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Critical Discussion on Female Genital Cutting/Mutilation and Other Genital Alterations

Perspectives From a Women’s Rights NGO

  • Sociocultural Issues and Epidemiology (J Abdulcadir & D Bader, Section Editors)
  • Published:
Current Sexual Health Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The goal of this paper is to discuss the juxtapositions between FGM/C and other medically unjustified genital alterations performed on adult women (aesthetical genital surgeries) and on children (male circumcision and intersex genital surgeries). The authors join the debate from their position as professionals working in Belgium’s main “anti-FGM organization” as well as researchers.

Recent Findings

Recent research and contributions from scholars have raised critique of policies around FGM/C, particularly in the global North. Some of the concerns include critiques of laws that infantilize adult women, problematic use of genital examination, discourses that stigmatize migrant persons from FGM/C practicing communities, and professionals who are insufficiently trained to support women with FGM/C in a respectful and empowering way. Scholars have also argued that there is a lack of medical distinction between different types of genital cutting such as FGM/C type I and type IV, male circumcision, and aesthetical genital cutting. Authors have stressed the discrepancy in terms of both discourse on genital cutting, and called for equal protection of girl, boy, and intersex children from medically unnecessary genital cutting, without discrimination in regard to ethnicity, religion, or immigration status of their parents.

Summary

The paper argues that the discussion on FGM/C and other genital alterations must consider existing socially constructed inequalities, particularly gender and “race”, and how they affect those submitted to genital alterations. The authors highlight practical challenges raised in their daily work in a women’s rights NGO and conclude with recommendations.

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Notes

  1. While these practices are not integrated in the description or the specific examples, the WHO (2008) states that labia elongation « might be defined as a form of female genital mutilation » because of the social pressure on young girls to undergo it and because it created permanent physical changes. [12 , p.27]

  2. For information on care of women living with FGM/C in Belgium, see Caillet, M. et al. “Addressing FGM with Multidisciplinary Care. The Experience of the Belgian Reference Center CeMAViE”, Current Sexual Health Reports, vol. 10, p.44–49

  3. We chose to use the term “survivor” as “this term to emphasize the woman or girl’s resilience and as an empowering element of language, but without prejudice to the fact that the woman or girl may prefer to use the term victim.” [1]

  4. Even clitoridectomies were historically used in “the West” to treat female “conditions” such as hysteria, nymphomania, lesbianism, and other “deviant” behaviour.

  5. For example, in Senegal, the Fulani use the term kaddungal, while the Wolof use the term xarafal

  6. See for example the French organization « Droit au corps »

  7. https://www.secularism.org.uk/news/2015/10/council-of-europe-retreat-on-circumcision-of-young-boys

  8. “Cisgender” refers to a person whose gender identity fits the gender they were assigned at birth. A baby born with male sex attributes and therefore assigned male, who perceives himself to be a boy/man, is cisgendered. The opposite of cisgender is trans-gender.

  9. While national studies on SGBV are lacking in Belgium, in the neighbour country France, the extensive VIRAGE study found that 14.5% of women and 3.9% of men reported experience of at least one form of sexual assault (excluding harassment and exhibitionism) in their lifetime. The authors stress that « [s]exual violence against women is not only much more frequent, but occurs in all life spaces throughout life. ». The study further shows that « [w]hatever the life space, sexual violence reported by women is practically always committed by one or more men (between 94% and 98%) » while the majority of cases of violence reported by men is also committed by other men. [8]

  10. Intersex people are born with sex characteristics that do not fit typical binary notions of male or female bodies. See OII Intersex Network http://oiiinternational.com/

  11. The exception is Malta who banned unnecessary genital surgeries on minors in 2015.

  12. Contrary to common beliefs about the rarity of intersex persons, people who are intersex in Belgium probably represent several 100,000 if you go with the available data, a much larger group than women having undergone FGM/C.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. END FGM EU Network (2016) How to talk about FGM – Position paper. Retrieved: https://www.endfgm.eu/editor/files/2017/05/How_to_Talk_about_FGM_FINAL__position_paper_v4_2.pdf (25/5/2020).

