Female Genital Mutilation
Abstract and Keywords
Female genital mutilation (FGM) has been portrayed in the literature as an inhumane practice and a form of human rights abuse. Young women and girls who undergo FGM are subjected to the risk of developing infections as well as gynecological and psychological complications. Where severe bleeding occurs, the risk of death is imminent. Although FGM has been decried as an unnecessary and harmful ritual, it continues to be practiced in many parts of Africa, some parts of Asia, and the Middle East. Beliefs about the benefits of FGM are deeply entrenched in tradition and culture, making it a difficult practice to eradicate. This entry aims to portray the cultural embeddedness of FGM as the main factor in preventing its eradication. The information reviewed in this entry can be used to provide a framework for social workers to understand personal and societal reasons for FGM. Furthermore, this entry provides information that could be used to guide social workers in formulating culturally appropriate interventions with FGM practicing communities.
Female genital mutilation (FGM), also referred to as female genital cutting or female circumcision, is seen as a rite of passage for young girls in some communities and is most often performed between the ages of 4 and 10 (World Health Organization, 1997). More than 100 million girls and women have undergone female genital cutting and more than 3 million female infants and children are likely to undergo this procedure annually (Sipsima et al., 2012). Societies that engage in this practice believe that it enhances fertility, promotes purity, increases marriage opportunities, and prevents stillbirths (Freymeyer & Johnson, 2007; World Health Organization, 1997). In addition, FGM is believed to be the induction into a social network and support group of powerful women, and ultimately marriage and motherhood (Shewder, 2000). By and large, most FGM practicing societies view it as a guarantor of family honor, virginity, chastity, purity, marriageability, and childbearing, which are paramount virtues of the said societies (Hayes, 1975; Kouba & Muasher, 1985). The centrality of FGM in the societies that practice it and its corresponding sociocultural role make it a difficult practice to eradicate.
Rationale for the Investigation into Female Genital Mutilation
Every year more than 3 million girls are at risk of undergoing FGM (Sipsima et al., 2012). Most of these girls reside in FGM-practicing communities in Africa (Kouba & Muasher, 1985). FGM has been reported to occur in all parts of the world, but it is most prevalent in the western, eastern, and northeastern regions of Africa (World Health Organization, 2008). FGM has also been reported in Asia and the Middle East and among certain immigrant communities in North America and Europe (World Health Organization, 2008). Young girls and women who undergo FGM are subjected to extreme pain, risk of contracting infections, possibilities of gynecological and obstetric complications, and psychological trauma (Sipsima et al., 2012). From a human rights perspective, FGM reflects deep-rooted inequality between the sexes, and it constitutes an extreme form of discrimination against women (World Health Organization, 2008). Since FGM has serious physical and mental health implications, it is important that practitioners seek to minimize risks to both individuals and communities by using culturally appropriate interventions.
Misconceptions about Female Genital Mutilation
Educational level, wealth, and religion do not affect the prevalence of FGM; rather, as the literature reveals, it persists within communities that have strong beliefs and customs supporting FGM that place girls at the risk of undergoing the rite (Mudenge, Egondi, Beguy, & Zulu, 2012). Another commonly held misconception about FGM is its association with Islam (Bartels, 2004; Hayes, 1975; Shewder, 2000). This belief probably stems from the continuing practice of FGM among Muslim immigrants in Western countries. It was observed that Somali immigrants in the Netherlands continue to practice FGM, leading many Dutch to believe that the practice is mandated by Islam (Bartels, 2004). FGM is a cultural practice and one that is not supported by Islam, as is evidenced by its absence in countries with majority Muslim populations, such as Iran, Jordan, and Saudi Arabia. Moreover, the Holy Quran rejects intervention with the human body for reasons other than on medical grounds; it thus forbids FGM (Wangila, 2007). Sayed, El-Aty and Fadel (1996) note that the practice of FGM predates both Islam and Christianity.
Another commonly held misconception is that FGM is propagated by males in mostly chauvinistic and patrilineal societies. Conversely, it is women, especially older women who have undergone FGM, that are the “guardians” of the practice and are seen to propagate it (Afolayan & Oguntoye, 2009; Garba, Mohammed, Abubakar, & Yakasai, 2012).
