Women Fight Back: The Politics of Female Genital Mutilation

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Women Fight Back: The Politics of Female Genital Mutilation

by Fran Hosken

‘Science for the People’ Vol. 12, No. 6, November-December 1980, p. 12 – 16

Fran Hosken is the Editor of the Women’s International Network News. She is an architect planner concerned with modernization and urbanization worldwide.

Seminar on Traditional Practices Affecting the Health of Women and Children

“Traditonal Practices Affecting the Health of Women and Children” was the title of an international, five-day seminar held in Khartoum, Sudan in February, 1979. The seminar, which was sponsored by the World Health Organization, marks the first time that genital and sexual mutilation, practices that blight the lives and destroy the health of millions of women and girls in Africa and the Middle East, have been addressed in an international forum. Participants included health department delegations from Sudan, Egypt, Somalia, Djibouti, Ethiopia, Kenya, Oman, Southern Yemen and Nigeria. Upper Volta sent the president of the National Women’s Organization as an observer. The meeting was also attended by representatives from international nongovernmental organizations, and by the U.S. Agency for International Development (AID).

Physicians, midwives and other health professionals described the ways that external genitalia, including the clitoris, of tens of millions of female children are cut off or mutilated. The most frequently practiced operation, clitoridectomy or excision, involves cutting out, without anesthetic, most or all of the external genitalia of female children, at any age from birth to puberty. The most dangerous operation, infibulation or pharaonic circumcision, involves removing the exterior genital organs of the child and closing the vagina by sewing or scarification. The legs of the child are tied together for several weeks until the wound is healed; only a small opening, created by inserting a splinter of wood into the wound, is left for elimination.

These operations often have serious medical consequences including: hemorrhage, which may be fatal; dangerous infections, including tetanus; terrible scarring, which results in difficult childbirth and even infertility; menstrual problems; fistulas (rupture of the vaginal walls); incontinence and other permanent disabilities. The operations can result in life long frigidity and painful intercourse; chronic inflammations; and infections of the internal genitalia may finally cause infertility.1 The mental problems which result have never been systematically studied.

The Egyptian Country Report presented at the WHO Seminar, showed that excision continues to be widely practiced all over Egypt by a majority of families, except the western-educated upper class. The operations continue despite a 1959 statute (which was further strengthened in 1978) that states that the operations are forbidden “for scientific and health reasons … “. According to all estimates, more than half of Egyptian female children under the age of eight continue to be mutilated. The results of a survey conducted at a Family Planning Clinic in Cairo, showed that 90% of the women attending the clinic were mutilated, 46% of their daughters were already excised, and 34% more intended to do so. Moreover, the survey revealed that female clinic personnel not only were excised themselves, but the majority already had or were planning to have their own daughters excised. These women are trained with the assistance of Western-devised programs, including training programs financed and designed by U.S./AID, to teach family planning and health. 

SOMALIAN WOMAN DESCRIBES OPERATIONS

Edna Adan Ismail from Somalia, a midwife and head of the training division of the Somalian Health Department, described the operations practiced in her country2:

The operation consists of clitorodectomy and excision of the labia minora as well as the inner walls of the labia majora; and the suturing together or approximating of the raw edges of the labia majora in order that the opposite sides heal together and form a wall over the vaginal opening. A small opening is left for the passage of urine and menstrual flow.
The operations are carried out by women who earn their living by the performance of such operations, including the opening up after marriage of the bride, and they are often also the village midwives. Such women have no knowledge of asepsis or anatomy, and use no form of anaesthesia.
The operations may also be done by paramedical personnel in their spare time; such people use local anaesthesia, sterile instruments and have some knowledge of the importance of asepsis. However, because of the local anaesthesia, the child struggles less and more tissues may be cut away.
In Somalia, the operations are done on young girls between the ages of five and eight. and may be done on individuals or groups of girls, either related or neighbors …
The physical complications are, immediate shock from fear, pain and hemorrhage. Extensive lacerations may be sustained which may involve vaginal and urethral openings, as well as sometimes the rectum. The hemorrhages may be so severe that quite a few are brought into the hospital for suturing of deep lacerations and for blood transfusions.
Within the first ten days: sepsis ranks high in the list of complications, and tetanus may also result. Retention of urine is another common complication due to the fact that the urethra is now covered with a flap of skin, thorns and blood clots, as well as the swelling which develops and obstructs the small opening which has been left to permit the passage of urine. In the case of failure of infibulation, which means that occasionally the walls of the labia majora fail to stick together, another attempt at infibulation is usually made.
At the time of marriage: forcible penetration of the skin barrier by the husband may cause lacerations, which may involve the perineum, the urethra, and sometimes even the rectum, particularly if a knife is used by the husband.
At childbirth: the scars of the external genitalia have very little elasticity and require being opened up in order to permit the passage of the baby through the obstructed birth outlet. Once more, infections may occur and this unnecessary suffering is imposed on the woman during every childbirth.
Other complications: rectovaginal and vesico-vaginal fistulae are often seen. The rupture of the uterus results in incontinence. The slow trickle of urine (as opposed to the strong jet of her bladder) reminds her constantly of the operation. The onset of menstruation, with its accompanying discomfort and odors, forces her to recall her agony. Marriage and the opening up of the infibulation to permit the consummation of the marriage is an ordeal. The birth of the first child, and the knowledge that subsequent deliveries are not going to be any easier on her scar riddled genitals, haunts every woman constantly.

Edna Adan Ismail also describes from her own experience some of the mental complications that affect the female child from an early age, that “remain with her throughout her life”:

Well before the child is operated on, she hears tales of horror relating to the act of infibulation. At the same time, girls who have been operated taunt others with insults and call them ‘unclean’.
In this frame of mind of fear, mixed with a sense of inferiority, the girl reaches her turn for surgery. Many of the physical wounds will heal; their pain and discomfort subside. But at each stage of her later life, further mental injuries are added. 

*From WIN News, Spring 1979, Vol. 6 No.2, pp. 30-31. Edna Adan Ismail made these remarks at a Regional Conference in Lusaka, Zambia.

WHO Seminar Recommendations 

Four recommendations on “Female Circumcision”, the traditional term still used all over Africa (though medically incorrect), were unanimously adopted by the delegations. They read: 

  • Adoption of clear national policies for the abolishment of female circumcision. 
  • Establishment of national commissions to coordinate the activities of the bodies, including where appropriate, the enactment of legislation prohibiting female circumcision. 
  • Intensification of general public education, including health education, on the dangers and the undesirability of female circumcision. 
  • Intensification of education programs for traditional birth attendants, midwives, healers and other practitioners of traditional medicine, showing the harmful effects of female circumcision, with a view to enlist their support in general efforts to abolish these practices.

Action on the International Level 

Since the Khartoum Resolutions, very little action has taken place despite WHO’s call for “collaborative action at the international level … ” The proceedings of the Seminar were published in 1980, as well as an article in May 1979 in the international journal, World Health.3 Aside from this, there has been mostly silence on the part of the international community, with a few exceptions.
UNICEF, which until last year refused to acknowledge the operations, has drastically reversed its position. This has not happened easily: it took concerted political effort, led by WIN NEWS to make the facts about the operations known. Then, UNICEF had to be urged – especially by women contributors – to address the issues. As the foremost agency concerned with maternal and child health it is their responsibility to speak out against genital mutilation.

In March, 1980, UNICEF finally joined WHO in a “joint action program of research, education and training designed to support governments in their approach to female circumcision and its health hazards.” At the United Nations Mid-Decade Conference on Women, held in Copenhagen during July 1980, UNICEF announced its support of the Khartoum Seminar recommendations. The UNICEF program included “encouragement of community initiated activities,” provision of “information to media to address the issue,” integration of the “discussion of female excision into all educational and training programmes – including the development and preparation of training materials,” and “the direction of strong advocacy efforts towards national policy and decision-makers, as well as health workers and the general public in affected area.”
In Copenhagen, aside from WHO and UNICEF, the only delegation that addressed the issue was Sweden. Karin Anderssom, Swedish Cabinet Minister for Equality, delivered the following statement: 