  2. WHO (2018). Female genital mutilation. Accessed: https://www.who.int/news-room/fact-sheets/detail/female-genital-mutilation. Accessed 1 Oct 2020.

  3. Shell-Duncan B, Hernlund Y. Female “circumcision” in Africa: dimensions of the practice and debates. In: Shell-Duncan B, Hernlund Y, editors. Female circumcision in Africa: culture, controversy, and change. Boulder: Lynne Rienners Publishers; 2001. p. 1–40.

    Google Scholar 

  4. UN WOMEN (2017) Female genital mutilation/cutting and violence against women and girls strengthening the policy linkages between different forms of violence: www.unwomen.org/-/media/headquarters/attachments/sections/library/publications/2017/policy-note-female-genital-mutilation- cutting-and-violence-against-women-and-girls-en.pdf. Accessed 1 Oct 2020.

  5. UNFPA, UNICEF, UN Women (2017). POLICY NOTE: Female genital mutilation/cutting and violence against women and girls - strengthening the policy linkages between different forms of violence. Retrieved: https://www.unwomen.org/-/media/headquarters/attachments/sections/library/publications/2017/policy-note-female-genital-mutilation-cutting-and-violence-against-women-and-girls-en.pdf?la=en&vs=905 (2/06/2020).

  6. Abdulcadir J, Ahmadu FS, Lucrezia C, (The Public Policy Advisory Network on Female Genital Surgeries in Africa), et al. Seven things to know about female genital surgeries in Africa. Hast Cent Rep. 2012;42(6):19–27.

    Article  Google Scholar 

  7. •• Johnsdotter S. Meaning well while doing harm: compulsory genital examinations in Swedish African girls. Sexual Reprod Health Matters. 2019;27:87–99 The author discusses compulsory genital examinations in Swedish African, mainly Somali, girls, based on data from 122 police files, including criminal investigations regarding suspected FGM. Johnsdotter criticizes the “dominant discourse stating that FGM is secretively practiced on a large scale among some immigrant groups in Europe”, for which she finds there is little evidence. She highlights some of the drawbacks of what she sees as a of a “very harsh, although well-intended, policy to check for FGM in Europe”, arguing that current policies have negative consequences for the girls involved and calls for a better European response to FGM.

    Article  Google Scholar 

  8. Berer M. The history and role of the criminal law in anti- FGM campaigns: is the criminal law what is needed, at least in countries like Great Britain? Reprod Health Matters. 2015;23(46):145–57. https://doi.org/10.1016/j.rhm.2015.10.001.

  9. Gruenbaum E. The female circumcision controversy: an anthropological perspective. Philadephia: University of Pennsylvania Press; 2001.

    Book  Google Scholar 

  10. Bell K. Genital cutting and Western discourses on sexuality. Med Anthropol Q. 2005;19(2):125–48.

    Article  Google Scholar 

  11. Abusharaf RM (2006) « Introduction: The custom in question » in : Female circumcision, Abusharaf RM (Ed.), University of Pennsylvania Press.

  12. WHO (2008) Eliminating female genital mutilation an interagency statement (OHCHR, UNAIDS, UNDP, UNECA, UNESCO, UNFPA, UNHCR, UNICEF, UNIFEM, WHO).

  13. Johansson ER (2020) Labia pulling and Type IV [email, personal communication] Email to: r.e.b.johansen@nkvts.no (July 2019 and May 2020).

  14. Crown Prosecution Service UK (2019) Female genital mutilation prosecution guidance, Updated 17 October 2019 Retrieved : https://www.cps.gov.uk/legal-guidance/female-genital-mutilation-prosecution-guidance (20/05/2020).

