Female Genital Mutilation

Orders National Board of Health and Welfare Customer Service, SE-120 88 Stockholm, Sweden. Web shop: www.sos.se/plus/skrift.htm Fax: +46 8-779 96 67 Article number: 2003-114-9 Female Genital Mutilation

This brochure deals with female genital mutilation or female circumcision as it is sometimes also called. Female genital mutilation in any form is prohibited by Swedish law. Female genital mutilation is not commanded by any religious scripture. Female genital mutilation endangers the health of women and children. tryckeri: Ale Tryckteam, Bohus, mars 2003 grafisk form: Typoform AB artikelnummer: 2003-114-9 ISBN: 91-7201-752-X These issues are described in greater detail on the following pages.the brochure was developed in cooperation with RFSU and based on a previous brochure published by RFSU. It is available in Swedish, English, Somali,Tigrinya, and Amharic.

Introduction Article 1. All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood. Article 2. Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, color, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Article 3. Everyone has the right to life, liberty and the security of person. Article 5. No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment. (Excerpt from the Universal Declaration of Human Rights.) The eradication of female genital mutilation (FGM) is a significant element of the struggle to establish human rights and to extend those rights to everyone, including women and children. It is also a struggle whose purpose is to ensure that human rights encompass the aspects of life that concern the right to decide about one s own body and sexuality and therewith the right to not be subjected to violence. The International Planned Parenthood Federation (IPPF) has reviewed how human rights and other rights expressed in various declarations and conventions stand concerning sexuality and reproduction. On that basis, the IPPF wrote a declaration of sexual and reproductive rights in which FGM is explicitly addressed in articles 2 and 9. The fight against FGM is also supported by Article 19 of the UN Convention on the Rights of the Child, which explicitly states that measures shall be taken to protect the child 3

from all forms of physical or mental violence, injury or abuse... Article 24.3 also says that States Parties shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children. From having been a relatively obscure issue in the western world in the early 1980s, FGM has become an issue on which political efforts are being made at, e.g., UN conferences on women s and children s health, which have clearly stated that female genital mutilation is an unacceptable procedure and an abuse of human rights and that the governments of each state bear the responsibility for efforts to eliminate the practice. But the campaign is also being carried out on the practical level by many individuals and organizations all over the world, particularly women s organizations and networks in countries where the custom is practiced. Without the work of those women, the UN would probably not have been able to arrive at its position on the issue. Current estimates are that between 100 and 140 million girls and women in the world have been subjected to genital mutilation. According to the World Health Organization, an additional two million girls are at risk of undergoing FGM every year. There is every reason to continue the campaign against female genital mutilation and for the human, sexual, and reproductive rights of women and children. This brochure was written to give the facts about female genital mutilation, what it entails, and where it occurs. The brochure also describes what we know about the origins of the practice and contains information about laws and current initiatives against female genital mutilation. It was written for people who want to know more about the issue or who are already active in the work to eliminate FGM. What is female genital mutilation? Female genital mutilation (FGM) is sometimes referred to as female circumcision. In the procedure, a sharp instrument is used to excise all or part of the external sex organs of girls. There are four variants of FGM as defined by the WHO: Type 1 Full or partial clitoridectomy, in which the hood of the clitoris is excised along with, in some cases, all or part of the clitoris. Type 2 Clitoridectomy and excision, where the clitoris is excised along with all or part of the labia minora. Type 3 Infibulation or pharaonic circumcision, where all external parts of the female genitalia, i.e., the clitoris and labia minora and labia majora, are excised. The raw edges of the labia majora are then sewn together to cover the vaginal opening. A small hole is left open at the bottom towards the anus to allow urine and menstrual blood to escape. Type 4 Pricking or cutting of the clitoris and/or labia. This type may also entail burning of the clitoris and surrounding tissue. There are also instances where the tissue is scraped away or where the girl is cut around the vaginal opening or caustic substances or herbs are inserted in the vagina to induce bleeding or make the opening smaller. There are also mixed forms of the four types. The most common form of genital mutilation, used in about 80 percent of cases (WHO Fact Sheet No. 241 June 2000), is the excision of the clitoris and labia minora. Type 3, infibulation, is used in about 15 percent of cases. In discussions of different types of FGM, sunna is often mentioned as 4 5

