By Kath Gelber
Female circumcision, more correctly called female genital mutilation, is a crime against women. It occurs in Sahelian Africa, in Arab states, parts of Asia, and in migrant families in Europe, North America and Australia.
The procedure occurs to varying degrees. In the mildest form, "sunna", the hood of a girl's clitoris is cut off. The most common form is total excision — clitoridectomy. The extreme form, infibulation, involves cutting off both the clitoris and labia minora and scraping out the flesh inside the labia majora. The vulva is sewn together or pinned with thorns, leaving a very small aperture for the expulsion of blood and urine by the insertion of a small piece of wood during healing.
The procedure is usually performed without any anaesthetic and is carried out by older women on girls aged from a few months to puberty. The girls' legs may be tied until the wound has healed.
The World Health Organisation (WHO) estimates 90 million girls and women alive today have endured one of these procedures, and 2 million more girls do so each year.
Efua Dorkenoo, director of the Foundation for Women's Health, Research and Development (FORWARD), states, "This is far worse than male circumcision, both at the time and in long-term effects. This can only be described as mutilation."
The reasons given for the practice include religious custom and tradition, and are based in the belief that the mutilation curbs a woman's sexual desires and practice and therefore makes her fit to be married.
It is seen as part of a ritual signifying that girls have been "protected" in the ownership of a father until they are ready to be passed on to a husband. Without it, the girl could not find a husband or be treated as a full member of adult society.
The practice awesomely exemplifies men's fear of women's sexuality. Cut and restitched, the girl's genital area is under control. If her virginity is lost it will be obvious. Sex for the future woman is to be a duty, not a pleasure.
Often religious, particularly Islamic, custom is regarded as the justification for such mutilation. Yet Egyptian feminist Nawal El Saadawi points out in her book The Hidden Face of Eve that the practice was widespread in some areas of the world before the Islamic era. The prophet Mohammed tried to oppose this custom since he considered it harmful to the sexual health of women. Genital mutilation of girls has been practised in societies with widely varying religious backgrounds.
Female genital mutilation is related to the systematic oppression of women and women's sexuality. This, as Saadawi points out, is not characteristic of Arab or Middle Eastern societies or countries of the "Third World" alone.
Female genital mutilation has come under severe criticism internationally, and campaigns have been waged to end the practice for at least 15 years. Originally, much of the impetus came from Western feminists, but African women have become increasingly active and now predominate.
In the words of Hadijah Ahmed from the African Women's Welfare Group, "I love my culture, but it is not this. This is torture hiding behind culture. Children have no voice — adult women must speak out to protect them."
The medical risks of the practice are huge. The actual operation can cause complications such as haemorrhage, tetanus, septicaemia, damaged urinary tract, severe pain, psychological shock and death. Health problems can persist during the woman's lifetime, including pain and infections due to trapped urine or menstrual blood, and the possibility of infection leading to infertility. Sex can be very painful, and birth complicated.
For a woman who has undergone infibulation, the violation continues. She must be "opened up" when she is married to allow intercourse to take place, then opened up even further to allow the birth of a child and sewn up again afterwards. In some cases, divorced women are sewn up until they remarry, at which time they must be again opened up for their husbands.
Combating the practice requires a sensitivity towards the beliefs and traditional values held by each community.
Carol Horowitz, a doctor in the US, points out, "If your only message is that this is barbaric, women who have been circumcised will be less likely to seek the medical care they need. They're not doing it to their children to hurt them. They're doing it because they love them."
Attempts to ban the practice have varied in success and approach. One of the most successful has been that in Egypt where the Cairo Family Planning Association (FPA) has been publicly tackling the practice since 1979. In 1992 the project formed itself as the Egyptian Society for the Prevention of Traditional Practices Harmful to Women and Children.
Throughout the 1970s the Cairo FPA was bombarded by questions about female genital mutilation, prompted by the writings of doctors including Nawal El Saadawi. In 1979 a study was commissioned which concluded that female genital mutilation was practised by at least 87% of the women interviewed in urban and rural areas.
Following this a seminar was held entitled "Bodily Mutilation of Young Females" which reported the following findings:
- Sacred books of all religions made no mention of female circumcision. Any attributions to the Prophet's sayings on the subject were not authenticated. The practice predated Islam and Christianity and is unknown in the most religiously devout societies like Saudi Arabia, Iran and Iraq, while both Muslims and Copts practise it in Egypt.
- The practice can cause serious damage to health and lead to disharmony in marital sexual relations, infertility and frigidity.