  15. Bader D. Nationalisme sexuel: le cas de l’excision et de la chirurgie esthétique génitale dans les discours d’experts en Suisse. Swiss J Sociol. 2016;42(3):574–98. https://doi.org/10.1515/sjs-2016-0025.

  16. •• The Brussels Collaboration on Bodily Integrity. Medically unnecessary genital cutting and the rights of the child: moving toward consensus. Am J Bioeth. 2019;19(10):17–28. https://doi.org/10.1080/15265161.2019.1643945This is a collective contribution by a range of professionals, ranging from health professionals to legal scholars, ethicists, social scientists, psychologists, and feminists, originating from different continents, with interdisciplinary expertise in child genital cutting practices across a wide range of cultural contexts. The authors share their “concern about widespread inaccuracies, inconsistencies, double standards, and Western cultural bias in the prevailing discourses on genital cutting of children”, while not agreeing on one single policy perspective or uniform moral assessment. They argue for “a more coherent, sex- and gender-inclusive approach that recognizes the special vulnerability of young people—regardless of the ethnicity, religion, or immigration status of their parents—to medically unnecessary genital cutting and the moral importance of bodily integrity, respect for bodily/sexual boundaries, and consent.” Both authors of the present article have signed this contribution. Accessed 1 Oct 2020.

  17. Davis SD. Male and female genital alteration: a collision course with the law? Health Matrix: J Law-Med. 2001;11:487–570.

    CAS  Google Scholar 

  18. Shahvisi A. Why UK doctors should be troubled by female genital mutilation legislation. Clin Ethics. 2017;12(2):102–8. https://doi.org/10.1177/2F1477750916682671.

  19. •• Johnsdotter S. Girls and boys as victims: assymetries and dynamics in European public discourses on genital modifications in children. In: Fusaschi M, Cavaforta G, editors. FGM/C: from medicine to critical anthropology: Meti Edizioni; 2018. The author discusses compulsory genital examinations in Swedish African, mainly Somali, girls, based on data from 122 police files, including criminal investigations regarding suspected FGM. Johnsdotter criticizes the “dominant discourse stating that FGM is secretively practiced on a large scale among some immigrant groups in Europe”, for which she finds there is little evidence. She highlights some of the drawbacks of what she sees as a of a “very harsh, although well-intended, policy to check for FGM in Europe”, arguing that current policies have negative consequences for the girls involved and calls for a better European response to FGM.

  20. Boddy J. The normal and the aberrant in female genital cutting Shifting paradigms. Hau: J Ethnogr Theory. 2016;6(2):41–69.

    Article  Google Scholar 

  21. Dubourg D, Richard F. Estimation de la prévalence des filles et femmes ayant subi ou à risque de subir une mutilation génitale féminine vivant en Belgique, 2018 - Mise à jour au 31 décembre 2016, IEFH, SPF Santé publique. 2018. Retrieved: http://www.strategiesconcertees-mgf.be/wp-content/uploads/20190204-gams-MGF_Etude-de-prev-longue-FR.pdf (2/2/2020).

  22. GAMS Belgique. Femmes, excision et exil. Quel accompagnement thérapeutique possible? 2015. Retrieved : http://www.strategiesconcertees-mgf.be/ouvrage-femmes-excision-et-exil/ (3/1/2020).

  23. Florquin S. Ongoing research : Diagnostic communautaire sur les besoins en matière de santé sexuelle et reproductive des femmes vivant avec les MGF à Bruxelles. 2019.

  24. European Parliament. Resolution on zero tolerance for FGM. 2018. Retrieved: https://www.europarl.europa.eu/news/en/press-room/20180202IPR97032/zero-tolerance-for-female-genital-mutilation (2/1/2020).

  25. European Commission. Communication towards eliminating FGM. (2013). eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52013DC0833&from=EN.

  26. UNICEF. Female genital mutilation/cutting: a global concern. 2016. www.unicef.org/media/files/FGMC_2016_brochure_final_UNICEF_SPREAD.pdf. Accessed 1 Oct 2020.

