Female Genital Mutilation, Relativism and Recommendations

To End Cutting: FGM and Relativism in North-East Africa

St. Thomas University

8 December 2008

Female Genital Mutilation (FGM) is one of the most important issues in the argument over cultural relativism. It is a brutal, unnecessary practice used to sexually discriminate against women. Approximately 115 to 130 million (US State Department 4) women have undergone the procedure worldwide, with another 2 million subjected to it each year. It is a practice that violates several human rights and is an affront to human dignity. There is almost universal international, religious, regional and local consensus against FGM. It can also be an important aspect of the path leading to the enslavement of woman, and should be considered a practice similar to slavery. It must be stopped. However, it is a deeply ingrained cultural practice. There are powerful relativist arguments for it, but these can be proven false in the light of consensus, simple reasoning and scientific and medical fact. These arguments must be shown to be false, but the practice must be ended carefully, with a multilateral and educational approach that completely avoids any trace of paternalism.

FGM is exactly what it sounds like, the mutilation, usually by cutting, of the female genitals. But there are many types of FGM, some which do less damage than others. The practice is broken into four categories, one of which does not always seem to violate human rights, two which clearly do, and one which is too broad to classify. The prevalence of all four types varies. According to the United Nations Population Fund (UNFPA) FAQ on FGM, the practice, “is common in parts of Africa, Asia and in some Arab Countries.” It is very rare in most Arab countries, but is according to the US State department, is common in, “Egypt, the Republic of Yemen. … Oman. … (and) Saudi Arabia,” (7). FGM is also practiced in Indonesia. This essay will concentrate on FGM among Nubian and Arab peoples in Egypt and Sudan. However, it should be noted that most of the information in this essay (aside from specific statistics) applies to most cultural situations in which FGM is practiced.

The 2004 US State Department report on the Prevalence of the practice of Female Genital Mutilation classifies the types of FGM as follows. There is general international consensus on these definitions.

Type I, or clitoridectomy is, “removal of the clitoral hood, with or without removal of all or part of the clitoris,” (5). This is the form of FGM most similar to male circumcision, except that total or partial removal of the clitoris is common. This means type I actually damages or removes a sexual organ, whereas male circumcision does not. When only the clitoral hood is removed, and when it is done in sanitary conditions and by trained professionals, Type I has very little risk and can possibly be argued for. This essay will also argue that this type of FGM should be divided into another two categories. However, the medicalization of the practice has been condemned by the United Nations and World Health Organization, as is shown in this quote from the WHO website, “the “medicalization’ of FGM – which is willful damage to healthy organs for non-therapeutic reasons – is unethical and has been consistently condemned by WHO.” (WHO, FGM – Policy Guidelines).

Type II, called excision, is removal, “of the clitoris together with part of the labia minora (the inner vaginal lips),” (US State Department 5). Again, this has no medical benefits. It is the most common type of FGM, making up to 80% of cases in Africa (Mohammed A Tag-Eldin 2). It is extremely dangerous to the health of the girls and women on which it is performed, and is most often performed in unsanitary conditions and with unsanitary tools.

Type III, called infibulation, is removal, “of part or all of the external genitalia (clitoris, labia minora and labia majora) and stitching or narrowing of the vaginal opening, leaving a very small opening, … to allow for the flow of urine and menstrual blood,” (US State Department 5). This is the most dangerous form of FGM. Not only is it the most invasive, but the opening left is only about the size of the thickest part of a toothpick. Urine and menstrual fluid escape in drips, leading to, “chronic infections of the bladder and vagina,” (US State Department 6). This is extremely hazardous to the physical, mental and sexual health of women, and has it has the weakest supporting arguments.

The fourth type of FGM is unclassified. It varies greatly; from a small prick of the clitoris, which is easily defensible and not (necessarily) much of a health hazard, to cauterization, scraping and cutting, and even using corrosive or acidic substances to cause bleeding (US State Department 5). The fourth category is essentially all types of FGM that do not fall under the other three categories. As such, each form of FGM under this category has different health issues, and each must be justified or discredited on an individual basis.

It is important to remember that there are four categories of FGM, but type IV is very broad and type I is somewhat broad. Some forms of FGM involve no mutilation whatsoever, and as such do not need to be condemned, so long as they are done in a sterile environment and without discrimination. These cases (which are somewhat rare) can be legitimate coming of age ceremonies, and should not be called FGM, as there is no mutilation. But most forms of FGM are brutal, risky and discriminatory practices, which may play an important part in forcing women into a form of domestic slavery.

Female Genital Mutilation is often an extremely dangerous procedure which irreversibly alters a woman’s reproductive organs. The procedure comes with serious health risks both immediately and over the long term. The rate of complication varies widely, anywhere from “13-69 %,” (Mohammed A Tag-Eldin 272) according to a WHO report. Complication rates depend on  sanitation, the age of the person on which FGM is being done, the experience of the practitioner,  which type of FGM is being carried out, the tools used and many other factors (US State Department 5). The US State Department report also points out that, “when medical complications occur, they are not generally understood as having resulted from the practice of FGM,” (16). This ignorance of the consequences helps to perpetuate the practice and highlights the importance of education in eradicating FGM.

The US state department lists the following problems as being immediately associated with FGM. The first is, “bleeding,” (6), which can become severe and often lead to death. This is especially dangerous if blood vessels in the clitoris are ruptured. There is also a risk of, “post-operative shock, damage to other organs resulting from lack of surgical expertise of the person performing the procedure and the violence of the resistance of the patient when anesthesia is not used,” (6). FGM is often performed by old women, barbers or sometimes trained midwives. They are frequently inexperienced, and generally have very little medical expertise. There is also a high risk of, “infections, including tetanus and septicemia, because of the use of unsterilized or poorly disinfected equipment; urine retention caused by swelling and inflammation,” (US State Department 6). It must be noted that FGM is often performed on many girls at once and with the same instruments for each girl. This leads the possible spread of STI’s like HIV and hepatitis B and C (WHO 272). The use of anesthesia is rare. Without anesthesia, FGM is very painful. In Egypt, the surgery is most often performed outside of hospitals. However, medicalization is becoming common in Egypt, Nigeria and other countries (Mohammed A Tag-Eldin 4). Violent resistance, screaming, and thrashing in an attempt to get away, are extremely common. Girls are almost always held down by several people (Abusharaf 43). One case study puts it this way, “the girl started squirming and had an expression of fear on her face… she began to twist to free herself from the women’s grasp. … The girl was screaming and bleeding,” (Abusharaf 43).