- A Ministry of Health decree which restricted the operation to doctors and confined it to partial excision resulted in more clandestine, unsupervised operations.
- The operation should be made illegal.
A campaign was begun which focused on research, provision of information, education and training for the general population, the use of publications and eventually making the practice illegal. The campaign was geared to people directly involved in the perpetuation of the custom — nurses, midwives, parents, doctors, leaders from schools and universities, social work institutes, NGOs and government departments.
Training workshops, seminars and meetings were conducted for nurses, doctors, religious leaders, social workers, town and village leaders, teachers, and TV and radio personnel. Education was directed at mothers, traditional birth attendants, community health nurses, university and secondary schools, public health and midwifery schools.
In 1992, the number of people reached by the campaign was staggering: 228 nurses, 51 doctors, 284 social workers, 197 TV personnel, 228 broadcasters, 228 public health and medical cadres, 261 nursery supervisors, 1845 university graduates, 600 nursing students and 200 youth in youth camps.
The results of the research and the campaign demonstrated a positive correlation between formal education of girls and the non-practice of female circumcision. Around 35% of girls with above secondary education were circumcised, while 89% of girls with primary education and over 90% of illiterate women had been circumcised.
Aziza Hussein, president of the Cairo FPA, cautioned that "there is still a long way to go, perhaps for another generation, before we can speak of eliminating female circumcision".
In other countries, campaigns have taken a more legislative approach. Here, NSW minister for the status of women Kerry Chikarovski has proposed legislation to make female genital mutilation illegal in the state. The proposals include penalties of up to seven years' jail.
This contrasts with the approach in Egypt, where legislative change is seen as the last step in an ongoing, thorough, participatory education campaign within the community to change attitudes that perpetuate the practice.
Dr Tuntuni Bhattacharyya, currently practising in Sydney, commented in regard to the proposed legislation that careful consideration needs to be given to legal initiatives. "People need to consider whether it is going to be counterproductive, and send it underground instead of abolishing it. Making it illegal doesn't on its own mean that people know why it shouldn't be done."
Other countries have taken a legislative approach. In Canada the practice violates the criminal code. A practitioner can get up to 14 years' imprisonment and parents up to 10 years for criminal negligence. In Britain it was made explicitly illegal in 1985, and a child considered to be at risk can be put on the child protection register.
In the Netherlands, the minister of health has been asked to make the practice allowable in Dutch hospitals. This has been criticised by the president of the Inter-African Committee (IAC) Against Harmful Traditional Practice, Berhane Ras-Work: "This would put our work back to the beginning".
The World Health Organisation agrees: "To permit the operation in the hygienic conditions of hospitals grants it medical acceptance and effectively legalises it".
In the US a woman who fears her daughter will be circumcised if she returns to Nigeria has claimed residency on the basis of "cultural asylum". The case is being made for gender oppression to be recognised as a basis for asylum.
Also in the US, some campaigns have called for economic sanctions against countries that practise genital mutilation. However, African-born women in the US have criticised this tactic. They claim it hurts rather than protects the people. "The goal should be to improve the economic and educational status of women", says Dr Asha Mohamud, a Somali-born paediatrician in Washington. Empowerment of women is crucial to any successful campaign against female genital mutilation.
A recent article by Richard Harding in the Bulletin criticised female genital mutilation on the basis that "such practices are unacceptable in Australia and are utterly inimical to our values". This approach makes one wonder whether he considers the practice to be acceptable elsewhere.
The UN Declaration on Violence Against Women specifies that female genital mutilation is an act of gender-based violence that results in or is likely to result in physical, sexual or psychological harm or suffering to women. This is regardless of location or cultural tradition.
An international non-government organisation founded in Dakar, Senegal, in 1984, called the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children, works to "promote the health of women and children in Africa by struggling against traditional practices that are dangerous and encouraging those that are beneficial". This includes genital mutilation, and also child marriages, excessive pregnancies and nutritional taboos — all practices causing intense suffering and the death of thousands of young women.
IAC has member groups in 23 African countries. It avoids value judgments and instead points to the physical and psychological health damage to girls and women. The groups hold workshops and promote training among village midwives — the guardians of women's reproductive health in most of Africa.
Overwhelmingly, it is education, especially of women, that is seen as the single most important factor in persuading communities to abandon the practice: education about the health dangers, notions of femininity and sexuality and reproductive rights. This will take time. But only a campaign which takes into account the historical and social factors that cause the perpetuation of this mutilation, and which doesn't stigmatise and victimise women from those communities where it does occur, can hope to be successful.