Anthropological and sociological literature presents information regarding the purpose of FGM in practicing communities, its cultural significance, prevalence, and resistance by communities to its eradication (Garba, Mohammed, Abubakar, & Yakasai, 2012; Lindmark & Dirie, 1991). The literature also provides an insight into the cultural beliefs, attitudes, and mores that support FGM in societies that practice it (Freymeyer & Johnson, 2007; Kouba & Muasher, 1985; Sipsima et al., 2012). Medical literature provides information about the physical and psychological harm associated with the practice (Bartels, 2004; Degni, Souminen, Essen, El Ansari, & Vehnilainen-Julkunen, 2012). Reports of compilations of research from intergovernmental agencies such as the World Health Organization and the United Nations Children’s Fund (UNICEF) provide current information about FGM prevalence and efforts in its eradication (World Health Organization, 1997, 2008; UNICEF, 2013). A report on the role of alternative rites of passage provides insight on why previous efforts to eradicate FGM have not been successful (Oloo, Wanjiru, & Newell-Jones, 2011). Definition, prevalence, reasons, and psycho-sociocultural aspects of FGM from the literature are presented below.
Defining Female Genital Mutilation
Female genital mutilation (FGM) comprises partial or total removal of the female external genitalia, or other injury to the female genitals, for nontherapeutic purposes (Toubia, 1994). The extent and severity of FGM varies from one to community to another and is generally classified into four major types (World Health Organization, 1997).
This is also known as “sunna”; it involves the partial or total removal of the clitoris. In some rare cases, only the prepuce (the fold of skin surrounding the clitoris) is removed (World Health Organization, 1997).
This is the partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are “the lips” that surround the vagina). Excision is different from clitoridectomy in that it goes beyond removing the clitoris to include the removal of the labia minora (World Health Organization, 1997).
Also known as “pharaonic circumcision,” infibulation involves the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris (World Health Organization, 2013).
This includes all other harmful procedures to the female genitalia for non-medical purposes, such as pricking, piercing, incising, scraping, and cauterizing the genital area (World Health Organization, 1997).
Prevalence of Female Genital Mutilation
The practice of FGM is widespread (World Health Organization, 2013). The World Health Organization (WHO) estimates that more than 130 million women worldwide have undergone FGM and more than 3 million female infants and children are at risk for this procedure annually (WHO study group on female genital mutilation and obstetric outcome, 2006). FGM prevalence is estimated to be more than 70 million for women and girls living in Africa (UNICEF, 2013; World Health Organization, 2008). This statistic is documented by various intergovernmental agencies such as the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). Data on FGM prevalence in Asia and the Middle East is not readily available. However, studies have documented female genital mutilation in countries such as India, Indonesia, Iraq, Israel, Malaysia, and the United Arab Emirates, but no national estimates have been made (World Health Organization, 2008). The age at which FGM is executed varies depending on the prevailing custom of the area (Afolayan & Oguntoye, 2009). It is performed during infancy, childhood, or adolescence (UNICEF, 2013). For example, in Ethiopia it is performed within eight days from birth, in Somalia between the ages of 3 to four years, around 9 years in Ghana, while in parts of Nigeria, FGM is performed anytime from the neonatal period to late adulthood (Garba, Mohammed, Abubakar, & Yakasai, 2012). Although the age for carrying out FGM varies, the reasons for the practice are strongly rooted in tradition and culture (Sipsima et al., 2012).
According to a 2007 compilation of national surveys by the United Nations Children’s Fund (UNICEF), African countries had the highest numbers of girls who have undergone FGM (UNICEF, 2013). Compilation of data from surveys carried out by UNICEF indicated that in the year 2006, 97.9% of females aged between 15 to 59 years in Somalia had undergone FGM (UNICEF, 2013). In Guinea, Sierra Leone, and Sudan, the percentages of females between 15 to 59 years who had undergone FGM were 95.6%, 94%, and 90%, respectively (UNICEF, 2013). These countries reported that persistence of the rite is attributed to a strong FGM practicing culture within their communities.