a milder form. But sunna can be any of the variants except type 3, and thus causes immediate and lasting suffering. Accordingly, it is important that efforts against female genital mutilation are targeted against sunna just as vigorously as against infibulation. Health risks The consequences of FGM depend on the type performed and the extent of mutilation. The immediate consequences of the mutilation are severe pain, bleeding, and shock. Some girls even suffer nervous breakdown. The urethra can be damaged and many girls have difficulty urinating afterwards. Even if all victims do not experience all symptoms, the long-term consequences for girls health are often pain in the genitals, especially while the wounds are healing, but also later in life. Itching, scarring, cysts, infections, infertility, and urinary disorders are common. Pain in the vulva caused by cutting of the nerve paths and difficult menstruation are other problems that may arise after genital mutilation. Some people claim that it is better if the mutilation is done when girls are very small, since they will not remember the experience when they get older. New research findings show that the body and the nervous system remember and that FGM can affect how victims of genital mutilation experience pain as adults. Sexuality Genital mutilation may not eliminate the woman s physical desire, but it makes it difficult or impossible for her to be sexually satisfied. We know little about the ability of women who have undergone FGM to achieve orgasm, but it seems to be affected by the type of mutilation and how it was performed. However, one thing we do know is that FGM has no positive effects on women s sex lives. It can be painful for men to have intercourse with a circumcised woman. In some cultures, it is the man s duty to open or dilate the woman after they marry. Although men sometimes dilate an infibulated woman in advance, penetration can still be painful for the man. It may also be emotionally difficult to be compelled to cause the woman to suffer. Marriage The importance of genital mutilation is evident in certain countries by the requirement in the marriage contract for the virginity test. This means that the future bridegroom s family has the right to inspect the mutilation scar before paying the bride price. According to some social anthropologists, the smaller the opening to the vagina, the higher the rank accorded to the woman, which may affect the marriage negotiations. Women who have not undergone FGM are often castigated and expelled from the social community. This is why it is important to also reach the men in the campaign against genital mutilation change will not be possible until men accept marriage with women who have not undergone FGM. 6 7

Where does the practice occur? The tradition of performing FGM on girls is most common in large parts of Africa, but also occurs in countries on the Arabian Peninsula including Yemen, Oman, United Arab Emirates, and Bahrain. It is also found in Indonesia, Malaysia, and among certain Muslim groups in Pakistan, India, and Philippines. It is impossible to say exactly where FGM occurs as it may vary from region to region within a country and among different population groups. Immigrants from countries where FGM is practiced take the custom with them, meaning that it also occurs in the western world. In Sweden, there are about 16,000 women from countries where FGM is practiced. We do not know if girls are currently undergoing FGM within Sweden s borders, but it is highly likely that girls are being transported either to their native countries or another country where they undergo illegal FGM. Origins FGM has been practiced for many thousands of years and probably originated in the patriarchal social system in which women were subordinate to men. Because a wife was the most important acquisition of a man s life, she became an investment that had to be controlled. The suppression of his wife solidified the man s position of power, which among else entailed his right to her genitalia and offspring. Some women believe that they are unclean if they have not undergone FGM and others believe that uncircumcised women are prostitutes. Many believe that the clitoris is a remnant of masculinity and must therefore be removed only after she has undergone FGM does a girl become a woman and eligible to join the company of her elders. In many societies where FGM is practiced, the people believe that the female orgasm kills sperm and that women will become more fertile after the procedure. The truth is precisely the opposite. Genital mutilation can cause damage that reduces women s chances of getting pregnant. Finally, there are historical records of beliefs that women could become nymphomaniacs, homosexual, or sexually hyperactive, resulting in harmful masturbation, if the clitoris was not excised. Women in Europe were subjected to FGM for such reasons as late as the early 1900s. Tradition Many older women and self-taught midwives contribute to the continuation of FGM of girls and young women. They are strongly bound by tradition and believe it is their duty to ensure that old customs are followed. Mothers are subjected to strong social pressure and may for that reason choose to allow their daughters to undergo FGM even though they do not want to. Mothers also see FGM as a way to secure their daughters futures, as uncircumcised girls are not desirable in the marriage market. It is important to understand the powerful myths surrounding FGM. As described above, some people believe the clitoris is a remnant of masculinity that must be removed for the girl to become a woman. There are also beliefs that the clitoris can keep growing 8 9

