- More than 230 million girls and women alive today have undergone female genital mutilation (FGM) in 30 countries in Africa, the Middle East and Asia where FGM is practiced.
- FGM is mostly carried out on young girls between infancy and age 15.
- FGM is a violation of the human rights of girls and women.
- The global cost of treating health complications from FGM is estimated at US$ 1.4 billion annually and is expected to increase without urgent action towards abandonment.
Female genital mutilation (FGM), also known as female circumcision or cutting, encompasses all procedures involving the partial or complete removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. It is crucial to understand that this practice offers no health benefits to girls and women. Instead, it can lead to a range of severe health problems, from immediate issues like hemorrhage and infection to long-term complications such as chronic infections, difficulties in childbirth, and even increased risks of newborn deaths.
Globally recognized as a fundamental violation of human rights, FGM reflects deeply entrenched gender inequality and constitutes an extreme form of discrimination against females. Predominantly performed on minors, FGM is a direct infringement upon the rights of children. Furthermore, it violates a person’s fundamental rights to health, security, and physical integrity, the right to freedom from torture and cruel, inhuman, or degrading treatment, and in tragic cases, the right to life itself when the procedure proves fatal. A disturbing trend in some regions is the increasing medicalization of FGM, driven by the misconception that the procedure becomes safer when performed by health professionals. The World Health Organization (WHO) unequivocally condemns the medicalization of FGM and actively urges healthcare workers to abstain from performing it. WHO has also developed comprehensive strategies and resources to support the health sector and healthcare professionals in their efforts to eradicate FGM.
The Four Types of Female Genital Mutilation
FGM is categorized into four primary types, each varying in severity and extent of tissue removal:
Type 1: Clitoridectomy
This type involves the partial or total removal of the clitoral glans (the sensitive, visible part of the clitoris) and/or the prepuce/clitoral hood (the skin fold surrounding the clitoral glans).
Type 2: Excision
Excision refers to the partial or total removal of the clitoral glans and the labia minora (inner vaginal lips), potentially including the labia majora (outer vaginal lips).
Type 3: Infibulation
Infibulation, also known as pharaonic circumcision, is the most severe form of FGM. It involves narrowing the vaginal opening by creating a sealing cover. This seal is formed by cutting and repositioning the labia minora or labia majora, sometimes with stitching, and may include the removal of the clitoral prepuce/clitoral hood and glans.
Type 4: Other Harmful Procedures
Type 4 encompasses all other damaging procedures to the female genitalia for non-medical purposes. These include practices like pricking, piercing, incising, scraping, and cauterizing the genital area.
Why is FGM Performed? No Health Benefits, Only Harm
It is vital to reiterate that FGM provides absolutely no health benefits. Instead, it is profoundly harmful, inflicting both immediate and long-term damage to the physical and psychological well-being of girls and women. The procedures involve the removal and damage of healthy and functional female genital tissue, disrupting the natural bodily functions. While all forms of FGM carry significant health risks, the severity of these risks escalates with the extent of the mutilation.
Immediate Complications of FGM:
- Excruciating pain
- Hemorrhage (excessive bleeding)
- Swelling of genital tissues
- Fever
- Infections, including tetanus
- Urinary problems
- Impaired wound healing
- Injury to surrounding genital tissues
- Shock
- Death
Long-Term Complications of FGM:
- Chronic urinary issues (painful urination, urinary tract infections)
- Persistent vaginal problems (discharge, itching, bacterial vaginosis, and other infections)
- Menstrual difficulties (painful menstruation, difficulty passing menstrual blood)
- Formation of scar tissue and keloids
- Sexual health problems (painful intercourse, reduced sexual satisfaction)
- Increased risk of complications during childbirth (obstructed labor, postpartum hemorrhage, cesarean section, infant resuscitation, and newborn mortality)
- Necessity for subsequent surgeries: Women with Type 3 FGM often require deinfibulation, a surgical procedure to open the infibulated scar to enable sexual intercourse and childbirth.
