By Kelly Loughery
“With the first slash of the razor blade, a bolt of agony shot through me like nothing I had ever experienced…But as the blade cut into me again I screamed, wide-eyed with terror and pain…I was a terrified child with all the adults in the world that I trusted causing me unspeakable pain…but the cutting and slicing just went on and on…I felt as if I was dying, and even death would have been preferable to where I was now” – Halima Bashir
For most children, the start of summer holidays is one of the most eagerly anticipated times of the year – that final school bell, sunshine beckoning lazy play days, and homework-less evenings. Yet for some young girls (estimated to be as many as 2,000 in the UK and Wales alone) – the start of summer holidays also represents the beginning of the “Cutting Season”. This appellation refers to the time of year when many young school girls are taken from Western countries to countries where female genital mutilation (FGM) is practiced. Because, FGM is generally performed on girls under the age of 12, the school holiday period offers sufficient time for the physical wounds to heal before the start of the subsequent school year.
For the majority of girls, the procedure is performed against their will, absent anesthetic. Rudimentary and unsanitary instruments such as razor blades and glass shards are often used to make the incisions. Infection, shock, hemorrhaging, post-traumatic stress disorder and lasting physical and psychological effects are all widely documented consequences of FGM. For these reasons the practice has been labeled a human rights violation by virtually every major international organization and banned in most developed countries. Yet the practice continues with as many as 60,000 girls in the UK and approximately 3 million girls in Africa still at risk.
But what exactly is FGM?
FGM is commonly practiced in 29 countries with the percentage of women having undergone the procedures in Egypt, Somalia, Guinea, Djibouti and Sudan registering greater than 80%. Although illegal, there is also evidence FGM is taking place in Western countries in so-called “cutting parties” where multiple girls are mutilated at the same time by a practitioner frequently flown in from a country where it is widely practiced to limit costs. Generally the girl is physically restrained during the procedure, is given no pain relief and spends weeks in isolation for recovery (for infibulation this also involves physically binding the girl’s legs together from the hips to the ankles).
The term “female genital mutilation” refers to “all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons.” The World Health Organization (WHO) developed four broad categories of FGM:
- Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).
- Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are “the lips” that surround the vagina).
- 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. Recovery from infibulation generally involves binding the legs together from the hips to the ankles for several weeks after the procedure.
- Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.
FGM has been used interchangeable with “female circumcision”, yet bears no relation to the widely performed male circumcision which has demonstrable medical benefits and involves far less genital trauma. FGM, in contrast, has no health benefits and is linked to a host of both short and long term physical and psychological issues.
What are the Health Consequences?
The immediate health consequences most commonly associated with FGM are shock and hemorrhaging. Although the actual death rates directly related to FGM are unknown, in countries where antibiotics are not widely available estimates are that as many as one third of girls undergoing FGM will die. Additionally, given that the instruments used for the procedure are often shared between girls the risk of transmitting HIV between girls is heightened, along with the propensity for the spread of other types of infections between girls which can also prove fatal.
The longer-term health consequences are well-documented and extensive: chronic pain, sexual dysfunction, urogenital complications, infections, psychological disorders. The evidence of obstetric complications is particularly alarming and difficult to dispute – including significantly higher incidences of caesarean sections and post partum hemorrhage. The risk of such complications is directly correlated with the severity of the FGM performed. Research further shows that the risk of newborn death increases in tandem with the severity of the FGM performed on the mother: 15% higher risk of newborn death for those whose mothers had Type I; 32% higher for those with Type II; and 55% higher for those with Type III.
What can we do?
FGM has been recognized as a violation of human rights law since the 1980s and is banned in virtually all developed countries, yet there has been little to no decline over time in a number of countries including Chad, Djibouti, Gambia, Guinea-Bissau, Mali, Senegal, Somalia, Sudan or Yemen. Other countries, such as Benin, Central African Republic, Iraq, Liberia and Nigeria show a moderate decline with countries like Kenya and Tanzania showing a dramatic decline over time. The reality is that if the current trend continues more than 30 million girls may be subject to FGM before their 15th birthday.
