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Date Posted: 22:23:14 02/11/16 Thu
Author: Hasanur Rahman
Subject: Female genital mutilation

Female genital mutilation (FGM), also known as female genital cutting and female circumcision, is the ritual removal of some or all of the external female genitalia. Typically carried out by a traditional circumciser using a blade, with or without anaesthesia, FGM is concentrated in 27 African countries, Yemen and Iraqi Kurdistan, and found elsewhere in Asia, the Middle East, and among diaspora communities around the world.[8][n 1] It is conducted from days after birth to puberty and beyond; in half the countries for which national figures are available, most girls are cut before the age of five.[4]

The procedures differ according to the ethnic group. They include removal of the clitoral hood and clitoral glans, removal of the inner labia, and in the most severe form (known as infibulation) removal of the inner and outer labia and closure of the vulva. In this last procedure, a small hole is left for the passage of urine and menstrual fluid; the vagina is opened for intercourse and opened further for childbirth. Health effects depend on the procedure, but can include recurrent infections, chronic pain, cysts, an inability to get pregnant, complications during childbirth, and fatal bleeding.[11] There are no known health benefits.[12]

The practice is rooted in gender inequality, attempts to control women's sexuality, and ideas about purity, modesty and aesthetics. It is usually initiated and carried out by women, who see it as a source of honour and fear that failing to have their daughters and granddaughters cut will expose the girls to social exclusion.[n 2] Over 130 million women and girls have experienced FGM in the 29 countries in which it is concentrated.[3] The United Nations Population Fund estimates that 20 percent of affected women have been infibulated, a practice found largely in northeast Africa, particularly Djibouti, Eritrea, Somalia and northern Sudan.[15][16]

FGM has been outlawed or restricted in most of the countries in which it occurs, but the laws are poorly enforced.[17] There have been international efforts since the 1970s to persuade practitioners to abandon it, and in 2012 the United Nations General Assembly, recognizing FGM as a human-rights violation, voted unanimously to intensify those efforts.[18] The opposition is not without its critics, particularly among anthropologists. Eric Silverman writes that FGM has become one of anthropology's central moral topics, raising difficult questions about cultural relativism, tolerance and the universality of human rights.[19]

Until the 1980s FGM was widely known as female circumcision, which implied an equivalence in severity with male circumcision.[20] The Kenya Missionary Council began referring to it as the sexual mutilation of women in 1929, following the lead of Marion Scott Stevenson, a Church of Scotland missionary.[21] References to it as mutilation increased throughout the 1970s.[22] Anthropologist Rose Oldfield Hayes called it female genital mutilation in 1975 in the title of a paper,[23] and in 1979 Austrian-American researcher Fran Hosken called it mutilation in her influential The Hosken Report: Genital and Sexual Mutilation of Females.[n 3]

The Inter-African Committee on Traditional Practices Affecting the Health of Women and Children and the World Health Organization (WHO) began referring to it as female genital mutilation in 1990 and 1991 respectively.[25] In April 1997 the WHO, United Nations Children's Fund (UNICEF) and United Nations Population Fund (UNFPA) issued a joint statement using that term. Other terms include female genital cutting (FGC) and female genital mutilation/cutting (FGM/C), preferred by those who work with practitioners.[26]
Local terms

The many variants of FGM are reflected in dozens of local terms in countries where it is common.[27] These often refer to purification. A common Arabic term for purification has the root t-h-r, used for male and female circumcision (tahur and tahara).[28] In Islamic texts the practice is referred to as khafḍ (Arabic: خفض‎)[29] or khifaḍ (Arabic: خِفَض‎).[30] In the Bambara language, spoken mostly in Mali, FGM is known as bolokoli ("washing your hands") and in the Igbo language in eastern Nigeria as isa aru or iwu aru ("having your bath" – as in "a young woman must 'have her bath' before she has a baby").[31]

Sunna circumcision usually refers to clitoridectomy, but is also used for the more severe forms; sunna means "path or way" in Arabic and refers to the tradition of Muhammad, although none of the procedures are required within Islam.[32] The term infibulation derives from fibula, Latin for clasp; the Ancient Romans reportedly fastened clasps through the foreskins or labia of slaves to prevent sexual intercourse.[33] The surgical infibulation of women came to be known as "pharaonic circumcision" in Sudan, but as "Sudanese circumcision" in Egypt.[33] In Somalia it is known simply as qodob ("to sew up")

Classification
Typologies

The WHO, UNICEF and UNFPA issued a joint statement in April 1997 defining FGM as "all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons."[41]

The procedures vary considerably according to ethnicity and individual practitioners. During a 1998 survey in Niger, women responded with over 50 different terms when asked what was done to them.[27] Translation problems are compounded by the women's confusion over which type of FGM they experienced, or even whether they experienced it. Several studies suggest survey responses are unreliable. A 2003 study in Ghana found that in 1995 four percent said they had not undergone FGM, but in 2000 said they had, while 11 percent switched in the other direction. In Tanzania in 2005, 66 percent reported FGM, but a medical exam found that 73 percent had undergone it.[42][n 5]

Standard questionnaires ask women whether they have undergone the following: (1) cut, no flesh removed (pricking or symbolic circumcision); (2) cut, some flesh removed; (3) sewn closed; and (4) type not determined/unsure/doesn't know.[n 6] The most common procedures fall within the "cut, some flesh removed" category, and involve complete or partial removal of the clitoral glans.[45]