Reasons Provided for Female Genital Mutilation
FGM is regarded as a necessary rite of passage from childhood to adulthood (Freymeyer & Johnson, 2007). Some communities believe that unless a girl’s clitoris is removed, she will not become a mature woman, or even a full member of the community (Freymeyer & Johnson, 2007). Among the Kikuyu tribe of Kenya, girls are expected to demonstrate bravery and not cry when undergoing the rite in order to be viewed as real women (Njambi, 2004). After undergoing FGM, girls are regarded as “sexually ripe” and ready for marriage (Njambi, 2004). Therefore, FGM serves as social puberty signifying a girl’s future passage to adulthood (Gordon, 1991) and preparing her for her role as wife (Kennedy, 1970). In FGM-practicing communities, general expectation is that men will marry only women who have undergone the practice (Lindmark & Dirie, 1991). The desire for a proper marriage, which is often essential for economic and social security as well as for fulfilling ideals of womanhood and femininity, may account for the persistence of the practice (World Health Organization, 2008).
FGM is also seen as a way of preserving a girl’s virginity before marriage (Lindmark & Dirie, 1991). The cutting and alteration of genitals is likely to lower the sexual urge of females, thus reducing their chances of engaging in sexual activity (Freymeyer & Johnson, 2007). Virginity, in FGM-practicing communities, is held in high esteem because it brings honor to the girl’s family, who are lauded for raising a girl of good moral character (Lindmark & Dirie, 1991). Infibulation ensures that a woman’s vaginal cavity is sealed up until marriage, which guarantees virginity upon marriage. In communities that practice infibulation, a man can be almost certain that the conceived offspring is his biological child, thus ensuring the continuity of the man’s family lineage.
Many FGM-practicing communities are patrilineal and patriarchal whereby women’s access to land and property is through marriage (Shewder, 2000; Hayes, 1975). Consequently, parents subject their female children to the rite to ensure their future access to resources (Shewder, 2000). Moreover, FGM usually takes place alongside male circumcision, thus culminating in the social recognition of both boys and girls into a more mature status as empowered men and women (Njambi, 2004). FGM is thus regarded as a case of society treating boys and girls equally before the common law and inducting them into responsible adulthood in parallel ways (Freymeyer & Johnson, 2007).
Young girls in FGM-practicing communities are often subjected to social pressure and threatened by rejection if they do not succumb to the rite (Mudenge, Egondi, Beguy, & Zulu, 2012; Oloo, Wanjiru, & Newell-Jones, 2011). The social pressure is usually magnified by the presence of a traditional excisor (person carrying out FGM). The traditional excisor is usually an older woman who is highly respected and a powerful societal figure (Moruzzi, 2005; Oloo, Wanjiru, & Newell-Jones, 2011). The practice of FGM might be the excisor’s primary source of income; therefore, the excisor is likely to use her clout to ensure the practice is perpetuated (Moruzzi, 2005).
Hygienic and aesthetic reasons
Many FGM-practicing societies view a woman’s external genitalia in its natural form to be ugly and dirty (Sipsima et al., 2012). The uncut female genitalia are likened to a man’s penis and are seen to diminish a girl’s femininity. These FGM-practicing communities also believe that the female genitalia will grow continuously unless cut off. Therefore, removing all or parts of the genitalia makes a girl hygienically clean and enhances the appearance of the genital area. Among the Okiek of Kenya, FGM is viewed as a modification of the body that enhances beauty and cleanliness (Mudenge, Egondi, Beguy, & Zulu, 2012; Wangila, 2007). Since beauty is held in high esteem among females, and is generally believed to be attained by some level of pain, many girls in FGM-practicing communities have been subjected to the painful practice in pursuit of beauty and cleanliness.
Spiritual and religious reasons
The removal of a girl’s external genitalia is believed to make a girl spiritually clean by practicing communities (Kouba & Muasher, 1985). Some Muslim clerics in FGM-practicing communities such as the Somali have wrongly claimed that Islam requires that girls undergo circumcision (UNICEF–Somalia, 2011). This has led to some Somali communities believing that Islam approves of FGM (Bartels, 2004). However, Muslim scholars find no mention of FGM in the Holy Quran (UNICEF–Somalia, 2011). Religious leaders who support the practice tend either to consider it a religious act or to see efforts aimed at eliminating the practice as a threat to culture and religion (World Health Organization, 2008). Other religious leaders support and participate in efforts to eliminate the practice because they believe that it is not a requirement of religion and is a practice that harms women and girls (UNICEF–Somalia, 2011). In many cases, when religious leaders are unclear or avoid addressing FGM, they are perceived as being in favor of it (World Health Organization, 2008).