  27. Crenshaw K. Mapping the margins: intersectionality, identity politics, and violence against women of color. 1993. Retrieved: https://www.racialequitytools.org/resourcefiles/mapping-margins.pdf (30/12/2019).

  28. Colette G. Sexe, race et pratique du pouvoir. L’idée de nature. Donnemarie-Dontilly, iXe « Racine de iXe », 238 p. [1re éd 1992. Paris, Côté- femmes]. 2016.

  29. Mikkola M. “Feminist perspectives on sex and gender”, The Stanford Encyclopedia of Philosophy (Fall 2019 Edition). Zalta EN, editors. 2019. Retrieved: https://plato.stanford.edu/archives/fall2019/entries/feminism-gender (2/1/2020).

  30. Lorber J, Yancey Martin P. The socially constructed body - insights from feminist theory. 2011. Retrieved : https://www.researchgate.net/publication/237118472_The_Socially_Constructed_Body_Insights_From_Feminist_Theory1/references (1/12/2019)).

  31. Earp B. Protecting children from medically unnecessary genital cutting without stigmatizing women’s bodies: implications for sexual pleasure and pain, Arch Sexual Behav (in press). 2019, forthcoming.

  32. Wahlberg A. Continuity or change? Improved understanding of attitudes towards female genital cutting after migration from Somalia to Sweden. Digital comprehensive summaries of Uppsala dissertations from the Faculty of Medicine. 1401st ed. Uppsala: Acta Universitatis Uppsaliensis; 2017. p. 94.

    Google Scholar 

  33. Florquin S & Richard F (2019) Avancées et obstacles dans la lutte contre les mutilations génitales féminines, In: Charmain Levy (ed.) Genre, féminismes et développement: Une trilogie en construction, University of Ottawa Press.

  34. Fainzang S. Circoncision, excision et rapports de domination. Anthropol Soc. 1985;9(1):117–27. https://doi.org/10.7202/006243ar.

    Article  Google Scholar 

  35. O'Neill S, Duborg D, Florquin S, et al. “Men have a role to play but they don’t play it”: a mixed methods study exploring men’s involvement in female genital mutilation in Belgium, the Netherlands and the United Kingdom men speak out. Technical Report. 2017. https://doi.org/10.13140/RG.2.2.13177.36963. Accessed 1 Oct 2020.

  36. Kelly B, Foster C (2012) Should female genital cosmetic surgery and genital piercing be regarded ethically and legally as female genital mutilation? https://doi.org/10.1111/j.1471-0528.2011.03260.x.

  37. Agboli A, Botbol M, O’Neill S, Richard F, Aujoulat I. Transforming vulnerability into power: exploring empowerment among women with female genital mutilation/cutting (FGM/C) in the context of migration in Belgium. J Human Dev Capabil. 2019;21:49–62. https://doi.org/10.1080/19452829.2019.1661981.

    Article  Google Scholar 

  38. •• Bader D. Picturing female circumcision and female genital cosmetic surgery: a visual framing analysis of Swiss newspapers, 1983–2015. Fem Media Stud. 2019. https://doi.org/10.1080/14680777.2018.1560348. Bader analyzes the similarities and differences between FGM/C and female genital aesthetical surgery through analysis of images from Swiss newspapers. The author finds that FGM/C is “depicted as the product of a “primitive” society” while female genital aesthetic surgery is “the product of a science-oriented one” because of the strong focus on the medicalisation of female genital aestetical surgery, absent in the visual narratives of FGM/C. The author argues that the object of criticism thus becomes how it is done rather than what is done, “thereby preventing the conflation of female genital cosmetic surgery with the World Health Organization’s definition of “female genital mutilation” (FGM)”.

  39. Özer M, et al. Labiaplasty: motivation, techniques, and ethics. Nature Reviews. 2018:179–89. https://doi.org/10.1038/nrurol.2018.