The WHO has created a more detailed typology, Types I–III, based on how much tissue is removed; Type III is "sewn closed." Type IV describes symbolic circumcision and miscellaneous procedures.[46]

Type I is subdivided into Ia, removal of the clitoral hood (rarely performed alone),[n 7] and the more common Ib (clitoridectomy), the complete or partial removal of the clitoral glans and clitoral hood.[48] (When discussing FGM, the WHO uses clitoris to refer to the clitoral glans, the visible tip of the clitoris.)[49] Susan Izett and Nahid Toubia write: "[T]he clitoris is held between the thumb and index finger, pulled out and amputated with one stroke of a sharp object."[50]

Type II (excision) is the complete or partial removal of the inner labia, with or without removal of the clitoral glans and outer labia. Type IIa is removal of the inner labia; IIb, removal of the clitoral glans and inner labia; and IIc, removal of the clitoral glans, inner and outer labia. Excision in French can refer to any form of FGM.[51]
Type III

Type III (infibulation or pharaonic circumcision), the "sewn closed" category, involves the removal of the external genitalia and fusion of the wound. The inner and/or outer labia are cut away, with or without removal of the clitoral glans. Type IIIa is the removal and closure of the inner labia and IIIb the outer labia.[n 8] The practice is found largely in Djibouti, Eritrea, Ethiopia, Somalia and Sudan (though not South Sudan) in northeast Africa. Estimates of numbers vary: according to one in 2008, over eight million women in Africa have experienced it.[n 9] According to UNFPA in 2010, 20 percent of women with FGM have been infibulated.[15]

Comfort Momoh, a specialist midwife, writes of Type III: "[E]lderly women, relatives and friends secure the girl in the lithotomy position. A deep incision is made rapidly on either side from the root of the clitoris to the fourchette, and a single cut of the razor excises the clitoris and both the labia majora and labia minora."[52] In Somalia the clitoral glans is removed and shown to the girl's senior female relatives, who decide whether enough has been amputated. After this the labia are removed.[53]

A single hole of 2–3 mm is left for the passage of urine and menstrual fluid by inserting something, such as a twig, into the wound.[n 10][55] The vulva is closed with surgical thread, agave or acacia thorns, or covered with a poultice such as raw egg, herbs and sugar.[56] The parts that have been removed might be placed in a pouch for the girl to wear.[57] To help the tissue bond, the girl's legs are tied together, often from hip to ankle, for anything up to six weeks; the bindings are usually loosened after a week and may be removed after two.[58] Momoh writes:

[The entrance to the vagina] is obliterated by a drum of skin extending across the orifice except for a small hole. Circumstances at the time may vary; the girl may struggle ferociously, in which case the incisions may become uncontrolled and haphazard. The girl may be pinned down so firmly that bones may fracture.[52]

If the remaining hole is too large in the view of the girl's family, the procedure is repeated.[59] The vagina is opened for sexual intercourse, for the first time either by a midwife with a knife or by the woman's husband with his penis. In some areas, including Somaliland, female relatives of the bride and groom might watch the opening of the vagina to check that the girl is a virgin.[60] Psychologist Hanny Lightfoot-Klein interviewed hundreds of women and men in Sudan in the 1980s about sexual intercourse with Type III:

The penetration of the bride's infibulation takes anywhere from 3 or 4 days to several months. Some men are unable to penetrate their wives at all (in my study over 15%), and the task is often accomplished by a midwife under conditions of great secrecy, since this reflects negatively on the man's potency. Some who are unable to penetrate their wives manage to get them pregnant in spite of the infibulation, and the woman's vaginal passage is then cut open to allow birth to take place. ... Those men who do manage to penetrate their wives do so often, or perhaps always, with the help of the "little knife." This creates a tear which they gradually rip more and more until the opening is sufficient to admit the penis.[61]

The woman is opened further for childbirth and closed afterwards, a process known as defibulation (or deinfibulation) and reinfibulation. Reinfibulation can involve cutting the vagina again to restore the pinhole size of the first infibulation. This might be performed before marriage, and after childbirth, divorce and widowhood.[n 11][63]
Type IV

The WHO defines Type IV as "[a]ll other harmful procedures to the female genitalia for non-medical purposes", including pricking, piercing, incising, scraping and cauterization.[1] It includes nicking of the clitoris (symbolic circumcision), burning or scarring the genitals, and introducing substances into the vagina to tighten it.[64] Labia stretching is also categorized as Type IV.[65] Common in southern and eastern Africa, the practice is supposed to enhance sexual pleasure for the man and add to the sense of a woman as a closed space. From the age of eight, girls are encouraged to stretch their inner labia using sticks and massage. Girls in Uganda are told they may have difficulty giving birth without stretched labia.[n 12][67]

A definition of FGM from the WHO in 1995 included gishiri cutting and angurya cutting, found in Nigeria and Niger. These were removed from the WHO's 2008 definition because of insufficient information about prevalence and consequences.[65] Gishiri cutting involves cutting the vagina's front or back wall with a blade or penknife, performed in response to infertility, obstructed labour and several other conditions. Over 30 percent of women with gishiri cuts in a study by Nigerian physician Mairo Usman Mandara had vesicovaginal fistulae. Angurya cutting is excision of the hymen, usually performed seven days after birth.[68]

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