In animist societies, the blood that is shed during the rite is believed to create a link between the person undergoing FGM and the ancestors (Sipsima et al., 2012). Since animist societies place great significance on the link between the living and deceased ancestors, females who do not undergo FGM are likely to be made to feel (either consciously or unconsciously) as being apart from mainstream society (Afolayan & Oguntoye, 2009). Beliefs exist in FGM-practicing communities that the clitoris has the power to cause harm, including blindness to anyone attending to an uncircumcised female during childbirth, the deformity or death of her infant, or the madness or death of her husband (Kouba & Muasher, 1985). Thus, to avoid potential exclusion of some of its members and to ensure the well-being of one’s offspring and immediate family, many FGM-practicing communities perpetuate the rite.
Among FGM-practicing communities, a girl who has not undergone FGM is believed to possess an uncontrollable sex drive that will cause her to lose her virginity prematurely, bringing disgrace to her family and ruin her chances of getting married (Hayes, 1975). These communities believe that the uncut clitoris will grow big and will arouse intense irrepressible desire for sex (Hayes, 1975). Therefore, FGM is seen as a solution to curb uncontrollable sexual urges that might lead to loss of virginity and promiscuity (Kouba & Muasher, 1985). Infibulation, a form of FGM whereby the genitalia are sewn together to narrow the vaginal opening, is seen as a way of creating a tight vaginal orifice, which will enhance male sexual pleasure and, in turn, prevent divorce or unfaithfulness (Lindmark & Dirie, 1991). FGM is also justified as a practice that solves infertility among women who cannot conceive since some FGM-practicing communities believe that the presence of the clitoris hinders conception (Freymeyer & Johnson, 2007).
Risks Brought on by Female Genital Mutilation
FGM poses several health risks to those who undergo the rite. Young girls and women who undergo FGC are subjected to extreme pain, since the procedure is often conducted without anesthesia and under non-sterile conditions (Sipsima et al., 2012). FGM also creates the risk of contraction of hepatitis and human immunodeficiency virus (HIV) infection (Toubia, 1994). Immediate complications of FGM include excessive bleeding as a result of the cutting, leading to anemia, hemorrhagic shock, or death. When a girl survives the ritual, the likelihood also exists of developing acute infections (World Health Organization, 1997). Tetanus, gangrene, and septic shock are more severe complications caused by cutting the genital area. Instances have occurred whereby the person conducting FGM causes injury to the vagina, rectum, and urethra, leading to complications such as localized infection and abscess formation, pelvic infection, sepsis, urinary retention, and chronic urinary tract infection (Garba, Mohammed, Abubakar, & Yakasai, 2012).
Reproductive health complications that can occur following FGM include obstructed menstruation, difficulty conceiving, prolonged labor, tearing of tissues during delivery, and neonatal death (International Association for Maternal and Neonatal Health, 1991). Infibulations pose the worst risks as they may also require that the orifice be cut open later to allow for sexual intercourse and childbirth (World Health Organization, 2001). Infibulations are also a cause of obstetric fistulas owing to a narrowed vaginal opening. Obstretic fistula is a medical condition in which a fistula (hole) develops between either the rectum and vagina or between the bladder and vagina after severe or failed childbirth, leading to incontinence—constant leaking of urine, feces, and blood. (Taba, 1979; WHO study group on female genital mutilation and obstetric outcome, 2006). Women with fistulas are likely to suffer mental anguish and ostracization owing to incontinence and inability to carry out day-to-day activities (World Health Organization, 2001; WHO study group on female genital mutilation and obstetric outcome, 2006). Communities that practice infibulation may demand that the vaginal orifice be restitched several times, including after childbirth. Hence, the woman goes through repeated opening and closing procedures, resulting in severe physical pain and psychological distress that could result in post-traumatic stress disorders (World Health Organization, 2001).
Cultural Centrality of Female Genital Mutilation
Societies in developing countries face a constant challenge of adopting some modern ideals while retaining certain cultural practices and time-honored traditions that are their heritage (Lindmark & Dirie, 1991). Female genital mutilation (FGM) is one such tradition that continues to be practiced by some societies as a cultural preservation effort. FGM has been lumped in with other cultural practices such as dowry murders, honor crimes, foot-binding, and forced or arranged marriage, which are all framed as cultural problems that border on human rights abuses (Degni, Souminen, Essen, El Ansari, & Vehnilainen-Julkunen, 2012).