- Psychological trauma (depression, anxiety, post-traumatic stress disorder, low self-esteem)
Who is at Risk of FGM?
FGM primarily affects young girls, typically between infancy and adolescence, although it can occasionally be performed on adult women. Data collected from 31 countries in Africa, the Middle East, and Asia where FGM is prevalent indicates that over 230 million girls and women alive today have undergone FGM. It is estimated that more than 4 million girls are at risk of FGM annually, highlighting this practice as a significant global concern.
Cultural and Social Reasons Behind Female Genital Mutilations: Why Does It Continue?
Understanding why female genital mutilations persist requires examining the complex interplay of cultural and social factors deeply embedded within communities. The reasons for performing FGM are diverse, varying across regions and evolving over time, shaped by a combination of sociocultural norms within families and communities.
- Social Convention and Norms: In societies where FGM is a deeply ingrained social norm, the pressure to conform is immense. Individuals fear social ostracization and rejection if they do not adhere to established practices. This social pressure to conform to tradition is a powerful driver in perpetuating FGM.
- Rite of Passage and Preparation for Adulthood and Marriage: FGM is frequently viewed as an essential rite of passage for girls, marking their transition into womanhood and preparing them for marriage. This often includes beliefs around controlling female sexuality to ensure premarital virginity and marital fidelity. In these contexts, FGM is mistakenly seen as a necessary step for a girl’s proper upbringing and societal acceptance.
- Misconceptions about Religious Support: Despite the absence of any religious mandate for FGM in religious scriptures, some communities mistakenly believe that the practice has religious backing. It is important to note that religious leaders hold diverse views on FGM, with many actively contributing to its abandonment by clarifying that it is not religiously required and is in fact harmful.
Why Medicalized FGM Occurs
The involvement of healthcare providers in performing FGM, known as medicalized FGM, is a concerning trend driven by several factors:
- False Belief in Reduced Complications: Some healthcare providers believe that medicalized FGM carries a lower risk of complications compared to traditional FGM performed by non-medical practitioners. This is a dangerous misconception, as any form of FGM is harmful, regardless of who performs it or where it is performed.
- Misguided Belief in Abandonment Strategy: There is a misguided notion that medicalizing FGM could be a step towards its eventual abandonment. The idea is that by making it “safer,” the practice might become more acceptable in the short term but eventually fade away. However, medicalization only legitimizes and perpetuates FGM.
- Social Norms within Healthcare Communities: Healthcare providers are often members of communities where FGM is practiced and are therefore subject to the same social norms and pressures. This can lead to healthcare professionals performing FGM to conform to community expectations.
- Financial Incentives: In some cases, financial gain can motivate healthcare providers to perform FGM, despite knowing its harmful consequences.
Despite these challenges, significant progress is being made. With the support and training from organizations like WHO, many healthcare providers are becoming vocal advocates against FGM. They are actively working to promote FGM abandonment within clinical settings and within their own families and communities, using their expertise to educate and change attitudes.
WHO’s Response to FGM
The World Health Organization (WHO) is at the forefront of global efforts to eliminate FGM. In 2008, the World Health Assembly adopted resolution WHA61.16, explicitly calling for the elimination of FGM and emphasizing the urgent need for coordinated action across all sectors, including health, education, finance, justice, and women’s affairs.
WHO’s comprehensive response to FGM encompasses both prevention and care. The organization develops guidelines and resources for healthcare workers to effectively prevent FGM and manage its complications. WHO also supports countries in adapting and implementing these resources to suit their specific local contexts. Furthermore, WHO plays a crucial role in generating evidence-based research to deepen the understanding of FGM and identify effective strategies for ending this harmful practice worldwide.
Through its global strategy against medicalized FGM, developed in collaboration with partner organizations, WHO continues to provide crucial support to countries in their efforts to implement effective interventions and ultimately eradicate female genital mutilation.
