The international community has spoken out against Female Genital Mutilation (FGM) since the 1970’s and the indigenous African campaign against the practice started in 1990 with a statement by the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children. For at least 30 years there have been consistent messages against the practice and yet, millions of women and young girls are still being mutilated with the UN estimating that about 3 million girls and women are at risk every year.
Eliminating Female Genital Mutilation: An Interagency Statement, written by UN, in 2008 is a statement made by several agencies within the UN including agencies involved in human rights, international development, women’s health and development, and children’s health and rights. The paper describes female genital mutilation and argues for a strict zero tolerance rule. Activists have proposed that the role of the international community is to take this zero tolerance role and to spearhead the movement for complete eradication. Some have called for Western countries to deny visas to those who participate in the practice or to have new immigrants sign a waiver denouncing the process. By raising awareness and taking a harsh stand it seems that the hope is to use the invasive power of Western culture to try to influence massive change. I believe these ideas are misguided and in some ways counterproductive to the point of reducing pain, suffering and death from the practice, and to the point of connecting with people and assisting them to get the tools they need to make up their own minds.
But what is there to learn when there are instances where anti-FGM campaigns have been associated with increases in the practice? Winterbottom et al (2009) describes how culturally insensitive, human rights based anti-FGM programs have been counterproductive in Masai communities and have resulted in more FGM at younger ages. Somewhere along the way, however well- intentioned, the UN raised a banner that few stood behind. The problem as I see it, is a lack of realism and a lack of open mindedness. Dr. Ester Kawira, an African physician working with women who have been mutilated states that “It’s good to have an open mind about female circumcision, where the reaction of a Western person might be automatic horror and revulsion.” This leads to an agency that supports neither, efforts to make the practice more safe (like medicalizing infibulation* for example as has been done in Egypt), nor, minor symbolic procedures that some communities are adopting as an alternative (like poking the clitoral hood with a needle as has been done in Kenya). If a practice is more safe, or even completely without long term side effects then why should it be banned? Why a zero tolerance stance? Why not regulate the practice and train practitioners of all types to use healthy techniques like in the case of male circumcision?
No organization should ignore the effects of culture on sexuality and definitions of womanhood, by first not engaging those with the most power in the system of FGM and second by allowing no dialog except that of complete eradication. Take male circumcision as an example. FGM and male circumcision are different, however the reasons that parents and individuals give for both practices are very similar. As a physician I have had the experience of discussing the decision of circumcision with parents. I do not recommend it as there is no evidence that there is medical benefit*. Since physicians stopped recommending circumcisions in the US, rates have dropped significantly. What types of interventions would help the (mostly) women who recommend FGM to stop recommending it, to instead recommend an alternative? What chances have they had to come together, to discuss the outcomes, the risks and benefits, and the cultural origins of the practice? The UN could provide an excellent forum for these enablers, facilitators, and practitioners of FGM to come together to discuss an alternative, even less desirable ones as discussed above, in ways that are meaningful to each particular community.
“Programmes that have demonstrated success in promoting abandonment of Female Genital Mutilation on a large scale build on human rights and gender equality and are non-judgmental and non-coercive. They focus on encouraging a collective choice to abandon female genital mutilation”(UNAIDS et al 2008).
This statement itself emphasizes the importance of the involvement of the whole community, and yet the zero tolerance stance, does not leave room for the community to decide. I believe the UN could be very useful, if it provided resources for indigenous activists or those intimately familiar with practice to first listen to the most significant actors in the community. They can then use their great influence to slowly change the practice.
The international community can also help by specifically addressing the root of a women’s sense of powerlessness regarding the decision to participate in the practice. Women who are empowered, educated, or financially independent are often less likely to participate in the practice (Elnasher, 2007). Those are touted as the keys to eradication of the practice. Until those aspects can be truly addressed it is likely that the practice will continue. If different organizations stand by the zero tolerance stance they may alienate the very groups that they mean to assist in issues like women’s empowerment or education.
The intention of the zero tolerance stance, is to make sure that the procedure is completely eliminated without even the slightest manipulation of the female genitalia. Those writing the statement believe FGM is a way to control women, causes harm, and should be eradicated. If a group in Africa participating in the practice, decides to provide an alternative procedure such at a small cut in the clitoral hood, or a pin prick, the UN group would be adamantly against it, rendering itself useless in the fight against the harms of the practice. The practice is not free to evolve like other practices do in cultures because external forces are forcing one point of view. As different groups attempt to find their own safer alternatives while maintaining the intent of the practice, the UN organizations are many other non-profits taking a similar stance, are not able to assist in areas such as providing expertise in sterile techniques, crediting practitioners and regulating the practice so that it is more safe, and people are more informed. The zero tolerance stance limits the UN organizations’ usefulness in reducing the harm of the procedure right now.
Ultimately, I believe the first step in the UN organizations role as players in the fight against the HARMS of FGM is to loosen its’ zero tolerance’ stance, so that the UN will be more consistent in its role to be both culturally sensitive and to provide the safest alternatives to undesirable practices.
*Definition of infibulation click here
* More information about medicalization available here
- Elnashar AM, et al (2007).Female sexual dysfunction in Lower Egypt. BJOG. Feb;114(2):201-6.
- UNAIDS et al. (2008), Eliminating Female genital mutilation: an interagency statement. http://web.unfpa.org/upload/lib_pub_file/756_filename_fgm.pdf Accessed 23 September 2009
- Winterbottom, Anna et al. 2009. Female Genital Cutting: Cultural Rights and Rites of Defiance in Northern Tanzania. African Studies Review; 52(1): 47-71