What is FGM?

  • Definition + Types
  • Prevalence
  • Reasons
  • Consequences
  • The law

Definition + Types

Definitions

The World Health Organisation (WHO) defines female genital mutilation as all interventions leading to a partial or total removal of the external female genitalia or other lesions to the female genital organs practiced for non-medical purposes (WHO, 2008).

Types

Female genital mutilations were classified into four types. This classification was modified in 2007.

  • type 1 or clitoridectomy is the partial or total removal of the clitoris.
  • type 2 or excision concerns the partial or total removal of the clitoris and the labia minora or small lips with or without excision of the labia majora or large lips
  • type 3 ou infibulation is the narrowing of the vaginal opening using a covering seal, formed by cutting and repositioning the labia minora or labia majora, sometimes through stitching, with or without the removal of the clitoris.
  • type 4 includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incision, scraping and cauterizing

In practice, they are frequently distinguished into two main categories: excision and infibulation (the distinction between the two types is not always easy for a clinician not familiar with female genital mutilation) It also happens that the labia minora (small lips) grow together spontaneously without being stitched with thread or with thorns from the Acacia tree.

[1] OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO. Eliminating female genital mutilation. An interagency statement [Online]. World Health Organization; 2008 [cited 2016 Apr 10].

Prevalence

Worldwide

The most recent estimations (UNICEF 2016) consider that 200 million girls and women underwent one female sexual mutulation and that a further 3 million girls are a risk every year. Half of the population concerned meaning 100 millions are scattered in three countrieses: Egypt, Ethiopia and Indonesia. If the practice is present in at least 28 African countries, and also among certain ethnic groups in Asia (Indonesia, Malaysia,…), in the Arabian Peninsula (Yemen, Oman,…), in the Middle East (Iraq, Iran, …) and Latin America (Colombia, Peru). The prevalence differs greatly by region, including within countries. The group ethnicity and region of origin are the determining factors..

Figure 2. Prevalence of female genital mutilation Worldwide
GAMS-carte2017EN

In Belgium

The prevalence study coordinated by ITM Antwerp and backed by SPF Public Health (collaborations : ICRH, ISP, ONE, K&G, Fedasil, CGRA, UNHCR) shows that on January 31st 2012 the estimated number of women and young girls originating from countries that practice female circumcision was 48 092. Amongst these, 13112 have most probably been circumcised and 4084 are at risk of being. The Flemish Region (6761) young girls and women already circumcised or at risk of being and the Brussels-Capital Region (5831) are the regions the most concerned followed by the Walloon Region (3303). We have to add to that another 1300 young girls and women asylum seekers who have not yet been located in the three regions as they are not recorded in the National Register. This estimation should be viewed as low with the influx of refugees originating for countries that still practice female circumcision (Somalia, Eritrea,…) in 2015 and 2016.
Figure 3. Estimation of the female population very probably circumcised or at risk of being by province at 31st December 2012. (Sources : DGSIE, ONE, K&G)
prevalence_MGF_Belgique

Reasons

Reasons in support of the practice

Several reasons are invoked by the populations concerned to justify these practices, and many combinations are possible. The reasons habitually cited differ from countries and ethnic groups, but aso within the same ethnic group, according to age or sex (Gillette-Frenoy 1992).

  • Respecting custom or tradition. Is the most frequent reply to the question: why circumcise? It’s always been done, and is done, that’s how it is, It’s natural, it’s normal.
  • Social cohesion, social integration  : to be the same as everyone else, not be excluded.
  • Marriage : a non circumcised girl won’t find a husband. Respecting custom is one of the most cited reasons. Some girls are re-circumcised before marriage if it’s noticed that it wasn’t done properly or, in the case of infibulations, if the scar has spontaneousy opened. Some mothers realise the dangers of FGM, but admit that not being able to marry in their society is worse than the complications of FGM, so they therefore feel that it’s the best choice they can make for their daughters.
  • Virginity, chastity, la fidelity  : FGM are seen as ways of preserving family honour by preventing >any sexual desire and pregnancy before marriage. Within the framework of polygamous marriages, where the husband may not be able to satisfy all of his wives and where the woman may be frustrated and tempted to have a relationship outside of the marriage, FGM are seen as a way of protecting the husbands honour.
  • Fertility : FGM are seen as ways of preserving family honour by preventing >any sexual desire and pregnancy before marriage. Within the framework of polygamous marriages, where the husband may not be able to satisfy all of his wives and where the woman may be frustrated and tempted to have a relationship outside of the marriage, FGM are seen as a way of protecting the husbands honour.
  • Seduction, beauty : Particularly in ethic groups that practice infibulation, an open, gaping sex is considered ugly. A sewn, closed, depilated sex is seen as more hygenic and is supposed to make the woman more attactive.
  • Purity, cleanliness: Particularly in ethic groups that practice infibulation, an open, gaping sex is considered ugly. A sewn, closed, depilated sex is seen as more hygenic and is supposed to make the woman more attactive.
  • Religion: The practice of FGM is prior to the advent of the monotheistic religions, and Islam in particular. While neither the Koran nor any other religious text prescribe female circumcision or infibulation, certain communities are still practicing in the belief that it is required by religion. Note that FGM remains within Christian communities (catholics, protestants, copte), Ethiopian Jews (Falachas) and animists. The various religious authorities differ in opinion: some encourage them, some regard them as foreign to their religion, whilst others are fighting for their abolition. With regard to Islam, during an International meeting at the University of al-Azhar, Cairo in 2006, senior Sunni representatives spoke out against FGM (fatwa declaring that FGM are unfounded in Muslim Law) (Andro & Lesclingand 2007). Type 1 FGM is often called Sunna by the Muslim communities. For Islam Sunna represents all that is good for God, so using this term to speak about a clitoridectormy adds to the confustion and to the idea that FGM would be a prescription of Islam.