One resonating theme surrounding FGM among communities in which it is practiced is that it is regarded as a rite of passage from an insignificant being to a full member of the society (Moruzzi, 2005). Therefore, women who endorse FGM do not view it in terms of a human rights issue; rather, they see it as part of their cultural heritage (Degni, Souminen, Essen, El Ansari, & Vehnilainen-Julkunen, 2012). Women who do not endorse the practice, on the other hand, typically argue that it is not permitted by their cultural heritage or their religion (Afolayan & Oguntoye, 2009).
Among communities in which FGM forms part of their cultural heritage, approval ratings for the custom are generally high. According to the Sudan Demographic and Health Survey of 1989–1990, which was conducted in northern and central Sudan, out of 3,805 women interviewed, 89% were circumcised (had undergone FGM). Of the women who were circumcised, 96% had circumcised their daughters or said that they would circumcise their daughters (Williams & Sobieszyzyk, 1997). When asked whether they favored continuation of the practice, 90% of circumcised women said that they favored its continuation. Where FGM is widely practiced, it is supported by both men and women, usually without question, and anyone departing from the norm may face condemnation, harassment, and ostracism (World Health Organization, 2008). As such, FGM is a social convention governed by rewards and punishments, which is a powerful force for continuing the practice since the perceived social benefits of the practice are deemed higher than its disadvantages (World Health Organization, 2008).
Proponents of FGM claim that efforts to eradicate the practice originate from Westerners, who seek to infiltrate their societies with Western values; hence, their resistance to its eradication (Wade, 2011). Moreover, the practice is almost always controlled, performed, and most strongly upheld by women (Afolayan & Oguntoye, 2009). It is therefore the women in FGM-practicing communities who are the cultural experts in this intimate feminine domain. Previous efforts to eradicate the practice have focused on persuading the visible leaders in society (mostly men) to abandon the practice while generally ignoring women’s role in perpetuating the practice (Wangila, 2007). This strategy has not been successful and necessitates the active involvement of women in FGM eradication efforts (Freymeyer & Johnson, 2007). Judging from the cultural importance of FGM in communities that practice it, it is plausible to suggest that it may not be fully eradicated unless replaced by a less harmful alternative rite that will serve the purpose of marking the transition into adulthood and identity formation.
Responses to Female Genital Mutilation
A decline in the prevalence of FGM in practicing communities can be attributed to publicity campaigns by local communities, governments, and national and international organizations (World Health Organization, 2008) highlighting the dangers of FGM. Research by WHO posits that if FGM-practicing communities abandon the practice altogether, the practice could be eradicated (World Health Organization, 2008). Due to the cultural centrality of FGM in some cultures, it seems plausible that replacing it with a less harmful alternative could be a step toward its eradication. Thus, forms of alternative rites of passage have been developed and implemented by FGM opponents in FGM-practicing communities. Other responses have been medicalizing FGM to make it safer and enforcing laws to criminalize FGM as a way of protecting vulnerable girls and women.
Alternative Rites of Passage
In Kenya, the Alternative Rite of Passage (ARP) was first introduced in 1996 by Maendeleo ya Wanawake (MYWO), a local women’s development movement, and a nonprofit organization, Program for Appropriate Technology in Health (PATH) (Oloo, Wanjiru, & Newell-Jones, 2011). This “alternative ritual” avoids genital cutting while maintaining the essential components of FGM, such as education for the girls on family life and women’s roles, exchange of gifts, celebration, and a public declaration for community recognition (Oloo, Wanjiru, & Newell-Jones, 2011). Findings on the effectiveness of ARP in Kenya were published in a 2011 report compiled by Population Council (Kenya), in partnership with Feed the Minds (United Kingdom), Education Centre for the Advancement of Women (Kenya), and Reach Women and Youths Development Organisation (Kenya). The research was based on a case study of Kisii and Kuria districts in Kenya. Kisii and Kuria refer to regional areas as well as ethnic groups inhabiting the southwestern part of Kenya. Kisii and Kuria communities have a similar history and culture. Some ethnic Kuria reside in the northern part of Tanzania that borders Kenya. Data collected by the Kenya Demographic Health Surveys in 2004 indicated that 96% of women of child-bearing age or older in Kisii and Kuria districts had undergone FGM (Oloo, Wanjiru, & Newell-Jones, 2011). This astounding prevalence led to the intensification of ARP programs in Kisii and Kuria districts, which resulted in the abandonment of the practice by some families. The Kenya Demographic Heath Survey conducted in 2008–2009 pointed to a decrease in prevalence of FGM whereby 27% of girls had undergone FGM, a decline from 32% in 2003 and 38% in 1998 (Oloo, Wanjiru, & Newell-Jones, 2011). Therefore it is plausible to suggest that ARP, a local women’s initiative (Bartels, 2004) (Degni, Souminen, Essen, El Ansari, & Vehnilainen-Julkunen, 2012), is a successful intervention to counter FGM and thus could be modified and replicated in other FGM-practicing communities.
