An estimated 230 million girls and women alive today are believed to have been subjected to some form of female genital mutilation. An estimated 27 million more girls will undergo the practice by 2030. A key challenge is not only protecting girls who are currently at risk, but also ensuring that those born in the future will be free from the dangers of the practice.
Girls and women who have undergone female genital mutilation live predominately in the African and Asian continents. UNFPA estimates that 68 million girls face female genital mutilation between 2015 and 2030.
Forms of Female Genital Mutilation
Female genital mutilation involves several practices such as cautery and chemical injury affecting several parts of the external genitalia, as opposed to male circumcision.
- Type I: (In Eastern and Northern Africa, this term is often used to describe female genital mutilation type I.)
- Type II, also called excision: Partial or total removal of the clitoral glans and the labia minora, with or without excision of the labia majora.
- Type III, also called infibulation: Narrowing of the vaginal orifice with a covering seal. The seal is formed by cutting and re-positioning the labia minora and/or the labia majora.
Types I and II are the most common globally, but there is variation in how they are performed between and within countries.
Health Consequences of Female Genital Mutilation
Female genital mutilation increases the risks of immediate and long-term psychological, obstetric, genitourinary and sexual and reproductive health complications. Immediate complications include severe pain, shock, haemorrhage, tetanus or infection, urine retention, ulceration of the genital region and injury to adjacent tissue, wound infection, urinary infection, fever and septicemia.
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Infibulation, or type III female genital mutilation, is the most severe form. A covering seal is made by cutting and appositioning the labia minora or labia majora with or without excision of the clitoral prepuce and glans, leaving a small opening for urine and menstrual blood. This type may result in urinary complications such as urination disorders or frequent urinary infections. In addition, infibulation may result in the accumulation of menstrual flow in the vagina and uterus, leading to chronic pelvic pain and infertility.
There is no clear direct association between female genital mutilation and HIV. Mechanisms that can potentially increase the risk of HIV infection include use of the same instrument among multiple girls or women when performing female genital mutilation.
Female genital mutilation may result in immediate or prolonged psychological effects.
The Terminology Debate
When the practice first came to international attention, it was generally referred to as “female circumcision.” However, the term “female circumcision” has been criticized for drawing a parallel with male circumcision and creating confusion between the two distinct practices. It is also sometimes argued that the term obscures the serious physical and psychological effects on women.
The term “female genital mutilation” is preferred because it establishes a clear distinction from male circumcision. The use of the word “mutilation” also emphasizes the gravity of the act and reinforces that the practice is a violation of women’s and girls’ fundamental human rights. This expression gained support in the late 1970s, and, since 1994, it has been used in several United Nations conference documents and has served as a policy and advocacy tool. In Resolution 65/170, Member States clearly stated that female genital mutilation should be used to refer to this harmful practice.
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In the late 1990s, the term “female genital cutting” was introduced, partly in response to dissatisfaction with the term “female genital mutilation.” There is concern that communities could find the term “mutilation” demeaning, or that it could imply that parents or practitioners perform this procedure maliciously. Some fear the term “female genital mutilation” could alienate practicing communities, or even cause a backlash, possibly increasing the number of girls subjected to the practice.
UNFPA uses the term “female genital mutilation” because it embraces a human rights perspective on the issue. Additionally, the term “female genital mutilation” is used in a number of United Nations and intergovernmental documents. One recent document is the 2016 UN Secretary General’s report (A/71/209) on intensifying global efforts for the elimination of female genital mutilation.
Historical Context and Cultural Aspects
The origins of the practice are unclear. It predates the rise of Christianity and Islam. It is said that some Egyptian mummies display characteristics of female genital mutilation. Historians such as Herodotus claim that, in the fifth century BC, the Phoenicians, the Hittites and the Ethiopians practiced circumcision. It is also reported that circumcision rites were practiced in tropical zones of Africa, in the Philippines, by certain tribes in the Upper Amazon, by women of the Arunta tribe in Australia and by certain early Romans and Arabs.
As recent as the 1950s, removal of clitoral glans was practiced in Western Europe and the United States to treat perceived ailments including hysteria, epilepsy, mental disorders, masturbation, nymphomania and melancholia.
It varies, but most performed between 5 and 9 years old. In some areas, female genital mutilation is carried out during infancy - as early as a couple of days after birth. In others, it takes place during childhood, at the time of marriage, during a woman’s first pregnancy or after the birth of her first child.
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Female genital mutilation is currently documented in 92 countries around the world through either nationally representative data, or using indirect estimates, small-scale studies or anecdotal evidence and media reports.
Female genital mutilation is typically carried out by elderly people in the community (usually, but not exclusively, women) who are designated to perform this task, or by traditional birth attendants.
