Female Genital Mutilation/Cutting Workshop (DISCLAIMER - this is a rather graphic post, so squeamish people should probably skip this one)

Last week I attended a very interesting workshop on Female Genital Mutilation/Cutting (FGM/C), put on by a local NGO focused on fighting FGM/C through educating and sensitizing health professionals. It was very informative, so I thought I would pass on some of what I learned for those of you who might not be familiar with the practice (last chance...STOP HERE if you don't want to read more about this practice):

What is FGM/C exactly? Also sometimes called Female Circumcision, Female Genital Mutilation/Cutting "comprises all procedures that involve partial or total removal of the external female genitalia, or injury to the female genital organs for non-medical reasons." The main types of FGM/C are three progressive levels of severity, the mildest being more or less the equivalent of male circumcision (Type 1) and the most severe involving significant removal of the genitalia and suturing (Type 3). Types 1 and 2 are practiced here in the Gambia - Type 3 is not practiced, but on occasion, the flesh can fuse during the healing process in a Type 2 procedure in a way that makes it resemble a Type 3 procedure when fully healed. The painful procedures are generally performed by an elderly women, often a traditional birth attendant, with generally non-sterile cutting instruments like razor blades, knives, and pieces of glass. After the procedure is complete, the wounds are generally dabbed with local materials like ash or cow dung to stop the bleeding. FGM/C is generally done as part of a cultural rite of passage. The age at which girls are cut varies by tribe and region, but it is generally done before puberty, and sometimes as young as newborns. I think that's more than graphic enough for now, so if you're interested in more detail on what these procedures entail, visit this link: http://www.who.int/mediacentre/factsheets/fs241/en/.

Where is it practiced? FGM/C is a common practice throughout western, eastern, and north-eastern regions of Africa in some countries in Asia and the Middle East, and among certain immigrant communities in North America and Europe. The WHO estimates that 100 to 140 million girls and women worldwide are currently living with the consequences of FGM/C. In the Gambia, current data shows that 78% of adult women have undergone this practice.

What are the health implications? In addition to inflicting long-term mental and emotional trauma, even the milder forms of FGM/C have very serious implications for a girl or woman's physical health. Immediate physical health complications can include: 1) contracting tetanus, hepatitis, HIV, etc, from the cutting instrument, especially if multiple girls are being cut in a single ceremony; 2) developing an infection in the wound; 3) shock, hemorrhage, anemia; 4) injuries sustained if the child struggles; and 5) urine retention to swelling or fear of pain when passing urine.

Long term physical consequences can include: 1) obstetric fistula, a serious and highly stigmatized medical condition - see http://en.wikipedia.org/wiki/Obstetric_fistula); 2) an increased risk of childbirth complications and infant mortality; 3) recurrent bladder and urinary tract infections, which can lead to infertility in severe cases; and 4) sexual dysfunction.

For women with suturing or severe scarring (Type 3 or Type 2 that healed with significant fusion), the health concerns are even more significant. The immediate health risks are often played out multiple times in a woman's life when she is "reopened," either through cutting or tearing to allow for sex and childbirth. These fresh wounds during sex and childbirth are not only exceedingly painful, but they also significantly increase the risk of contracting or transmitting HIV and other blood-borne diseases. Additionally, women with this condition have a significantly increased risk of obstructed labor and/or the need for a c-section, which is a serious danger to the life of both the mother and the baby in any context, but particularly in one where emergency obstetric care may not be readily accessible. These women are also prone to infections throughout their lives if urine and menstrual blood cannot exit the body properly.

So why do people do it? FGM/C is extremely deeply ingrained culturally as an crucial for: initiation into womanhood; social acceptance into the community; controlling women's sexual urges to reduce pre-marital sex, promiscuity, and unfaithfulness; a women's ability to get a husband (which, since virginity is highly valued, is closely linked to the previous point); and reaching and maintaining a clean and pure state, both physically and spiritually.

Is it a Muslim thing? Most Gambians think it is, so at the workshop, we spent a significant chunk of time discussing the relationship between FGM/C and Islam. Here were the highlights of the NGO's argument that FGM/C is not, in fact, a muslim "thing": (1) Most people here are not aware of it, but FGM/C in Africa actually pre-dates the arrival of Islam in Africa...historians believe it originated in Egypt and the Nile valley at the time of the Pharaohs; (2) FGM/C is not widely practiced in other deeply Muslim countries, such as Morocco, Saudi Arabia - including the holy city of Mecca!; (3) Most Gambians look to religious scholars in Senegal for spiritual guidance, and the prevalence of FGM/C among adult women is only 28% there, compared with 78% in The Gambia; (4) The prevalence is nearly 100% in Egypt and they have a significant Christian minority, and Jews in Ethiopia practice it as well, so it is not only Muslims who participate in FGM/C; and (5) In recent years numerous Muslim groups and leaders have issued statements and religious decrees or fatwas declaring FGM/C (particularly in its more severe forms) to be contrary to Islam, and some have gone as far as to recommend banning the practice.

For example, Dr.Muhammad Lutfi al-Sabbagh, Professor of Islamic studies at King Saud University in Riyadh stated: “Since all these risks are involved in female circumcision, it cannot be legitimate under Islamic law, particularly since nothing that recommends it is definitely established as said by the Prophet {Peace Be Upon Him}. It is, however, established that he has said: "Do not harm yourself or others". This hadith is one of the basic principles of this True Religion. The conclusion to be reached is that female circumcision is neither required nor is it an obligation nor a sunna. This is the view taken by a great number of scholars in the absence of any hadith that may be authentically attributed to the Prophet {Peace Be Upon Him}.”

If you're interested in learning more about the relationship between FGM/C and Islam, here are a few sites with some more information: http://www.iccservices.org.uk/news_and_events/updates/female_genital_mutilation.htm, http://www.minaret.org/fgm-pamphlet.htm, and http://www.religioustolerance.org/fem_cirm.htm.