Female Genital Cutting: Confronting Cultural Challenges and Health Complications Across the Lifespan

Miranda A Farage; Kenneth W Miller; Ghebre E Tzeghai; Charles E Azuka; Jack D Sobel; William J Ledger

Disclosures

Women's Health. 2015;11(1):79-94. 

In This Article

Prevalence

The practice of FGC has ancient sources, although no definitive evidence exists on how it began. It was part of ancient Egyptian culture and has been found in mummies.[3] Some speculate that it may have originated with the ancient Greeks or in pre-Islamic Arabia. In the 19th century, clitoridectomy was advocated in England and North America for the treatment of hysteria and masturbation, a theory that was eventually debunked.[4] Today, cutting is most prevalent in 28 countries of Africa, with the highest rates in Egypt, Somalia, Sudan, Eritrea, Guinea, Sierra Leone, Mali and Djibouti (Table 2). The type of FGC varies depending on the country, the traditional practices of the region, religious beliefs, levels of education and economic development and the ethnicity and tribe to which the woman belongs (Table 3).[5–9]

The practice continues among immigrants to the developed world. The European Parliament estimated that up to half a million women living in the European Union have been subjected to FGC, with 180,000 more at risk.[25] In 2001, it was estimated that 174,528 women residing in England and Wales had been born in a country that practices FGC, a figure considered to be an underestimate.[26] Based on the 2000 US census, the US CDC and the African Women's Health Center in Boston estimated that over 200,000 girls and young women in the USA were at risk for undergoing FGC.[27] However, between 2000 and 2012, the population of African-born immigrants to the USA more than doubled, from 750,000 to 1,724,000.[28] A total of 48% are women and 68% are from countries in North Africa, Eastern Africa and Western Africa where FGC is most prevalent.[28] Although prevalence varies by ethnicity, region and tribe, assuming that the prevalence of FGC among women in immigrant communities reflects that reported by the WHO for their country of birth overall, we estimate from 2012 figures that roughly 340,000 women in the USA may be affected or at risk for FGC (Table 4).

US healthcare providers should be aware of this growing at-risk population. States with the largest African-born populations are California, New York, Texas, Maryland and Virginia.[29] Sizeable numbers of immigrants from affected countries reside in the major metropolitan areas of: Los Angeles, Riverside, Orange County, San Diego and San Francisco, Oakland, San Jose, California; New York, Northern New Jersey, Long Island and New York, New Jersey, Pennsylvania; Houston, Galveston, Brazoria and Dallas, Fort Worth, Texas; and Washington, Arlington, Alexandria, Washington, DC, Virginia, Maryland, West Virginia.[27] In addition, sizeable enclaves of refugees from countries with civil unrest have formed in some mid-western cities. Somalis, for example, represent the largest influx of African refugees to the USA in the last two decades; 50,000 or more have settled in Minnesota and represent one in five immigrants to that state.[30] As of 2012, over 45,000 have settled in Columbus, Ohio, with 200 more arriving each month .[31]

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