Frequently Asked Questions
Female Genital Cutting
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Female genital cutting (FGC) is the collective name given to traditional practices that
involve the partial or total cutting away of the female external genitalia or other injury
to the female genitals, whether for cultural or other non-therapeutic reasons. 1,2
Historically, it has been also called "female genital mutilation" or
"female circumcision."
The age at which FGC is performed on women and girls varies. It may be performed during
infancy, childhood, marriage or during a first pregnancy.2 FGC is typically
performed on young girls who are between 4 and 12 years old, however, by a medically
untrained person-often an older woman-from the local culture or community.1,2, 4
Increasingly FGC is also performed by trained health personnel, including physicians,
nurses and midwives.4
FGC is practiced predominantly in 28 countries in Africa.1, 4 Eighteen
African countries have prevalence rates of 50 percent or higher, but these estimates vary
from country to country and within various ethnic groups.1, 4 FGC also occurs
in some Middle Eastern countries-Egypt, the Republic of Yemen, Oman, Saudi Arabia and
Israel-and is found in some Muslim groups in Indonesia, Malaysia, Pakistan and India.6
Some immigrants practice various forms of FGC in other parts of the world, including
Australia, Canada, New Zealand, the United States and in European nations.1, 6
It is estimated that 130 million girls and women have undergone FGC.1,2,3
Approximately 2 million are subjected to this practice each year worldwide.2
According to the Centers for Disease Control and Prevention (CDC), an estimated 168,000
women and girls in the United States had either undergone FGC or were at risk for FGC in
1990. Of these, 48,000 were girls younger than 18 years old.3
FGC has traditionally been called "female circumcision," which implies that
it is similar to male circumcision.1,2,3 The recognition of FGC's harmful
physical, psychological and human rights consequences, however, has led to the use of the
term "female genital mutilation" or "FGM," which distinguishes this
practice from the much milder practice of male circumcision. Many women who have undergone
FGC do not consider themselves to be mutilated and have become offended by the term
"FGM."3 Recently, other terms such as "female genital
cutting" (FGC) have increasingly been used.1, 3
Practices involving the cutting of female genitals have been found throughout history
in many cultures, but there is no definitive evidence documenting when or why this ritual
began. Some theories suggest that FGC might have been practiced in ancient Egypt as a sign
of distinction, while others hypothesize origins in ancient Greece, Rome, pre-Islamic
Arabia and Tsarist Russia. Up until the mid-20th century, some physicians in the United
States wrongly performed clitoridectomies for a variety of clinically unsound reasons.3
FGC is usually carried out by traditional practitioners or lay persons who use a
variety of instruments, which range from a scalpel to a piece of glass, to conduct the
procedure. Harsh, unsterile conditions under which FGC occurs are not conducive to
accurate, hygienic cutting.1 With the increasing awareness of the health
consequences of FGC, health providers have erroneously utilized more hygienic techniques
to conduct FGC and "improve" the practice. However, this medicalization of FGC
has been condemned by the World Health Organization and is considered to perpetuate and
promote FGC rather than to prevent or reduce its practice.2
The potential physical complications resulting from the procedure are numerous. Because
FGC is often carried out without anesthesia, an immediate effect of the procedure is pain.
