Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons. The practice is mostly carried out by traditional practitioners. In several settings, there is evidence suggesting greater involvement of health care providers in performing FGM due to the belief that the procedure is safer when medicalized. WHO strongly urges health care providers not to perform FGM.

FGM is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against girls and women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity; the right to be free from torture and cruel, inhuman or degrading treatment; and the right to life, in instances when the procedure results in death.

Types of FGM

Female genital mutilation is classified into 4 major types:

Type 1:  this is the partial or total removal of the clitoral glans (the external and visible part of the clitoris, which is a sensitive part of the female genitals), and/or the prepuce/ clitoral hood (the fold of skin surrounding the clitoral glans).

Type 2:  this is the partial or total removal of the clitoral glans and the labia minora (the inner folds of the vulva), with or without removal of the labia majora (the outer folds of skin of the vulva).

Type 3: Also known 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 clitoral prepuce/clitoral hood and glans.

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.

No health benefits, only harm

FGM has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls’ and women’s bodies. Although all forms of FGM are associated with increased risk of health complications, the risk is greater with more severe forms of FGM.

Immediate complications of FGM can include:

• severe pain
• excessive bleeding (haemorrhage)
• genital tissue swelling
• fever
• infections e.g., tetanus
• urinary problems
• wound healing problems
• injury to surrounding genital tissue
• shock
• death.

Long-term complications 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 (pain during intercourse, decreased satisfaction, etc.);
• increased risk of childbirth complications (difficult delivery, excessive bleeding, caesarean section, need to resuscitate the baby, etc.) and newborn deaths;
• need for later surgeries: for example, the sealing or narrowing of the vaginal opening (Type 3) may lead to the practice of cutting open the sealed vagina later to allow for sexual intercourse and childbirth (deinfibulation²). Sometimes genital tissue is stitched again several times, including after childbirth, hence the woman goes through repeated opening and closing procedures, further increasing both immediate and long-term risks;
• psychological problems (depression, anxiety, post-traumatic stress disorder, low self-esteem, etc.);

Who is at risk?

FGM is mostly carried out on young girls between infancy and adolescence, and occasionally on adult women. According to available data from 30 countries where FGM is practiced in the Western, Eastern, and North-Eastern regions of Africa, and some countries in the Middle East and Asia, more than 200 million girls and women alive today have been subjected to the practice with more than 3 million girls estimated to be at risk of FGM annually. FGM is therefore of global concern.

Cultural and social factors for performing FGM

The reasons why FGM is performed vary from one region to another as well as over time, and include a mix of sociocultural factors within families and communities.

• Where FGM is a social convention (social norm), the social pressure to conform to what others do and have been doing, as well as the need to be accepted socially and the fear of being rejected by the community, are strong motivations to perpetuate the practice.
• FGM is often considered a necessary part of raising a girl, and a way to prepare her for adulthood and marriage.
• FGM is often motivated by beliefs about what is considered acceptable sexual behaviour. It aims to ensure premarital virginity and marital fidelity.
• Where it is believed that FGM increases marriageability, it is more likely to be carried out.
• FGM is associated with cultural ideals of femininity and modesty, which include the notion that girls are clean and beautiful after removal of body parts that are considered unclean, unfeminine or male.
• Some people believe that the practice has religious support, although no religious scripts prescribe the practice.
• Religious leaders take varying positions with regard to FGM: some promote it, some consider it irrelevant to religion, and others contribute to its elimination.
• Local structures of power and authority, such as community leaders, religious leaders, circumcisers, and even some medical personnel can contribute to upholding the practice. Likewise, when informed, they can be effective advocates for abandonment of FGM.
• In most societies, where FGM is practised, it is considered a cultural tradition, which is often used as an argument for its continuation.

What are the main reasons for medicalized FGM?

There are many reasons why health-care providers perform FGM. These include:

• The belief that there is reduced risk of complications associated with medicalized FGM as compared to non-medicalized FGM.
• The belief that medicalization of FGM could be a first step towards full abandonment of the practice.
• Health care providers who perform FGM are themselves members of FGM- practising communities and are subject to the same social norms.
• There may be a financial incentive to perform the practice.