Female Genital Cutting
This research Web page focuses on female genital cutting (FGC), sometimes referred to as female genital mutilation or female circumcision. According to the World Health Organization, an estimated 100 to140 million women and girls worldwide have undergone this procedure, and approximately 2 million girls are at risk of being cut every year. Although this practice is performed mainly in Africa and the Middle East, studies have shown that large numbers of immigrants and refugees from these regions continue the practice after they arrive in Western countries. The issue made national news in October 2006 when an Ethiopian immigrant in the state of Georgia was sentenced to 10 years in prison for cutting his daughter.
It is becoming increasingly important for social workers to understand the cultural, ethical, mental, and physical aspects of FGC. There are many ways in which social workers may encounter this issue in their practice. Social workers working with refugee and immigrant populations need to be aware of the populations’ views of this practice. Often physicians and nurses are not educated on FGC and may not know how to respond to a patient who has been cut. Social workers in hospitals and medical clinics may be able to help doctors and other health care providers respond appropriately and act in a culturally sensitive manner. Child welfare workers must also understand the practice and learn how to help children who have undergone the procedure or are at risk. This Web page provides an overview of the major issues related to FGC and highlights research on the practice as well as some areas in which research is needed. It also links to organizations that are developing successful intervention models and are working to combat the practice.
FGC occurs mainly in the northern half of Africa and a few countries of the Middle East. The countries thought to have the highest rates of FGC include: Egypt, Eritrea, Sudan, Somalia, Yemen, Guinea, Mali, and Burkina Faso. The type of cutting varies widely by ethnic group and region. FGC can range from a nicking of the clitoris to partial or complete removal of the external female genitalia and closing of the vaginal opening. There are three main categories of FGC, although there are other variations.
- Clitoridectomy—a total or partial removal of the clitoris
- Excision—a removal of the clitoris and partial or complete removal of the labia minora
- Infibulation—a removal of the clitoris, the labia minora and labia majora, with narrowing or near closure of the vagina opening
Just as the type of cutting varies, so do the reasons given for FGC. Common reasons include control of female sexuality, religion, aesthetic preferences, hygiene, tradition, and improving marriage prospects. The age at which girls are cut also depends on the country and culture. In some places, girls are cut as infants, and in others, girls are cut during adolescence. In addition to the emotional trauma of the procedure, which is almost always done without anesthetic, the practice is linked to serious medical problems including infection and complications during childbirth.
In 1996, the United States criminalized the performance of FGC on a person under age 18 as part of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996. The act states that “whoever knowingly circumcises, excises or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years shall be fined under this title or imprisoned not more than five years, or both.” Additionally, 16 states have passed legislation outlawing this practice. These include California, Colorado, Delaware, Illinois, Maryland, Minnesota, Missouri, Nevada, New York, North Dakota, Oregon, Rhode Island, Tennessee, Texas, West Virginia, and Wisconsin.
Research on FGC is especially difficult in the United States because immigrants know the practice is not accepted in American culture and they often fear judgment and legal prosecution. Women rarely admit to having been cut and often will not speak openly about their feelings regarding FGC. Women may also be less likely to seek medical care if they have been cut. The U.S. Department of Health and Human Services estimated that 228,000 women in the United States have undergone the procedure or are at risk. The majority of research on FGC focuses on the practice in Africa and the Middle East. More research with U.S. immigrant populations is needed to understand the nature of the practice in the United States. Some potential areas of research include: to what extent FGC is practiced in America; whether the children of immigrants continue the practice with their daughters; who performs the procedure; the motivations behind the practice; how social workers and health professionals react when confronted with the issue; and what interventions may be useful in addressing this issue with clients.
Approaches to Eliminating FGC and Treating Women/ Girls Who Have Been Cut
The approaches used to address FGC in communities vary based on the culture and the reasons that the population uses the practice. Most successful programs use multiple approaches to address this complex cultural practice.
Population Council’s FRONTIERS Program
The Population Council’s FRONTIERS program has conducted two studies on the practice of FGC among Somali communities in Kenya. These communities hold a strong belief that FGC is an Islamic requirement. FRONTIERS has developed a religious-oriented community-based intervention for use with these communities. This approach involves Islamic scholars who cite specific religious texts and traditions to convince local Islamic leaders that FGC is not in fact mandated by Islam. The program has successfully persuaded 11 Islam leaders in communities where FGC is practiced that the practice is unislamic, and these leaders have committed to publicly condemn the practice. Other leaders have also been convinced, but are not yet ready to speak out against FGC.
