for the equality of women. Many Islamic leaders have condemned the practice, and have tried to influence their people to give it up. In many sense, FGM is more of a cultural practice than a religious practice.
"The UN Convention on the Elimination of All Forma of Discrimination Against Women, which came into force in 1981, sets out in detail the measures that have to be taken to eliminate discrimination. Article 5 of the convention requires states to work towards 'the elimination of prejudices and customary and all other practices which are based on the idea of the inferiority or the superiority of either of the sexes."
"General Recommendation 14(1990) calls on states to [eradicate FGM] including introducing appropriate health care and education strategies . . ."
"General recommendation 19 draws a connection between traditional attitudes which subordinate women, and violent practices such as FGM, domestic violence, dowry deaths, and acid attacks, stating that, 'Such prejudices and practices may justify gender-based violence as a form of protection or control of women.' The Recommendation also recognizes that violence against women not only deprives them of their civil and political rights; it denies them their social and economic rights."
" . . . the UN Declaration on the Elimination of Violence Against Women(1993) . . . addresses gender-based violence 'both in public and private life', and includes within its scope FGM and other traditional practices harmful to women. Article 4 provides that states should not invoke any custom, tradition or religious consideration to avoid their obligation to eliminate violence against women."
"At a regional level, the African Charter on the Rights and Welfare of the Child, adopted by the Organization of African Unity in 1990, but yet to enter into force, [has] . . . a number of unique provisions relat[ed] to FGM, including the provision that, 'any custom, tradition, social or religious practice that is inconsistent with the rights, duties, and obligations contained in the present Charter shall . . . be null and void.'" (Amnesty, 2001)