and get as big as a man s penis. Some population groups also believe that the clitoris can injure or even kill newborn infants during delivery. The identification of daughters with their mothers is a deeply rooted process. To gain a feminine identity, the little girl must be able to be like her mother. Studies have shown that the feminine sexual identity seems so firmly entwined with the changes in the external genitalia, caused by the mutilation, that it is difficult for women to imagine that FGM is not a requisite aspect of femininity. Religion The role played by religion with respect to FGM is often discussed. But the practice predates Christianity and Islam and is not connected to any religion. FGM is not mentioned or commanded in any religious scriptures. Neither the Bible nor the Quran mention female circumcision. Nevertheless, FGM is practiced among Christians, Muslims, and animists. Within Islam, there is a widespread belief among certain groups that FGM is a commandment. The Prophet Muhammad did not forbid circumcision when he came into contact with the practice, but he allowed it if the procedure was not too extensive. It is this upon which are based discussions of whether or not FGM is a tradition that should be followed. However, Muhammad is not believed to have allowed his daughters to undergo FGM and he never advocated circumcision. There is no question that FGM is not a Christian commandment, and no Christian girls can be subjected to it on religious grounds. Various Christian churches are working actively against the Laws tradition, but despite those efforts, Christian girls undergo FGM if they live in areas where the practice is a tradition. There is nothing in Jewish scriptures or law (the Talmud and the Torah) that commands the circumcision of women. Female genital mutilation is prohibited by law in Sweden (1982:316). The law reads: 1 Surgical incisions in the external female genitalia for the purpose of excising the organs or causing other permanent changes to them (genital mutilation) shall not be performed, regardless of whether or not consent has been given for the procedure (Act 1998:407 Prohibiting the Genital Mutilation ( Circumcision ) of Women). 2 Persons who violate the law pursuant to 1 shall be sentenced to imprisonment for a maximum of four years. If the crime caused danger to life, serious illness, or otherwise entailed extraordinarily heedless behavior, it shall be considered a gross offense. Persons convicted of a gross offense shall be sentenced to imprisonment for a term of no less than two years and no more than ten years. Persons convicted of attempt, preparation, and conspiracy to commit such crime, as well as failure to report such crime, shall be sentenced to penalty pursuant to chapter 23 of the Swedish Criminal Code (Act 1998:407). 3 Persons who have committed a crime pursuant to this law shall also be sentenced by a Swedish court even if the second chapter, sections 2 or 3 of the Swedish Criminal Code are inapplicable. 10 11

The law states that all types of female genital mutilation are prohibited, from the most extensive, where large parts of the genitalia are excised and the vaginal opening sewn closed (infibulation) to pricking of the clitoris with a sharp instrument. It is forbidden even if the girl or woman consents. People residing in Sweden who are involved in performing FGM abroad can be convicted of the crime in Sweden even if the procedure is legal in the country where it was performed, as stated by section 3 of the Act as amended in July 1999. Reinfibulation, that is, sewing the vagina together again after childbirth, is also prohibited in Sweden. However, the vagina shall be reconstructed so that it becomes as normal as possible. According to chapter 14, section 1 of the Swedish Social Services Act, all professionals who work with children and adolescents are required to file a report with the social services office if they have, in the course of their duties, become aware of anything that might require social services intervention to protect a minor child. An example of such a situation would be a child at risk of undergoing FGM or who has undergone FGM. In emergency situations, the social services office also has the right to take children at risk into care. Sweden is working in various ways, nationally and internationally, to protect the health, welfare, and rights of children. The campaign against FGM of girls and women is an important aspect of that effort. In common with many other countries, Sweden has ratified the UN Convention on the Rights of the Child. Article 24, section three stipulates that states parties shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children. Female genital mutilation is one such harmful practice. Women in Sweden who have undergone FGM Some 16,000 women (figures from 2000) from countries where FGM is practiced are now living in Sweden. Of those, approximately 14,500 are from Somalia, Ethiopia, and Eritrea. There are approximately 2,000 children under the age of seven in Sweden from countries where FGM is practiced. The refugees who have come to Sweden from African countries in recent years have made FGM a matter of increasing concern within Swedish women s and maternity health care. What help is available to women who have undergone FGM? There are now extensive opportunities for rehabilitation available to women who have undergone FGM. Help is available to them at outpatient youth and gynecological clinics and at hospital departments of women s health. Women who have undergone FGM commonly seek help due to menstrual problems, swelling, infections, difficulties having intercourse or with initial intercourse, or in connection with pregnancy. They can discuss the problems and possible remedies with a doctor. The chosen remedy varies depending on the type of FGM and how it was performed. The results are good and the woman s earlier symptoms are usually alleviated. 12 13

