1.1 WHO Definition and Classification

The World Health Organization (WHO) defines female genital mutilation and classifies the operation types as follows (WHO, UNICEF, and UNFPA 1997; UNICEF 2013) (Fig. 1.1):

  • Female genital mutilation comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for cultural or other non-therapeutic reasons.

  • Type I: Excision of the prepuce, with or without excision of part or all of the clitoris

  • Type II: Excision of the clitoris with partial or total excision of the labia minora

  • Type III: Excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (infibulation)

  • Type IV: Unclassified: includes pricking, piercing, or incision of the clitoris and/or labia; cauterization by burning of the clitoris and surrounding tissue; scraping of tissue surrounding the vaginal orifice (angurya cuts) or cutting of the vagina (gishiri cuts); introduction of corrosive substances of herbs into the vagina to cause bleeding or for the purposes of tightening or narrowing it; and any other procedure that falls under the definition of female genital mutilation provided above.

    Fig. 1.1
    figure 1

    Type I, II, III of the female genital mutilation/cutting (Grun 2015; modified by author)

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A wide variety of procedures fall under the term, “female genital mutilation.” They range from procedures which involve a minor incision at the tip of the clitoris to those that excise all of the external genitalia and stitch the vaginal opening. The WHO (2008) subdivided these types in their 2008 paper.Footnote 1

This procedure is mainly practiced in Africa. According to UNICEF (2013) more than 125 million girls and women alive today have undergone some form of FGM/C in a swath of 29 countries across Africa and the Middle East (Fig. 1.2). FGM/C has also been observed in Asian countries such as Indonesia and Malaysia (Iguchi and Rashid 2020). In recent years, this practice has become apparent in immigrant communities in Europe and the United States (Macklin 2006; Hernlund and Shell-Duncan 2007).

Fig. 1.2
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Countries and their practice rates of female genital mutilation/cutting in Africa and the Middle East (%) (UNICEF 2013; modified by author)

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1.2 Terminology

There are numerous terms for “female circumcision” or “female genital mutilation” in English, such as female genital cutting, female genital mutilation/cutting, female genital surgery, female genital modification, and so on. The diversity of terminology indicates the complexity of the problems related to this procedure. The term used to describe the issue reflects the position or context in which the issue is being discussed. We need to pay attention to how the term is used to understand the politics and principles surrounding this issue.

In many societies which practice or have practiced this procedure, the same word is used for male and female circumcision (Abusharaf 2006; UNICEF 2013: 6–7). For example, the Arabic word khtan, Somali word gudniinka, Kikuyu word irua, Maasai word emurata, and Samburu word muratare are used for both male and female circumcision. Colonial missionaries and colonial governments also used the English word “circumcision.” The term “female genital mutilation” appeared in the context of the abolitionist movement initiated by Western countries. In 1979, Fran Hosken––a renowned American social activist––started to use the term “female genital mutilation,” claiming that “circumcision” does not express the difference between male and female circumcision and thus causes confusion. She used the term to alert the world to the violent nature of the practice and called for its abolition (Hosken 1994 [1979]). The term was popularized in the international abolitionist movement of the 1980s. In 1991, the WHO urged UN agencies to adopt the term; the UN agencies agreed, and the use of the term quickly expanded (WHO 2008: 22).

However, the word “mutilation” has strong negative connotations that could be injurious to the dignity of the person undergoing the procedure. Thus, many individuals and organizations have not adopted this term. These individuals and organizations use the term “female genital cutting” (FGC) which includes the more objective and moderate term “cutting” in place of “mutilation.” In 1999, UNICEF and other UN agencies reviewed the use of “mutilation” and subsequently introduced the hybrid term “female genital mutilation/cutting” (FGM/C).