On top of the complications of the procedure itself, parts of the ceremony frequently lead to health problems. Midwives may use charcoal to give them a better grip. After the cutting herbs, eggs or substances like animal stool may be applied to the vagina (US State Department 5). These lead to a much higher risk of infection. There are also procedures under type 4 FGM, such as placing corrosive substances in, or the cauterization of, the vagina. These, by their very nature, lead to a high risk of infection.

FGM is not only dangerous immediately; there are many long term health consequences. These include, “chronic infections of the bladder and vagina,” (6). These are extremely common with type III FGM, where urine and menstrual fluid can only escape in drips. In fact, “the build up inside the abdomen and fluid retention often cause infections and inflammation that can lead to infertility,” (6). Other problems include, but are not limited to, “extremely painful menstruation; excessive scar tissue at the site of the operation; and formation of cysts on the stitch line,” (6). FGM also increases the risk of STIs during the procedure, if the same instruments are used on several girls. Later in life sex also comes with an increased risk of transmission, as circumcised vaginas can tear during sex.

On top of these problems, pregnancy and sex are often made extremely painful and more risky by FGM. With type III, a woman will re-live the experience of FGM throughout her life. A midwife will be needed to cut her back open on her wedding night and re-stitch her afterward (6). The hole is much too small for a baby’s head to fit through, and a midwife is needed to cut the woman open when she is giving birth, and again, re-stitch her afterward. FGM leads to an increased risk of death, for both the baby and mother, during pregnancy. If the woman is not cut back open, death for her and the baby is almost a certainty.

Not all problems are physical; psychological problems are common throughout the mutilated woman’s life. There have not been many scientific studies conducted, but primary documents report, “nightmares, depression, shock, passivity, (and) feelings of betrayal,” (6). Sometimes these girls do not know about FGM. They are led by their mothers to where the procedure will be performed, and then held down and forced to endure it. Even if they do know what is in store, and are willing to go through with it, they are still too young to legally consent.

The rational for FGM varies between regions and cultures, even within countries and within villages. However, the practice shares common characteristics cross-culturally, and there are several general reasons behind it.

The basic roots of FGM are not fully known. It is primarily practiced in Africa today, but is also done in parts of the Middle East (primarily Yemen and Oman) and Asia (primarily Indonesia). It was also carried out in Europe and North America, but not for initiation purposes. It was mostly done to cure women of ‘ailments,’ such as masturbation, lesbianism, and being over- or under-sexed. This was carried out, “as recent(ly) as the 1950s,” (UNFPA), but is no longer practiced.

Probably the most prevalent reason behind FGM in Africa is the idea of demasculating women. The clitoris is seen as masculine, something that could rival a man’s penis during intercourse. It has to be removed in order to strengthen gender identity. This also applies to men, whose foreskin may be considered feminine, and as such needs to be removed to make a man more masculine (Abusharaf 36).

One of the least understood reasons for FGM is religion. In Egypt, religion is the main justification for FGM, with 33.4% of those who defend the practice citing this as their reason (Mohammed A Tag-Eldin 273). However, “there is no doctrinal basis for this practice in either the Islamic and Christian faiths,” (Mohammed A Tag-Eldin 270-272), with the exception of a brief mention in the non-divinely inspired Islamic Hadith.

There is also a belief that FGM leads to better health, preventing infections and infertility. 18.9% of proponents of FGM in Egypt cited this as their main justification (Mohammed A Tag-Eldin 272). This is of course untrue. FGM leads to many health problems throughout a woman’s entire life, from immediate bleeding, to long lasting psychological effects, to frequent bladder infections.

17.9% of proponents of FGM cite other cultural and social reasons for carrying out the practice(Mohammed A Tag-Eldin 272). FGM is a coming of age ceremony which prepares women for marriage (and they frequently will not be able to find a husband without having FGM performed). It also proves that the woman will stick to the community despite pain and suffering, something that was very important in warrior cultures (UNFPA FAQ on FGM). Desexualization is also important, as FGM is seen as a way of controlling women from cheating on their husbands (Abusharaf 38). It also keeps them pure for marriage and prevents promiscuity, which is often believed to lead to bad health (UNFPA). This places women into a very specific gender role. It is the last step in initiating them into their community and into a role as mother and wife (and oftentimes, nothing else). Finally, FGM is defended simply because many Arabic and Nubian men prefer circumcised vaginas to uncircumcised vaginas. This supposedly makes sex more enjoyable for men and, in that culture, circumcised vaginas considered more sexually attractive then uncircumcised vaginas (Abusharaf 33).

There is an overwhelming international consensus against FGM in human rights documents. In terms of UN documents, FGM violates rights as outlined in the Universal Declaration of Human Rights (UDHR), both the Covenant on Economic, Social and Cultural Rights (CESCR) and the Covenant on Civil and Political Rights (CCPR), the Convention on the Rights of the Child (CRC), the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), The Declaration on the Elimination of Violence Against Women (DEVAW), and may or may not violate the 1926 Slavery convention and its supplementary Convention on the Abolition of Slavery. There is also a call from UNICEF to end FGM by 2010 (UNICEF), and by the UN to end it by 2015 in accordance with its Millennium Development Goals (UNDP). FGM also violates regional and religious documents, such as the African Charter on Human and Peoples’ Rights (ACHPR), its protocol on the Rights of Women in Africa, the African Charter on the Rights and Welfare of the Child, and the Cairo Declaration on Human Rights in Islam.