Surgical repair of infibulation (type 3) is usually performed at the hospital under general anesthesia, but is sometimes performed under local anesthetic. Some doctors use lasers, after which the wounds heal well. If the clitoris has been partially excised, the mucus membrane over the area is usually left in place, as it can otherwise become hypersensitive and make it difficult for the woman to sit and wear trousers. In conjunction with repair of the vaginal opening, other problems that may have been caused by the FGM are also repaired if possible. Some women suffer symptoms or pain after the repair, such as repeated yeast infections or chafing caused by the lack of protective labia. In such cases, it is important that the woman is offered several appointments while her wounds are healing. The worldwide campaign against FGM The campaign against FGM is being carried out on multiple levels and in many countries. Repudiation of FGM is growing more concerted, especially in the countries where it is practiced. The IAC (Inter African Committee on Traditional Practices Affecting the Health of Women and Children) was formed by African women in 1984 and serves as an advisory body to the UN on the issue. National committees in African countries are working against FGM politically and, e.g., by means of projects in rural areas. The organization has removed the shroud of silence around the issue and put it on the agenda in several key contexts. It has proven difficult to educate women on issues related to sexuality in countries where FGM is practiced due to the taboo nature of the subject. But talking about health and anatomy instead is a feasible way to get around what is otherwise considered taboo. In a project in Mali, women who have not undergone FGM travel around the countryside and talk to women who have undergone the procedure. In that model, women who have undergone FGM are invited to show their genitalia and talk about their problems. The project workers then show their intact genitalia and describe the functions of the original genitalia in relation to, e.g., menstruation and childbirth. In this way, women are taught about the connections between FGM and its consequences in the hope that their newfound knowledge will prevent the spread of the practice to the next generation. Another strategy that has been successful in, e.g., Gambia and Sierra Leone is to gather the people who perform FGM and investigate their reasons for practicing their profession. The occupation is the main source of income for these practitioners, who are mainly women, but they are usually untrained. They are also very powerful figures in the social structure. The practitioners are offered retraining that does not circumscribe their influence in, e.g., anatomy, so that they can work as midwives instead. They are also offered loans on favorable terms and small business training. The strategy has been so successful that new practitioners are now approaching the local organizations of their own volition to get access to the same training. Ninety percent of the women in Sierra Leone have undergone FGM, but the figure has dropped to 60 percent since the institution of the kind of interventions described above. Another successful method is to introduce models for new rites of passage. In many areas of the world, FGM is the occasion on which the girl is allowed to enter the world of adult women. Instead of the cruel ritual, alternative rites have been devised and are slowly replacing FGM in villages in Kenya, Tanzania, and elsewhere. The 14 15

