FGM (= Female Genital Mutilation) is mostly widespread in Africa amongst many tribes. In Egypt, Ethiopia, the Sudan or Djibouti nearly 100% of all women are affected. In other countries only the members of some tribes are circumcised, such as in Nigeria, Mali, Burkina Faso, Senegal, Kenya etc. FGM also occurs on the Arab half-peninsula (such as in the United Arab Emirates and South Yemen) and in parts of Asia.

According to estimations, between 100 and 157 million women and girls are afflicted by circumcision worldwide. Some two million girls are added to this each year. Which means that some 6000 girls a day are being circumcised. The circumcision of girls cannot be compared to that of boys, since, in general, it causes far more damage to the sexual organs and frequently affects health more seriously. This is why it is not viewed as circumcision by outsiders, but as female genital mutilation. There are many different forms:

	Mild Sunna (sunna = "tradition" in Arabic): clipping, slitting or removing the clitoris' foreskin;
	Modified Sunna: partial or complete removal of the clitoris;
	Clitoridectomy/Circumcision: The removal of part or the whole clitoris and part or all of the inner labia lips. This operation gives rise to scar tissue which is so large it covers the vaginal opening;
	Infibulation/Pharaonic Circumcision: The removal of the clitoris and inner labia lips and the inner layers of the outer labia lips. The remaining outer labia lips are then sewn together with cat gut or skewered together with thorns. This remaining skin grows together. A small tube is stuck in the wound to leave an opening for menstrual blood.

The operation is carried out using a wide variety of instruments such as razor blades, shears, knives or glass shards. It usually takes place without an anaesthetic or disinfection, but sometime natural medicines are used. Sexual mutilation is carried out by midwives or old women, sometimes by male priest or barbers. The age of the girls ranges between 4 and 8 as a rule.

The background: FGM is an old custom that stems from the time before the origination of the monotheistic religions. It is widely practised amongst Moslems, Christians and Animists. The reasons why genital mutilation is carried out are broad:

	Genital mutilation takes place by religious decree (although female circumcision is neither mentioned nor warranted in the Koran or Bible).
	The female sex is ugly and unclean, circumcision and infibulation protects the woman from illnesses, discharge, worms etc.
	The mutilation transforms the girls into complete women, because the "male" part of the woman is removed.
	The mutilation reduces the women's sexual desire and protects them from unbridled sexuality.
	The mutilation increases the woman's fertility and her chances of getting married.
	Men experience greater sexual pleasure with infibulated women.
	Old traditions have to be maintained, objections to this tradition are to be attributed to western influence.

The real motive for genital mutilation, in contrast, is often seen in patriachally structured societies. The mutilation serves to control female sexuality and is meant to function as protection against the loss of virginity and promiscuity in marriage. The consequences to health are grave:

	Shock due to the great loss of blood;
	blood poisoning, tetanus;
	infection with polio, hepatitis and HIV;
	problems with emptying the bladder, damage to and infection of urinary ducts and the kidneys;
	Inflammation of the oviduct and womb;
	heavy bleeding during the monthly period;
	infibulated women experience pain during sex, especially directly after the wedding or after the birth of babies, when the man penetrates the opening during intercourse.
	Problematic for the mother and child, is that infibulated women are prone to potentially fatal births (the vaginal opening is too small and normally has to be opened prior to the birth to allow the birth to take place. The scar tissue is inelastic and causes great pain during birth. Caesarean sections or the use of forceps frequently result. After the birth, the woman is sewn up again leaving just a pinhead-sized opening;
	Frequent illness ties the woman to the home, she is incapable of pursuing regular work and visiting school;
	The consequences for mental health are similar to those following other forms of trauma: suppression and splitting, fear, depression and disturbed behaviour. Frequently a law exists forbidding talking about the pain experienced.

What is Being Done Against Genital Mutilation? Laws against female genital mutilation have been introduced in many countries. In Egypt, the health minister recommended that the partial removal of the clitoris by doctors should replace extreme intervention. Similar prohibitive laws also exist in Sudan and Kenya. However FGM represents an integral component of society there. The laws primarily result in the practice of mutilation disappearing into the underground. Frequently, bleeding girls are no longer taken to the doctor. As the laws of the colonial powers were passed, strong counter movements often formed.

Female genital mutilation is in no way limited to just primitive tribes or in the process of dying out. On the contrary, it is also practised by the middle classes and in towns, and is expanding continually. The tendency is to prefer evermore drastic procedures in place of mild ones; the operations (these took place at early adult age earlier) are being carried out on girls of increasingly younger age, and even infants, because they are incapable of providing any strong resistance.

Female genital mutilation initially became a topic for international human rights and health organisations a few years ago. Now FGM is also being practised by refugees and immigrants in western countries. However no concrete measures are being taken against this practice except in France. FGM is often put down as being harmless. Taking the liberal viewpoint, it is viewed incorrect to interfere in other cultures and traditions due to tolerance. For outsiders it is also very difficult to comprehend that women allow this damaging practice to be carried out on their daughters, because they want to increase their chances of getting married and have a fulfilling life within their culture.

Small projects and local women's initiatives exist today in many countries. They are fighting against genital mutilation and its consequences at many levels. By carrying out informative work, providing medical care, safe houses for girls, education and qualification and creating alternative workplaces for midwifes. In addition, other rites and celebrations are being promoted in order to combat the fear of the loss of cultural identity.

[Author: Dorette Wesemann, Edited by: Ragnar Müller]

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