Under the UDHR, FGM violates the right to, “freedom and equality,” (article 1), as it restricts freedom and is a form of sex discrimination, which also violates article 2. It violates the right to, “life liberty and security of the person,” (article 3), because of its physical and psychological complications. In countries where FGM is illegal, but the law is not enforced, women and girls who undergo the procedure are not enjoying equal protection of the law, a violation of Article 7. If they receive no effective remedy, article 8 is also violated. Girls often have their legs bound for up to forty days after the procedure, to encourage the growth of scar tissue. Without informed consent (which a child cannot give), this is a form of arbitrary detention and a violation of article 9. The risk of sterilization destroys a girl’s right to have a family under article 16 (2). FGM may also go hand in hand with arranged marriages, which, when entered without consent, is a violation of article 16 (1). FGM, by entrenching certain gender roles (specifically being the last step in forcing a woman to exist only as a wife and mother), may violate a woman’s right to work under article 23. This is also related to article 4, “No one shall be held in slavery or servitude,” as FGM can be a precursor to a form of domestic slavery if the woman is not free to pursue roles aside from that of wife and mother. In a society where the worst types of FGM are very prevalent, women may not be able to enjoy their right to a social order where the rights of the UDHR can be enjoyed. Even article 19, which outlines the freedom of expression, can be violated by FGM due to the social importance of the practice and the outcast status uncircumcised woman may have to face.

Many of the rights violated in other agreements are very similar to those violated in the UDHR, so those rights will not be discussed for the sake of brevity. The African Charter on Human and Peoples’ Rights, its protocol on the Rights of Women in Africa, and the African Charter on the Rights and Welfare of the Child run fairly parallel to the UN’s protections. However, it should be kept in mind that they are a region specific guarantee of human rights, rights which FGM violates. These include rights to equality, the right to freedom from exploitation, the right to liberty, and the right to “the best attainable state of physical and mental health,” (ACHPR article 16). All of these rights are violated by FGM.  The ACHPR also specifically outlaws FGM in article 5, stating that states parties must work toward, “prohibition, through legislative measures backed by sanctions, of all forms of female genital mutilation, scarification, medicalization and para-medicalization of female genital mutilation and all other practices in order to eradicate them.” The ACHPR also has very strong legislation on discrimination against women. These documents are crucial and very strong evidence in the fight against relativist-supported FGM.

FGM violates a woman’s right to “self-determination,” (article 1) in the CCPR. It is a deeply ingrained practice, and one to which girls cannot (and often do not have the chance to) consent. It is both a symptom of and cause for discrimination, and it is often required for a woman to become a full member of her social community. When FGM is a precursor to slavery, it violates almost every article in the convention, as it destroys any chance of equality, power, or access to public life within society.

The Covenant on Economic, Social and Cultural rights is very similar to the UDHR and will not be discussed in depth. However, it should be noted that the covenant creates obligations on the states parties that ratify it. As such, those states are in violation of the covenant when they do not take action to stop practices that are a huge affront to human dignity, such as FGM.

FGM leads to several violations under the Convention on the Rights of the Child. Most forms of FGM are clearly not in the best interest of the child, a violation of article 3 (1). When the government does not ensure that these interests are being looked after, article 3 (2) is also violated. Article 24 states, “States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health” (CRC). Clearly this is violated by the immediate and long term problems of FGM. Several of article 24′s subsections are also violated. Article 37 (1) requires that, “No child shall be subjected to torture or other cruel, inhuman or degrading treatment or punishment.” (CRC), and requires that a child’s right to liberty be protected (37 [2]); both of those rights are violated by most forms of FGM.

FGM also violates several articles of the CEDAW. It is a discriminatory practice which makes a distinction based on sex, violating Article 2. Even in cultures where men are also circumcised, it is extremely rare for their circumcision to be anywhere near as brutal as that of FGM.  Article 3 states,

States Parties shall take in all fields, in particular in the political, social, economic and cultural fields, all appropriate measures … to ensure the full development and advancement of women, for the purpose of guaranteeing them the exercise and enjoyment of human rights and fundamental freedoms on a basis of equality with men

Rarely do states take effective measures to combat FGM. When these measures are not taken, states which have ratified the CEDAW (and other treaties) are not fulfilling their obligations. Again, when FGM is a precursor to a form of economic slavery, almost every article in the convention is violated.

The Declaration on the Elimination of Violence Against Women specifically names FGM as a violation of rights. Article 2(a) says violence is any, “physical, sexual and psychological violence occurring in the family, including battering, sexual abuse of female children in the household, dowry-related violence, marital rape, female genital mutilation and other traditional practices harmful to women, non-spousal violence and violence related to exploitation,” (DEVAW). FGM prevents women from enjoying their universal human rights as outlined in article 3, and article 4 asks states to stop violence against women. This may not have much in the way of teeth, but it is still an important document which better reveals the international consensus against FGM.

It is extremely important to look at religious agreements about FGM, since FGM is (mistakenly) believed to be rooted in religion. The Cairo Declaration on Human Rights in Islam has flaws. It does not guarantee freedom of religion, instead talking about, “the true religion,” (article 1). It also gives protection from state interference in marriage, but not on the basis of religion, and it could be interpreted as suggesting that men are superior to women. However, despite its flaws, the Cairo declaration is an effective document for fighting against relativists supporting FGM. It still outlines many rights which FGM violates. It says the, “right to life is guaranteed to every human being. It is the duty of individuals, societies and states to safeguard this right against any violation,” (article 2), and that, “safety from bodily harm is a guaranteed right,” (article 2). Article 6 establishes that, “woman is equal to man in human dignity,” a dignity which can easily be destroyed by FGM. Article 11 says, “Human beings are born free, and no one has the right to enslave, humiliate, oppress or exploit them.” FGM can be a precursor to slavery, a form of forced detention, and can certainly be humiliating. FGM can even violate article 17, the right to live in a “clean environment,” which is destroyed by the constant infections associated with type III, and complications from the other types.