In its 2013 report, UNICEF explained the background of its adoption of this hybrid terminology in view of the risk of “demonizing cultures under cover of condemning practices harmful to women and the girl child” (2013: 7). It noted that UNICEF and the United Nations Population Fund (UNFPA) use the hybrid term in consideration for the significance of the term “mutilation” at the policy level, and, at the same time, to acknowledge that the practice is a violation of the rights of girls and women. As such, it recognizes the importance of employing respectful terminology when working with practicing communities (UNICEF 2013: 7). Subsequently, many individuals and organizations have begun to use the term “FGM/C.” However, UN agencies often use the term “FGM” as a “tool” to advocate for the abolition of this practice. Since the UN General Assembly adopted a resolution to eradicate FGM in 2012, many individuals and organizations have begun to use the term again in the context of a stronger campaign for abolition. In the chapters of this book, each author has chosen the term that they think is most appropriate in their context. In this introduction, the hybrid term “FGM/C” is mainly used in consideration for both practicing community members and abolitionists.

1.3 The Abolition Movement and Politics and Economics in Western Societies

Attempts by Western societies to abolish FGM/C were first observed as early as the colonial period. For example, in Kenya, missionaries of the Protestant Church began efforts to stop the practice in 1906 (Thomas 2003: 22). Owing to the pressure exercised by the colonial government and missionaries to abolish the practice, FGM/C became an instrument of opposition to the colonial government by the end of the 1950s, especially for those living in central Kenya where resistance to the colonial government was fierce (Thomas 2003: 79–102; Matsuda 2009: 271–273). The women in this region even showed their resistance by circumcising themselves. The issue was extremely tricky for the new Kenyan government to address once it gained independence because it could potentially divide the populace and make it difficult for the government to achieve national unity (Thomas 2003: 179).

With the rise of feminism in the West, female circumcision in Africa was “discovered” at the end of the 1970s, and the movement to abolish it gained momentum. At the Second World Conference on Women in 1980, Fran Hosken brought forward the issue of female circumcision, a gesture strongly opposed by the African women who participated in the conference.

In the 1980s, the WHO, UNICEF, and other UN agencies joined the abolition movement. In the 1990s, many international organizations, including international NGOs, began to develop projects in various parts of Africa to promote abolition. The United States enacted the Anti-FGM Act in 1996, requiring nations to implement initiatives to abolish FGM/C as a condition for receiving international aid (Center for Reproductive Rights 2004), thus linking the abolition of FGM/C with conditions for aid from the World Bank and the International Monetary Fund. This meant that African countries hoping to receive economic support from the international community felt forced to work toward the elimination of FGM/C within their nations. Later, in 2012, the UN declared in a General Assembly resolution that it would step up its efforts to eradicate FGM/C. Since 2015, the number of projects aimed at eliminating FGM/C have skyrocketed in line with the Sustainable Development Goals (SDGs) which call for its eradication.

1.4 Enactment of Prohibition Laws and Local Reactions

The first step taken by African countries to abolish FGM/C was the enactment of prohibition laws, which proceeded rapidly during the 1990s and the 2000s. Of the 29 countries in Africa and the Middle East where FGM/C is practiced, 24 have enacted prohibition laws as of 2020 (UNICEF 2013) (see Table 1.1). This book deals with three cases in Kenya (Chapters 5, 6 and 7) where the Children Act of 2001 explicitly prohibits “circumcision” for girls under 18 (Republic of Kenya 2012), and the Prohibition of Female Genital Mutilation Act (FGM Act) delivers harsh punishment and fines (Republic of Kenya 2012 [2011]).

Table 1.1 Countries with FGM/C prohibition laws and the years in which they were enacted (UNICEF 2013; modified by author)
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The rapid progress in enacting legislation to ban FGM/C is highly commendable, as it has contributed to a dramatic decrease in the practice of FGM/C. The legislation provided an opportunity to reexamine the procedure’s necessity to those who would typically perform it unquestioningly and provided a strong justification for refusal to those who sought to escape it. However, there was simultaneously a negative reaction to its abolition through the coercive force of state laws. Those who wished to continue this practice began to practice it in secret owing to their fear of fines and imprisonment (Chapters 5 and 6). In Somalia, where the procedure symbolizes virginity, there was a reported increase of young marriages before sexual maturity––an alternative way to demonstrate the purity of the girl at the time of marriage (World Vision 2014: 12; Pell and Robinson 2014). Community fragmentation also occurred in Kenya (Chapter 6), and the women in Ethiopia displayed fierce resistance to anti-FGM/C legislation (Chapter 2). It thus became clear that the development of prohibition laws could not be the goal of the abolition movement. There are women who actively want to practice FGM/C. For them, the ban has created a situation in which they are deprived of their freedom over their own bodies by the state. We need to pay attention to the complexities of the situation.