  40. Bennett. ‘Beauty’ and ‘the beast’: analogising between cosmetic surgery and female genital mutilation. Flinders Law Journal. 2012;14(1):49–68.

    Google Scholar 

  41. Coordination des ONG pour les droits des enfants, CODE. (2014). Les mineurs ont-ils le droit de disposer de leur corps? Analyse mars 2014.

  42. ISAPS (2016) The international study on aesthetic/cosmetic procedures performed in 2016.

  43. Liao L-M, Taghinejadi N, Creighton SM. An analysis of the content and clinical implications of online advertisements for female genital cosmetic surgery. BMJ Open. 2012;2:e001908. https://doi.org/10.1136/bmjopen-2012-001908.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Le Gay A discours sur l’excision doit changer, Slate.fr, 06.02.2015.

  45. Morris BJ, Wamai RG, Henebeng EB, et al. Estimation of country-specific and global prevalence of male circumcision [published correction appears in Popul Health Metr. 2016;14:11]. Popul Health Metrics. 2016;14:4. Published 2016 Mar 1. https://doi.org/10.1186/s12963-016-0073-5.

    Article  Google Scholar 

  46. Earp. Female genital mutilation and male circumcision: toward an autonomy-based ethical framework. Medicolegal Bioethics. 2015;5(1):89–104.

    Article  Google Scholar 

  47. Aldeeb Abu-Sahlieh, S. (2004) Circoncision masculine et féminine: Y a-t-il une différence? https://www.sami-aldeeb.com/articles/. Accessed 20 Dec 2019.

  48. •• Earp BD, & Steinfeld R (2017). Gender and genital cutting: a new paradigm. In Teresa Giménez Barbat (Ed.), Gifted women, fragile men. Euromind Monographs - 2, Brussels: ALDE Group-EU Parliament. Available online at http://euromind.global/brian-d-earp-andrebecca-steinfeld/?lang=en. The article draws attention to the overlapping harms to which female, male, and intersex children may be exposed as a result of having their genitals cut. It outlines arguments against common distincitions between the three types of genital cutting and proposes a paradigm which is “sex and gender neutral”, based on the right to bodily integrity and genital autonomy of all children. While recognizing that a call for a total ban of all childhood genital cutting is not currently possible, the authors argue that it will become more and more difficult to maintain “fundamentally different treatment of female, male, and intersex children” in policy.

  49. Nunn G, The Guardian (June 20th 2019) Foreskin reclaimers: the ‘intactivists’ fighting infant male circumcision.

  50. Royal Dutch Medical Association (KNMG). (2010). The non- therapeutic circumcision of male minors. Retrieved: http://www.knmg.nl/Publicaties/KNMGpublicatie/77942/ Nontherapeutic-circumcision-of-male-minors-2010.htm (20/10/2016).

  51. Comité consultative de bioéthique de Belgique, (2017), Avis n° 70 du 8 mai 2017 relatif aux aspects éthiques de la circoncision non médicale.

  52. [FRA] FRA (2014), Violence against women: an EU-wide survey - Main results. Retrieved : https://fra.europa.eu/sites/default/files/fra_uploads/fra-2014-vaw-survey-main-results-apr14_en.pdf (20/05/2020).

  53. INSEE-ONDRP-SSMSI, (2018), CVS 2015–2018, in La lettre de l’Observatoire national des violences faites aux femmes, n°13, Novembre 2018. Retrieved: https://www.stop-violences-femmes.gouv.fr/IMG/pdf/violences_au_sein_du_couple_et_violences_sexuelles_novembre_2018.pdf (20/05/2020).