As a violation of human rights law, the governments in countries where FGM is practiced have a responsibility to ensure basic human rights are sustained within their jurisdictions. These countries need to establish legislation banning the practice, continue to spread awareness for the health consequences associated with the procedure and create outreach programs to protect vulnerable girls. While the misinformed frequently label the practice a ‘religious’ issue, in fact it predates all formal religions (including Islam and Christianity) and is deeply rooted in certain cultural and societal frameworks. There are many misconceptions within these communities associated with the practice including the belief that women who have not undergone FGM are in some way ‘unclean’, subject to obstetric complications or not suitable for marriage. At the grassroots level, community leaders need to dispel misconceptions about the procedure and work to reverse traditional beliefs about female sexuality, chastity and suitability for marriage.
To compel action, the international community needs to confront the issue head on and speak unabashedly about the brutality of the procedure itself, the physical and psychological consequences and the human rights violations associated with the practice. All countries need to be vigilant in enforcing existing laws prohibiting the practice within their own jurisdictions. Young women need to be educated about their rights and the risks associated with the practice, as well as aware of safe havens and reporting mechanisms available to them. FGM should be covered within child protection laws to enable authorities to remove a vulnerable child from the home where necessary. Likewise, the criminal repercussions for parents who facilitate FGM on their children should be swift and severe. Victims should also have civil remedies at their disposal – such as the right to pursue damages against practitioners – which could also act as deterrence.
Although this issue is mired with cultural and societal beliefs, gender inequality and medical misconceptions, at the most basic level the practice imposes grave physical and psychological harm on a child. Global leaders need to tackle this issue directly, speaking out unabashedly against the horror of the practice – even when discussing it is embarrassing and uncomfortable. Until the world’s most powerful take dramatic steps to protect its most vulnerable millions of girls will suffer, many will die and all will be denied basic human rights.
There are a number of organizations working to end FGM worldwide including the Orchid Project (http://orchidproject.org/), the End FGM European Network (www.endfgm.eu) and Equality Now (www.equalitynow.org). Please consider donating and take action within your own communities to bring awareness for this issue.
 Tears of the Desert (New York: One World Books, 2009), 56-57.
 According to the Foundation for Women’s Health Research and Development, “A Statistical Study to Estimate the Prevalence of Female Genital Mutilation in England and Wales’” October 7, 2007.
 World Health Organization, available at http://www.who.int/mediacentre/factsheets/fs241/en/
 World Health Organization, Eliminating Female Genital Mutilation: An interagency statement, WHO, UNFPA, UNICEF, UNIFEM, OHCHR, UNHCR, UNECA, UNESCO, UNDP, UNAIDS, WHO, Geneva, 2008.
 Specific benefits cited by the American Academy of Pediatrics include prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. Policy statement available at: http://pediatrics.aappublications.org/content/130/3/585.full.
 Path.org – http://www.path.org/files/FGM-The-Facts.htm citing Women’s Policy, Inc. (July 12, 1996). “Female Genital Mutilation”. Women’s Health Equity Act of 1996: Legislative Summary and Overview. Women’s Policy, Inc. pp. 48.
 Mutenbei IB, Mwesiga MK. “The impact of obsolete traditions on HIV/AIDS rapid transmission in Africa: The case of compulsory circumcision on young girls in Tanzania”. (Abst 23473). Int Conf on AIDS 1998;12:436. As cited by Brady, Margaret “Female Genital Mutilation: Complications and Risks of HIV Transmission” AIDS PATIENT CARE AND STDs, Volume 13, Number 12: Pages 709-716. December 1999.
 World Health Organization, Eliminating Female Genital Mutilation: An Interagency statement, WHO, UNFPA, UNICEF, UNIFEM, OHCHR, UNHCR, UNECA, UNESCO, UNDP, UNAIDS, WHO, Geneva, 2008.