Key facts
- Female genital mutilation (FGM) includes procedures that
intentionally alter or cause injury to the female genital organs for
non-medical reasons.
- The procedure has no health benefits for girls and women.
- Procedures can cause severe bleeding and problems urinating, and
later cysts, infections, infertility as well as complications in
childbirth and increased risk of newborn deaths.
- More than 125 million girls and women alive today have been cut in
the 29 countries in Africa and Middle East where FGM is concentrated (1).
- FGM is mostly carried out on young girls sometime between infancy
and age 15.
- FGM is a violation of the human rights of girls and women.
Female
genital mutilation (FGM) comprises all procedures that involve partial or total
removal of the external female genitalia, or other injury to the female genital
organs for non-medical reasons.
The
practice is mostly carried out by traditional circumcisers, who often play
other central roles in communities, such as attending childbirths. However,
more than 18% of all FGM is performed by health care providers, and the trend
towards medicalization is increasing.
FGM
is recognized internationally as a violation of the human rights of girls and
women. It reflects deep-rooted inequality between the sexes, and constitutes an
extreme form of discrimination against women. It is nearly always carried out
on minors and is a violation of the rights of children. The practice also
violates a person's rights to health, security and physical integrity, the
right to be free from torture and cruel, inhuman or degrading treatment, and
the right to life when the procedure results in death.
Procedures
Female
genital mutilation is classified into four major types.
- Clitoridectomy: partial or total removal of the clitoris (a small,
sensitive and erectile part of the female genitals) and, in very rare
cases, only the prepuce (the fold of skin surrounding the clitoris).
- Excision: 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).
- Infibulation: 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.
- Other: all other harmful procedures to the female genitalia for
non-medical purposes, e.g. pricking, piercing, incising, scraping and
cauterizing the genital area.
No health benefits, only harm
FGM
has no health benefits, and it harms girls and women in many ways. It involves
removing and damaging healthy and normal female genital tissue, and interferes
with the natural functions of girls' and women's bodies.
Immediate
complications can include severe pain, shock, haemorrhage (bleeding), tetanus
or sepsis (bacterial infection), urine retention, open sores in the genital
region and injury to nearby genital tissue.
Long-term
consequences can include:
- recurrent bladder and urinary tract infections;
- cysts;
- infertility;
- an increased risk of childbirth complications and newborn deaths;
- the need for later surgeries. For example, the FGM procedure that
seals or narrows a vaginal opening (type 3 above) needs to be cut open
later to allow for sexual intercourse and childbirth. Sometimes it is
stitched again several times, including after childbirth, hence the woman
goes through repeated opening and closing procedures, further increasing
and repeated both immediate and long-term risks.
Who is at risk?
Procedures
are mostly carried out on young girls sometime between infancy and age 15, and
occasionally on adult women. In Africa, more than three million girls have been
estimated to be at risk for FGM annually.
More
than 125 million girls and women alive today have been cut in the 29 countries
in Africa and Middle East where FGM is concentrated (1).
The
practice is most common in the western, eastern, and north-eastern regions of
Africa, in some countries in Asia and the Middle East, and among migrants from
these areas.
Cultural, religious and social
causes
The
causes of female genital mutilation include a mix of cultural, religious and
social factors within families and communities.
- Where FGM is a social convention, the social pressure to conform to
what others do and have been doing is a strong motivation to perpetuate
the practice.
- FGM is often considered a necessary part of raising a girl
properly, and a way to prepare her for adulthood and marriage.
- FGM is often motivated by beliefs about what is considered proper
sexual behaviour, linking procedures to premarital virginity and marital
fidelity. FGM is in many communities believed to reduce a woman's libido
and therefore believed to help her resist "illicit" sexual acts.
When a vaginal opening is covered or narrowed (type 3 above), the fear of
the pain of opening it, and the fear that this will be found out, is
expected to further discourage "illicit" sexual intercourse
among women with this type of FGM.
- FGM is associated with cultural ideals of femininity and modesty,
which include the notion that girls are “clean” and "beautiful"
after removal of body parts that are considered "male" or
"unclean".
- Though no religious scripts prescribe the practice, practitioners
often believe the practice has religious support.
- Religious leaders take varying positions with regard to FGM: some
promote it, some consider it irrelevant to religion, and others contribute
to its elimination.
- Local structures of power and authority, such as community leaders,
religious leaders, circumcisers, and even some medical personnel can
contribute to upholding the practice.
- In most societies, FGM is considered a cultural tradition, which is
often used as an argument for its continuation.
- In some societies, recent adoption of the practice is linked to
copying the traditions of neighbouring groups. Sometimes it has started as
part of a wider religious or traditional revival movement.
- In some societies, FGM is practised by new groups when they move
into areas where the local population practice FGM.
International response
In
December 2012, the UN General Assembly adopted a resolution on the elimination
of female genital mutilation.
In
2010 WHO published a "Global strategy to stop health care providers from
performing female genital mutilation" in collaboration with other key UN
agencies and international organizations.
In
2008 WHO together with 9 other United Nations partners, issued a new statement
on the elimination of FGM to support increased advocacy for the abandonment of
FGM. The 2008 statement provides evidence collected over the past decade about
the practice. It 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 on why FGM continues, how to stop it,
and its damaging effects on the health of women, girls and newborn babies.
The
new statement builds on the original from 1997 that WHO issued together with
the United Nations Children’s Fund (UNICEF) and the United Nations Population
Fund (UNFPA).
Since
1997, great efforts have been made to counteract FGM, through research, work
within communities, and changes in public policy. Progress at both
international and local levels includes:
- wider international involvement to stop FGM;
- international monitoring bodies and resolutions that condemn the
practice;
- revised legal frameworks and growing political support to end FGM
(this includes a law against FGM in 24 African countries, and in several
states in two other countries, as well as 12 industrialized countries with
migrant populations from FGM practicing countries);
- in most countries, the prevalence of FGM has decreased, and an
increasing number of women and men in practising communities support
ending its practice.
Research
shows that, if practicing communities themselves decide to abandon FGM, the
practice can be eliminated very rapidly.
WHO response
In
2008, the World Health Assembly passed a resolution (WHA61.16) on the elimination
of FGM, emphasizing the need for concerted action in all sectors - health,
education, finance, justice and women's affairs.
WHO
efforts to eliminate female genital mutilation focus on:
- strengthening the health sector response: guidelines, training and
policy to ensure that health professionals can provide medical care and
counselling to girls and women living with FGM;
- building evidence: generating knowledge about the causes and
consequences of the practice, how to eliminate it, and how to care for
those who have experienced FGM;
- increasing advocacy: developing publications and advocacy tools for
international, regional and local efforts to end FGM within a generation.
WHO
is particularly concerned about the increasing trend for medically trained
personnel to perform FGM. WHO strongly urges health professionals not to
perform such procedures.
1.
UNICEF. Female Genital Mutilation/Cutting: a statistical overview and
exploration of the dynamics of change, 2013.