We, too, share the widespread concern over the practice of female circumcision. The serious medical and social consequences of this practice are of concern to women in many countries. We welcome recent initiatives by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to take up this issue. My government stands ready to support all health programmes which include measures designed to abolish female circumcision … 

Map of African continent labeling countries that practice Excision and/or Infibulation

All other governments working in affected areas of Africa and the Middle East have been silent. In addition, private organizations including charitable and church groups have not taken a position against the operations. Christian converts all over Africa mutilate their female children. This is condoned and tolerated by international Christian organizations, although local Protestant ministers have tried to stop the mutilations, especially in Kenya. The Catholic authorities have never opposed them. The Pope in the 18th century sent a medical mission to Ethiopia who determined that the operations were necessary on medical grounds. Rome has ever since provided approval by silence.

POLITICS OF ERADICATING GENITAL MUTILATION
Norma Swenson, co-author of Our Bodies, Ourselves, and member of the National Women’s Health Network.  

African women express a range of feelings about genital mutilation, and are often divided about whether or not to stop the practices, and if so, how. Within Africa, many women are unaware of the practices, or unaware that it is not universal. Many of them resent strongly the anti-mutilation activities of Western women, feeling that it is an African women’s problem and must be dealt with by them alone. Others feel that, while they want to be consulted and involved, African women need the sensitive help and active support of women from the West. Indeed, even though it will take a long time to eradicate genital mutilation, many are convinced that eradication cannot come about without outside help.

Observers of the controversy have expressed concern that there is already the beginning of a “backlash”, an intensification of the practices out of resentment over perceived Western imperialist and racist criticisms of African culture. All of this is being exacerbated by the rise in the operations through the spread of anti-Western Islam through Africa (even though female circumcision is only culturally associated with Islam and not actually part of the Koran’s teaching.)

Clitoridectomy and infibulation are “cultural” practices in the sense that their purpose is not to mutilate or punish women, (even if the effects are harmful), but rather to control and protect women in the context of African patriarchy. These operations are based upon ideas about male and female sexuality in African mythology and legend, and upon the importance of the survival of the family, a whole fabric of beliefs sustaining the way of life of many different African peoples. It is only with the modern Western ideas of anatomy and medicine that evidence can be presented which shows the damage from these procedures. Only in the context of modern and relatively recent ideas and information about female sexuality can the full implications of the operation for women and their political status be comprehended. Reform of marriage laws, including abolition of polygamy, and many changes in education, employment and general status of women will have to go hand in hand with the campaign to eradicate female circumcision in Africa.

This is the framework, then, in which international agencies like UNICEF and the World Health Organization (WHO) are becoming involved in female circumcision in Africa. AID has become notorious throughout the developing world for the proliferation of damaging drugs, devices, and procedures forced on women without their full knowledge or consent, primarily for the purpose of population control. It becomes a strange irony for AID, then, to be asked to build into its expansion of health and family-planning services in Africa, a model plan to stop the damage to women and children done through female circumcision. Thus far, AID has refused to become involved. Yet it is entirely appropriate to insist on accountability from international agencies, for example to insist that any rural health program not ignore such a profound and basic cause of maternal and child disability and death. Once again it will be up to women to monitor, if they can find out where and how to look, the role of AID and other international agencies in pursuing their own interests against the interests of women, as the issue of female circumcision becomes even more publicized and controversial than at any point in the past.

The larger questions of what techniques patriarchal societies use to control the sexuality and autonomy of women, and what kinds of damage are done in order to assure that control, need also to be extended to women outside of Africa. Our Western institutions, particularly medicine, have found many ways to mutilate women and deprive them of the knowledge of their full human and sexual potential. Childbirth and gynecological practices have damaged and continue to damage both women and infants, and psychiatry has created elaborately worked out “scientific” rationales to convince women that their sexuality is infantile. Outside of the West, in India, young brides are set on fire “accidentally” in order to acquire dowry money. In China, foot binding was an ancient practice which controlled women until modern times. It is no longer so easy to be sure that one technique that male dominated societies have used to control women is so much more horrible than another. We hope that Western women who do become involved in trying to eradicate African female circumcision also become knowledgeable about their own culture’s techniques for controlling women.  