The Banjul Declaration (not to be confused with the ACHPR) was written in Gambia by, “the participants at the Symposium for Religious Leaders and Medical Personnel on FGM as a Form of Violence,” (Banjul Declaration) in 1998. It specifically declares that FGM must be stopped. It also condemns, “the misuse of religious argument to perpetuate FGM and other forms of violence,” (Banjul Declaration), asks for religious leaders to help stop the practice, and asks for legislation to stop FGM and punish those perpetuating it.

Although FGM is a brutal practice which violates human rights, it is very difficult to argue that it is a form of slavery. Kevin Bales, the leading expert on slavery in the world, defines slavery as the, “state marked by the loss of free will, in which a person is forced through violence or the threat of violence to give up the ability to sell freely his or her own labor power,” (Bales, 57). He lists three characteristics of slavery, “loss of free will, the appropriation of labor power, and the use or threat of violence,” (Bales, 57). FGM does not meet all three of Bales’ requirements. It does include the loss of free will, and is in itself the use of violence, but there is no appropriation of labour power. However, FGM is often the final step in placing a girl into a very specific gender role in her society. FGM can desexualize her. It can take her from being a self-determined human being, and make her a wife and mother, nothing else. In this case, the woman is put into a form of domestic labour where she has no ability or choice to move out of the household and pursue a meaningful life for herself. Generally women go into this willingly, but it cannot be ignored that the traumatic and psychological effects of FGM, and the discriminatory environment it is conducted within, may have an effect on her decision. By looking at it in this light, extreme forms of FGM may be the violent control that leads to a form of slavery. This may be similar to a situation where women are forced into prostitution and, after being physically and psychologically abused, become dependent on their pimps and do not try to escape. Girls often do not consent to FGM, and cannot give consent under international law anyway. But they may become more willing to consent to a life of domestic servitude to their husband and community after undergoing FGM.

The United Nations Slavery Convention, which was adopted in 1926, calls slavery, “the status or condition of a person over whom any or all of the powers attaching to the right of ownership are exercised,” (article 1-1). This is a much broader definition then what Bales gives, and it is further augmented by the Supplementary Convention on the Abolition of Slavery. This convention has an interesting section that relates to FGM. Article 5 states, “the act of mutilating, branding or otherwise marking a slave or a person of servile status in order to indicate his status … shall be a criminal offence under the laws of the States Parties to this Convention.” FGM is certainly mutilation for the sake of identifying a status. This treaty seems to make FGM illegal; however, FGM still does not quite fit the definition of slavery under either treaty. FGM is a slavery-like practice, which may be the violent control of a woman that leads to the loss of labour power. This is supported by the UN fact sheet on Contemporary Forms of Slavery. It says that Benjamin Whitaker, a UN researcher, called it a “slavery-like practice,” (UN Fact Sheet No. 14, Special Rapporteurs), in his 1982 report. The Slavery Convention should be updated and made more specific so that it can effectively combat slavery without being too broad. It should use Bales’ definition of slavery and his three attributes, as they are logical and he is the foremost expert in that field. Unfortunately for the fight against FGM, the practice will not fit directly into these definitions. However, it can still be effectively fought. Relativist arguments still stand in the way of that fight, but they can be beaten.

There is a very crucial point in laying out this background behind FGM. The breakdown of the four types and the outline of the physical and mental health risks objectively show that FGM is a brutal practice. The discussion of the roots of FGM reveals that many, maybe even most, people who practice FGM do not really know its roots. They either do not fully understand the cultural reasons for it, or they live in a culture where it is now totally unnecessary (and it is true that a violation of human rights like FGM is never necessary). The point in outlining the human rights documents is to show that there is massive international, national, regional and religious consensus against FGM.  The point in talking about slavery is to reveal the culture of discrimination FGM often exists in, and show that it can be a precursor to slavery. The point of the whole discussion is this. FGM is an affront to human dignity. It removes that right to human dignity, the fundamental and universal right from which all others flow. It must be stopped, as it is a symptom and a cause of discrimination. Women must be empowered to eliminate this culture of discrimination, and this cannot happen when they do not even have the security of their own person. Bringing these facts to light sucks most of the strength out of relativist arguments. The rest of this essay is dedicated to dissecting those relativist and cultural arguments in favour of FGM, and making recommendations as to how the practice can be combated.

Diana Ayton-Senker defines cultural relativism in a United Nations Background note. She says, “Cultural relativism is the assertion that human values, far from being universal, vary a great deal according to different cultural perspectives,”  (Ayton-Shenker). FGM is one of the most important debates in the relativist/universalist argument today because it is both so culturally ingrained and so vehemently opposed internationally. However, despite its importance in this debate, almost all of the arguments for the practice are extremely weak. They emphasize supposedly cultural values that have little grounding in history, and that are extremely discriminatory. They can be refuted, in the light of international consensus, with scientific fact and reasonable thinking. However, they must not be refuted in a paternalistic way, and refuting them is not enough. Legal methods, education campaigns, and international and national support must be used to combat FGM. These will be discussed later in this essay. The arguments presented here are primarily from Nubian and Arab culture in Egypt and neighboring Sudan, but they are easily transferrable to other parts of the world.

The weakest argument in favour of FGM is that it makes woman cleaner and prevents disease and infections. This makes up the rational for FGM in 18.9% of cases in Egypt (Mohammed A Tag-Eldin 4). As the earlier parts of this essay outline, this is totally untrue. FGM has a very high risk of infection, and creates health problems throughout a woman’s life. However, this fact is often not recognized, as infections and problems that happen later in life, such as severe bladder infections, are not realized to be associated with FGM (US State Department, 16). Tied in with this argument is the idea that FGM keeps women healthy during adolescence through a, “curtailment of sexual energy,” (Female Circumcision 35). The idea is that too much sexual energy will, “drain her health, make her weak and skinny,” (35). Again, this has no basis in fact. Promiscuous sex can of course lead to sexually transmitted diseases, but FGM is not an effective way to combat this problem.  According to the UNFPA FAQ on FGM, “due to damage to the female sexual organs, sexual intercourse can result in lacerations of tissues, which greatly increases risk of transmission, (of STIs)” (UNFPA). FGM also creates a risk for the transmission of STIs when it is carried out, as the same instruments are often used on a number of girls, without sanitation.

