No health benefits, only harm and who is at risk
Female genital mutilation/cutting (FGM/C) refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.
According to a recent UNICEF publication more than 130 million girls and women have experienced FGM/C in 29 countries in Africa and the Middle East where the practice is most common. But without far more intensive and sustained action now from all parts of society, hundreds of millions more girls will suffer profound, permanent, and utterly unnecessary harm. If rates of decline seen in the past three decades are sustained, the impact of population growth means that up to 63 million more girls could be cut by 2050.
Overall, an adolescent girl today is about a third less likely to be cut than 30 years ago. Kenya and Tanzania have seen rates drop to a third of their levels three decades ago through a combination of community activism and legislation. In the Central African Republic, Iraq, Liberia and Nigeria, prevalence has dropped by as much as half. Attitudes are also changing: recent data show that the majority of people in the countries where FGM is practiced believe it should end, but continue to compel their daughters to undergo the procedure because of strong social pressure.
FGM/C may cause severe pain and can result in prolonged bleeding, infection, infertility and even death. A 2006 World Health Organisation’s study found that FGM/C is also harmful to new-born due to adverse obstetric outcomes, leading to an extra 1 to 2 perinatal deaths per 100 deliveries.
FGM/C is a fundamental violation of the rights of girls and is a deeply entrenched social norm. It is a manifestation of gender discrimination. The practice is perpetrated by families without a primary intention of violence, but is de facto violent in nature. Communities practice FGM/C in the belief that it will ensure a girl’s proper marriage, chastity, beauty or family honour. Some also associate it with religious beliefs although no religious scriptures require it. The practice is such a powerful social norm that families have their daughters cut even when they are aware of the harm it can cause. If families were to stop practicing on their own they would risk the marriage prospects of their daughter as well as the family’s status.
Though the practice has persisted for over a thousand years, programmatic evidence suggests that FGM/C can end in one generation. While UNICEF currently works in 22 countries on the elimination of FGM/C, since 2008 UNFPA and UNICEF have collaborated on the UNFPA-UNICEF Joint Programme on Female Genital Mutilation/Cutting: Accelerating Change in 15 of those countries in West, East and North Africa. Among the largest programmes on the issue, UNFPA and UNICEF jointly support government and other partners to strengthen legislation outlawing the practice and to carry out activities enabling communities to make a coordinated and collective choice to abandon FGM/C. Integrated and culturally-sensitive programmes including community conversations and education about human rights and fundamental values with adults, adolescents and religious leaders allow community members to discuss alternative ways of doing the best for their daughters without having them cut. This participatory process has led communities to organize public commitments to abandon FGM/C. A joint evaluation of the UNFPA-UNICEF Joint Programme was recently concluded finding that the Joint Programme had contributed to the acceleration of abandonment of FGM/C at community and national levels.
Categories of fundamental human rights and duties
FGM is a violation of the human rights of women and girls as recognized in numerous international and regional human rights instruments. While early human rights instruments do not specifically refer to FGM, they provide a foundation for the right of women to be free from various forms of violence, including FGM. In addition to the specific human rights instruments included in this section below, there is an increasingly accepted interpretation that the practice of FGM is an infringement upon broader categories of identified rights into which those instruments may fit. (See: Female Genital Mutilation: A Guide to Laws and Policies Worldwide, Chapter 2 for full discussion)
The right to be free from all forms of discrimination against women
Article 1 of the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), 1979 defines discrimination against women broadly as:
“Any distinction, exclusion or restriction made on the basis of sex which has the effect or purpose of impairing or nullifying the recognition, enjoyment or exercise by women, irrespective of their marital status, on a basis of equality of men and women, of human rights and fundamental freedoms in the political, economic, social, cultural, civil or any other field.”