  54. WHO (2013) Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence, Retrieved: https://apps.who.int/iris/bitstream/handle/10665/85241/WHO_RHR_HRP_13.06_eng.pdf;jsessionid=ACA23EB7588C0AC863B0768814A7800A?sequence=1

  55. IWEPS (2016) Les violences contre les femmes en Wallonie - Des chiffres qui font mal, Retrieved : http://actionsociale.wallonie.be/sites/default/files/documents/stats-violences-femmes-2511206.pdf?fbclid=IwAR3WKiBTtjoviIGPS-j8Fr42hghUiRb7VJlGdsCzfUWVYvLGVD4AdqoNhUQ (20/05/2020).

  56. Hamel et al. (2016) Rape and sexual assault in France: initial findings of the VIRAGE survey, Population & Societies, No538, Nov 2016 https://virage.site.ined.fr/fichier/s_rubrique/20838/pop.soc.na.538.version.anglaise.fr.pdf

  57. European Parliament (2019) Experiencing backlash in women’s rights and gender equality in the EU - European Parliament resolution of 13 February 2019 on experiencing a backlash in women’s rights and gender equality in the EU (2018/2684(RSP)), Retrieved: https://www.europarl.europa.eu/doceo/document/TA-8-2019-0111_EN.pdf (20/05/2020).

  58. Fraser S. Constructing the female body: using female genital mutilation law to address genital-normalizing surgery on intersex children in the United States. Int J Human Rights Healthcare. 2016;9(1):62–72.

    Article  Google Scholar 

  59. Guterman L. (2012). Why are doctors still performing genital surgery on infants? [blogpost] Open Society Foundation. Retrieved: https://www.opensocietyfoundations.org/voices/why-are-doctors-still-performing-genital-surgery-on-infants (10/10/2016).

  60. Human Rights Watch (2017) “I want to be like nature made me” medically unnecessary surgeries on intersex children in the US, Available at: https://www.hrw.org/report/2017/07/25/i-want-be-nature-made-me/medically-unnecessary-surgeries-intersex-children-us (1/1/2020).

  61. Ehrenrich N, Barr M. Intersex surgery, female genital cutting, and the selective condemnation of cultural practices. Harv Civ Rights-Civ Liberties Law Rev. 2005;40(1):71–140.

    Google Scholar 

  62. •• Steinfeld, R., & Earp, B. D. (2017). How different are male, female, and intersex genital cutting? The Conversation. Retrieved: https://theconversation.com/how-different-are-female-male-and-intersex-genital-cutting-77569 (26/05/2020) Building on their research in ethics and politics, the authors join the public debate on male, female, and intersex genital cutting and call for a need for a “gender-neutral approach to genital cutting” and an equal protection from non-therapeutic genital alteration for all children. See also reference 48.

  63. Genres Pluriels (2019) Memorandum interesexe, Retrieved : http://www.genrespluriels.be/Memorandum-Intersexe

  64. Convention relative aux droits de l’enfant des Nations Unies (CRC) (80ème session): https://tbinternet.ohchr.org/Treaties/CRC/Shared%20Documents/BEL/CRC_C_BEL_CO_5-6_33811_E.pdf

  65. European Union Agency for Fundamental Rights (FRA). (2015). The fundamental rights situation of intersex people, FRA FOCUS, 4. Accessible: http://fra.europa.eu/en/publication/2015/fundamental-rights-situation-intersex-people (20/10/2016)).

  66. Lightfoot-Klein H, Chase C, Hammond T, Goldman R (2000) Genital surgery on children below the age of consent, in Ed. Szuchman, L.T. and Muscarella, F., Psychological perspectives of human sexuality.

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  1. GAMS Belgium, Brussels, Belgium

    Stéphanie Florquin & Fabienne Richard

  2. School of Public Health, CR5 Unit, Université Libre de Bruxelles, Brussels, Belgium

    Fabienne Richard

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Florquin, S., Richard, F. Critical Discussion on Female Genital Cutting/Mutilation and Other Genital Alterations. Curr Sex Health Rep 12, 292–301 (2020). https://doi.org/10.1007/s11930-020-00277-1

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