If the status of the circumcisors isn’t part of the justifications invoked by the population, it can however, be considered as an element favouring the continuity of these practices. Indeed, female genital mutilations are a source of income and social recognition for the circumcisors. They have, therefore, no interest in stopping the practice.

Raisons invoquées

Consequences

Who practices female circumcision and at what age ?

In the countries of origin, the mutilations are practiced by old women, traditional birth attendants or barbers and sometimes by doctors or trained midwives even though this is prohibited by WHO.

In the Western countries that host communities originating from these countries, young girls are still victims. The family call upon an expatriated cutter or send their daughter on holiday to that country so that she can be circumcised.

The mutilations are generally performed between the ages of 4 and 14 years, but can also be done at only a few months old or just before the marriage. Recent years have seen a lowering of the age of female circumcision. One of the reasons is to hide the practice from the authorities as many countries have legistated against this practice. The child being too small to run from the circumcision or to lodge a complaint.

What are the complications

Short term health risks :

  • Severe pain accompanied by fear and anxiety which may lead to a state of shock.
  • Excessive bleeding (Haemorrhage) which may cause death.
  • Infection of wounds and urinary retention
  • Infection of wounds.

Possible long term health risks:

  • Urinary tract infections, genital infections, gall stones, neurinomas.
  • Difficulty urinating, painful menstruation, incontinence
  • Pain around the scar, cysts, abscesses.
  • Problems linked to pregnancy and childbirth (obstructed labour, tears, and fistulas).
  • Sexual disorders (for both partners).
  • Risk of HIV transmission.
  • Infection of the fallopian tubes, sterility

Psychological consequences
The traumatic aspect of the event can be pushed into the child’s subconcious at the time of the mutilation only to reappear years later under different forms.

  • Loss of trust in loved ones (parental betrayal)
  • Behaviour disorders
  • Anxiety, anguish (flash-back, nightmares)
  • Depression and PTSD

The Law

Belgium

Since 2001, a specific criminal law provision on FGM was adopted under Belgian law.
Article 409 of the Belgian Penal Code (entered into force on 27th March 2001) provides for a prision snetence of 3 to 5 years for

« all persons participating, facilitating or encouraging all forms of female genital mutilations or any attempt to do so, with or without consent of the person concerned. Any attempt will be punished with a term of imprisonment from eight days to one year (…)». - Art. 409 of Penal Code

Since the month of July 2014, all incentive to practice FGM is equally punished with a term of imprisonment (of 8 days to 1 year). The fact that the victim is a minor constitutes an aggravating circumstance, as well as the importance of the aftereffects, profit, and in a general manner situations of dependency and vulnerability (when the author has authority over the victim, either a parent, doctor…). According to the circumstances the punishment can rise as high as 15 years imprisonment.

The statutory limitation is 5 years. 10 years in case of aggravating circumstances and 15 years if the victim is a minor at the time of the events. In this case, the statutory limitation does not begin until the victim has reached 18 years of age.

Furthermore, any person who has participated in, encouraged or facilitated FGM on a minor, including abroad, can be pursued in Belgium on the condition that the author is on Belgian territory (Principal of extraterritoriality).

In Belgium very few complaints have been filed and no conviction has been pronounced since the provision penal entered into force (15 complaints between 2009 and 2014). Thus, there is no available jurisprudence on this subject.


International level :

Numerous countries repress female genital mutilations in Europe but also in Africa : Senegal, Burkina Faso, Ivory Coast, Togo, etc…

Various international conventions have been ratified by Belgium and numerous other countries:

  • CEDAW – The International Convention on the Elimination of all forms of Discrimination against Women (January 13th 1984)
  • The African Charter on Human and Peoples’ Rights (Ocober 21st 1986) to which has been adhered to by more than fifty African States
  • CRC – The International Convention of Children’s Rights (1990)
  • The Maputo Protocol (adopted in July 2003) : this protocol comes as a supplement to The African Charter to promote the fundamental rights of women in Africa and to ensure the protection of these rights.
  • The Istanbul Convention : convention on the prevention and fight against violence against women and domestic violence. (ratified by Belgium in 2016)