For most of us, our childhood evokes vivid memories of playing with toys, making new friends at school, or going out with our parents. But for almost 200 million girls, as of February 2023, those memories are tarnished by the barbaric custom of genital mutilation. All they might remember about their childhood would be the dreadful day they were forced to undergo a procedure by someone they trusted.
Female genital mutilation (FGM), also called female circumcision or female genital cutting includes procedures that involve partial or total removal of the external female genitalia, or any other injury to the female genital organs for non-medical reasons. Some might be acquainted with the practice by its local names - ‘khatna’, ‘sunat’, ‘sunat perempuan’. Based on the extent of mutilation, the World Health Organization (WHO) has classified FGM into 4 major types (Table). Young girls between infancy and age 15 years are the usual victims, although adult women might be subjected to this practice uncommonly.
FGM is recognized internationally as a human rights violation as it violates the rights of unsuspecting, and voiceless minors. FGM also deprives a person of rights centered around health, physical integrity, and freedom from torture, cruelty, and inhumane treatment. When the procedure results in death, it robs the victim of their right to life.
The practice is primarily an expression of deep-rooted gender inequality and several factors contribute to its persistence. Some societies deem it a rite of passage, while others consider it a necessary part of raising a girl. In communities that practice FGM, the clitoris is falsely believed to cause insatiable sexual desire. Removing or cutting it is said to rein in their sexuality, promoting premarital virginity and marital fidelity.
The practice is considered equivalent to male circumcision by many but offers no health benefits. Removal or damage of the healthy, normal female genital tissue impairs the natural reproductive and sexual functions of the female body. Women who have undergone FGM can experience a plethora of complications. Severity of complications increases in more extensuive forms of FGM. In the early period, one can experience severe pain, heavy bleeding, urinary tract infections, and painful urination. Questionable aseptic practices render them susceptible to serious infections like tetanus and HIV. It can also be fatal to the victim.
Often in women with extensive FGM, a severe narrowing of the vaginal opening physically impedes menstrual flow. It also interferes with intercourse and childbirth, and the genital tissue has to be cut again to permit these functions. Their offspring aren’t immune to the repercussions either, these babies are more likely to die during labor or at birth due to the resulting complications in the mother.
The most debilitating consequence, however, is the mental toll incurred by these women. Multiple studies state that women with FGM have higher rates of psychiatric complications like depression, anxiety, and post-traumatic stress disorder, than those without. These women often end up feeling ashamed, disempowered, and incomplete leading to low self-esteem and a negative body image.
Presently, over 92 countries across the globe are home to the practice, of which over a third are in Africa. An estimated 9 out of every 10 women aged 15-49 have undergone some form of genital mutilation in Somalia, Guinea, Egypt, Djibouti, Mali, and Eritrea. Nevertheless, the western world isn’t free of this menace either, underscoring the universality of the problem.
In India, the practice is prevalent among the Bohras, a trading community and Sunni Muslim, a sect of 1 million people. The community’s practitioners justify their stand-alone practice of khatna as one that removes just a pinch of clitoral skin, without the risks of the more radical procedures. A study within the community in 2018 revealed that an astonishing 75% of the respondents’ daughters had undergone FGM. Evidence also suggests the involvement of some healthcare providers in performing FGM misguided by their belief that the procedure is safer when medicalized. This is dangerous as the practice has no medical indication and can thus, never be truly “safe”.
By 2030, nearly 68 million girls are projected to be at risk of FGM in countries where it is most prevalent. Abolishing the practice remains a daunting task due to its magnitude and cultural importance. The social dynamics fuelling FGM are fundamentally gender-based and reinforce norms that devalue girls. The risk of ostracism and the prospect of their daughters being shunned for marriage keeps families from disowning the practice.
Despite its patriarchal origins, the perpetrators aren’t solely men. Men are just as, and sometimes more likely than women to oppose the practice. They can be pivotal as community members shaping societal practices, as future husbands speaking up against FGM, or as fathers debating the decision to end the practice.
However, progress has been made in some parts of the world to tackle this problem. In 2012, the UN General Assembly declared February 6th as the International Day of Zero Tolerance for Female Genital Mutilation, with the aim of amplifying and directing efforts to eliminate the practice. In 2017, a target of eliminating FGM by 2030 was set under the Sustainable Development Goal (SDGs) 5.3. Recognizing the untapped potential of the opposite gender in ending the practice, the UNFPA-UNICEF Joint Programme on the Elimination of FGM has put forth; "Partnership with Men and Boys to transform Social and gender Norms to End FGM" as the theme for 2023.
Of the 92 countries where FGM is practised, about 51 countries have prohibited FGM, either through specific laws or by adding a provision to existing child protection, violence against women, or domestic violence laws. Over half (55%) of the global laws against FGM have been enacted by 28 African countries. The USA, Canada, Australia, New Zealand, and 16 European nations also have specific laws or legal provisions. In contrast to this, in the Middle East, only Iraq and Oman have specific laws or legal provisions banning FGM, in place. Sadly, not a single Asian country prohibits the practice.
Today, a girl is a third less likely to experience FGM than 30 years ago. Survivors who stayed silent due to the overbearing stigma, are now speaking up, hoping it will save others. However, sustained efforts are needed to eliminate this issue of public health concern.
Loud, powerful, and effective advocacy would help strengthen and pass laws, especially in countries where FGM exists in pockets. As the practice is sowed deep in tradition, It necessitates an approach that is simultaneously strategic, feasible, and culturally sensitive. Awareness of the perils of FGM must be spread and those affected must be provided quality and empathetic care. The journey to eliminating FGM is arduous and long, and not without frustrations, but one that can be overcome by compassion, will, and unity.
Divya Shrinivas is an MBBS intern at Government Medical College, Ambajogai. Apart from being a research intern at ASAR, she is a coordinator at Mukti-an NGO, which helps people overcome substance use disorders. Her key interests are maternal and child health, and she hopes to work in preventive paediatrics. In her free time, she can be found reading fiction and non-fiction and watching wildlife documentaries.