1.5 Zero Tolerance and the UN Ban on “Medicalization”

The focus of the early abolition movement against FGM/C was its health hazards. The WHO report on health hazards had a strong impact and moved people to support abolition. Gradually, UN agencies shifted their focus from “physical” and “medical” reasons to “human rights” and “ethics.”

The WHO (2010) clearly stated that the “medicalization” of FGM would be detrimental to the elimination of it. Here, “medicalization” refers to operations conducted by medical professionals.Footnote 2 For example, 38% of procedures in Egypt, 67% in Sudan, and 15% in Kenya are reported to be “medicalized” (Kimani and Shell-Duncan 2018: 26). Despite the fact that medicalization would undoubtedly reduce the risk of health problems, UN agencies are attempting to curb it. This is because the operation may be perceived as safe if a medical professional performs it. Additionally, given the respect and influence that medical professionals wield in the community, their participation in this practice may further discourage people from seeking its abolition (Kimani and Shell-Duncan 2018: 29; WHO 2010: 9). Medical professionals have become reluctant to perform FGM/C because those who perform the operation are also subject to punishment as per the prohibition laws that have been enacted in various countries.

UN agencies have clearly stated that this practice violates women’s human rights and should be eradicated, even if it is not a health risk. This position is symbolized by their “zero tolerance” slogan. The slogan refers to their strong determination to forbid a single exception to be made in the campaign for abolition. This implies not tolerating any type of FGM/C procedure, not even a very minor one such as pricking the clitoris/labia with a needle. Ironically, if an international consensus that FGM/C is a human rights violation against women is formed and the pursuit of “zero tolerance” intensifies, the mitigation of the health hazards of FGM/C may well be neglected (Kimani and Shell-Duncan 2018: 30–31). The chapters in this book provide examples to further this discussion.

1.6 Chapter Contents

In Chap. 2, Toda begins with an overview of the efforts and achievements thus far by the international and African communities with regard to the abolition of FGM/C. She then examines why “zero tolerance” has not been successful and points out the deep-rooted values of patriarchal societies in Africa. She explains the usefulness of the “positive-deviance approach,” which involves finding a small number of successful cases and expanding the activities from within the community to the outside of the community. This approach is characterized by the fact that it is the insiders (and not outsiders) who facilitate change, unlike the top-down “zero tolerance” approach. Toda also raises the issue of “women living in a patriarchal society” and warns against the easy othering of this issue, using El Saadawi’s term “victims of psychological and cultural clitoridectomy” (El Saadawi 2015).

In Chap. 3, Miyawaki takes the example of a small community in a peripheral Ethiopian district. He examines how the global idea of banning FGC was distorted as it reached the local grassroots community. The case clarifies how the straightforward enforcement of abolition can bring about conflicts. Miyawaki points out that FGC is embedded in societies not uniformly, but in various ways depending on each society. If the abolition of FGC is intended to empower women and to improve the social conditions in which they live, it is necessary to look for an approach that is localized for each society, particularly when FGC is accepted by inhabitants.

Chapter 4 is based on field research in a Somali community in Ethiopia. Mehari reveals the reality of the rapid transition from Type III (infibulation) to type I (sunna) in the region and the transformation of people's attitudes behind this transition. Local FGM intervention actors such as religious leaders, community leaders, health extension workers and schoolteachers play an important role in the transformation of people's consciousness. Their persuasion has led to widespread awareness of the health hazards of infibulation. Mehari especially points out the dual influence of religious leaders who, while supporting the abandonment of infibulation, encourage sunna circumcision as a religious obligation.

In Chap. 5, Miyachi uses statistical data to discuss the changes surrounding female circumcision in the Gusii community in Kenya over the past two decades which have been a time of drastic change in the Gusii community––a society that was suddenly opened to the world through cell phones, the internet, migrant workers. However, Miyachi wonders why the campaign to abolish FGC has not been as successful as expected. People have become aware of the health risks of the procedure, but at the same time its significance as a rite of passage has been maintained. She also points out that a shift to medicalization had already occurred 20 years ago in the Gusii community, but the enactment of Kenya’s prohibition law concealed the practice. She highlights the possibility that the zero tolerance approach has pushed the procedure underground, and because of that, girls’ health may be at risk.