rites are based on the motivations usually cited for FGM: hygiene, virginity, family honor, and control of women s sexuality. The alternative ceremony is designed based on those motivations, often combined with hygiene and health education. In Senegal, the American volunteer organization Tostan is working locally to promote human rights and eradicate FGM in cooperation with Unicef. Tostan s educators travel to villages and present the Village Empowerment Program, which educates villagers about human rights in order to empower them to identify and solve their specific problems, which may have to do with anything from health issues to leadership training and how to run a company. As an obvious consequence, the Village Empowerment Program has inspired the people in many villages to discontinue the practice of FGM. FGM has been addressed at UN world conferences on children s and women s health, most recently in Cairo (1994) and Beijing (1995). In brief, the conferences stated that the governments of each country are responsible for ensuring that the issue is brought to the fore and the practice eradicated. FGM should always be connected to the issue of human rights. The EU has also recommended that its member states should combat the practice. Other organizations working against FGM include FORWARD, the Foundation for Women s Health, Research and Development, in London and its counterpart GAMS in France, and Rainbo, an international organization with offices and projects in several countries. The campaign against FGM in Sweden Some immigrant associations, e.g., the Somalian Association in Stockholm, are running programs aimed at stopping FGM within the context of their regular activities or as part of their health initiatives. The main purpose of the Göteborg Project is to improve women s and children s health in general and to prevent FGM in particular. Cooperation with the groups concerned has been a prerequisite for implementing the project. A change in attitudes towards FGM within the immigrant groups that practice the custom can only take place in a dialogue characterized by respect for culture, values, religion, and lifestyle. The project was also directed towards people who encounter women in professional contexts who have undergone FGM and families whose children risk of undergoing FGM. A report produced by the project is titled Den smärtsamma traditionen ( The Painful Tradition, in Swedish only). RISK, The National Association for Ending FGM, was founded in 1994 to combat FGM in Sweden. The association is the Swedish representative within the IAC and participates in a European network within the EU that is working to eradicate the custom. RISK has run educational projects for African immigrants who have chosen to work against FGM in their own national groups. Local projects have hired women as educators and offer their services as a source of knowledge, e.g., in areas of Stockholm, Uppsala, and Malmö with large immigrant populations. The association s activities are oriented towards encouraging and supporting Africans and others encompassed by the tradition to work towards changing attitudes and views so that the custom can be eradicated both in their native countries and elsewhere in the world. 16 17

RFSU s position is that FGM is an expression of control and repression of women s sexuality. RFSU also believes that FGM must be considered a gross assault against women and is therefore a violation of fundamental human rights. The campaign against FGM is being pursued primarily on the international level. In partnership with local organizations, RFSU s aim is to promote the eradication of the custom in the countries where it exists. In Sweden, RFSU works primarily with information: the issue can be brought to the fore through written material and cooperation with immigrant associations and other organizations. Cooperation with various immigrant organizations and networks also results in concrete action programs. Rädda Barnen, the Swedish branch of the International Save the Children Alliance is working actively to reduce harmful customs. The work carried out by Save the Children is based on the UN Convention on the Rights of the Child. The organization believes that FGM is a violation of human rights and of the UN Convention on the Rights of the Child, and that FGM carries serious medical and psychosocial consequences. Save the Children works in various cultural contexts and approaches people with respect and understanding. In the practical effort, it is important to discover what function the custom fills and then attempt to influence the situation based upon that knowledge. Save the Children is working actively against FGM in Ethiopia, Eritrea, Guinea Bissau, and regionally in West Africa. The work is carried out primarily through local and regional information and opinion initiatives. Prioritized target groups include traditional opinion makers, legislators, decision makers, judges and attorneys, and religious leaders. Also important are local educators and organizations that work in a decentralized manner with men, women, girls, boys and the people who perform genital mutilations. Initiatives by Save the Children take the greatest possible consideration of local structures. The Swedish International Development Agency (Sida) has for several decades actively contributed to supporting the campaign against FGM, especially in Africa. Efforts have been pursued primarily through grants to NGOs like the IAC to support preventive and opinion-shaping efforts; through bilateral support to Sida s partner countries; and through multilateral support, primarily via UN organizations like WHO, UNFPA, and Unicef. At present, Sida s health unit is funding the network-based organization Rainbo, whose activities include a small grant project, by which Rainbo can fund small projects in various African countries. Rainbo organizes the African network Amanitare, which is active in the campaign against FGM in most African countries. The Swedish National Board of Health and Welfare was given a three-year government mandate on FGM in 1998 Mandate to develop and disseminate methods and initiate projects aimed at preventing female genital mutilation, etc. (S98/5141/ST). The mandate focused in part on relevant professions and in part on relevant immigrant groups. Within the framework of the mandate, the National Board of Health and Welfare has worked with various programs and methods directed at each target group. Efforts have focused on both prevention and rehabilitation, oriented towards skills enhancement, shaping opinion, and follow-up. Grants were previously awarded to a three-year project in Göteborg. The project ended in 1996, but the project leaders have continued to act as consultants throughout Sweden. The National Board of Health and Welfare has funded local projects in Stockholm and Malmö as well as the writing of a number of research reports between 1998 and 2001. For more information, you are invited to visit www.sos.se. 18 19

