Strengthening protection from Female Genital Mutilation (FGM): consultation

Part 3: Background

Physical description of Female Genital Mutilation (FGM)

The World Health Organisation (WHO) defines FGM as 'all procedures involving partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons'. WHO classifies the practice into four types^[4]:

• Type 1: Often referred to as clitoridectomy, this is the partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals), and in very rare cases, only the prepuce (the fold of skin surrounding the clitoris).

• Type 2: Often referred to as excision, this is the partial or total removal of the clitoris and the labia minora (the inner folds of the vulva), with or without excision of the labia majora (the outer folds of skin of the vulva).

• Type 3: Often referred to as infibulation, this is the narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the labia minora, or labia majora, sometimes through stitching, with or without removal of the clitoris (clitoridectomy). Deinfibulation refers to the practice of cutting open the sealed vaginal opening in a woman who has been infibulated, usually to allow intercourse or to facilitate childbirth.

• Type 4: This includes all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area. It can cover vaginal elongation, the practice of stretching the vulva using weights for aesthetics or enhancement of sexual pleasure.

Terminology

'Female genital mutilation' or 'FGM' is an internationally-recognised term^[5]. It is supposed to convey the severe harm caused to women and girls by the practice. However, it should be noted that women affected by FGM may not describe themselves as 'mutilated' and may not recognise the term. Although 'FGM' or 'cutting' are common, they are not universally understood because they are English words. However, the term 'female circumcision' is anatomically incorrect and also misleading because it implies parity with non-medical male circumcision.

Health Impacts

FGM has no health benefits. It involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls' and women's bodies. Generally speaking, risks increase depending on the severity of the procedure. Immediate complications can include severe pain; excessive bleeding (haemorrhage); genital tissue swelling; fever; infections such as tetanus; urinary problems; wound healing problems; injury to surrounding genital tissue; shock; and death. Long-term consequences can include urinary problems (painful urination, urinary tract infections); vaginal problems (discharge, itching, bacterial vaginosis and other infections); menstrual problems (painful menstruations, difficulty in passing menstrual blood, etc.); scar tissue and keloid; sexual problems (such as pain during intercourse, or decreased satisfaction); increased risk of childbirth complications (such as difficult delivery, excessive bleeding, caesarean section, or need to resuscitate the baby) and new-born deaths; need for later surgeries; and psychological problems (such as depression, anxiety, post-traumatic stress disorder, and low self-esteem).

Perpetrators of FGM

FGM is often performed by older women, for whom it can be a lucrative source of income and prestige. It is often without medical expertise, anaesthesia or attention to hygiene. In some communities, health professionals are performing FGM because they think that, if they do it, it will protect women from infection and pain. Despite the harm it causes, many women think it is in the best interests of their daughters for reasons of faith, chastity, status, honour, marriageability, belonging, tradition, cleanliness or desirability. It can be claimed as a religious practice, but no religion condones it and faith leaders have condemned it. In some communities, women who oppose FGM or who try to protect their daughters from it are abused or ostracised, and their daughters shunned or stigmatised. Local structures of power and authority, such as community leaders, religious leaders, circumcisers, and even some medical personnel can contribute to upholding the practice. In most societies, where FGM is practised, it is considered a cultural tradition, which is often used as an argument for its continuation. And in some societies, recent adoption of the practice is linked to copying the traditions of neighbouring groups. Sometimes it has started as part of a wider religious or traditional revival movement.

Countries where FGM takes place

FGM has been practised across different continents, countries, communities and belief systems for over 5,000 years. This includes Europe, America, Asia, the Middle East and central Africa. It is most concentrated today from the west coast of Africa to the Horn of Africa. However, global migration patterns mean that FGM can be found all over the world.

While the exact number is unknown, at least 200 million girls and women in 30 countries are estimated to have undergone FGM. The actual figure is not known because there are little reliable data on prevalence.

FGM in Scotland

Whilst survivors of FGM are found in some communities in Scotland, not all women and girls born in countries or communities where it is practised are affected or at risk. In its report, "Tackling FGM in Scotland: towards a Scottish model of intervention (2014)"^[6], the Scottish Refugee Council analysed census, birth register and other data in an attempt to estimate the size and location of communities in Scotland which might be affected by FGM. It found that:

• In 2011, around 24,000 men, women and children living in Scotland were born in a country where FGM is practised to some extent.
• There are communities potentially affected by FGM in every local authority area, with the largest communities in Glasgow, Aberdeen, Edinburgh and Dundee respectively.
• Between 2001 and 2012, 2,750 girls were born in Scotland to women born in countries where FGM is practised to some extent.
• There is no data on ethnicity or other variables which influence the practice of FGM in local communities, so it is not known how many people in those communities are directly affected.