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

Efforts to End FGC

Over the last three decades, the international community has mounted efforts to end the practice of FGC, spearheaded by organizations within the United Nations, the WHO, the legislatures of affected countries and nongovernmental organizations. In numerous international and regional declarations, FGC is acknowledged to be a violation of human rights and bodily integrity, as the practice has no therapeutic benefits, is known to cause physical and psychological harm and is often carried out on children too young to give informed consent.[1] Although the practice remains deeply rooted, slow progress has been made. Prevalence remains high in Somalia, Djibouti and Egypt,[77] but change is underway. In Somalia, for example, the adverse consequences of Type III cutting have become more broadly acknowledged; however, some religious leaders defend milder forms of the practice, leading to the erroneous perception that the Sunna form is benign and fulfills religious obligations.[37,78] Prevalence has dropped most dramatically in Burkina Faso, Mauritania and Senegal.[7,77] In Burkina Faso and Mauritania, authorities employ a multi-pronged approach: They initiate educational programs to change perceptions, enlist prominent groups to champion eradication, gain support from practitioners such as midwives and traditional healers, promote alternative symbolic rites of passage and enforce legislation.[7] Tostan, an nongovernmental organization working in rural areas of Djibouti, Guinea, Guinea-Bisau, Mali, Mauritania, Senegal, Somalia and the Gambia, fosters respectful and inclusive community-led training for broad-scale development and social change.[17] A 3-year community empowerment program with trained facilitators provides villagers with information on human rights, as well as practical skills in the areas of hygiene, health, democracy, literacy, math and project management. Community members then determine a collective vision for their future, consider which practices in their villages do not lead to well-being, and make celebratory public declarations committing to end harmful ones such as FGC. UNICEF reports that although in Mali, Guinea, Sierra Leone, Somalia, Gambia and Egypt more than half of the female population think the practice should continue, in 19 of 29 African countries where FGC is practiced, most girls and women now think that it should end.[79]

Ending the practice among immigrant communities in the West also presents a challenge. Attitudes among immigrant women vary from region to region, depending on evolving norms. Some women see migration as an opportunity to reassess the practice, but obstacles to change do exist. FGC-affected communities encounter an alien culture: promoting traditional norms maintains social cohesion against intrusive foreign ideas.[36] Some communities are deeply threatened by the sexual liberalism in western society. The emphasis on individual rights over group identity is seen as discriminatory and in conflict with religious beliefs.[38] To protect their daughters, women themselves keep the practice alive. The illegality of FGC in host countries drives the practice underground; it persists by enlisting the help of traditional circumcisers within the immigrant community or by sending girls to relatives in the home country for vacation cutting .[73]

Women from FGC-affected societies face a culture of silent endurance; some are unaware of the prevalence of complications, and may attribute their personal suffering to shameful behavior or unclean spirits. Because western notions of individual rights do not always resonate, changes in perception require interventions that are respectful and sensitive to the culture. An example from Norway illustrates the challenges of cross-cultural intervention.[72] When a foreign speaker addressed a group of Gambian immigrants about the health consequences of FGC, the information was rejected as not credible. However, when a female Gambian doctor presented slides of little Gambian girls with scars, cysts and fistulas caused by FGC, the information, although shocking, was believable; as the doctor hummed the secret songs from the initiation ceremony, the audience was galvanized by the realization that she too had been cut. Such discoveries are psychologically painful, however, prompting a deep sense of loss.[72] Time and emotional healing are needed to process this new understanding. Consequently, educational efforts require great sensitivity, the cooperation of families and influential leaders and access to culturally competent support groups. The power of social norms cannot be overemphasized. Only when communities feel it is not detrimental to do so, will they change.

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