Sources and literature Agholme Johansson, Birgitta (1994), Tusen om dagen En fältstudie om kvinnlig könsstympning i Egypten. Uppsala University, Department of Theology. Andersson Brolin, Lillemor (1997), Vi har ju alltid omskurit våra flickor! Om kvinnlig könsstympning. Rädda Barnen. Orders: Rädda Barnen. Carlbom, Aje et al (2000), Som Gud skapade oss -- Förhållningssätt till kvinnlig omskärelse bland somalier i Malmö. Malmö stads program Sexuell hälsa. ISBN 91-631-0051-7. Orders: Malmö stads program Sexuell hälsa, Box 171 95, 200 10 Malmö. Also available in Swedish and Somali editions at www.sos.se. Dorkenoo, Efua (1994). Cutting the Rose. Female Genital Mutilation: The practice and its prevention. Minority Rights Publications. ISBN 1-873194-95-1. Orders: Minority Rights Publications, 379 Brixton Road, London SW9 7DE, United Kingdom. Hosken, Fran P. (1995), Stop Female Genital Mutilation Women speak. Facts and actions. Women s International Network News. ISBN 0-942096-10-x. Orders: WIN NEWS, 187 Grant Street, Lexington MA 02173, USA. Ismail, Nima & Sörman, Nath Ylva (2000), Ingen frågade mig. En rapport om kvinnlig könsstympning i Sverige. Stiftelsen Kvinnoforum (The Women s Forum Foundation). Orders: www.kvinnoforum.se or Kvinnoforum, +46 8-562 288 00. Kulick, Don ed. (1987), Från kön till genus. Includes the article Ett sätt att skapa kvinnor och män by Aud Talle. Carlsson Förlag. ISBN 91-7798-124-3. Omsäter, Margareta (1996), Den smärtsamma traditionen om Göteborgsprojektet mot kvinnlig könsstympning. Göteborgs invandrarförvaltning. ISBN 91-630-4821-3. Rahman, Anika & Toubia, Nahid (2000), Female Genital Mutilation: A guide to laws and policies worldwide. Zed, London. ISBN 1-85649-773-9. National Board of Health and Welfare fact sheet no. 5/00, Ändringar i lagen (1982:316) med förbud mot könsstympning av kvinnor. Orders: www.sos.se/plus/skrift.htm Kvinnlig könsstympming ett utbildningsmaterial för skola, socialtjänst och hälso- och sjukvård. Swedish National Board of Health and Welfare 2002. ISBN 91-7201-660-4. Sennemark, Said Musse & Abdulkadir (2002), Kvinnlig könsstympning. Om kvinnlig könsstympning som kulturarv. Tre somaliska workshops i Göteborg. Available for download at www.tidsspeglar.goteborg.se, search keyword könsstympning. Other sources WHO has current statistics and information about female genital mutilation on its web site. Go to: www.who.int/frh-whd/fgm/index.htm Fiction Devine, Laurie (1984), Nilen. Bokförlaget Forum. ISBN: 91-37-10429-2. English edition: Nile. Simon and Schuster, 1983. ISBN: 0671451707. Dirie, Waris (2001), En blomma i Afrikas öken. Bra Böcker pocket. ISBN 91-7133-812-8. English edition: Desert Flower. Quill Press, 1999. ISBN: 0688172377. Kassindja, Fauziya & Miller Bashir, Layli (2000), Vem hör mina tårar? Bra Böcker. ISBN 91-7133-499-8. English edition: Do They Hear You When You Cry? Delacorte, 1998. ISBN: 0-385-31832-4. Walker, Alice (1992), Omskärelsen. Trevi förlag AB. ISBN 91-7161-042-1. English edition: Possessing the Secret of Joy. Vintage, 1991. ISBN: 0-09-9224119-9. 20 21