Types of FGM:

Ending Female Genital Mutilation/Cutting

Female genital mutilation/cutting (FGM/FGC) threatens the sexual and reproductive health of millions of girls in parts of Africa, Asia and some Arab States. It is also practiced in some immigrant communities in Europe and North America.

Worldwide, about 130 million girls and young women have experienced FGM/FGC, and an additional 2 million are at risk each year. Most procedures are done by non-medical personnel -- including traditional birth attendants, midwives, and 'old women.'

The effects of FGM/FGC vary on the type performed, the circumstances under which it is performed and general health condition of the girl/woman undergoing the procedure. Complications occur in all types of FGM/FGC, but are most frequent with infibulation, the most radical form of the procedure, which includes stitching together of the labia majora.

FGM/FGC has both immediate and long-term consequences to the health of women.

Immediate complications Long-term consequences
  • Severe pain

  • Shock

  • Haemorrhage

  • Tetanus or sepsis

  • Urine retention

  • Ulceration of the genital region and injury to adjacent tissue

  • Wound infection

  • Urinary infection

  • Fever

  • Septicaemia

  • Haemorrhage and infection can be of such magnitude as to cause death
  • Anaemia, the formation of cysts and abscesses, keloid scar formation, damage to the urethra, resulting in urinary incontinence, painful sexual intercourse and sexual dysfunction, hypersensitivity of the genital area.

    Infibulation can cause severe scar formation, difficulty in urinating, menstrual disorders, recurrent bladder and urinary tract infection, fistulae, prolonged and obstructed labour, and infertility (as a consequence of earlier infections).

    Cutting of the scar tissue is sometimes necessary to facilitate sexual intercourse and/or childbirth. Almost complete vaginal obstruction may occur, resulting in accumulation of menstrual flow in the vagina and uterus. During childbirth the risk of haemorrhage and infection is greatly increased.

    Many countries have passed laws banning FGM/FGC. While the laws call for fines and jail terms, enforcement is often lax and the practice continues, cloaked in greater secrecy.

    A quotation from Zainab (22) who was infibulated at the age of 8:

    "My two sisters, myself and our mother went to visit our family back home. I assumed we were going for a holiday. A bit later they told us that we were going to be infibulated. The day before our operation was due to take place, another girl was infibulated and she died because of the operation. We were so scared and didnít want to suffer the same fate. But our parents told us it was an obligation, so we went. We fought back; we really thought we were going to die because of the pain. You have one woman holding your mouth so you wonít scream, two holding your chest and the other two holding your legs. After we were infibulated, we had rope tied across our legs so it was like we had to learn to walk again. We had to try to go to the toilet, if you couldnít pass water in the next 10 days something was wrong. We were lucky, I suppose, we gradually recovered and didnít die like the other girl. But the memory and the pain never really goes." (WHO)

    UNFPAís approach

    UNFPA addresses the practice of FGM/FGC not only because of its harmful impact on the reproductive and sexual health of women, but also because it is a violation of womenís fundamental human rights. The basis for a rights approach is the affirmation that human well-being and health is influenced by the way a person is valued, respected and given the choice to decide on the direction of her life without discrimination, coercion or neglect of attention.

    UNFPA supports a number of country-level programmes to abolish FGM/FGC. Among the most successful are those that offer alternative safe rituals to serve as rites of passage. Another component of successful projects is the participation and support of local leaders, including religious leaders, who thoroughly understand existing norms, attitudes and social dynamics, and who serve as agents of change.

    For example, in Uganda, a UNFPA-supported project met with success in tackling FGM/FGC by taking a culturally sensitive approach and enlisting strong participation from the community. The Reproductive, Educative and Community Health Project (REACH), was carried out in partnership with the Sabiny Elders Association (a group whose mission is to promote the welfare of the Sabiny people and preserve their language and culture)

    Previous efforts at discouraging female genital mutilation/cutting in Uganda had met with considerable resistance. The difference with the REACH project is that it worked to eliminate the practice while reinforcing the cultural dignity of the community. The importance of involving local people was recognized from the start. Early on, a conference for nearly 300 elders was held, followed by a series of workshops and seminars for women and young people.

    At first, the broader topic of improving reproductive health was addressed. Only gradually was the subject of the female genital mutilation/cutting introduced and community involvement solicited in an analysis of both its harmful effects and the positive values it was meant to promote. District officials drafted the project document, backed up by technical support from Ugandaís Population Secretariat and UNFPA.

    Other stakeholders were also identified and brought into the process. An 'ally group' of peer educators was established to support girlsí education and to disseminate messages about reproductive health. Traditional birth attendants, midwives and nurses were also trained and sensitized on issues surround harmful practices.

    At all times, the project staff took care to show respect for the elders and their concerns so that the projectís goals were not misinterpreted as a value judgment on the society or its culture. The idea of celebrating an annual 'culture day' in one district was promoted as a way of positively reinforcing local customs and traditions. Moreover, attention was paid to providing alternative cultural roles and sources of income to those who were performing female genital mutilation/cutting. As a result, their values and prestige were not compromised or undermined when the practice was discarded. In fact, by the projectís end, male youths and even many former practitioners spontaneously formed pressure groups to oppose it.

    An evaluation conducted 15 months after the project was launched concluded that FGM/FGC had been reduced by 36 per cent. In 2002, out of 12,000 potential candidates, just over 5 per cent were subjected to cutting in a district that had, at one time, a by-law making genital cutting compulsory for all women.

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