In Chap. 6, Nakamura raises awareness of the problem that members of the abolitionist movement may have an overly fixed view of the women of local communities where FGM/C is practiced, as “victims deprived of their autonomy.” In order to break this stereotype, she describes the reaction of the local community to the abolition movement by incorporating the narratives of the locals as much as possible. This ethnographic description reveals that even within a single community with a common cultural background, the parties involved are diverse and flexible to change. She also mentions that community fragmentation and negative feelings emerge as a result of the very powerful top-down approach of the abolitionist movement.

In Chap. 7, Hayashi also reports on a Kenyan case, focusing on the Maasai women’s grassroots abolition movement. She describes the typical programs of the abolition project, including the establishment of rescue centers and the implementation of alternative rites of passage (known as ARP) and examines their effectiveness.

Most of the FGM/C practice occurs in Africa and in the Middle East, but it is also prevalent among the Muslim communities in Southeast Asia, including Malaysia, Thailand, Singapore, Brunei, Philippines and Indonesia. However, there is scarcity of information related to its practice in this region. In Chap. 8, Rashid, Iguchi and Afiqah introduce the case of Malaysia. In Chap. 9 they discuss FGC in Malaysia from the aspect of medical control over the human body by using the theoretical framework of Michel Foucault’s “medical gaze”. They reveal that local people had initially thought that FGC functioned as a mark of religious identity, but they eventually came to adopt the same medical gaze as that of the European ideology of their colonizers. They point out Malaysian case provides an interesting example of a site of negotiation between the local traditional views of FGC based on custom or religion, and global discourses on FGC.

In Chap. 10, Varol discusses the importance of high-quality healthcare and expertise in FGM management in the context of Australia. Australia received 100,000 migrants and refugees from Sub-Saharan Africa between 2011 and 2019, many from countries with high FGM prevalence rates. Varol discusses the problems and ramifications faced by women with FGM in developed countries which lack the adequate expertise and referral pathways for issues relating to their FGM. She holds that Australia can play a leading role in protecting these children and women. Further, she points out the commanding role migration plays as a catalyst for the abandonment of FGM, suggesting that, were developed countries to collaborate on research, training and prevention programs, they could make a significant contribution.

In Chap. 11, Higashi examines the lack of interrogation around the issue of male genital cutting. While global discourse has highlighted the injustices of FGM, it has, at the same time, remained largely silent on human rights with regard to medically unnecessary male genital cutting (male circumcision) in the absence of informed consent. Higashi asserts that this double standard should be addressed and argues for the protection of the rights of all infants and young children to grow to an age where they can make their own informed decisions. Pertinent parallels are drawn between male circumcision (without consent) and the rights infringements of sex-normalizing medical procedures employed on intersex infants and children.

In Chap. 12, in response to the editors’ questions Abusharaf discusses the feminist movement in Sudan. After describing the feminist movement in Sudan in comparison to that in the West, she concludes that the international campaign can frame its efforts with the community activists who are aware of the local conditions and are working diligently to address elimination efforts.

None of the chapters in this book intends to give readers “the right answers” on how to understand and act on FGM. Rather, they attempt to present the diversity of local societies where FGM is practiced, the diversity of individuals within those societies, and the diversity of approaches to the problem, while being skeptical about the idea that there is one “right” answer. This is because each of the authors has witnessed in their fieldwork that the “zero tolerance” approach, which excludes diversity, has not worked well.

Using this book as a guide will enable readers to understand how the bodies of African women living in the same era are governed through the complex intertwining of politics, economics, society, culture, and religion. Readers will find themselves within the global discourse as they unravel a tangle of unexpected situations: conflicts of interest, the exercise of power and resistance, escape, concealment, bargaining, and the dichotomies that arise as the global discourse becomes increasingly powerful. I hope that this book will provide an opportunity for us to think about FGM/C not merely as a problem faced by distant “others” in Africa and Asia, but as one for all of us living in a global society.