Tostan, an international nonprofit organization in Senegal, has been very successful with their strategy of community education and empowerment. Because it is often difficult for individuals within a community to stand up against cultural norms such as FGC, Tostan uses a community-oriented approach. They engage community leaders and eventually all members of a community in discussions about human rights and how they relate to community goals. Together, communities make the decision to end the practice of FGC and formalize their decision in a public declaration, often a celebration, which is covered by the local media. Each public declaration makes it easier for other communities to decide to change their practices as well. The Tostan program has been evaluated by a number of organizations. Study results reveal positive outcomes, not only in the abandonment of FGC, but also in economic, education, and health indicators. One study revealed that 94 percent of participants in a Tostan program reported that they would not cut their daughters.
Centre for Development and Population Activities (CEDPA) www.cedpa.org/content/publication/detail/751
CEDPA is using a similar strategy of community empowerment in Egypt. CEDPA/Egypt has developed a model for community-level FGC abandonment programs based on community education, advocacy with local leaders, formation of teams of anti-FGC activists, and home visits to parents of at-risk girls. These interventions have led to more open community discussion about FGC and greater opposition to the practice.
Brigham and Women’s Hospital
Brigham and Women’s Hospital African Women’s Health Center (AWHC) in Boston, MA focuses on improving the health of refugee and immigrant women who have undergone FGC:
It provides access, understanding and community to refugee women who have long-term complications from this tradition and who seek access to improved reproductive health care. The AWHC provides culturally and linguistically appropriate obstetric, gynecologic and reproductive health care to African immigrants and refugees. It is the first and only African health practice in the United States that focuses on issues regarding female genital cutting. It was founded in July 1999. It has increased its patient population from 8-10 women per session to 15-20 women per session. The patients are predominantly from Somalia, Sudan and Ethiopia. Approximately ninety percent of these women have been circumcised (www.brighamandwomen’s.org/africanwomenscenter).
FGC Research Initiatives and Resources
Centre for Development and Population Activities (CEDPA) www.cedpa.org
CEDPA uses a community-level approach to FGC abandonment activities in Egypt that includes education and empowerment while also addressing religious issues associated with FGC.
Center for Reproductive Rights www.reproductiverights.org
The Center for Reproductive Rights provides information on legal conventions and laws pertaining to FGC. They offer free, downloadable publications from their Web site including: Female Genital Mutilation: A Matter of Human Rights, An Advocate’s Guide to Action http://www.reproductiverights.org/pdf/fgmhandbook.pdf and
Legislation of Female Genital Mutilation in the United States http://www.reproductiverights.org/pdf/pub_bp_fgmlawsusa.pdf
Female Genital Cutting Education and Networking Project www.fgmnetwork.org
Online clearinghouse and a community for researchers, activists, attorneys, and health care practitioners.
Ford Foundation www.fordfound.org
The Ford Foundation funds projects related to human rights and sexuality. The Foundation has funded FGC projects such as Rainbo.
International Network to Analyze, Communicate and Transform the Campaign Against Female Genital Cutting, Female Genital Mutilation, Female Circumcision (INTACT Network) www.intact-network.net/
The INTACT Network is an international group of researchers, scholars, and activists committed to bringing scientific evidence to bear on the campaign to end FGC. Its mission is to contribute to the abandonment of FGC by advancing social, behavioral, and epidemiological research on the practice.
International Center for Research on Women (ICRW) www.icrw.org
Female Genital Cutting: Breaking the Silence by Julia M. Masterson and Julie Hanson Swanson discusses three projects in Egypt, The Gambia, and Senegal that successfully supported community efforts to end FGC. www.icrw.org/docs/FGCfinalpdf.pdf
MEASURE DHS+ Demographic and Health Surveys www.measuredhs.com
MEASURE DHS+ assists countries in the collection and use of data to monitor and evaluate population, health, and nutrition programs. The project is implemented by ORC Macro and funded by the U.S. Agency for International Development. For DHS information specific to FGC, see: DHS Comparative Reports No. 7: Female Genital Cutting in the Demographic and Health Surveys: A Critical and Comparative Analysis, September 2004.
National Association of Social Workers (NASW) www.socialworkers.org
NASW’s International Policy on Human Rights says,
The profession also endorses the treaties and conventions as they have evolved that establish that the rights of people take precedence over social customs when those customs infringe on human rights. Ritual genital mutilation is a case in point
Population Council www.popcouncil.org
The Population Council is an international, nonprofit organization that conducts research on three fronts: biomedical, social science, and public health. They have conducted research on FGC in a number of countries. www.popcouncil.org/rh/fgc.html
Population Reference Bureau www.prb.org
Using surveys, interviews, and other resources, The Population Reference Bureau, in collaboration with Family Health International, PATH, Population Council, and The Manoff Group, released a publication titled Abandoning Female Genital Mutilation/Cutting: An In-Depth Look at Promising Practices in December 2006. Funded by the United States Agency for International Development, the publication outlines three promising interventions for reducing FGC.