Another weak argument is that FGM cannot be stopped because the practice is to economically important for the people who perform it. Removing the practice removes their job, and takes them from living a fairly affluent life in their communities, to poverty. The payment a midwife received in Nubian Egypt is described in Female Circumcision, “the midwife received a fee of thirty piastres (1/100 of the Egyptian pound). In addition she was given cigarettes, dates, soap and gargush (sweet crackers),” (Abusharaf 45). Considering the massive prevalence rates across Africa, from 97% in Egypt to 72.7% in Ethiopia and 98.6% in Guinea, (US State Department 28-49) practitioners have a lot of work, and they are generally well paid. But this argument is no reason to continue FGM; the economic benefit of one group cannot possibly justify the massive suffering of another. Also, these practitioners can be retrained (US State Department, 19), and this must be an integral part of any program to stop FGM. In fact, traditional practitioners, in some countries where medicalization is more common (such as Egypt) are already losing their jobs (Mohammed A Tag-Eldin 4) without any outside interference.

The most common argument for FGM is also the greatest misconception about the practice. This is that FGM is an important part of Islam. That is untrue. FGM, “predates the rise of Christianity and Islam,” (United Nations Population Fund), and is not mentioned in the Koran or the Christian Bible. It is mentioned in the Islamic Hadith, (which is generally not considered to be divinely inspired) but only very briefly, and not in a way that requires the procedure to be carried out. Mohammed tells a practitioner of FGM, “when you cut, do not go too far: this allows the woman more pleasure and is more agreeable for the man,”  (Kerstin). Many Islamic leaders and scholars, including the grand mufti of Egypt, came together to make the Cairo and Banjul declarations (not to be confused with the ACHPR), both of which condemned FGM, saying it is against Islam and human rights.

Another common argument for FGM is that it is required to keep women pure before marriage, and that it will prevent them from cheating while their husbands are away (Abusharaf 37). It is possible that this is true, especially considering the violent nature of FGM. However, it is not worth the pain and suffering or the massive human rights violations. This argument is, in and of itself, extremely discriminatory against women.

An interesting relativist argument is that FGM makes women more sexually appealing to men. This is especially true in Nubian culture, where the external female genitalia is often thought of as unattractive, and women say men prefer, “vaginal tightness,” (Abusharaf 32), for sex. This however, is not always true. In several cases in Egypt, men forbade their daughters from undergoing FGM once they were educated as to what the practice was, regardless of their ideas of what was sexually appealing. One man put it this way, “I will not permit you to circumcise my daughter or pierce her ears – both practices alter the natural body and are decadent,” (Abusharaf 35). Also, the preference of men is no justification for the human rights violations of FGM, especially in light of the massive consensus against the practice.

Linked to the idea of beautification through surgery is that FGM is considered to be a practice similar to breast augmentation or enlargement in the Western world (Abusharaf 33). Many women argue that FGM is not mutilation, just as breast augmentation is not considered to be mutilation. This may be true, if they are talking about only removing the clitoral hood (although life-long health risks may still exist with this form). But any other type of FGM, as discussed earlier in this essay, is clearly mutilation. It is dangerous, permanent, and removes a sexual organ. It must be noted that breast augmentation, although it is a (usually) unnecessary surgical procedure, does not carry risks anywhere near that of FGM. Most importantly, breast augmentation is done with the consent of the women undergoing the procedure. Also, breast augmentation is not required by the community in order for women to find a husband.

A similar argument is that FGM is no different than male circumcision in the west (Abusharaf 35). Male babies are also not given a choice and male circumcision has little medical purpose. However, male circumcision has been medicalized. It is not invasive and does not remove a sexual organ. It is similar to type I FGM (when only the clitoral hood is removed), but without unsanitary conditions or possible discrimination. When type I involves the removal of the clitoris (which is often), it is somewhat akin to removing the head of a man’s penis, in terms of the amount of nerve endings in both organs. In the end, this argument is not really a defense of FGM, but a condemnation of male circumcision. However, if something as simple as male circumcision is unnecessary, then something as invasive as FGM is certainly a crime.

In certain parts of Egypt, woman adopted forms of FGM that were less extreme then their traditional practices. Generally, this was a move from type III to type II FGM (Abusharaf 41). But less extreme does not mean no longer extreme, and type II is still a human rights violation that is condemned almost universally. However, this movement is very important. It is proof that FGM can be stopped. Movements like it must be fostered and taken further, as FGM cannot be stopped unless the women in these communities are willing to stop it themselves, as a whole.

Some women in Nubian Egypt have argued that men have nothing to do with FGM, and as such it is not a discriminatory practice (Abusharaf 35). It is true that men have little to do with FGM in Egypt, and often do not even really know what it is. However, the practice is still discriminatory, regardless of who perpetuates it. It still violates rights, is extremely dangerous, and has the potential of placing women into domestic slavery. Also, fathers have the right to make an informed choice about the health of their children. If they do not know what FGM is, they cannot make an informed decision, and their rights are also being violated.

Finally, there is the most powerful and legitimate argument in favour of FGM. It is the argument that some types of FGM do no or very little damage. They are no worse than male circumcision. They are not discriminatory, but are a legitimate coming of age practice and similar to a practice performed on boys. It is put this way in Female Circumcision, “the two gendered rituals play equivalent roles in the transition of male and female children into adulthood,” (Abusharaf 30). This argument is completely true. It is the test to determine the borders of universalism and legitimate relativism. It proves that all types of FGM cannot be lumped into one category, in fact, the categories should be re-organized.