U.S. Agencies are Silent 

AID, despite the Khartoum Seminar recommendations and the recent changes in UNICEF’s policy, remains silent. Yet, AID collaborates in health and family planning programs all over affected areas of Africa. AID is involved in a $14,000,000 Rural Health Delivery Program in Somalia; a $4,000,000 Rural Health Program in Mali and an $8,000,000 Sudanese Primary Health Care Project. Excision is not included among the health hazards named in any of these projects, although most female children in these countries are excised; in Somalia and Sudan, the prevailing operation is infibulation, the most dangerous of the operations.

There are many people in those countries, including in the Health Ministries, who are actively trying to abolish the operations. In Somalia, a National Commission for abolishment of the operations was formed in 1978, with the Ministries of Health and Education represented, and the Somali Women’s Democratic Organization as executor. In the Sudan, the Fifth OB/GYN Congress voted unanimously for abolishment as their official position.

At the present time, genital mutilations are being introduced into modern medical practice and hospitals. In urban areas of Africa, the operations are often performed on newborn babies, as sexual castrations and stripped of all traditional rites. This is a gross abuse of modern medicine and medical ethics. Increasingly, health equipment and training contributed by AID and other western donors is used to mutilate female children in affected countries.
AID has been repeatedly informed about this situation, but no action has been initiated to prevent such abuse and no preventive education has been included in any of their training programs. The official AID position remains, “We cannot interfere with tradition practices.”

In a meeting in early summer, 1980, with the Health Coordinator of AID, Dr. Stephen Joseph, Deputy Assistant Administrator, preventive measures were discussed, specifically childbirth education materials and programs to teach positive, reproductive health. Several months later AID still had taken no action. AID’s only action to date is to initiate the development of a bibliography via a library computer search: this despite the fact that a bibliography was provided to AID by WIN News some time ago. AID has appointed a coordinator to address the issue of genital mutilation, but she has yet to integrate programs to eliminate genital mutilation into some of the major AID health programs.

Recently, testimony about AID’s failure to act and take preventive measures was presented before the Subcommittee on Foreign Operations of the Committee on Appropriations. AID’s response to a request by the committee for an explanation produced no fact nor any proposals for preventive measures. Preventive education is now especially important as the operations are performed on even younger children who have no choice. As a result of population growth, more children are mutilated today than ever before.

It is intolerable that AID, whose programs are financed by tax dollars, has continued to ignore the wishes expressed by African and Middle Eastern Health Departments, and that they have refused to collaborate in international actions sponsored by WHO and UNICEF. The unwillingness of AID and other national and international agencies to stop genital mutilation reveals the politics of deliberate neglect and obfuscation which are fatal to many children in Africa and the Middle East.

Update 

To support preventive actions, write to Senator Daniel K. Inouye, the Chairperson of the Foreign Affairs/Foreign Relations Committees (Committee on Foreign Affairs, The Congress, Washington, D.C. 20515); and to AID Administrator, Mr. Douglas Bennett (U.S. Agency for International Development, Department of State, Washington, D.C. 20523).
For further information write to WIN News, 187 Grant Street, Lexington, MA 02173. WIN News has published many reports on Genital Mutilation, including The Hosken Report: Genital and Sexual Mutilation of Females and Female Sexual Mutilations: The Facts and Proposals for Action.

>> Back to Vol. 12, No. 6 <<

References

  1. *One clinical study of the medical effects of genital mutilation is by Dr. Abu el Futuh Shandall, “Circumcision and Infibulation of Females: A General Consideration of the Problem and a Clinical Study of the Complications in Sudanese Women”, published in the Sudan Medical Journal, 1967.
  2. *From WIN News, Spring 1979, Vol. 6 No.2, pp. 30-31. Edna Adan Ismail made these remarks at a Regional Conference in Lusaka. Zambia.
  3. *The proceedings are available from The World Health Organization’s Eastern Mediterranean Regional Office, P.O. Box 1517, Alexandria, Egypt. World Health is published in many languages, and is available from WHO, 1211 Geneva 27, Switzerland.