Psychosexual reasons: Female genital mutilation is carried out as a way to control women’s sexuality, which is sometimes said to be insatiable if parts of the genitalia, especially the clitoris, are not removed.
Hygiene and aesthetic reasons: In some communities, the external female genitalia are considered dirty and ugly and are removed, ostensibly to promote hygiene and aesthetic appeal.
No religious text promotes or condones female genital mutilation. Still, more than half of girls and women in four out of 14 countries where data are available believe female genital mutilation is a religious requirement. Female genital mutilation is thus a cultural rather than a religious practice.
Culture and tradition provide a framework for human well-being, and cultural arguments cannot be used to condone violence against people, male or female. Moreover, culture is not static, but constantly changing and adapting. Nevertheless, activities for the elimination of female genital mutilation should be developed and implemented in a way that is sensitive to the cultural and social background of the communities that practice it.
The "Medicalization" of Female Genital Mutilation
In some cases, health workers perform female genital mutilation. This is referred to as the “medicalization” of female genital mutilation. According to estimates in UNICEF’s latest report, around 2 in 3 girls and women between the ages of 15 and 49 who have undergone the practice (66 per cent) had undergone the practice by health personnel. (In some countries, this ratio can reach as high as 3 in 4 girls.) This proportion is twice as high among adolescents (34 per cent among those between the ages of 15 and 19) compared with older women (16 per cent among those between the ages of 45 and 49).
Most of female genital mutilation is carried out with special knives, scissors, scalpels, pieces of glass or razor blades. Anaesthetic and antiseptics are generally not used unless the procedure is carried out by health workers.
According to WHO, the medicalization of female genital mutilation is when the practice is performed by a health worker, such as a community health worker, midwife, nurse or doctor. Medicalized female genital mutilation can take place in a public or private clinic, at home or elsewhere. It also includes the procedure of reinfibulation at any point in time in a woman’s life.
In 2010, the joint interagency Global Strategy to Stop Health-Care Providers from Performing FGM was released. In 2016, the WHO also released guidelines on the management of health complications from female genital mutilation. This strategy reflects consensus between international experts, United Nations entities and the Member States they represent.
Female genital mutilation can never be “safe.” Even when the procedure is performed in a sterile environment and by a health worker, there can be severe health consequences that are immediate and can span a lifetime. Medicalizing the practice gives a false sense of safety. In addition, there is no medical justification for the practice. Advocating any form of harm to the genitals of girls and women and suggesting that health workers should perform it is unacceptable from a public health and human rights perspective.
Furthermore, the belief that female genital mutilation performed by health worker is less severe is unfounded. Several studies have shown that girls can be subjected to the practice repeatedly when members of their family or community are dissatisfied with the results of earlier procedures. Furthermore, studies have shown that women’s reporting on less severe forms of female genital mutilation is often not clinically correct.
When health workers perform female genital mutilation, they wrongly legitimize the practice as medically sound or beneficial for girls and women’s health.
What Is The Role Of Medical Professionals In Preventing Female Genital Mutilation?
Efforts to Eliminate Female Genital Mutilation
Every child has the right to be protected from harm in all settings and at all times. The movement to end female genital mutilation - often local in origin - is intended to protect girls from profound, permanent and completely unnecessary harm. The evidence shows that most people in affected countries want to stop cutting girls and that overall support for female genital mutilation is declining even in countries where the practice is almost universal (such as Egypt and Sudan).
These societal rules make it difficult for individuals or families to abandon the practice.
UNFPA is at the forefront of global efforts to eliminate female genital mutilation, leading initiatives to protect and empower girls and women. With UNFPA’s technical expertise, there has been a surge in activities to prevent FGM and support survivors. Public health services have been strengthened, health workers trained to manage FGM complications, and survivor care integrated into medical education curricula. Additionally, referral systems have been enhanced to coordinate healthcare providers and community actors.
Legal frameworks have also seen progress. Several countries have passed new national legislation banning specifically female genital mutilation and developed national policies with concrete steps towards achieving the abandonment of the practice. Radio networks have aired call-in shows about the harm caused by female genital mutilation.
To accelerate these efforts, UNFPA and UNICEF jointly lead the largest global programme to accelerate the elimination of female genital mutilation and to ensure that survivors receive the appropriate health, social and legal services for their needs. This approach has seen progress. Civil society organizations are implementing community-led education and dialogue sessions on human rights and health. These networks are helping a growing number of communities declare their abandonment of female genital mutilation.
A shift has occurred among religious leaders, many of whom have gone from endorsing the practice to actively condemning it.
Most governments in countries where female genital mutilation is practiced have ratified international conventions and declarations that make provisions for the promotion and protection of the health of women and girls.
The Universal Declaration of Human Rights proclaims the right of all human beings to live in conditions that enable them to enjoy good health and health care (article 25).
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