Type 1 FGM should be split into two categories. It is mutilation when the clitoris is removed. However, it is not mutilation when only the clitoral hood is removed. This practice is roughly equivalent to male circumcision. This is because, in both cases, no sexual organs are actually being destroyed. Also, Pricking of the clitoris, a practice under type IV, is not really mutilation and should be recognized as such. It is somewhat debatable as to whether these two practices need to be stopped, because they cannot legitimately be called mutilation when male circumcision is allowable. If they were to be condemned, male circumcision would also have to be condemned.  Pricking and removing the clitoral hood are viable alternatives to mutilation, at least in the short term, but only when they are done in the right conditions. However, there are still problems. The underlying roots of FGM need to be addressed. When the practice is safe, does not involve mutilation, and is nothing but a coming-of-age ceremony, then it is fine. But if it done in an unsanitary way, or is based on discrimination, or contributes to the de-sexualisation of women, the practice must be stopped.

The final argument in favour of FGM proves that a broad, paternalistic approach to ending FGM will not do. The practice must be ended, but it must be ended in an intelligent way. Countries must make the practice illegal. But laws are not enough, they simply establishes the foundation on which a campaign must be built. There must be a multilateral approach. International organizations like the UN, UNICEF and the UNFPA must fund, participate, and give support, as should NGOs like Human Rights Watch and Tostan. There must be support from local governments, and education campaigns need to be funded. The best model of an education to stop FGM comes from Senegal. In that country, approximately 140,000 people have stopped FGM (US State Department 16) thanks to a program put in place by Tostan. It is being replicated in Sudan, Mali and Burkina Faso, and similar programs should be initiated in every other country where FGM is prevalent. According to the US State department, the program, “emphasizes participation and empowerment of woman and uses material that draw on Senegalese culture and oral traditions,” (16). Tailoring programs to the local culture is crucial, as paternalism must always be avoided. Tostan works through, “games, small group discussion, theater, songs, dance, storytelling and flip charts,” (16). Groups meet several times a week, and there are almost no drop outs. It does not immediately condemn FGM, but explains the risks, dispels the misconceptions and explains relativist arguments. People are then allowed to make their own decisions, and they usually decide to stop the practice. Programs like this, that respect and work with local culture, that help movements already in place, and that emphasize a community approach can be successful. There has also been success with similar programs in Egypt, where the government has outlawed FGM and started education campaigns. The prevalence rate is still 97%, but it has fallen to only 33-57% among school age girls (Mohammed A Tag-Eldin 3), meaning overall prevalency rates will decrease in the future. FGM will continue so long as girls will not be able to marry if it is not performed on them, so communities, not just individuals, have to make the choice to stop. That is why a community approach, like the one being fostered by Tostan, is so crucial.

There are some who would say there should be no movement to stop FGM. They are wrong, and their arguments hold no water. There can be no question that FGM is dangerous, and that it is an affront to human dignity. It violates human rights as outlined in UN documents, in African human rights documents, and in Islamic human rights documents. It is extremely discriminatory against women, it is a practice similar to slavery, and it can be a precursor to a form of domestic slavery. Many countries where it is prevalent have outlawed the practice, and education campaigns have been successful in ending it. With massive consensus internationally, regionally, religiously and often locally, with the obvious physical and mental harm FGM does in the short- and long-term, and with its problems relating to slavery, the practice cannot be reasonably argued for. But FGM is a deeply engrained cultural practice. Education programs must be tailored to specific regions, and they must be carried out multilaterally, with upmost respect for local culture.  It is a complicated issue, but it is one that can be sorted out, and one that can be stopped.

Works Cited

Abusharaf, Mustafa. Female Circumcision. Philadelphia, Pennsylavnia: University of Pennsylvanie

Press, 2006.

Ayton-Shenker, Diana. “The Challenge of Human Rights and Cultural Diversity.” 1995. United

Nations.org. 25 October 2008 <http://www.un.org/rights/dpi1627e.htm&gt;.

Kerstin, Lisy. “Female Genital Mutilation and Islam.” November 2007. GTZ. 4 November 2008

<http://www.gtz.de/de/dokumente/en-fgm-topics-islam.pdf&gt;.

Mohammed A Tag-Eldin, Mohsen A Gadallah, et al. “Prevalence of Female Genital Cutting Among

Egyptian Girls.” Bulletin of the World Health Organization (2008): 269-274.

Organisation of African Unity. “African Charter on Human and People’ Rights.” 1981. Banjul,

Gambia: African Union.

Symposium for Religious Leaders and Medical Personnel on FGM as a Form of Violence. “A

DECLARATION ON FGM BY RELIGIOUS LEADERS.” 1998. 10 November 2008

<http://www.uneca.org/docs/Publications/ACW/old/iac/banjul.htm&gt;.

UNICEF. “Press Centre.” 8 March 2003. To the symposium on female genital mutilation in Berlin.

6 December 2008 <http://www.unicef.org/media/media_9297.html&gt;.

United Nations Development Programme. “Newsroom.” 27 February 2008. UN Agencies Unite

Against Female Genital Mutilation. 6 December 2008

<http://content.undp.org/go/newsroom/2008/february/un-genital-mutilation-20080227.en&gt;.

United Nations. “Division for the Advancement of Women.” 1979. Convention and the Elimination

of all forms of Descrimination Against Women. 1 November 2008 <http://www.un.org/womenwatch/daw/cedaw/&gt;.

-. “Office of the High Commissioner for Human Rights.” 2 September 1990. Convention on the

Rights of the Child. 16 November 2008 <http://www.unhchr.ch/html/menu3/b/k2crc.htm&gt;.

-. “Office of the High Commissioner for Human Rights.” June 1991. Fact Sheet No. 14,

Contemporary Forms of Slavery. 1 November 2008 <http://www.unhchr.ch/html/menu6/2/fs14.htm&gt;.

-. “UN.org.” 10 December 1948. The Universal Declaration of Human Rights. 16

November 2008 <http://www.un.org/Overview/rights.html&gt;.

-. “University of Minnesota Human Rights Library.” 30 April 1957. Supplementary Convention

on the Abolition of Slavery, the Slave Trade, and Institutions and Practices Similar to Slavery. 16 Novmeber 2008 <http://www1.umn.edu/humanrts/instree/f3scas.htm&gt;.