Research, Action and Information Network for the Bodily Integrity of Women (Rainbo) www.rainbo.org
Rainbo is an organization focused on the rights and health of African women, particularly immigrants. The organization publishes a number of useful fact sheets, guides, and pamphlets for health care providers and immigrants. These include: Female Genital Mutilation: A Guide to Laws and Policies Worldwide; Caring for Women with Circumcision: A Technical Manual for Health Care Providers; Female Circumcision: A Religious & Cultural Discussion; and Caring for Women with Circumcision: Fact sheet for Physicians.
United Nation’s Children’s Fund (UNICEF) www.unicef.org
UNICEF’s research entity, Innocenti Research Centre, compiled a comprehensive document titled Changing a Harmful Social Convention: Female Genital Mutilation/Cutting. The publication discusses FGC and where it is practiced, as well as human rights issues related to the practice. It also provides information on how to address the issue at community and government levels. http://www.unicef-icdc.org/publications/pdf/fgm-gb-2005.pdf
U.S. Agency for International Development (USAID) www.usaid.gov
USAID funds many FGC abandonment projects and coordinates FGC research and resources. http://www.usaid.gov/our_work/global_health/pop/techareas/fgc/index.html
U.S. Department of Health and Human Services www.4women.gov
U.S. Department of Health and Human Services has been mandated by Congress to carry out educational outreach to affected communities in the United States and develop and disseminate recommendations for students in medical and osteopathic schools. The Department has worked to fulfill Congress’ mandate on FGC by collecting and compiling FGC data, holding community meetings, and educating health professionals on FGC.
U.S. Department of State www.state.gov
The Immigration and Naturalization Service (INS), in cooperation with the U.S. Department of State, has been directed by Congress to provide information to immigrants and refugees entering the United States from countries where FGC is practiced about the adverse health consequences associated with FGC and the legal consequences of performing the procedure in the United States. http://www.state.gov/g/wi/rls/rep/c6466.htm
Tahara is a short film by Sara Rashad about an Egyptian woman in Los Angeles who must decide whether or not to follow tradition and circumcise her daughter. Copies of the film may be purchased from the Web site.
World Health Organization (WHO) www.who.int/topics/female_genital_mutilation/en/
The WHO Web site has research, publications, and training materials on FGC at: www.who.int/reproductive-health/publications/fgm.html
Social Work-Related Articles on FGC
Bashir, L. M. (1997). Female genital mutilation: Balancing intolerance of the practice with tolerance
of culture. Journal of Women’s Health, 6(1), 11-4.
Berg, K. (1997). Female genital mutilation: Implications for social work. Social Worker, 65(3), 16-
Burson, I. (2007). Social work and female genital cutting. Journal of Social Work
Values and Ethics, 4(1), Retrieved from http://www.socialworker.com/jswve/content/view/49/50/ on April 5, 2007.
Eyega, Z. & Conneely E. (1997). Facts and fiction regarding female circumcision/female genital
mutilation: A pilot study in New York City. Journal of the American Medical Women’s Association, 52(4),174-178, 187.
Gibeau, A. M. (1998). Female genital mutilation: When a cultural practice generates clinical and
ethical dilemmas. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 27(1), 85-91.
Jones, W. K., Smith. J., Kieke, Jr. B., & Wilcox, L. (1998). Female genital mutilation/female
circumcision. Who is at risk in the U.S.? Public Health Reports, 112(5), 368-377.
Kellner, N. I. (1993). Under the knife: Female genital mutilation as child abuse. Journal of Juvenile
Law, 141, 18-32.
Key, F. L. (1997). Female circumcision/female genital mutilation in the United States: Legislation
and its implications for health providers. Journal of the American Medical Women’s Association, 52(4), 179-180, 187.
Morgan, M. A. (1997). Female genital mutilation: An issue on the doorstep of the American
medical community. Journal of Legal Medicine, 18(1), 93-115.
Ortiz, E. T. (1998). Female genital mutilation and public health: Lessons from the British
experience. Health Care for Women International, 19(2), 119-129.
Walker, L. R. & Morgan, M. C. (1995). Female circumcision: A report of four adolescents. Journal of
Adolescent Health, 17(2), 128-32.