Medicalization of Female Genital Mutilation
Medicalization of FGM, where it may be impossible to eradicate, has dominated recent debates with some arguing that it is more humane. To minimize the negative risks brought on by FGM, some communities have turned to medical professionals whose expertise on physiology allows them to carry out the cutting in a relatively safer way (Wade, 2011). A study consisting of interviews with health-care providers and their clients from the Kisii community in Kenya indicated an overwhelming belief that FGM fulfills a traditional cultural obligation, limiting a woman’s sexual desire and securing a marriage partner (World Health Organization, 2013). The majority of respondents reported that they favored medicalized FGM because less tissue is cut and local anesthesia and sterilized tools are used to minimize pain and prevent infections. Medicalized FGM, where practiced, is often performed in health facilities and involves pricking or making just a slight cut in the clitoris (Wade, 2011). This is a symbolic cut that some nurses refer to as “psychological circumcision” (World Health Organization, 2013). Proponents of medicalized FGM and the health professionals who carry out FGM argue that it is the first step toward prevention of the practice (Wade, 2011; Wangila, 2007). Further, they assert that if they refuse to conduct the procedure, communities will turn to traditional excisors, who may carry it out under unhygienic conditions and without the use of anesthesia, thus exacerbating associated negative risks (Gordon, 1991; World Health Organization, 2013).
Intergovernmental reactions to Female Genital Mutilation
The harmful repercussions of FGM have been widely documented and this has sparked international response to achieve its eradication. In 1997, WHO issued a joint statement with the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) against the practice of FGM (World Health Organization, 2013). In February 2008, a new statement with broader backing within the United Nations was issued to support increased advocacy for the abandonment of FGM (World Health Organization, 2013). The 2008 statement documents evidence collected over the past decade about FGM with regard to prevalence, severity, harmful effects, and factors supporting the continuation of the practice. In addition, the statement highlights the increased recognition of the human rights and legal dimensions of the problem and provides data on the frequency and scope of FGM. It also summarizes research about why FGM continues, how to stop it, and its damaging effects on the health of women, girls, and newborn babies. WHO efforts to eliminate female genital mutilation focus on:
a) Advocacy: developing publications and advocacy tools for international, regional, and local efforts to end FGM within a generation;
b) Research: generating knowledge about the causes and consequences of the practice, how to eliminate it, and how to care for those who have experienced FGM;
c) Guidance for health systems: developing training materials and guidelines for health professionals to help them treat and counsel women who have undergone procedures.
WHO is also particularly concerned about the increasing trend for medically trained personnel to perform FGM and strongly urges health professionals not to perform such procedures (World Health Organization, 2013).
The Maputo Protocol
The Maputo Protocol is an African regional document that came into force in November 2005 that prohibits and condemns FGM (Human Life International, 2011). Since then, at least sixteen African countries have banned the practice. The Maputo Protocol provides directives to African nations to adopt and implement appropriate measures to ensure the protection of every woman’s right to respect for her dignity and protection of women from all forms of violence, particularly sexual and verbal (Human Life International, 2011). Since the Maputo Protocol many African countries have criminalized FGM. One country that has had success in this effort is Burkina Faso, which established a government-led national committee to fight excision through public education and has been at the forefront of prosecuting those participating in FGM (Sipsima et al., 2012).