United Nations Population Fund. FAQs on Female Genital Mutilation. 2008. 2008

<http://www.unfpa.org/gender/practices2.htm#7&gt;.

US State Department. Prevalence of the practice of Female Genital Mutilation (FGM); laws

prohibiting FGM and their enforcement; recommendations on how to best work to eliminate FGM. Government Document. Washington, D.C.: United States State Department, 2004.

World Health Organization. Female Genital Mutilation – Policy Guidelines. 2001. 1 December 2008

<http://www.who.int/reproductive-health/publications/rhr_01_18_fgm_policy_guidelines/index.html&gt;.

19 Comments

Filed under Human Rights, Research Papers

19 responses to “Female Genital Mutilation, Relativism and Recommendations

  1. “This means type I actually damages or removes a sexual organ, whereas male circumcision does not.”

    The usual type of circumcision removes the most sensitive parts of the male penis, thus damaging a sexual organ. I see no fundamental difference between removing a female prepuce and removing a male prepuce, and I would classify both as genital mutilation.

    • I agree that removing only the prepuce is roughly equivalent in both forms of circumcision. However, that quote is slightly out of context. My point is in the preceding line, where I mention that part of or the entire clitoris is often removed in type 1 FGM. In terms of the concentration of nerve endings, that is equivalent to removing part of or the entire head of the male penis.
      I agree that male circumcision can also be damaging and is unnecessary, but it does not run the same risks or lead to the same long term damages/loss of sensitivity that FGM does.
      Also, I’m looking at this from a human rights perspective, and judging by your organization I’m assuming you’re looking at the practice from a medical perspective. Our standards of judgment are different, but in the end I probably agree with you.

  2. Opposition to male circumcision comes also from a human rights perspective, and virtually all Male Genital Cutting opponents are also opposed to FGC. The only reason for the existence of an organisation like Doctors Opposed to Circumcision is that in the west MGC has been medicalised.

    When it comes to anatomy, the male glans is relatively poorly innervated, compared to the foreskin – unlike the female.

    But comparisons are odious. 37 youths have died from MGC in the Eastern Cape this circumcision season alone. How much worse can it get than death?

    We would make better allies than enemies, but far too many FGC opponents defend or trivialise MGC – even while they use the phrase “equality of the sexes” and are in countries where ALL FGC – no matter how minor – is outlawed, without exemption for religion or culture. Involuntary genital cutting is evil, and should be stopped.

    • My point in talking about human rights is that it can be universally agreed that FGM harms human dignity. I wouldn’t be surprised if male circumcision is universally a problem medically, but in terms of human rights it is a more difficult argument to make. I am a strong universalist, but if male circumcision can be done safely and is an important cultural rite, then it is extremely hard to argue against. If not, then it should be stopped. Also, I don’t know what complication rates are like in South Africa, but as far as I know death is extremely rare where it is medicalized and performed by competent physicians.

  3. I’m actually motivated more by human rights than the medical issues, but I included that link as useful information. I’m including a link to the Canadian Children’s Rights Council with this comment.

    The more extreme forms of female circumcision are unquestionably worse than the usual form of male circumcision. That said, I think most people underestimate the damage of male circumcision. There is a very definite loss of sensitivity, and that was promoted as one of the benefits when western non-religious circumcision first started in the 19th century.

    I too, am adamantly opposed to FGM, but I don’t understand your distinction between FGM and MGM. The people that promote female circumcision don’t see much difference either (try debating with them). Female circumcision can be done safely, and is regarded as an important cultural rite. In many countries, female circumcision is performed by doctors in operating theatres, and the minor forms are probably safer than male circumcision.

    Does that make it right though, or do people have a basic human right not to have part of their genitals removed?

    And how do we end female circumcision, whilst at the same time telling people that male circumcision is acceptable?

  4. I’m not saying you’re wrong about male circumcision, in fact in the essay I say that in order to realistically condemn FGM we have to address male circumcision as well. And I argue that FGM, when it is only removal of the clitoral hood and is performed medically, although medically unnecessary, may not be much of a human rights issue. Rights have to be weighed against relativist and cultural arguments. I believe the ultimate goal should be no cutting whatsoever, absolutely. But the fact is that realistically the worse forms have to be fought first. Type II FGM is by far the most common (80% in Africa), and that is much more invasive. I’m not arguing in favour of either male circumcision or type I FGM, I’m simply saying that the worst forms of FGM need to be addressed first.

    And the other thing is that we can’t simply condemn FGM as evil and try to reason it out of people from far away. That doesn’t work, and it sounds like you’ve argued with people about it yourself. People have to be educated in a non-paternalistic, local and tolerant way. The most successful program to end FGM, which is outlined in the essay, is done by the Tostan NGO. It does not condemn FGM at all when it educates people, it gives them the facts and allows them to come to their own conclusion.

  5. “Rights have to be weighed against relativist and cultural arguments.” That’s an interesting claim. Can you give some other examples where they have to be?

    “But the fact is that realistically the worse forms have to be fought first.” It would certainly be perverse to attack minor forms while ignoring worse forms, but nobody is suggesting that. Laws in the western world for example outlaw ALL female genital cutting (absent pressing medical need) no matter how minor (or sterile and anaesthetised). And in some cultures they justify female cutting by reference to the male form as practised in the US, so to attack one helps to attack the other.

  6. I completely agree, and as I say in the essay, the argument that FGM is okay because of male circumcision doesn’t really support FGM, rather it condemns male circumcision.

    And like I said, I’m a strong universalist when it comes to rights. But the fact is that all rights have to be weighed against relativist arguments when enforcing those rights harms a cultural practice. That doesn’t mean practices that contradict rights should not be ended, but they need to be ended properly. My point is that we cannot simply dismiss or ignore relativist arguments, we have to dissect them and disprove them in a culturally tolerant way. All human rights must be made a reality for everyone, that is the cover all requirement. But they must be implemented with as little a cost to culture as possible, and the way in which they are implemented will often be different for every country and every culture. Some people see rights as a threat to their culture or way of life, it has to be demonstrated that they are not, unless of course a persons way of life involves systematic and frequent human rights abuses.