Short-term complications, such as severe bleeding, which can lead to shock or death, are
greatly affected by the type of FGC performed, the degree of struggle by the woman or
girl, unsanitary operating conditions, and inexperienced practitioners or inadequate
medical services once a complication occurs. There is a very high risk of infection, with
documented reports of ulcers, scar tissue and cysts. Female genital cutting may also
interfere with a woman's pregnancy or labor. Other lasting effects that commonly result
from FGC procedures include urine retention, resulting in repeated urinary infections and
obstruction in menstrual flow, which may lead to frequent reproductive tract infections,
infertility1,2,3 and chronic pelvic pain.3 FGC is also thought to
facilitate the transmission of HIV through several mechanisms. Significant psychological
and psychosexual consequences of FGC exist, but these factors have not been adequately
studied.1,2,3
Female genital cutting is done for many complex, poorly understood reasons. In some
cultures, the practice is based on love and the desire to protect because it is viewed as
a culturally normal practice that has social significance for females.3 Some
societies support FGC because they consider it a "good tradition" or a necessary
rite of passage to womanhood. In many cultures that practice FGC, a woman achieves
recognition and economic security through marriage and childbearing, and FGC is often a
prerequisite for qualifying for wifehood. Therefore, FGC affords economic and social
protection.1,3
Other rationale for FGC include beliefs that FGC enhances male sexuality;3
curbs female sexual desire; has aesthetic, purifying or hygienic benefits; and prevents
promiscuity and preserves virginity1 and that the clitoris is an unhealthy,
unattractive and/or lethal organ.3 Some argue that FGC has religious
significance, but the custom cuts across religions and is practiced by Muslims,
Christians, Jews and followers of indigenous religions.1,3
FGC is considered an important part of gender identity, which explains why many women
and family members identify with and defend the practice.1 However, FGC is
conducted in the broader context of gender discrimination.1,2,3 In cultures
where FGC is practiced, men often control and perpetuate FGC by paying for their daughters
to undergo the practice. They also may refuse to marry women who have not undergone FGC.
These explanations for FGC do not justify its practice. Whatever the reason, the end
result of FGC is that a female is subjected to an unnecessary, painful and
health-compromising procedure.1
Because significant numbers of females continue to emigrate from countries where FGC is
practiced, the population of females in the United States who have undergone FGC or who
are at risk for FGC is increasing.3 Immigrants and refugees often establish
social support systems and networks in the West that reflect the social and cultural
diversity of their country or origin or ethnic group. Cultural activities and family
obligations such as FGC may be unaltered by the geographic location of an individual.
Furthermore, the problem of FGC in the United States is compounded by complex barriers
that immigrants and refugees may face difficulties with cultural adaptation, immigration
status, economic issues, isolation 1 and access to education and healthcare
services for populations who have undergone FGC or who are at risk for FGC.3
Under federal law, FGC is illegal in the United States for girls under the age of 18. But
if FGC is still performed, it is unlikely that the girl would be brought to a health care
facility for the treatment of complications because the fear of legal repercussions would
be too strong.1
FGC is deeply rooted in the traditions of a number of societies, but it is a form of
violence against women and girls. In order for this practice to be understood, FGC must be
placed within the broader context of discrimination against women across cultures and as a
symptom of the greater problem of women's subordination and compromised dignity. The
documented complications of FGC constitute a violation of a person's right to physical and
mental health. Such fundamental freedoms are protected by several universal human rights
instruments, including the Universal Declaration of Human Rights (UDHR). 2
Since 1998, 16 states have instituted criminal sanctions against the practice of FGC:
California, Colorado, Delaware, Illinois, Maryland, Minnesota, Missouri, Nevada, New York,
North Dakota, Oregon, Rhode Island, Tennessee, Texas, West Virginia and Wisconsin.5
A federal law criminalizing the practice was passed in 1996 and became effective in April
1997. The law provides that the practice of FGC on a person(s) under the age of 18 is a
federal crime, unless the procedure is necessary to protect the health of a young person
or for medical purposes connected with labor or birth. The penalty for violating this law
is a fine or imprisonment for up to five years, or both. This law specifically exempts
cultural beliefs or practices as a defense for conducting FGC.1, 4
In addition to criminalizing the practice, Congress passed three other legislative
measures relating to FGC. In 1996, Congress directed the Secretary of the U.S. Department
of Health and Human Services to carry out educational outreach to affected communities,
develop and disseminate recommendations for students in medical and osteopathic schools,
and undertake a study on FGC in the U.S. to determine the population who was at risk
(statistics cited earlier). That same year, the second legal measure directed the
Immigration and Naturalization Service (INS), in cooperation with the Department of State,
to provide information to immigrants and refugees entering the United States from
countries where FGC is practiced about the adverse health consequences associated with FGC
and the legal consequences of performing the procedure in the United States. Finally, as
part of fiscal year 1997, Congress enacted legislation requiring U.S. executive directors
of international financial institutions to oppose non-humanitarian loans to countries
where FGC is practiced and whose governments have not implemented educational programs to
prevent the practice of FGC. 1,4
Within the past decade, the silence that has surrounded FGC has faded. FGC has become
one of the most talked-about subjects among women's groups, especially in Africa. 1
International and professional organizations as well as many governments have recognized
that FGC is a violation of the human rights of women and girls. Many communities,
governments and organizations recognize that gender discrimination underlies the practice
of FGC and that the most effective strategies for dealing with FGC involve helping women
and girls to become educated and empowered within their own communities and cultures. In
addition, these groups recognize that the support of men, community leaders and other
cultures is vital to stopping the practice.1 Advocacy by women's groups has
placed FGC on the agenda of governments and has contributed to the formation of FGC
programs, laws and policies worldwide.