The practice of FGM fits within the definition of discrimination against women as set forth in various human rights instruments as a practice exclusively directed towards women and girls with the effect of interfering with their enjoyment of their fundamental rights. Furthermore, FGM causes great short-term and long-term physical and mental harm to its victims and perpetuates the fundamental discriminatory belief of the subordinate role of women and girls. Article 2 of the Universal Declaration of Human Rights states: “Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, and sex.”
The practice of FGM is often a deeply rooted custom and in areas where the practice is required or prevalent, there is substantial pressure to undergo FGM. Often it is a prerequisite to marriage and required for acceptance within the community. Governments enacting legislation to prohibit the practice must acknowledge that not undergoing FGM may also subject women to further discrimination as they are ostracized or not able to marry. As such, governments must address the larger issues of women’s status in the family and economy, their access to education and health services, and the overall social norms and customs that support the practice of FGM.
The right to life and physical integrity, including freedom from violence
The right to physical integrity includes the right to freedom from torture, inherent dignity of the person, the right to liberty and security of the person, and the right to privacy. This category of rights is protected by various human rights instruments including: The Universal Declaration of Human Rights, Articles 1 and 3; International Covenant on Economic, Social and Cultural Rights, Preamble; International Covenant on Civil and Political Rights (ICCPR), Preamble and Article 9 (1); and The Convention on the Rights of the Child (CRC), (Article 19) FGM causes severe physical and mental damage, sometimes resulting in death. As such, it interferes with a woman’s right to physical integrity, privacy, and freedom from violence.
The right to health
Because FGM can result in severe physical and mental harm and because it constitutes an invasive procedure on otherwise healthy tissue without any medical necessity, it is seen as a violation of the right to health. The International recognizes the right of all human beings to the “highest attainable standard of physical and mental health.” The World Health Organization includes physical, mental and social well-being in its definition of health and recognizes that health is “not merely the absence of disease or infirmity.” The 1994 Programme of Action of the International Conference on Population and Development in Cairo, Egypt, includes “sexual health, the purpose of which is the enhancement of life and personal relations” in its discussion of reproductive health.(Para.7.2) Furthermore, the Committee on the Elimination of Discrimination against Women (CEDAW), General Recommendation No. 24 (20th Session, 1999) has specifically recommended that governments devise health policies that take into account the needs of girls and adolescents who may be vulnerable to traditional practices such as FGM.
The rights of the child
Because FGM predominantly affects girls under the age of 18, the issue is fundamentally one of protection of the rights of children. The Convention on the Rights of the Child (CRC), 1989, acknowledges the role of parents and family in making decisions for children, but places the ultimate responsibility for protecting the rights of a child in the hands of the government.(Article 5) The CRC also established the “best interests of the child” standard in addressing the rights of children.(Article 3) FGM is recognized as a violation of that best interest standard and a violation of children’s rights. The CRC mandates governments to abolish “traditional practices prejudicial to the health of children.”
The Concluding Observations of the Committee on the Rights of the Child (CRC): Togo (1997) explicitly directs governments to enact legislation that will abolish the practice of FGM as it is a violation of the rights of children.
In addition to recognizing that FGM violates these fundamental rights, numerous instruments establish that governments have a duty to prohibit the practice and protect women and girls vulnerable to the practice. This duty is fulfilled by enacting legislation and implementing other methods of social and cultural education. Legislation should be enacted that encompasses these fundamental rights and governmental duties related to the practice of FGM:
· the duty to modify customs that discriminate against women;
· the duty to abolish practices that are harmful to children;
· the duty to ensure health care and access to health information; and
· The duty to ensure a social order in which rights can be realized.
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;
. Cystitis; (bladder infection)
. Infertility; (childless)
· 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.
For more data on female genital mutilation/cutting, visit http://data.unicef.org/child-protection/fgmc, WHO notional and international web site, firstname.lastname@example.org, www.mgf.uab.es, Gamcotrap web site,
Author Dr AZADEH Senior Lecturer in Obstetrics & Gynaecology at the University of the Gambia W. Africa Senior Consultant in O & G and Clinical Director of Medicare Health Services.