  7. Emiley

    Great article! Thank you for putting it together. Potential patients will be better served going with a service like The Patients Advantage (www.ThePatientsAdvantage.com). It’s a great way to find the best surgeons and it does not cost anything. I found them when searching for breast augmentation surgeons. Check them out.

  8. bikerbernie

    Right now your post is too long to read but I read about a 1/3.

    It is difficult to fathom a man seemingly not taking issue with male circumcision.

    Sorry no mater what you say that is male genital mutilation. For Christ’s sake it removes 33-50% of the male organ or 15in^2 of tissue. This is no small (not trying to be humorous but I guess one could argue that now it is a small issue. There are so many nerves that are removed and in some cases amputation is necessary afterward.

    That is NINE HUNDRED SEVENTY FIVE MILLION (975,000,000) MEN/BOYS walking around with MGM. In the United States about 60% of men are circumcised that is ONE HUNDRED FIVE MILLION MEN/BOYS (105,000,000).

    READ MORE HERE

    http://bikerbernie.wordpress.com/2009/03/17/fgm-mgm-it-is-all-circumcision/

    b

  9. I didn’t say I don’t take issue with male circumcision, in the essay I specifically say in order to condemn certain types of FGM it also needs to be condemned. What I did say is that it is not as extreme a practice and is not as much of a human rights issue, but it is still damaging and is still a human rights issue.

    I have to disagree that male circumcision removes 33-50% of a penis, foreskin is not nearly 33-50% of the organ. And also, the amount of nerve endings removed in male circumcision is no where near comparable to the amount destroyed in removing the clitoris. In order for that many nerves to be destroy you would have to remove the entire head of the penis.

    Also, I am taking about male circumcision as it is practiced in sterile environments by qualified practitioners, and I am still saying it should be condemned, just that it is not as harmful a practice as FGM. Obviously circumcision performed in unsterile conditions and by unqualified persons needs to be condemned as well.

  10. Male circumcision removes 33-50% of the *surface area* of the penis, and it is is at or near the surface that the erogenous nerves are. The clitoris is the embyological equivalent of the glans, but there is no reason to assume that it is also the neurological equivalent. “…the amount of nerve endings removed in male circumcision is no where near comparable to the amount destroyed in removing the clitoris.” Have you some figures to back up that claim?

    “all rights have to be weighed against relativist arguments when enforcing those rights harms a cultural practice.” The question arises, whose rights, whose culture? When a cultural practice is carried out by adults on children, the rights of the children trump the culture of the adults, even if those children grow up to be adults practising the culture on the next generation of children. Consider footbinding, or chimney-climbing boys…

    • During my research I found that comparison, and its in the essay. I don’t specifically remember the source but it’s in my bibliography. The second quote is taken out of context. I’m not talking about weighing peoples rights against each other, I’m talking about weighing them against relativist arguments. If you continue reading you’ll see that I conclude that those relativist arguments are invalid, and as such the rights of the victims are far more important.

  11. bikerbernie

    “This means type I actually damages or removes a sexual organ, whereas male circumcision does not.”

    The usual type of circumcision removes the most sensitive parts of the male penis, thus damaging a sexual organ. I see no fundamental difference between removing a female prepuce and removing a male prepuce, and I would classify both as genital mutilation.

    ===========

    Mark you are kidding right?!?! MGM removes 35 – 50% of the male tissue and much of its nerves, it reduces sexual pleasure and causes ED. WOW

    b

  12. bikerbernie

    I do not understand the concern with just females anywhere when we are still doing this to males all over the world.

    What is the big deal 130 million there are almost that many males in America that have suffered the same fate and 975 Million world wide?!?! Kinda puts FGM even further back than the back burner.

    Check this out.

    http://bikerbernie.wordpress.com/2009/03/17/fgm-mgm-it-is-all-circumcision/

    b

  13. I’m not going to explain the whole case again, the essay does the for me. The answer is very simple, FGM does way, way more damage. And also, the foreskin is not the most sensitive part of the penis.

  14. Mark Lyndon

    The inner foreskin is waaay more sensitive than any part of the glans (Sorrells, 2007). The glans is only roughly as sensitive as the base of your heel. Even for a circumcised man, it’s not the glans that’s the most sensitive part of the penis – it’s usually the scar line (or the frenulum if that wasn’t removed).

    http://www.ncbi.nlm.nih.gov/pubmed/17378847

    Heck, try it for yourself. Try to masturbate touching only the glans, and not stimulating anything underneath.

    Nerve endings in the male glans: about 4,000
    Nerve endings in the external clitoris: about 8,000
    Nerve endings in the foreskin: about 20,000

    Have you ever tried debating with the people that promote female circumcision? (they get incensed if you call it “mutilation” btw, so if you don’t want to call it “female circumcision”, call it “female genital cutting”) They will use the exact same arguments to defend it as are used to defend male circumcision. They’ll tell you how it’s cleaner, more hygienic, healthier, better aesthetically, a simple safe painless operation, and they will *aways* compare it to male circumcision (often saying that it does less damage). We’re never going to be able to stop people cutting parts off girls’ genitals while we tolerate cutting parts off boys’ genitals.

  15. I checked out your source and seems reliable, I’ll concede that point to you. But sensitivity aside, FGM, especially type 2 and 3, still does way more damage. And the fact that it’s usually performed in unsterilized conditions and by untrained people makes it worse. I agree that male circumcision should be stopped, but I still hold that FGM is a much larger problem.

  16. In Malaysia and Indonesia, FGC seems to be performed in more sterile conditions and by better trained people, doctors even. It also seems to be more minor, sometimes purely tokenistic. (I say “seems” because I’m relying on anecdotes by mothers who had it done to their daughters, and that may not be exhaustive or accurate.) There seems a tendency for people to compare the worst-case scenario of FGC with the best-case of MGC.

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