The influx of immigrants and refugees from countries where FGC is prevalent has led
global governments and professional and grassroots organizations to examine and take
action on FGC in host countries. For example, the U.S. Department of Health and Human
Services has worked to fulfill Congress' mandate on FGC by collecting and compiling FGC
data, holding community meetings, and educating health professionals on FGC through the
development and distribution of the technical manual called "Caring for Women with
Circumcision."1
For more information
Amnesty International
http://www.amnesty.org/ailib/intcam/femgen/fgm1.htm
Reproductive Health Outlook Annotated Bibliography on Harmful Traditional
Practices
http://www.rho.org/html/hthps-b-02.html#fgm
Center for Reproductive Rights
http://www.crlp.org/
The World Health Organization
http://www.who.int/health_topics/female_genital_mutilation/en/
To obtain a complete copy of "Caring for Women with Circumcision," written by
Dr. Nahid Toubia, please call the National Women's Health Information Center's toll-free
referral service at 1-800-994-WOMAN or 1-888-220-5446, TDD. You may also contact RAINBO
for this publication and to obtain resources on community FGC education programs and
materials.
RAINBO
915 Broadway, Suite 1109
New York, New York 10010
Tel: (212)-477-3318
Fax: (212)-477-4154
Website: http://www.rainbo.org
For legal information regarding FGC, contact:
Center for Reproductive Law and Policy (CRLP), International Program
120 Wall Street
New York, New York 10005
Tel: (212)-514-5534
Fax: (212)-514-5538
Website: http://www.crlp.org
To obtain a list of published and unpublished literature on FGC, contact:
The Population Information Program of the Johns Hopkins Center for Communications Programs
The FGM Resource Group, POPLINE,
111 Market Place, Suite 310
Baltimore, MD 21202-4012
Tel: (410)-659-6300
Fax: (410)-659-6266
Website: http://www.jhuccp.org
References
- Toubia, N. (1999). Caring for Women with Circumcision. RAINBO: NY, NY.
- WHO. (Downloaded 8/9/01). Female Genital Information: Information Pack
- ACOG. (1999). Slide-lecture kit, Female Circumcision/Female Genital Mutilation: Clinical
Management of Circumcised Women.
- Rahman, A. & Toubia, N. (2000). Female Genital Mutilation: A Guide to Laws and
Policies Worldwide. Zed Books Ltd: London, UK.
- Center for Reproductive Law and Policy. (November 2000). Female Circumcision/Female
Genital Mutilation: Global Laws and Policies Towards Elimination. http://www.crlp.org/pub_fac_fgmicpd.html
- Department of State. (March, 2001). Report on Female Genital Mutilation as Required by
Conference Report (H. Rept. 106-997) to Public Law 106-429.
- Morison, L., Scherf, C., Ekpo, G., Paine, K., West, B., Coleman, R. & Walraven, G.
(2001). The long-term reproductive health consequences of female genital cutting in rural
Gambia: A community-based study. Tropical Medicine and International Health, 6, 7, 1-11.
For additional information and resources on FGC, log on to the National Women's Health
Information Center internet site at www.womenshealth.gov or call 1-800-994-WOMAN (TDD:
1-800-994-9662).
This FAQ was reviewed by Nawal Nour, M.D. of the African Women’s Health Center.
Content last updated February 1, 2005.
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