Social Work with Communities Practicing Female Genital Mutilation
A basic principle of social work is that practitioners need to be able to intervene on behalf of various clients, including families, organizations, and communities, to minimize harm and improve lives (Ashford & Lecroy, 2012). Social workers’ engagement with FGM-practicing communities needs to be guided by empowerment theory, a process of increasing personal, interpersonal, or political power so that local women can take action to improve their life situations (Kirst-Ashman, 2011). Utilizing a strengths perspective, social workers can educate and assist local women and girls to be more involved in solving problems around them (Ashford & Lecroy, 2012). As the women and girls become more trusting of the social workers in their own countries and their international counterparts, and gain a better appreciation of their own competencies, social workers can then begin to share information in culturally appropriate ways about the harmful effects of FGM. This process of educating women and girls should be carried out in order to raise their consciousness about the harms of FGM without pressuring them to take action (Kirst-Ashman, 2011). The women and girls should be encouraged to offer each other mutual support as this facilitates mutual aid and group cohesiveness (Kirst-Ashman, 2011). Group cohesiveness will enable women and girls to carry out collective actions efficiently; consequently, it will help them to view themselves as capable of making change in their community. Ultimately, women and girls may feel empowered to change oppressive practices within their systems, which could bring an end to the practice of FGM (Wangila, 2007). Empowerment theory in application is thus expected to bring about change in oppressive cognitive, behavioral, social, and political structures and is likely to bring an end to, or minimize, the harmful effects of FGM (Kirst-Ashman, 2011).
It is important for social workers to recognize that the decision to end FGM needs to come from the local community itself. While it is possible for social workers to exert their expert power to convince or even coerce certain communities to end the practice, such change may be short-lived and recidivism may occur. Understanding that the abandonment of harmful cultural practices may take a long time, social workers devoted to ending FGM should not be discouraged when change does not come quickly enough. Instead, efforts should be made to understand the values of the FGM-practicing communities so that alternative, less harmful, culturally appropriate rites can be suggested to replace FGM.
Afolayan, J., & Oguntoye, F. (2009). Practice of female genital mutilation in Ijomu-Oro community state, Nigeria. Journal of Behavioral Sciences, 19(1–2), 75–93.Find this resource:
Ashford, J. B., & Lecroy, C. W. (2012). Human behavior in the social environment: A multidimensional approach. Belmont, CA: Cole Cengage.Find this resource:
Bartels, E. (2004, October). Female circumcision among immigrant Muslim communities: Public debate in the Netherlands. Journal of Muslim Minority Affairs, 24(2), 393–399.Find this resource:
Degni, F., Souminen, S., Essen, B., El Ansari, W., & Vehnilainen-Julkunen, K. (2012). Communication and cultural issues in providing reproductive health care to immigrant women: Health care providers’ experiences in meeting Somali women living in Finland. Journal of Immigrant & Minority Health, 14(2), 330–343. doi:10.1007/s10903-011-9465-6Find this resource:
Freymeyer, R. H., & Johnson, B. E. (2007). An exploration of attitudes towards female genital mutilation In Nigeria. Population Research and Policy Review, 26(1), 69–83. doi:10.1007/s/11113-006-9016-3Find this resource:
Garba, I. I., Mohammed, Z. Z., Abubakar, I. I., & Yakasai, I. I. (2012). Prevalence of female genital mutilation among female infants in Kano, northern Nigeria. Archives of Gynecology & Obstetrics, 286(2), 423–428. doi:10.1007/s00404-012-2312-8Find this resource:
Gordon, D. (1991, March). Female circumcision and genital operations in Egypt and the Sudan: A dilemma for medical anthropology. Medical Anthropology Quarterly, 5(1), 4–31. doi:10.1525/maq.1991.5.1.02a00010Find this resource:
Hayes, R. O. (1975, November). Female genital mutilation, fertility control, women’s roles, and the patrilineage in modern Sudan: A functional analysis. American Ethnologist, 2(4)617–633. doi:10.1525/ae.1975.2.4.02a00030Find this resource:
Human Life International. (2011). The Maputo Protocol: A clear and present danger. Front Royal, VA: Human Life International. Retrieved February 20, 2014, from http://www.maputoprotocol.com/about-the-protocolFind this resource:
International Association for Maternal and Neonatal Health. (1991). Female circumcision. Mother and Child International Newsletter, 17, 4–5.Find this resource:
Kennedy, J. (1970). Circumcision and excision in Egyptian Nubia. Man, 5(2), 175–191.Find this resource:
Kirst-Ashman, K. K. (2011). Human behavior in the macro environment: An empowerment approach to understanding communities, organizations, and groups (3rd ed.). Belmont, CA: Brooks/Cole.Find this resource:
Kouba, L. J., & Muasher, L. (1985). Female circumcision in Africa: An overview. African Studies Review, 28, 95–110.Find this resource:
Lindmark, G., & Dirie, M. A. (1991). Female circumcision in Somalia and women’s motives. Acta Obstetricia et Gynecologica Scandinavica, 70(7–8), 581–585.Find this resource:
Moruzzi, N. (2005). Cutting through culture: The feminist discourse on female circumcision critique. Critical Middle Eastern Studies 14(2), 203–220. doi:10.1080/10669920500135587Find this resource:
Mudenge, N., Egondi, T., Beguy, D., & Zulu, E. M. (2012). The determinants of female circumcision among adolescents from communities that practice female circumcision in two Nairobi informal settlements. Health Sociological Review, 21(2), 242–250.Find this resource:
Njambi. (2004). Dualisms and female bodies in representations of African female circumcision: A feminist critique. Feminist Theory, 5(3), 305–311.Find this resource:
Oloo, H., Wanjiru, M., & Newell-Jones, K. (2011). Female genital mutilation practices in Kenya: The role of alternative rites of passage. London: Feed the Minds. Retrieved February 5, 2014, from http://www.feedtheminds.org/downloads/FGM%20Report_March2011.pdfFind this resource:
Sayed, G. H., Abd El-Aty, M. A., & Fadel, K. A. (1996). The practice of female genital mutilation in Upper Egypt. International Journal of Gynecology and Obstetrics, 55, 285–291.Find this resource:
Shewder, R. A. (2000). What about “Female Genital Mutilation”? And Why Culture Matters in The First Place. Daedalus, 129(4), 209–232.Find this resource:
Sipsima, H. L., Chen, P. G., Ofori-Atta, A., Ilozumba, U. O., Karfo, K., & Bradley, E. H. (2012). Female genital Cutting: Current practices and beliefs in western Africa. Bulletin of the World Health Organization, 90(2), 120–127. doi:10.2471/BLT.11.090886Find this resource:
Taba, A. H. (1979). Female circumcision. In Traditional practices affecting the health of women and children (pp. 43–52). WHO/EMRO Technical Publication No. 2. Alexandria, Egypt: World Health Organization.Find this resource:
Toubia, N. (1994). Female circumcision as a public health issue. New England Journal of Medicine 331, 712–716.Find this resource:
UNICEF. (2013, February). Female genital mutilation/cutting. Retrieved February 3, 2014, from http://www.childinfo.org/fgmc_progress.html
UNICEF–Somalia. (2011, December 9). Religious leaders join the fight to end female circumcision in Somalia. Retrieved from February 3, 2014, http://www.unicef.org/somalia/cpp_10195.html
Wade, L. (2011). The politics of acculturation: Female genital cutting and the challenge of building multicultural democracies. Social Problems, 4(58), 518–537. doi:10.1525/sp.2011.58.4.518Find this resource:
Wangila, M. N. (2007). Female circumcision: The interplay of religion, culture, and gender in Kenya. San Francisco: Orbis.Find this resource:
Williams, L., & Sobieszczyk, T. (1997). Attitudes surrounding the continuation of female circumcision in the Sudan: Passing the tradition to the next generation. Journal of Marriage and the Family, 59, 966–981.Find this resource:
World Health Organization. (1997). UN agencies call for end to female genital mutilation. Geneva, Switzerland.Find this resource:
World Health Organization. (2001). A systematic review of the health complications of female genital mutilation including Sequelae in childbirth. Geneva, Switzerland: World Health Organization. Retrieved October 14, 2011, from http://orchidproject.org/resource/a-systematic-review-of-the-health-complications-of-female-genital-mutilation-including-sequelae-in-childbirth/Find this resource:
WHO study group on female genital mutilation and obstetric outcome. (2006, June 3). Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries. The Lancet, 367(9525), 1835–1841. doi:10.1016/S0140-6736(06)68805-3Find this resource:
World Health Organization. (2008). Eliminating female genital mutilation: An interagency statement. Geneva, Switzerland: World Health Organization. Retrieved February 5, 2014, from http://whqlibdoc.who.int/publications/2008/9789241596442_eng.pdfFind this resource:
World Health Organization. (2013). Research studies on the medicalization of female genital mutilation. Retrieved http://www.who.int/reproductivehealth/topics/fgm/medicalization_fgm_kenya/en/